Missed Nursing Care in Medical and Surgical Wards in Jordan: A Cross-Sectional Study.

Missed nursing care is a multifaceted patient safety issue receiving increased attention among healthcare scholars worldwide. There is limited research on missed nursing care in the Jordanian healthcare context. The current study sought to examine the perceptions of Jordanian nurses toward the amount and types of missed nursing care in medical and surgical wards. We also examined the differences in missed care items between public, private, and university hospitals in Jordan. This was a cross-sectional study using the MISSCARE Survey tool. Data collection spanned 4 months between March and July 2021. The final study sample consisted of 672 registered nurses employed in five public, three private, and two university hospitals in Jordan. Data were analyzed using descriptive statistics, Analysis of variance, and Pearson correlation coefficent test. Of the 672 registered nurses who participated, the majority were females (n = 421; 62.6%). Most participants held a bachelor's degree in nursing (n = 577; 85.9%). The three most common missed nursing activities in the participating hospitals were: ambulation, oral care, and emotional support. Nurses working in public hospitals reported the highest missed nursing care. The age and number of patients under care significantly correlated with missed nursing care. The findings could help nursing managers develop plans to reduce missed nursing care in their healthcare institutions.

Rationed nursing care as one of the indicators of the occurrence of medication errors.

AIM: The aim was to analyze selected studies on rationed nursing care as one of the indicators that influence the occurrence of medication errors. METHODS: A descriptive review study. Articles and studies were searched in the following selected electronic databases: EBSCO (Academic Search Ultimate, Academic Search Complete), CINAHL Plus with Full Text, MEDLINE Complete, ScienceDirect and Central & Eastern European Academic Source. The search for relevant sources was based on the following English keywords: unfinished care, omitted care, rationing care, missed care, nursing care, medication errors. RESULTS: Total of 86 contributions found. After duplicit and irrelevant publications were the analysis comprised 8 primary studies and 2 systematic reviews. The studies were concerned with rationed or otherwise defined non-standard nursing care not merely related to medication errors. Each study described selected activities most frequently omitted by nurses with respect to medication: assessment of drug efficacy, medication errors, administration of incorrect drugs or doses, wrong time of administration, high-risk drug protocols and adhering to rules with each administration. The most frequently reported factor influencing the occurrence of missed care was understaffing and the related number of patients per nurse, resulting in a lack of time for selected patient activities. CONCLUSION: Despite difference in methods, all studies consistently claimed that rationed, unfinished, missed or omitted nursing care has or may have a negative impact on both patients and nurses. Some of the recommendations were increasing the number of nurses, improving team collaboration and work organization including setting systemic and preventive measures.

Missed Care from the Patient's Perspective - A Scoping Review.

Missed care, defined as any aspect of patient care that is omitted or delayed, is receiving increasing attention. It is primarily caused by the imbalance between patients' nursing care needs and the resources available, making it an ethical issue that challenges nurses' professional and moral values. In this scoping review, conducted using the five-stage approach by Arksey and O'Malley, our aim is to analyze the patients' perspective to missed care, as the topic has been mainly examined from nurses' perspective. The search was conducted in April 2019 in PubMed, CINAHL, PsycINFO, Web of Science, ProQuest and Philosophers Index databases using the following terms: omitted care, unfinished nursing care, care undone, care unfinished, missed care, care left undone, task undone and implicit rationing with no time limitation. The English-language studies where missed care was examined in the nursing context and had patients as informants on patient-reported missed care or patients' perceptions on nurse-reported missed care were selected for the review. Thirteen studies were included and analyzed with thematic content analysis. Twelve studies were quantitative in nature. Patients were able to report missed care, and mostly reported missed basic care, followed by missed communication with staff and problems with timeliness when they had to wait to get the help they needed. In statistical analysis, missed care was associated with patient-reported adverse events and patients' perceptions of staffing adequacy, and in patients' perception, it was mainly caused by lack of staff and insufficient experience. Furthermore, patients' health status, as opposed to gender, predicted missed care. The results concerning patients' age and education level were conflicting. Patients are able to identify missed care. However, further research is needed to examine patient-perceived missed care as well as to examine how patients identify missed care, and to get a clear definition of missed care.

Examining missed care in community nursing: A cross section survey design.

AIM: To examine the prevalence of missed care in the community nursing. BACKGROUND: Previous studies have used a missed care framework to identify challenges routine nursing care in acute care environments. Several issues related to quality of care, safe staffing, job satisfaction and poor teamwork. However, this concept has not been examined in the community nursing context. DESIGN: A cross-sectional survey design was used to explore the concept of missed care in community nursing using demographical information, community nursing roles and reasons for missed care. METHODS: Online questionnaires were completed by 458 community nurses in the Republic of Ireland to determine the prevalence of and reasons for missed care (31 July-25 September 2015). RESULTS/FINDINGS: With a response rate of 29%, findings were above 70% in several routine care responsibilities. Other findings point to a higher level of missed care in nurses who had less than five years' experience and other variables such as age, those who worked additional unpaid hours and there were some regional variations. CONCLUSION: The results of the study indicate a high prevalence of missed care in the community nurses surveyed and that preventative care was the type of care most likely to be missed. This has serious implications for a nursing service that is preventative in nature and suggests that the missed care framework could benefit workforce planning for community nursing services both in Ireland and elsewhere. Accordingly, policy, practice and educational reforms are fundamental to meet current and future population needs.

The relationship of staffing and work environment with implicit rationing of nursing care in Swiss nursing homes--A cross-sectional study.

BACKGROUND: Implicit rationing of nursing care refers to the withdrawal of or failure to carry out necessary nursing care activities due to lack of resources, in the literature also described as missed care, omitted care, or nursing care left undone. Under time constraints, nurses give priority to activities related to vital medical needs and the safety of the patient, leaving out documentation, rehabilitation, or emotional support of patients. In nursing homes, little is known about the occurrence of implicit rationing of nursing care and possible contributing factors. OBJECTIVES: The purpose of this study was (1) to describe levels and patterns of self-reported implicit rationing of nursing care in Swiss nursing homes and (2) to explore the relationship between staffing level, turnover, and work environment factors and implicit rationing of nursing care. DESIGN: Cross-sectional, multi-center sub-study of the Swiss Nursing Home Human Resources Project (SHURP). SETTINGS: Nursing homes from all three language regions of Switzerland. PARTICIPANTS: A random selection of 156 facilities with 402 units and 4307 direct care workers from all educational levels (including 25% registered nurses). METHODS: We utilized data from established scales to measure implicit rationing of nursing care (Basel Extent of Rationing of Nursing Care), perceptions of leadership ability and staffing resources (Practice Environment Scale of the Nursing Work Index), teamwork and safety climate (Safety Attitudes Questionnaire), and work stressors (Health Professions Stress Inventory). Staffing level and turnover at the unit level were measured with self-developed questions. Multilevel linear regression models were used to explore the proposed relationships. RESULTS: Implicit rationing of nursing care does not occur frequently in Swiss nursing homes. Care workers ration support in activities of daily living, such as eating, drinking, elimination and mobilization less often than documentation of care and the social care of nursing homes residents. Statistically significant factors related to implicit rationing of care were the perception of lower staffing resources, teamwork and safety climate, and higher work stressors. Unit staffing and turnover levels were not related to rationing activities. CONCLUSIONS: Improving teamwork and reducing work stressors could possibly lead to less implicit rationing of nursing care. Further research on the relationship of implicit rationing of nursing care and resident and care worker outcomes in nursing homes is requested.