Identification and comparison of missed nursing care in the United States of America and South Korea.

AIMS AND OBJECTIVES: This study aimed to identify and compare missed nursing care types and reasons between South Korea and the United States of America. BACKGROUND: Patient safety has become a significant task of the healthcare delivery systems worldwide. The omission of nursing care constitutes a growing concern because it threatens both patient safety and nursing care quality. DESIGN: This study used a cross-sectional, descriptive and comparative design. METHODS: Data were collected from registered nurses working in two university-affiliated tertiary hospitals and a general hospital in Korea and a Midwest United States tertiary hospital. In addition, the STROBE checklist was used in this study. RESULTS: While substantial, the level of missed nursing care reported by Korean nurses was lower than that of United States nurses. Only three nursing care activities, setting up meals, patient assessment and skin/wound care, did not significantly differed between two countries. More basic nursing care types such as ambulation, feeding and mouth care were missed more than others in both countries. The reasons for missed care differed between two countries. However, both Korean and US nurses reported labour resource problems as reasons for missed care. CONCLUSIONS: Although the types of missed nursing care differed significantly between countries, both Korean and US nurses reported labour resource problems for the top reasons for missed care. Thus, comparing missed nursing care could assist nursing administrators in developing strategies to improve care quality and patient safety. RELEVANCE TO CLINICAL PRACTICE: The level and reasons for missed nursing care are very influential factors for patient outcomes and patient safety. Appropriate skill mix and staffing are needed to decrease extent of missed care, so that enhancing patient safety and quality of nursing care.

The association of missed nursing care and determinants of satisfaction with current position for direct-care nurses-An international study.

AIM: To describe the association of missed nursing care and to identify the determinants of satisfaction with current position for direct-care nurses. BACKGROUND: Missed nursing care and job satisfaction are important issues regarding quality patient care and safety in health care, globally. METHOD: This was a cross-sectional quantitative study using MISSCARE Survey data. Participants were 7,079 nursing staff providing direct patient care in hospitals in Australia, Iceland, Turkey and the USA. Multivariable nested models were used to identify the relationship between missed nursing care and nurses' satisfaction with current position. RESULTS: More missed nursing care was associated with less satisfaction with current position. Other determinants of job satisfaction included country, nursing experience, overtime worked, adequacy of staffing and the number of shifts missed during the previous 3 months. CONCLUSION(S): Internationally, more missed nursing care is associated with less nursing job satisfaction and is influenced by work experience, overtime worked, levels of staffing and absenteeism. IMPLICATIONS FOR NURSING MANAGEMENT: This study identifies that the association between missed nursing care and satisfaction with nursing position is of global concern. Other factors requiring the attention of nurse managers are staffing levels, absenteeism and work experience.

The extent to which adequacy of staffing predicts nursing teamwork in hospitals.

AIMS AND OBJECTIVES: The purpose of this study was to examine the extent to which staffing adequacy predicts nursing teamwork, controlling for demographic and background variables. BACKGROUND: Findings from former studies indicate that hospital, unit and staff characteristics may be related to nursing teamwork, such as type of hospital and unit, role, gender, age, work experience, type of shift worked, shift length, number of working hours per week, overtime and staffing adequacy. Teamwork as well as staffing is identified as significant contributors to patient and staff safety in hospitals. However, the contribution of staffing to the quality of nursing teamwork is scarcely studied. DESIGN: This was a quantitative descriptive cross-sectional study using the paper-and-pencil questionnaire Nursing Teamwork Survey-Icelandic. METHODS: The study was conducted in 27 inpatient units in eight hospitals in Iceland with a sample of 925 nursing staff members. Participants were 567 registered nurses, practical nurses, unit secretaries and nurse unit managers. The Strengthening the Reporting of Observational Studies in Epidemiology checklist was used for this paper. RESULTS: When controlling for unit type, role, experience on current unit and intent to leave, perceived adequacy of staffing alone explains up to 10% of overall teamwork. Unit type, role, years of experience on current unit and perceived staffing adequacy correlated significantly with overall teamwork. CONCLUSIONS: The findings of this study indicate that unit and staff characteristics, including perceived adequacy of staffing, are associated with and explain the variability in nursing teamwork on inpatient hospital units. The findings of this study provide important information for clinical nurses, nurse managers, policymakers and instructors in health care. RELEVANCE TO CLINICAL PRACTICE: The findings underline the importance of adequate staffing for nursing teamwork in inpatient hospital units.

A revised MISSCARE survey: Results from pilot testing.

BACKGROUND: Missed nursing care has been recognized as a universal patient care issue that affects outcomes for patients, nurses, and healthcare institutions. The MISSCARE Survey was developed to measure and determine the reasons for missed nursing care episodes. An extensive literature review and expert nurse opinion revealed five additional reasons for missing care that the authors utilized to revise the Survey. METHODS: The revised MISSCARE Survey was pilot tested with a group of 145 nursing staff from a public, non-profit, acute care hospital in the Midwestern U.S. RESULTS: Analysis indicated favorable results for the revised Survey's acceptability, reliability, and construct validity. CONCLUSION: Based on the initial pilot study results, the authors recommend further use and study of the revised MISSCARE Survey with other nursing populations and additional psychometric testing.

Determinants of nurse absenteeism and intent to leave: An international study.

AIM: To determine factors associated with nurses' intent to leave their positions and absenteeism. BACKGROUND: There is a recognized global shortage of nurses but limited data describing and determining factors associated with nurse absenteeism and intent to leave. METHODS: This study involved a secondary analysis of the results from direct-care registered nurses' responses to the MISSCARE Survey, with data from seven countries included. Multi-level modelling was used to determine nurse characteristics and working environment factors associated with nurse absenteeism and intent to leave. RESULTS: The level of absenteeism and intent to leave varied significantly across countries, with registered nurses in Lebanon reporting the highest intention to leave within 12 months (43%) and registered nurses in Iceland and Australia the highest level of absenteeism (74% and 73%, respectively). Factors associated with outcomes included perceived staffing adequacy of unit, job satisfaction, and age of the nurse. CONCLUSIONS: A significant difference between countries was identified in nurse absenteeism and intent to leave. Increased perception of unit staffing inadequacy, lower job satisfaction, less nurse experience, and younger age were significant contributors to nurse absenteeism and intent to leave. IMPLICATIONS FOR NURSING MANAGEMENT: These findings suggest that regardless of country and hospital, by ensuring that units are adequately staffed and increasing job satisfaction, younger, less experienced nurses can be retained and absenteeism reduced.

Development and validation of the MISSCARE survey - Pediatric version.

AIM: Develop and test the validity and reliability of MISSCARE Survey-Ped adapted from previous versions of the MISSCARE Survey, which measures omitted nursing activities and the reasons why they were left undone. Our secondary aim was to pre-test the construct validity using Exploratory Factor Analysis (EFA). BACKGROUND: Missed Nursing Care is described as "every care activity necessary for the patient that is not provided or is seriously delayed". Missed Care is correlated with negative patient outcomes, such as mortality and adverse events. DESIGN: A mixed-mode cross-sectional survey. METHODS: Participants included registered pediatric nurses and nurses working in pediatric wards. This study was conducted between June and September 2017 and consisted of four phases: (a) analysis of existing surveys and item construction; (b) content and face validity; (c) reliability analysis (acceptability for ease of use, Cronbach's alpha for internal consistency and test-retest to measure stability); and (d) construct validity (EFA). RESULTS: The MISSCARE Survey-Ped consists of two sections: Section A "Missed Nursing Care Activities" (29 items) and Section B "Reasons for Missed Nursing Care Activities" (17 items). The new survey showed good validity properties and effectively identified Missed Nursing Care activities in pediatric settings. CONCLUSION: The development and validation of the MISSCARE Survey-Ped made it possible to conduct an objective and standardized study of missed nursing care activities in the field of pediatrics. This new survey offers the opportunity to collect data that enable to design and implement interventions that improve the quality and safety of pediatric nursing.

Comparison of reports of missed nursing care: Registered Nurses vs. practical nurses in hospitals.

BACKGROUND: Missed nursing care is an error of omission defined as standard, required nursing care that is not completed or is seriously delayed. Study findings from around the world show that missed nursing care is a global concern. PURPOSE: The purpose of this study was to compare reports of missed nursing care by two types of nurses - registered nurses and practical nurses - in acute care hospitals in Iceland. Former studies in the USA indicate a variance in reports of missed nursing care by staff with different roles. METHODS: This was a cross-sectional descriptive study using the MISSCARE Survey-Icelandic questionnaire for data collection. The questionnaire asks about the amount of missed nursing care on the unit for 24 nursing elements (Part A) and 17 reasons of care being missed (Part B). Participants were nursing staff from medical, surgical and intensive care units in all hospitals in Iceland. FINDINGS: A t-test for independent groups showed a significant difference for the overall missed nursing care score (Part A) between registered nurses (M = 2.09, SD = 0.51) and practical nurses (M = 1.82, SD = 0.59) [t(541) = 5.703, p < 0.001]. A comparison of the overall mean score for reasons of missed nursing care (Part B) between registered nurses (M = 2.32, SD = 0.38) and practical nurses (M = 2.21, SD = 0.62) indicated a significant difference in their reporting [t(299) = 2.210, p = 0.028]. In spite of the overall significant difference in ratings of the elements and reasons for missed nursing care by registered nurses and practical nurses, a pattern is evident in the ranking of the elements of nursing care being missed and reasons. CONCLUSIONS: The findings of this study point to the need to acknowledge certain aspects of missed nursing care and the different roles within nursing. They indicate a need to improve open, sincere and structured communication and mutual respect and trust within healthcare teams in Icelandic hospitals.

Correlates and predictors of missed nursing care in hospitals.

AIMS AND OBJECTIVES: To identify the contribution of hospital, unit, staff characteristics, staffing adequacy and teamwork to missed nursing care in Iceland hospitals. BACKGROUND: A recently identified quality indicator for nursing care and patient safety is missed nursing care defined as any standard, required nursing care omitted or significantly delayed, indicating an error of omission. Former studies point to contributing factors to missed nursing care regarding hospital, unit and staff characteristics, perceptions of staffing adequacy as well as nursing teamwork, displayed in the Missed Nursing Care Model. DESIGN: This was a quantitative cross-sectional survey study. METHODS: The samples were all registered nurses and practical nurses (n = 864) working on 27 medical, surgical and intensive care inpatient units in eight hospitals throughout Iceland. Response rate was 69·3%. Data were collected in March-April 2012 using the combined MISSCARE Survey-Icelandic and the Nursing Teamwork Survey-Icelandic. Descriptive, correlational and regression statistics were used for data analysis. RESULTS: Missed nursing care was significantly related to hospital and unit type, participants' age and role and their perception of adequate staffing and level of teamwork. The multiple regression testing of Model 1 indicated unit type, role, age and staffing adequacy to predict 16% of the variance in missed nursing care. Controlling for unit type, role, age and perceptions of staffing adequacy, the multiple regression testing of Model 2 showed that nursing teamwork predicted an additional 14% of the variance in missed nursing care. CONCLUSIONS: The results shed light on the correlates and predictors of missed nursing care in hospitals. This study gives direction as to the development of strategies for decreasing missed nursing care, including ensuring appropriate staffing levels and enhanced teamwork. RELEVANCE TO CLINICAL PRACTICE: By identifying contributing factors to missed nursing care, appropriate interventions can be developed and tested.

The psychometric testing of the Nursing Teamwork Survey in Iceland.

The purpose of this study was to test the psychometric properties of the Nursing Teamwork Survey-Icelandic (NTS-Icelandic), which was translated from US English to Icelandic. The Nursing Teamwork Survey, with 33 items, measures overall teamwork and five factors of teamwork: trust, team orientation, backup, shared mental models, and team leadership. The psychometric testing of the NTS-Icelandic was carried out on data from a pilot study and a national study. The sample for a pilot study included 123 nursing staff from five units, and the sample for a national study included 925 nursing staff from 27 inpatient units. The overall test-retest intraclass correlation coefficient in the pilot study was 0.693 (lower bound = 0.498, upper bound = 0.821) (p < 0.001). The Cronbach's alpha reliability for the total scale and subscales ranged from 0.737 to 0.911. A confirmatory factor analysis indicated a good fit of the data from the national study with the five-factor model for nursing teamwork. The NTS-Icelandic tested valid and reliable in this study. Study findings support further use of the Nursing Teamwork Survey internationally.

Translation and psychometric testing of the Icelandic version of the MISSCARE Survey.

BACKGROUND: Missed nursing care, required standard care that is not provided, is a relatively new concept in nursing, and prior to this study, it had not been discussed in Iceland. AIM: To successfully translate the MISSCARE Survey from US English to Icelandic. METHOD: The translation and psychometric testing of the MISSCARE Survey-Icelandic was completed in six steps: (1) forward translation, (2) revision of the translation, (3) back-translation, (4) revision of the back-translation, (5) pilot-testing, (6) data collection and psychometric testing. Back-translation included work of linguists, clinicians and scholars in the original and target country. Psychometric testing was completed on data from a pilot-test and a national study. The target population was nursing staff providing patient care in medical, surgical and intensive care units in hospitals in Iceland. Pilot study data were collected in November-December 2011, and data for the national study were collected in March-April 2012. The MISSCARE Survey asks about missed nursing care activities (part A), and reasons for missed nursing care (part B), besides demographic and background questions. RESULTS: Response rate for the pilot study was 57% (67/118), and for the national study, it was 69% (599/864) with good acceptability. Overall test-retest Pearson's correlation coefficient for part A was 0.782 (p < 0.001) and 0.530 (p < 0.05) for part B. Cronbach's alpha reliability coefficient for the overall part B and subscales ranged from 0.795-0.894. Confirmatory factor analysis for part B indicated a good model fit to the three factors: Communication, Material resources and Labour resources. CONCLUSION: The MISSCARE Survey was successfully translated from US English to Icelandic, using a stringent back-translation method. The Icelandic version tested reliable and valid. This study supports global use of the MISSCARE Survey.

Nurse Staffing Levels and Patient-Reported Missed Nursing Care.

A total of 729 inpatients were surveyed using the MISSCARE Survey-Patient. Missed timeliness, patient reports of the time it took for them to receive care from nursing staff, was negatively associated with total nursing staff hours of care per patient-day (r = -0.09, P = .015), registered nurse (RN) hours per patient-day (r = -0.14, P = .0002), and RN skill mix (r = -0.13, P = .0004). RN skill mix was also a predictor of missed timeliness (P = .01).

Outcomes of inpatient mobilization: a literature review.

AIMS AND OBJECTIVES: To review current research evidence on the outcomes of mobilising hospitalised adults. BACKGROUND: Although immobility is known to cause functional decline or complications, inpatient ambulation emerged as the most often missed element of nursing care. This study is designed to review research studies that give evidence as to the consequences of mobilising or not mobilising hospitalised adult patients. DESIGN: A literature review of published peer-reviewed empirical research was undertaken. METHODS: The electronic databases of MEDLINE (Ovid), CINAHL, and PubMed were accessed to search for relevant empirical articles, supplemented by a search of reference lists contained in retrieved articles and citation tracking. RESULTS: Thirty-six studies were identified for inclusion in the review. Four areas (study design, sample size, measurement and statistical analysis) were evaluated for methodological quality, and most studies showed strong quality. A synthesis of the findings generated four themes of the effects of inpatient mobilisation: (1) physical outcomes included pain, deep vein thrombosis, fatigue, etc.; (2) psychological outcomes included anxiety, depressive mood, distress, comfort and satisfaction; (3) social outcomes included quality of life and independence; and (4) organisational outcomes included length of stay, mortality and cost. CONCLUSION: Mobilising hospitalised adults brings benefits for not only physical functioning, but also their emotional and social well-being. Moreover, ambulation yields important organisational benefits. These benefits of mobilisation on four areas required viewing the patient in a holistic manner. Even though each study approached different types of patients, illnesses and procedures, this review showed that most inpatients would benefit from mobilisation and would experience optimal functions. RELEVANCE TO CLINICAL PRACTICE: The importance of mobilisation for positive patient outcomes highlights the need to develop methods to ensure that this nursing action is completed on a systematic basis.

Train-the-trainer intervention to increase nursing teamwork and decrease missed nursing care in acute care patient units.

BACKGROUND: Teamwork is essential for patient safety and results in less missed nursing care. OBJECTIVES: The aim of this study was to test the impact of a train-the-trainer intervention on the level of satisfaction with nursing teamwork and the amount of missed nursing care. METHODS: This study used a quasiexperimental design with repeated measures taken at pretest, posttest, and 2 months after completion of the intervention. The sample for this study was the nursing staff on three medical-surgical units in three separate acute care hospitals (one unit in each hospital). Three nurses from each unit underwent a training program and then taught the skills and knowledge they acquired to the staff members on their units in three-hour-long sessions. The training involved staff role-playing scenarios based on teamwork problems that occur regularly on inpatient units in acute care hospitals followed by debriefing, which focused on teamwork behaviors (e.g., leadership, team orientation, backup, performance monitoring) and missed nursing care. Four measures were used to test the efficacy of this intervention: The Nursing Teamwork Survey, the MISSCARE Survey, and questions about the knowledge of and satisfaction with teamwork. Return rates for the surveys ranged from 73% to 84%. Follow-up tests individually comparing pretest, posttest, and delayed posttest were conducted within the mixed model and used the Bonferroni correction for multiple comparisons. RESULTS: Teamwork increased (F = 6.91, df = 259.01, p = .001) and missed care decreased (F = 3.59, df = 251.29, p = .03) over time. Nursing staff also reported a higher level of satisfaction with teamwork and an increase of teamwork knowledge after the intervention. DISCUSSION: The intervention tested in this study shows promise of being an effective and efficient approach to increase nursing teamwork and decrease missed nursing care.

Missed nursing care, level of staffing, and job satisfaction: Lebanon versus the United States.

Missed nursing care refers to omission of standard required nursing care of patients in acute care hospitals. The objective of this study was to compare the amounts and reasons of missed nursing care, the level of nurse staffing, and job satisfaction between the United States and Lebanon. Several studies in the United States have shown that a significant amount of care is being missed. This study is designed to determine if Lebanon is experiencing a similar phenomenon and what reasons are given for missing nursing care. Findings support that a substantial amount of nursing care is missed in Lebanon, although less than that in the United States (t = 11.53, P < .001), that nurses in Lebanon were less satisfied with being a nurse than are nurses in the United States, and there was no difference in the identification of staffing resources as a reason for missed care in the 2 countries.

Variations of nursing teamwork by hospital, patient unit, and staff characteristics.

The aim of this cross-sectional study was to examine the relationship among hospital, patient units, and staff characteristics and nursing teamwork. Using multiple linear regression analysis, we found that nursing role, shift, absenteeism, perceived adequacy of staffing, and unit type were significant predictors of teamwork.

Safety of mobilizing hospitalized adults: review of the literature.

This article examines literature that provides evidence about the safety of mobilizing hospitalized adults. A search of electronic databases and hand searches yielded 24 studies that were included in the review. Evidence of mobilization safety was found in 4 clinical settings (medical, surgical, cardiac procedure, and intensive care), and the findings from these studies suggest that early mobilization of hospitalized adults is safe.

The Relationship of Nursing Teamwork and Job Satisfaction in Hospitals.

Introduction: Teamwork is identified as a key contributor to patient safety and good teamwork is recognized as one of the presumptions of healthy work environment in nursing. The importance of job satisfaction in nursing has repeatedly been confirmed, but only recently has the association of job satisfaction and nursing teamwork been identified. Objective: To identify the level of nursing teamwork in hospitals in Iceland and its relationship with job satisfaction. Methods: This was a quantitative descriptive cross-sectional study. Data were collected with the Nursing Teamwork Survey administered to nursing staff in medical, surgical, and intensive care units in hospitals in Iceland. This study is based on data from 567 participants. Results: A logistic regression analysis indicated that work experience on current unit and perceived staffing adequacy contributes to job satisfaction and when controlling for unit type, role, experience on current unit and staffing adequacy, those reporting better teamwork are significantly more likely to be satisfied with their current position. With an additional unit for overall nursing teamwork, participants are almost five times likelier to be satisfied with their current position. Conclusion: Study findings show that there is a significant relationship between nursing teamwork and job satisfaction. The findings of this study confirm the importance of adequate staffing and good teamwork for nurses' job satisfaction. Staffing however, will remain the most challenging part of the equation as lack of nursing staff is foreseen globally in the coming decades turning the spotlight to teamwork. All stakeholders, including clinical nurse leaders, administrators, and instructors, need to emphasize on strengthening nursing teamwork. Good teamwork with increased job satisfaction may prevent turnover and shortage of nurses, an issue expected to grow during and following the COVID-19 pandemic. Facilitating good teamwork should be one of the priorities of every nurse leader.

Patient perceptions of missed nursing care.

BACKGROUND: A series of studies involving nursing staff perception have shown that a significant amount of standard nursing care is being "missed"-that is, aspects of required patient care are omitted or significantly delayed. A study was conducted to (1) determine the elements of nursing care that patients are able to report on and (2) to gain insight into the extent and type of missed nursing care experienced by a group of patients. METHODS: In-depth, semistructured, face-to-face interviews, guided by open-ended and interactive questions, were conducted with 38 inpatients on seven different patient care units in an acute care hospital. FINDINGS: For Question 1, elements were categorized as fully reportable (for example, mouth care, bathing, and pain medication), partially reportable (hand washing, vital signs, and patient education), or not reportable (nursing assessment, skin assessment, intravenous site care). For Question 2, patients identified mouth care, ambulation, discharge planning, patient education, listening to them, and being kept informed as frequently missing. Patients sometimes missed response to call lights and alarms, meal assistance, pain medication and follow-up, other medication administration, and repositioning. Nursing care identified as rarely missed were bathing, vital signs, and hand washing. CONCLUSIONS: There is a large area of care for which patients can give an account if they are cognizant of their surroundings and mentally able to do so. For certain aspects of care, patients' perceptions of missed care were similar to those of nursing staff. There is a need to link specific aspects of nursing care to patient outcomes to assist in determining how essential specific elements of nursing care are and the cost-benefit balance of completing them or not.

Congruence of perceptions among nursing leaders and staff regarding missed nursing care and teamwork.

The objective of this study was to test the congruence of the perceptions of unit-based nurse leaders (managers, advanced practice nurses) and nursing staff members (registered nurses, nursing assistants, unit secretaries) in acute care hospitals as to the extent and type of missed nursing care and nursing teamwork. Based on the leader-member exchange congruence framework (LMX), nursing staff and nursing leaders completed the MISSCARE Survey, and a segment of the participants completed the Nursing Teamwork Survey. The findings of this study show a lack of LMX congruence between leaders and nursing staff members. Nursing staff report less missed care and lower teamwork than do leaders, and nursing staff list more problems with having adequate material and labor resources than do leaders. LMX congruence has been associated with positive organizational outcomes.

A comparison of patient care units with high versus low levels of missed nursing care.

BACKGROUND: In a previous study, the nursing staff on 110 patient care units in 10 hospitals participated in a quantitative study of missed nursing care. PURPOSE: The aim of this study was to gain an understanding of the differences in patient care units that had the most missed nursing care with those with the least missed nursing care. METHODOLOGY: Focus groups were conducted with the registered nurse staff on the 5 units with the most missed nursing care and 5 units with the least missed care. FINDINGS: Ten themes were identified: (a) staffing levels, (b) communication, (c) collective orientation, (d) backup, (e) monitoring, (f) leadership, (g) long tenure, (h) unit size, (i) trust, and (j) accountability. Taken together, the predominant difference found was that units with the least missed care had higher teamwork. PRACTICE IMPLICATIONS: Strategies for developing interventions to decrease missed care and increase teamwork are presented.