An empirical analysis of the constructs of Fundamentals of Care Framework using structural equation modelling.

AIM: First, to identify which aspects of missed care accurately define the integration of care and context of care dimensions of the Fundamentals of Care Framework. Second, to test the Framework for validity and reliability and lastly, to explore how leadership influences care integration. DESIGN: A non-experimental research design using self-audit data collected information about variations in nursing care as exemplars for dimensions of the Framework. METHODS: A multi-variate approach using path analysis was used to apply the consensus scores of 3079 Australian residential care nurses and carers to define the dimensions of the Framework. RESULTS/FINDINGS: In the Australian residential care setting, the factors that define both the contexts of care and the integration of care dimensions constructs are now empirically established. The most direct predictor for the integration of care dimension arises from both the leadership and resource allocation variables, while the remaining context of care factors have indirect but significant effects. The integration of psychosocial care in the residential care sector is not influenced by any of the Framework's context-based factors. CONCLUSION: The component variables of the Framework show both good reliability and convergent validity. These findings confirm a predictive relationship exists between the elements of the context of care and the different types of nursing activities that form the integration of the care dimension, including organizational leadership.

Causal links behind why Australian midwifery care is missed.

AIMS: The aim of this study is to reliably estimate why midwifery care is missed and to crystallize those factors that have causal links to it. BACKGROUND: Studies involving the incidences and types of missed midwifery care are sparsely described. The rationales behind these deficits in care are even less well researched. METHODS: A non-experimental, descriptive method using a Likert developed MISSCARE scale was used to measure consensus estimates made by Australian midwives. Data analysis was undertaken using both Rasch analysis and Structural Equation Modeling. RESULTS: Midwives' rationales behind why Australian midwifery care is missed can be quantified based on consensus estimates of participating midwives and the variances in the total scores of how important each contributing factor was in accounting for why midwifery care was missed, can be both explained and predicted. CONCLUSIONS: Ten latent variables have significant predictor effects on why midwifery care was missed. These include insufficient human and physical care resources, increased work intensity and issues with workplace communication. These factors are further exacerbated by the midwives' teamwork satisfaction levels, work roster preferences and other midwife demographic variables. The age of midwife, their highest qualification achieved and where they obtained their midwifery credentials had no influence on their consensus estimates as to why midwifery care was missed. IMPLICATIONS FOR NURSING MANAGEMENT: While this study confines itself to the Australian midwifery context, outcomes are informative for an international midwifery management audience. While the setting of the midwifery practice (be it private or public hospitals) is not significant in predicting why midwifery care is missed, resource allocation for care of mothers and their babies remains instrumental, as a factor contributing to care omissions. Midwife demographic factors including age, type of midwifery qualification and where the credentials were obtained from exerted no influence as to why care was omitted. Midwifery recruitment should focus instead on re-dressing skills and skills mix shortages. Teamwork skills within the midwifery sector requires strengthening, as problems arising from workplace communication, coupled with decreased midwifery staffing numbers and increased work intensity, are strongly thought to be significant reason for missed care.

The presence of missed care: A staff development response.

AIMS: This study quantifies the types and frequencies of missed care identified by nurses and measures its impact on their capacity to demonstrate mandatory practice standards as future hospital staff. BACKGROUND: Considerable literature exists as to the nature of missed care but there is a paucity of findings about how missed care impacts on learning firstly as a student and then as a graduate nurse employed in a hospital setting. Additionally, there is little emphasis as to how staff development for nurses exposed to missed care may be implemented. METHODS: A non-experimental research design using self-audit data was selected to collect information about the types and frequencies of missed care from nurses engaging in clinical experience. A convenience sample of 471 nursing students completing their undergraduate nursing degree programme was explored. A multi-variate statistical approach was used to apply and then model the consensus scores of undergraduate nurses' beliefs about the frequency of missed care. Implications for their developing competence in critical thinking, therapeutic communication and maintaining capacity for professional practice has been considered. RESULTS: Eight variables directly affect student's total scores underpinning their understanding of missed care and their ability to meet professional standards of practice, given their exposure to care omission. These factors reflect differing nurse attributes, the nature of the clinical venues and shift times, preceptor type, student satisfaction with work teams and staffing adequacy. CONCLUSIONS: Modelling outcomes suggest possible changes to hospital staff development learning programme content, learning processes and how it may be better delivered through to minimize episodes of missed care. IMPLICATIONS FOR NURSING MANAGEMENT: Staff development needs to note that nursing staff believe missed care occurs across all three-patient acuity domains with patient observation, education, support, and timely medication administration being most frequently omitted. Different clinical venues within the hospital sector and shift times vary in nurses' exposure with missed care. Student nurses' learning and associated development of practice standards is impacted by prior exposure to missed care during clinical placement. Non-native English-speaking nurses require greatest learning support in the presence of missed care. As missed care can be predicted, remedial changes to the nurse staff development program content and learning processes can be orchestrated.

Predictors of missed infection control care: A tri-partite international study.

AIM: This study aimed to quantify types and frequencies of missed infection control care and to develop a theoretical model for estimating nurses' consensus scores about this form of missed care. DESIGN: A non-experimental research design using self-audit data was selected to collect information about the types and frequencies of missed infection control care from nurses employed in hospitals located in three different countries. Data collection commenced mid-year 2018. METHODS: A multivariate approach was used to apply the consensus scores of 1.911 internationally based nurses in the missed opportunities for maintaining infection control. RESULTS/FINDINGS: Thirteen variables exert direct effects on the nurses' total scores underpinning missed infection control care. These include the methods used to prevent hospital-acquired infections, surveillance and hand hygiene practices. Significant nurses' demographic factors also included their countries of origin, employment status, employer type, job retention intentions, work intensity, length of clinical experience and staff development attendance. CONCLUSION: In magnitude of importance and having the largest effect on missed infection control care is missed care related to reducing hospital-acquired infections followed closely by surveillance. Missed infection control care can be quantified, and variances in its practices can be accounted by exploring the nurses' differing demographic factors, including the nurses' country of origin. IMPACT: Variations in missed infection control care can be accounted for across three countries. While ward hygiene is underestimated by staff as a mechanism to minimize nosocomial infections, infection control surveillance remains the key to reducing hospital-acquired infections. The study's outcomes invite the use of an ongoing, whole-of-organization approach to infection control with scrutiny being needed for improved staff adherence particularly with hand hygiene.

Adaptation and Psychometric Testing of the Czech and Slovak Version of the Missed Nursing Care in Infection Prevention and Control Survey.

BACKGROUND AND PURPOSE: Only a limited number of items involved in missed nursing care inventories specifically focused on infection control practices. The study aimed to adapt and evaluate psychometric properties of the Czech and Slovak version of the Infection Control Missed Care survey; and to assess and compare the amount, type,and reasons for missed nursing care in infection prevention and control amongCzech and Slovak nurses. METHODS: The convenience sample of 1459 nurses from the Czechand Slovak republic was recruited. Analysis of the nurses' responses to both subscales of the surveys and validation of their data was undertaken using the item response theory (Rasch scaling). RESULTS: The now-modified Czech version consists only of 20 items measuring the type and frequency of missed care and 11 items focusing on the reasons for missed care. The now modified Slovak version consists of 34 items measuring the type and frequency of missed care and 17 items measuring the reasons for missed care. Reliability estimates with the removal of unreliable items showed acceptable reliability estimates for both sub-scales of the instrument. CONCLUSIONS: With modification to the two subscales used in the survey (removal of poorly fitting items) it should be reliable, and the resulting data could be used for further investigation such as factor analysis or modelling. The modified Infection Control Missed Care survey could be useful in further research investigating a relationship between nurse staffing, skill mix, and infection control outcomes in acute care hospitals.

Comparing infection control and ward nurses' views of the omission of infection control activities using the Missed Nursing Care Infection Prevention and Control (MNCIPC) Survey.

AIM: To compare the perceptions of nurses with infection control expertise and ward nurses as to what infection control activities are missed and the reasons why these activities are omitted. BACKGROUND: Infection prevention activities are viewed as important for reducing health care-acquired infections (HAIs) but are often poorly performed. METHODS: Data were collected through the Missed Nursing Care Infection Prevention and Control (MNCIPC) Survey delivered to 500 Australian nurses prior to COVID-19. RESULTS: Significant differences were found on the mean scores between infection control and other nurses on ten items. In eight cases, five relating to hand hygiene, infection control specialists viewed the activity as more likely to be missed. Factors viewed as having greater contribution to omission of infection control prevention were as follows: 'Patients have to share bathrooms', 'Urgent patient situation' and 'Unexpected rise in patient volume and/or acuity on the ward/unit'. Infection control nurses were more likely to highlight the role of organisational and management factors in preventing effective infection control. CONCLUSIONS: Differences in response between nurses suggest that the extent of omission of infection control precautions may be under-estimated by ward nurses. IMPLICATIONS FOR NURSING MANAGEMENT: Infection control specialists are more likely to identify organisational barriers to effective infection control than other nurses. Work demands arising from pandemic management may contribute to infection control precautions being missed.

Corrigendum to "Modelling nurses" use of local anaesthesia for intravenous cannulation and arterial blood gas sampling: A cross-sectional study" [Heliyon 6 (3) (2020) e03428].

[This corrects the article DOI: 10.1016/j.heliyon.2020.e03428.].

Modelling nurses' use of local anaesthesia for intravenous cannulation and arterial blood gas sampling: A cross-sectional study.

BACKGROUND: Needle insertions are painful, yet they are frequently performed for adults and children without using local anaesthetic (LA) to minimise pain and anxiety. OBJECTIVES: A hypothetical model was formulated to explore the factors related to Saudi nurses' self-reported readiness to use LA prior to undertaking parenteral procedures in their workplaces. DESIGN: This was an exploratory, cross-sectional study. METHODS: Four hundred seventy-five nurses were recruited from one hospital in Saudi Arabia. We considered eighteen latent variables related to nurses' attitudes and ability to pursue six roles associated with LA before needle procedures. A model was created to identify the staff attitudes and self-efficacy pathways influencing readiness to use LA. RESULTS: The nurses' readiness to use LA before needle procedures was directly predicted by organisational factors (e.g., hospital policy, doctors' orders), procedural time constraints, underestimation of needle pain, patient characteristics and medical conditions, nurses' knowledge and skills related to LA, and parenteral procedure practices. CONCLUSIONS: Nurses' readiness to use LA was influenced by their beliefs about certain aspects of their practice and the nature of patients' presenting problems. IMPACT STATEMENT: Identifying factors that affect LA use helps us understand this issue and may assist policymakers in developing nursing practice.

Causal links to missed Australian midwifery care: What is the evidence?

INTRODUCTION: The incidences and types of missed nursing care in the acute care and community sectors are both ubiquitous and quantifiable, however, there are few research studies relating to the type and frequency of missed maternity-based care for mothers and families. The aim of this study is to estimate the incidences and types of Australian missed midwifery care and to identify those factors that have causal links to it. METHODS: A non-experimental, descriptive method using a Likert developed MISSCARE scale was used to ascertain consensus estimates made by Australian midwives. Electronic invitations were extended to their membership using an inclusive link to the MISSCARE survey. Inclusion criteria were all ANMF members who were midwives and currently employed within the Australian public and private healthcare systems. Data analysis was undertaken using both Rasch analysis and Structural Equation Modelling. RESULTS: The type and frequency of missed Australian midwifery care can be quantified and several demographic factors are significant predictor variables for overall missed midwifery care. The most prevalent aspects of missed care in the Australian midwifery setting are midwives' hand hygiene, supportive care, perinatal education, and surveillance type midwifery practices. CONCLUSIONS: As the frequencies and types of missed midwifery care in Australia have been identified, it is possible for midwives to be mindful of minimising care omissions related to hand hygiene, providing supportive care and education to mothers as well as surveillance-type midwifery practices.

Measuring the validity and reliability of the Lithuanian missed nursing care in infection prevention and control scales using Rasch analysis.

AIM: The aim was to translate and validate the Missed Nursing Care in Infection Prevention and Control Survey for its use in the Lithuanian context. METHODS: A convenience sample of 331 nurses was surveyed. The study instrument explored missed care in the context of infection prevention and control practices. Rasch analysis was undertaken using Winsteps® Rasch measurement computer program and the generalized item response modelling software. RESULTS: The Missed Nursing Care in Infection Prevention and Control Survey in the Lithuanian language demonstrated unidimensionality and provided evidence of item fit to the modified instrument. The reliability of both sub-scales was 0.78 and 0.98, respectively. Differing consensus between the nurses based on their perceived frequencies and reasons of missed care was demonstrated. CONCLUSIONS: The final Lithuanian version of the Missed Nursing Care in Infection Prevention and Control Survey consists of 29 items that assess type and frequency of missed care and 17 items that identify reasons for missed care. IMPLICATIONS FOR NURSING MANAGEMENT: Unit managers will be able to use the modified scales to generate evidence as to the sources of missed infection control practices in their clinical areas and the rationale for the breaks in the hierarchy of mandatory infection prevention.

Causal links associated with missed residential aged care.

AIMS: To estimate and model the types and frequencies of care that nurses and carers self-identify as being missed in the Australian residential aged care sector. BACKGROUND: The study advances missed care research to explore how the care of elderly Australians is compromised. METHODS: A multi-variate approach was used to apply the consensus scores of 2,467 staff to missed opportunities for resident health promotion and restorative care. RESULTS: Eight latent care variables have direct predictor effects on missed Australian residential aged care, all of which are largely under the control of residential care management, with the exception of the physical locality of the aged care settings. CONCLUSION: Missed care, associated with maximizing the residents' life potential, relieving their distress and maintaining their current health can be quantified and predicted. IMPLICATIONS FOR NURSING MANAGEMENT: Aged care policies that maximize adequate staffing numbers with appropriate levels of skill are paramount to minimizing missed Australian residential care.

Developing policies and actions in response to missed nursing care: A consensus process.

AIM: To support the development of appropriate policies and actions in the field of missed nursing care (MNC). BACKGROUND: There has been an ever-growing international debate on MNC, interventions that nurses have identified as necessary for their patients, but which for various reasons they are unable to provide or are forced to delay. Despite MNC's relevance, its translation into policies and actions has not been documented to date. METHOD: A consensus development method was employed involving (a) a nominal group composed of experts in the field, policymakers and the President of the Regional Nursing Professional Boards, and (b) 218 nurses appointed primarily at the managerial levels. RESULTS: A total of eight consensus statements were approved and organized in a series of sub-statements designed to (1) render the concept of MNC culturally acceptable in the Italian context, with the agreement that compromised nursing care (CNC) is the best term to be used in this field, as a synonym for MNC; (2) measure CNC as a strategy to increase patient safety; (3) select an appropriate CNC measurement tool; (4) optimize CNC measurement; (5) conduct effective CNC data analysis; (6) design and implement interventions to prevent and/or minimize CNC; (7) assess and disseminate findings on interventions' effectiveness; and (8) provide final remarks on the way to move forward. CONCLUSIONS: We developed a process to introduce the phenomenon of MNC in the Italian culture and agreed firstly on the term compromised nursing care, which better reflects MNC's meaning according to the context and facilitates an open discussion on the phenomenon both within and outside the profession. The following consensus statements emerged represent a systematic approach, starting from the measurement and finishing with the re-measurement of the occurrence of MNC after having implemented concrete actions. IMPLICATIONS FOR NURSING MANAGEMENT: The approved consensus statements can guide decision-makers to develop concrete policies and actions that promote the improvement of quality of care and patients' safety by minimizing and/or preventing MNC's occurrence.

[Missed nursing care and italian nursing practice: preliminary finding of a consensus conference]. / Missed nursing care e pratica infermieristica italiana:risultati preliminari di una consensus conference.

. Missed nursing care and italian nursing practice: preliminary findings of a consensus conference. In recent years in Italy there has been renewed interest in missed nursing care due to various factors, such as participation in the RANCARE project, with 28 European and non-EU countries, the opportunity to develop international exchanges, specific projects and field based research. We explored a range of ideas and processes, culminating in a conference designed to address specific issues relating to missed nursing care, in the Italian nursing practice. After a preliminary review of the literature on the psychometric properties of the available tools, with the intent of further deepening our understanding of the concept of missed nursing care, its implications for practice, management, education and research. After two days of presentations and discussions, the more than participating nurses agreed on a set of preliminary recommendations regarding missed nursing care and Italian nursing practice. This paper reports on the preliminary consensus findings from the conference.

Modeling Missed Care: Implications for Evidence-Based Practice.

BACKGROUND: There is a growing nursing literature that views missed care as an inevitable consequence of work intensification associated with the rationing of nursing and material resources available to deliver care. Global studies recognize that missed care is now ubiquitous, although studies tend to be conducted in one region, rather than nationwide. This study seeks to understand the Australian context of missed care. AIMS: To explore self-reported reasons for missed care and to identify the main factors for predicting missed care within a sample of Australian nurses and midwives working in public and private hospitals in New South Wales, Victoria, Tasmania, and South Australia. METHODS: A nonexperimental, descriptive method using Kalisch's (2006) MISSCARE survey was used. Responses from 1,195 nursing and midwifery staff with differing qualifications, English language skills, and Australian employment settings were analyzed using Rasch analysis and then modeled using the Structural Equation Modeling. RESULTS: The frequency of missed care on the morning shift directly impacted on higher priority care missed during the afternoon shift. Staff skill mix imbalances and perceived inadequacy of staff numbers for the work demands further exacerbated all aspects of care during afternoon shifts. Other major factors associated with missed care were the different clinical work settings and staff to patient ratios. LINKING EVIDENCE TO ACTION: The incidences, types, and reasons behind missed care are a multidimensional construct which can be predicted when known significant factors behind missed care are simultaneously accounted for.

Predicting variations to missed nursing care: A three-nation comparison.

AIMS: To measure and model Australian, Cypriot and Italian nurses' beliefs about what care is missed and how frequently it occurs within their settings. BACKGROUND: This study expands on previous MISSCARE research but now applies and predicts missed care within three countries. METHODS: Multivariate analysis was performed to estimate 1,896 nurses' consensus scores about missed care activities based on Alfaro-Lefevre's conceptual framework of care priorities. RESULTS: Five latent variables have direct predictor effects on missed care frequencies. Another four variables including the nurses' age, highest qualifications, absenteeism rate and workplace type, contributed to explaining the overall variance of missed care scores. The nurses' gender had no influence on missed care. CONCLUSION: Cross country comparisons of missed nursing care allow for a more refined identification of strategies for remediation for both managers and clinicians. IMPLICATIONS FOR NURSING MANAGEMENT: Reliable consensus estimates about the types and frequencies of missed care can be scaled with variables identified to predict missed care across three different countries. Comparative international studies build on the foundations for understanding missed care in terms of nursing practices, policies and related social policies.

Evaluating the Performance of a Single-Item, Global, Estimate of Missed Nursing Care.

BACKGROUND AND PURPOSE: Current measures of missed nursing care employ inventories of tasks which are rated for the frequency with which each is missed. These lists have shortcomings for research and clinical evaluation. There is a need for measures with less response burden, wider generalizability, and greater sensitivity and specificity for identifying poor quality care. METHODS: We tested a single-item, global, measure using data from a large study of missed care in Australia. We employed traditional and innovative analysis techniques such as receiver operating characteristic curve and item response theory. RESULTS: The single-item measure had adequate concurrent and convergent validity when compared to one list-format measure of missed care and strong sensitivity and specificity for identifying poor quality care. CONCLUSIONS: A well-crafted single-item measure, such as the one tested, can be useful for measuring missed nursing care.

Can Nursing Students Practice What Is Preached? Factors Impacting Graduating Nurses' Abilities and Achievement to Apply Evidence-Based Practices.

BACKGROUND: In order to meet national Australian nursing registration requisites, nurses need to meet competency requirements for evidence-based practices (EBPs). AIMS: A hypothetical model was formulated to explore factors that influenced Australian nursing students' ability and achievement to understand and employ EBPs related to health care provision. METHODS: A nonexperimental, descriptive survey method was used to identify self-reported EBP efficacy estimates of 375 completing undergraduate nursing students. Factors influencing participants' self-rated EBP abilities were validated by Rasch analysis and then modeled using the partial least squares analysis (PLS Path) program. RESULTS: Graduating nursing students' ability to understand and apply EBPs for clinical improvement can be directly and indirectly predicted by eight variables including their understanding in the analysis, critique and synthesis of clinically based nursing research, their ability to communicate research to others and whether they had actually witnessed other staff delivering EBP. LINKING EVIDENCE TO ACTION: Forty-one percent of the variance in the nursing students' self-rated EBP efficacy scores is able to be accounted for by this model. Previous exposure to EBP studies facilitates participants' confidence with EBP, particularly with concurrent clinical EBP experiences.

The impact of rationing of health resources on capacity of Australian public sector nurses to deliver nursing care after-hours: a qualitative study.

Australia, along with other countries, has introduced New Public Management (NPM) into public sector hospitals in an effort to contain healthcare costs. NPM is associated with outsourcing of service provision, the meeting of government performance indicators, workforce flexibility and rationing of resources. This study explores the impact of rationing of staffing and other resources upon delivery of care outside of business hours. Data was collected through semistructured interviews conducted with 21 nurses working in 2 large Australian metropolitan hospitals. Participants identified four strategies associated with NPM which add to workload after-hours and impacted on the capacity to deliver nursing care. These were functional flexibility, vertical substitution of staff, meeting externally established performance indicators and outsourcing. We conclude that cost containment alongside of the meeting of performance indicators has extended work traditionally performed during business hours beyond those hours when less staffing and material resources are available. This adds to nursing workload and potentially contributes to incomplete nursing care.

Rounding, work intensification and new public management.

In this study, we argue that contemporary nursing care has been overtaken by new public management strategies aimed at curtailing budgets in the public hospital sector in Australia. Drawing on qualitative interviews with 15 nurses from one public acute hospital with supporting documentary evidence, we demonstrate what happens to nursing work when management imposes rounding as a risk reduction strategy. In the case study outlined rounding was introduced across all wards in response to missed care, which in turn arose as a result of work intensification produced by efficiency, productivity, effectiveness and accountability demands. Rounding is a commercially sponsored practice consistent with new public management. Our study illustrates the impact that new public management strategies such as rounding have on how nurses work, both in terms of work intensity and in who controls their labour.

Psychometric Evaluation of a Self-Report Evidence-Based Practice Tool Using Rasch Analysis.

AIMS: This paper reports if estimates of final year nursing students' self-rated abilities in responding to evidence-based practice (EBP) issues is a psychometrically robust measure. BACKGROUND: EBP as it applies to nursing continues to be heralded as a method to improve clinical patient care. Health professionals such as nurses are well positioned to respond to this demand; however, evidence suggests they are not always able to embrace this important foundation of everyday nursing practice. DESIGN: Instrument development. METHODS: The study was a survey set in a large teaching university in Adelaide, South Australia. The evidence-based practice survey was made available to a convenience sample of 471 final year nursing students, with a response rate of 79.6% (n = 375). Rasch analysis was used to critique and develop a scale for future learning based on the conjoint estimates of nursing students' self-efficacy estimates, when meeting the challenges of various EBP of differing complexities. RESULTS: Outcomes confirm that final year nursing students' EBP ability measures can be reliably estimated and a hierarchical scale of learning can be developed for use by beginning registered nurses' in their staff development. LINKING EVIDENCE TO ACTION: Although Australian health and nursing authorities acknowledge the desirability of the nursing workforce in adopting EBP for patient management, elements of this approach remains problematic for nurses. Measures to estimate EBP skills difficulty can be reliably generated to inform EBP education and skills development.