The nurse's experience of decision-making processes in missed nursing care: A qualitative study.

AIMS: To explore nurses' perspectives regarding the decision-making processes that lead to missed nursing care and to identify the personal and contextual attributes involved in these processes. DESIGN: A qualitative study was undertaken between April - October 2018. METHODS: A total of 28 registered nurses working in different wards in hospital settings participated in nine focus groups with semi-structured interviews. An interview guide encouraged nurses to share perceptions of missed care and the personal and contextual attributes shaping their decision-making. RESULTS: Content analysis revealed three themes related to nurses' decision-making processes for whether to omit or delay care. First, nurses emphasized the role of nurses' agency, suggesting explicit or implicit rationing of care, regardless of scarce resources. Second, nurses distinguished between two modes of thinking that they labelled "automated thinking," activated in routine situations and "effortful thinking," initiated in more novel situations. Finally, nurses identified situational factors triggering fluctuations in their awareness such as task type, difficult patients and the presence of relatives and the head nurse. CONCLUSIONS: Nurses are aware of the processes guiding a decision to omit or delay care. They pointed to patient, nurse and ward conditions that serve as cues in their decision whether to miss care. Identifying these cues supports Hammond's cognitive continuum theory of decision-making and may serve in the development of training programmes for nurses aimed at limiting the phenomenon. IMPACT: The study addressed missed nursing care through a decision-making lens. The findings pointed to nurses' agency as shaping decisions about whether to miss care and identified the personal and contextual cues that guide nurses' decisions. These findings call for organizational training programmes encouraging nurses to identify barriers and facilitators of missed nursing care and how to overcome them.

Analyzing online forums to identify information needs and knowledge gaps in patients with left ventricular assist devices: a qualitative study.

AIM: To explore the knowledge and unmet informational needs of candidates for left ventricular assist devices (LVADs), as well as of patients, caregivers, and family members, by analyzing social media data from the MyLVAD.com website. METHODS AND RESULTS: A qualitative content analysis method was employed, systematically examining and categorizing forum posts and comments published on the MyLVAD.com website from March 2015 to February 2023. The data was collected using an automated script to retrieve threads from MyLVAD.com, focusing on genuine questions reflecting information and knowledge gaps. The study received approval from an ethics committee. The research team developed and continuously updated categorization matrices to organize information into categories and subcategories systematically. From 856 posts and comments analyzed, 435 contained questions representing informational needs, of which six main categories were identified: clothing, complications/adverse effects, LVAD pros and cons, self-care, therapy, and recent LVAD implantation. The self-care category, which includes managing the driveline site and understanding equipment functionality, was the most prominent, reflecting nearly half of the questions. Other significant areas of inquiry included complications/adverse effects and the pros and cons of LVAD. CONCLUSION: The analysis of social media data from MyLVAD.com reveals significant unmet informational needs among LVAD candidates, patients, and their support networks. Unlike traditional data, this social media-based research provides an unbiased view of patient conversations, offering valuable insights into their real-world concerns and knowledge gaps. The findings underscore the importance of tailored educational resources to address these unmet needs, potentially enhancing LVAD patient care.

Toward understanding nurses' decisions whether to miss care: A discrete choice experiment.

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 (b = -0.46; p = 0.001), difficult patient (b = -0.20; p = 0.001), and patient clinical complexity (b = -0.10; p = 0.006) were negatively linked to the probability of missed care. The interaction between workload and task type (b = 0.252; p = 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 (b = 0.230; p = 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 (b = -0.219; p = 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 (b = -0.48; p = 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.

Promoting patient care: work engagement as a mediator between ward service climate and patient-centred care.

AIMS: To test a model that suggests the ward's climate of service facilitates nurses' patient-centred care behaviours through its effect on nurses' work engagement. BACKGROUND: Organizational efforts to promote patient-centred care focused on interventions aimed to improve nurses' communication skills, or to improve patient's participation in the decision-making process. These interventions have been only partially successful, as they do not take the ward context into account; so caring professionals who attend workshops can rarely apply their newly acquired skills due to the daily pressures of the ward. METHOD: A nested cross-sectional research design (nursing staff within wards) was adopted, with three measures of the care behaviour of nurses. Data were collected in 2009, from 158 nurses working in 40 wards of retirement homes in northern Israel. Nurses' work engagement, ward's climate for service and control variables were measured via validated questionnaires. Patient-centred care behaviours were assessed by structured observations. RESULTS: The findings supported our model: service climate proved a link to nurses' work engagement and patient-centred care behaviours. Nurses' work engagement mediated the service-climate patient-centred care behaviours. CONCLUSION: The research is pioneering in demonstrating a close relation between ward service climate and patient-centred care. In practice, to improve patient-centred care managers should invest in facilitating ward service climate, highlighting the importance of service to the organization through appropriate rewards, guidance and administrative practices.

Work interruptions and missed nursing care: A necessary evil or an opportunity? The role of nurses' sense of controllability.

AIM: To explore nurses' experiences with work interruptions (WIs) through the lens of missed nursing care (MNC). DESIGN: A qualitative descriptive design. METHODS: Eleven small focus groups involving 34 nurses (three nurses per group on average) from acute-care hospital wards were conducted. Nurses shared their experiences with WIs (sources, reactions and decisions) from the MNC perspective. Data analysis was conducted via content analysis. RESULTS: A preponderant theme emerged-the dynamic of controllability. Nurses who perceived a sense of controllability felt that they could decide whether to accept or reject the WI, regardless of WI type, and emotions of anger emerged. Conversely, nurses who did not perceive sense of controllability attended the secondary task: MNC occurred, and distress emotions emerged. Results emphasized that nurses are active agents prioritizing whether to omit or complete care in the face of WIs. Controllability, accompanied by active negative emotions, perpetuate a prioritization process that makes it less probable that MNC occurs.