Toward understanding nurses' decisions whether to miss care: A discrete choice experiment.
Int J Nurs Stud
; 139: 104448, 2023 Mar.
Article
en En
| MEDLINE
| ID: mdl-36746011
ABSTRACT
BACKGROUND:
Studies of missed nursing care suggest that it results from ward-level, patient-related, and task-type factors, while nurses' decision-making style was scarcely studied. Studying the effect of nurses' decision-preference structures, namely a pattern of joint ward and patient factors, on missed care may also contribute to understanding the phenomenon.OBJECTIVES:
To examine the relationships between decision-preference structures and missed care and the moderating effects of decision-making styles and task type in these links.DESIGN:
A discrete choice experiment with a between- and within-participants design.PARTICIPANTS:
A sample of 387 registered nurses working in acute medical surgical wards in Israel.METHODS:
Based on the protocol for discrete choice experiments, a survey was developed to assess the decision-preference structure, considering five factors overload, presence of head nurse, clinical complexity, difficult patient, and presence of relatives. Participants were randomly assigned to four task-type conditions and completed a survey regarding their task. Decision-making style was assessed using a validated questionnaire.RESULTS:
Extensive workload (bâ¯=â¯-0.46; pâ¯=â¯0.001), difficult patient (bâ¯=â¯-0.20; pâ¯=â¯0.001), and patient clinical complexity (bâ¯=â¯-0.10; pâ¯=â¯0.006) were negatively linked to the probability of missed care. The interaction between workload and task type (bâ¯=â¯0.252; pâ¯=â¯0.017) indicated that the probability of missed care under extensive compared with regular workload was lowest for developing a discharge plan and highest for providing emotional support. The interaction of patient complexity and task type (bâ¯=â¯0.230; pâ¯=â¯0.013) indicated that the probability of missed care in developing a discharge plan and medication administration was lower for patients having high compared with low clinical complexity. The interaction between difficult patient and task type (bâ¯=â¯-0.219; pâ¯=â¯0.044) indicated that the probability of missed care in emotional support, developing a discharge plan, and patient's mobility was lower for difficult than for non-difficult patients. Finally, the interaction between workload and decision-making style (bâ¯=â¯-0.48; pâ¯=â¯0.001) indicated that the probability of missed care under heavy compared with regular workloads was lower for the dual-preference or the dominantly intuitive styles.CONCLUSIONS:
This design enabled examining the prioritizing processes nurses use when deciding about whether to miss care. The likelihood of missing more in structured tasks is lower under a heavy overload and when patients appear difficult or clinically complex. Dual-preference styles or dominantly intuitive styles are more suitable for the routine high workload.Palabras clave
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Enfermeras y Enfermeros
/
Atención de Enfermería
/
Personal de Enfermería en Hospital
Tipo de estudio:
Clinical_trials
/
Guideline
/
Prognostic_studies
/
Qualitative_research
Límite:
Humans
Idioma:
En
Revista:
Int J Nurs Stud
Año:
2023
Tipo del documento:
Article