To what extent Unfinished Nursing Care tools coincide with the discrete elements of The Fundamentals of Care Framework? A comparative analysis based on a systematic review.

ABSTRACT

AIMS AND OBJECTIVES: To establish whether, and to what extent, tools measuring Unfinished Nursing Care (UNC) that have been validated to date have the ability to detect the discrete elements of the 'Integration of care' dimension of The Fundamentals of Care Framework (The Framework). BACKGROUND: UNC and The Framework have been established as two separate research lines, focused on (a) omitted care and related tools, and (b) on how to improve patient care, respectively. However, no attempts have been made to date to establish whether, and to what extent, tools measuring UNC have the ability to represent the discrete elements of The Framework. DESIGN: A two-step study (a) a secondary analysis of a systematic review up to June 2018 later updated in May 2020, followed by (b) a comparative analysis. METHODS: A systematic review of studies on validated tools measuring UNC was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Then, researchers independently performed a comparative analysis between the extracted (a) discrete elements of The Framework and (b) items of the UNC tools retrieved. RESULTS: A total of 14 tools were analysed. The physical dimension of The Framework was the one mostly covered by UNC tools (up to 87.5% with the Perceived Implicit Rationing of Nursing Care). The Norwegian Basel Extent of Rationing of Nursing Care showed the highest level of representation (41.6%) for the psychosocial dimension. Only the Perceived Implicit Rationing of Nursing Care and the Unfinished Care tool measure the relational dimension (22.2%, respectively). By considering all elements of the 'Integration of care' dimension, the Perceived Implicit Rationing of Care had the highest percentage of convergence (41%). CONCLUSION: Not all UNC tools have the same ability to represent the discrete elements of The Framework. Moreover, physical needs are more often detected in UNC tools compared to the relational and psychological ones. RELEVANCE TO CLINICAL PRACTICE Unfinished care tools validated to date can represent a body of knowledge on which to build The Framework metrics, especially for the physical dimensions.