Nursing Professional Commitment as a Mediator of the Relationship Between Work Environment and Missed Nursing Care Among Nurses: A Cross-Sectional Analysis.
SAGE open nursing
Introduction:Nursing care plays a pivotal role in promoting patient well-being and optimizing health outcomes. The nursing profession is characterized by its commitment to delivering high-quality care to patients. Objective:The purpose of the study was to explore the role of nursing professional commitment as a mediator between the work environment and missed nursing care. Methods:A cross-sectional analysis study "STROBE guideline" used an online structured questionnaire to collect data. It was conducted on a sample of 813 nurses who worked at seven governmental hospitals in Egypt, in the hospital wards, operating rooms, intensive care unit (ICU) or outpatient clinics, during a 4-month period from April to August 2022. Researchers used Characteristics of nurses, Nursing Work Index-Revised, Nursing Professional Commitment Scale, and MISSCARE Questionnaire to collect the data. Structural equation modeling by AMOS was used for testing nursing professional commitment as a mediator between the work environment and missed nursing care. Nurses' professional commitment was used as a mediator between work environment and missing nursing care. Results:The working environment has a direct impact of -0.175, an indirect impact of -0.139, and a total impact of -0.314. Furthermore, professional commitment has a direct impact of -0.421. Additionally, when the working environment increases by 1, professional commitment increases by 0.33. Similarly, when the working environment increases by 1, missed care decreases by 0.175. Moreover, when professional commitment, as a mediating factor, increases by 1, missed care decreases by 0.421. Conclusion:In conclusion, the findings of this study highlight the significant role of professional commitment as an intermediary factor between the working environment and missed nursing care. According to these results, it is necessary to formulate and implement intervention strategies to improve nurses' professional commitment and working environment, which is the key to reducing their missed nursing care.
10.1177/23779608231226063
Post-operative mortality, missed care and nurse staffing in nine countries: A cross-sectional study.
Ball Jane E,Bruyneel Luk,Aiken Linda H,Sermeus Walter,Sloane Douglas M,Rafferty Anne Marie,Lindqvist Rikard,Tishelman Carol,Griffiths Peter,
International journal of nursing studies
BACKGROUND:Variation in post-operative mortality rates has been associated with differences in registered nurse staffing levels. When nurse staffing levels are lower there is also a higher incidence of necessary but missed nursing care. Missed nursing care may be a significant predictor of patient mortality following surgery. AIM:Examine if missed nursing care mediates the observed association between nurse staffing levels and mortality. METHOD:Data from the RN4CAST study (2009-2011) combined routinely collected data on 422,730 surgical patients from 300 general acute hospitals in 9 countries, with survey data from 26,516 registered nurses, to examine associations between nurses' staffing, missed care and 30-day in-patient mortality. Staffing and missed care measures were derived from the nurse survey. A generalized estimation approach was used to examine the relationship between first staffing, and then missed care, on mortality. Bayesian methods were used to test for mediation. RESULTS:Nurse staffing and missed nursing care were significantly associated with 30-day case-mix adjusted mortality. An increase in a nurse's workload by one patient and a 10% increase in the percent of missed nursing care were associated with a 7% (OR 1.068, 95% CI 1.031-1.106) and 16% (OR 1.159 95% CI 1.039-1.294) increase in the odds of a patient dying within 30days of admission respectively. Mediation analysis shows an association between nurse staffing and missed care and a subsequent association between missed care and mortality. CONCLUSION:Missed nursing care, which is highly related to nurse staffing, is associated with increased odds of patients dying in hospital following common surgical procedures. The analyses support the hypothesis that missed nursing care mediates the relationship between registered nurse staffing and risk of patient mortality. Measuring missed care may provide an 'early warning' indicator of higher risk for poor patient outcomes.
10.1016/j.ijnurstu.2017.08.004
Inadequate environment, resources and values lead to missed nursing care: A focused ethnographic study on the surgical ward using the Fundamentals of Care framework.
Jangland Eva,Teodorsson Therese,Molander Karin,Muntlin Athlin Åsa
Journal of clinical nursing
AIMS AND OBJECTIVES:To explore the delivery of care from the perspective of patients with acute abdominal pain focusing on the contextual factors at system level using the Fundamentals of Care framework. BACKGROUND:The Fundamentals of Care framework describes several contextual and systemic factors that can impact the delivery of care. To deliver high-quality, person-centred care, it is important to understand how these factors affect patients' experiences and care needs. DESIGN:A focused ethnographic approach. METHOD:A total of 20 observations were performed on two surgical wards at a Swedish university hospital. Data were collected using participant observation and informal interviews and analysed using deductive content analysis. RESULTS:The findings, presented in four categories, reflect the value patients place on the caring relationship and a friendly atmosphere on the ward. Patients had concerns about the environment, particularly the high-tempo culture on the ward and its impact on their integrity, rest and sleep, access to information and planning, and need for support in addressing their existential thoughts. The observers also noted that missed nursing care had serious consequences for patient safety. CONCLUSION:Patients with acute abdominal pain were cared for in the high-tempo culture of a surgical ward with limited resources, unclear leadership and challenges to patients' safety. The findings highlight the crucial importance of prioritising and valuing the patients' fundamental care needs for recovery. RELEVANCE TO CLINICAL PRACTICE:Nursing leaders and nurses need to take the lead to reconceptualise the value of fundamental care in the acute care setting. To improve clinical practice, the value of fundamentals of care must be addressed regardless of patient's clinical condition. Providing a caring relationship is paramount to ensure a positive impact on patient's well-being and recovery.
10.1111/jocn.14095
Missed nursing care: Magnet versus non-Magnet hospitals.
Kalisch Beatrice J,Lee Kyung Hee
Nursing outlook
BACKGROUND:The objective of this study was to examine whether the amount, type, and reasons of missed nursing care differ between Magnet and non-Magnet hospitals. METHOD:Data were collected from 124 medical-surgical, intermediate, intensive care, and rehabilitation units in 11 hospitals located in the Midwest and Western regions of the United States. A cross-sectional, descriptive study was conducted. The MISSCARE Survey was utilized to collect data on the level of perceived missed nursing care, and nursing staffing data was collected for each study unit. FINDINGS:Missed nursing care showed significant differences according to Magnet status. Separate analysis showed no staffing-level difference between Magnet and non-Magnet hospitals. CONCLUSIONS:The authors concluded that efficiencies in operations, work environment, and culture characterized by Magnet hospitals should be promoted.
10.1016/j.outlook.2012.04.006
The relationship between attitude of nurses toward the patient safety and missed nursing care: A predictive study.
Journal of healthcare quality research
BACKGROUND:Positive attitude of nurses toward patient safety can play a major role in increasing the quality of nursing care and reducing missed nursing care. This study was conducted to determine the relationship between the Attitude of Nurses Toward Patient Safety and missed nursing care. METHODS:This study was conducted in 2021 at the hospitals of Tabriz University of Medical Sciences (Iran). In the present study, 351 nurses were included in the study by using a stratified random sampling method. Data collection tools were demographic questionnaire, missed nursing care questionnaire, and patient safety attitudes questionnaire. Missed Nursing Care Questionnaire includes 24 items, such as patient movement, rotation, evaluation, training, discharge planning, medication prescription, scored on a 4-point Likert scale ranging from score 1 (I miss rarely), score 2 (I miss occasionally), score 3 (I miss usually), and score 4 (I miss always). The highest score is 96 and the lowest score is 24 on this scale. A higher score indicates a higher possibility of missed care. RESULTS:The mean total (standard deviation) of missed nursing care was 32.76 (7.13) (score range: 24-96) and the mean total score of nurses' patient safety attitudes was 53.19 (18.71) out of 100. Results of the present study showed that nurses' patient safety attitudes are at a moderate level and have a significant inverse relationship with the incidence of missed nursing care (P<0.001). CONCLUSION:According to the results and given the relationship between patient safety attitudes and missed nursing care, it is essential to use individual and organizational interventions to increase patient safety attitudes in various dimensions in nurses and consequently to reduce missed nursing care and improve the quality of healthcare.
10.1016/j.jhqr.2021.10.007
Missed nursing care and stoma care: an Italian survey.
British journal of nursing (Mark Allen Publishing)
BACKGROUND:In Italy, nursing research has paid special attention to 'missed nursing care'. The studies carried out, varying in tools and settings, describe considerable percentages of missed care. In the field of stoma care, the phenomenon has not been investigated to date. AIM:To investigate the prevalence of missed nursing care (MNC) in the Italian ostomy patient population and the most relevant causes suggested for this by stoma care nurses. DESIGN:Cross-sectional study. METHOD:The Italian version of the MISSCARE survey was used with some questions related to the stoma care pathway. The survey was targeted at hospitals in the country with dedicated services and/or pathways for ostomy patients, between February and April 2023. FINDINGS:A total of 461 questionnaires were sent out, 214 (53.3%) were analysed. The majority of the participants were female (160, 76.2%), median age of 50 years (35.0-53.8). The most common qualification was a Bachelor's degree (=117; 54.9%) and work experience in stoma care was more than 10 years in 95 cases (50.3%). Prominent instances of MNC were identified, with hand washing (score 4.6 out of 5), compilation of nursing documentation and hygiene/skin care (score 4.5 out of 5) and patient/family education (score 4.4 out of 5) emerging as the most prevalent. The most notable omissions in the stoma care process encompassed educational facets, clinical monitoring, a comprehensive discharge plan, and diligent follow-up. Among the most frequent reasons were staff shortages (score 3.1 out of 4), unsuitable nurse-patient ratios (score of 3 out of 4) and insufficient numbers of experienced stoma care personnel (score of 3 out of 4). CONCLUSION:A substantial number of basic and clinically relevant nursing interventions were perceived to be missed, and this may lead to an increase in negative outcomes for ostomy patients.
10.12968/bjon.2024.33.6.S12
The frequency and reasons for missed nursing care in Australian perioperative nurses: A national survey.
Journal of clinical nursing
AIM:To describe Australian perioperative nurses' reported frequency and reasons for missed nursing care in the operating room. DESIGN:Cross-sectional online survey conducted in March-April 2022. METHODS:A census of Australian perioperative nurses who were members of a national professional body were invited to complete a survey that focussed on their reported frequency of missed nursing care and the reasons for missed nursing care in the operating room using the MISSCare Survey OR. RESULTS:In all, 612 perioperative nurses completed the survey. The perioperative and intraoperative nursing care tasks reported as most frequently missed included time-intensive tasks and communication with multiple surgical team members present. The most frequently reported reasons for missed care were staffing-related (e.g. staff number, skill mix, fatigue and complacency) and affected teamwork. There were no significant differences in the frequency of missed care based on perioperative nurse roles. However, there were statistically significant differences between nurse management, circulating/instrument nurses and recovery room nurses in reasons for missed care. CONCLUSIONS:Much of the missed care that occurs in the operating room is related to communication practices and processes, which has implications for patient safety. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE:Understanding the types of nursing care tasks being missed and the reasons for this missed care in the operating room may offer nurse managers deeper insights into potential strategies to address this situation. REPORTING METHOD:Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement. PATIENT OR PUBLIC CONTRIBUTION:No patient or public contribution.
10.1111/jocn.17082
Job embeddedness and missed nursing care at the operating theatres: the mediating role of polychronicity.
BMC nursing
BACKGROUND:Perioperative missed nursing care is a serious issue that can compromise patient safety and quality of care. However, little is known about the factors that influence perioperative missed nursing care. AIM:This study aimed to examine the effects of job embeddedness and polychronicity on perioperative missed nursing care as well as to test the mediating role of polychronicity on the relationship between job embeddeness and perioperative missed nursing care. METHOD:This was a cross-sectional correlational study that used a convenience sample of 210 operating room nurses from nine hospitals in Egypt. Data were collected using self-administered questionnaires that measured job embeddedness, polychronicity, and perioperative missed nursing care. Structural equation modeling was used to test the hypothesized relationships among the variables. RESULTS:The findings demonstrated a significant negative and moderate association between missed perioperative care and both nurses' job embeddedness and polychronicity. Moreover, there was a moderately positive and significant correlation between polychronicity and job embeddedness. Path analysis revealed a significant positive causal effect between job embeddedness and polychronicity. The results of mediation revealed that the indirect effect of job embeddedness on missed care through polychronicity was statistically significant; suggesting that polychronicity partially mediated this relationship. CONCLUSION:This study sheds light on the intricate relationship between nurses' job embeddedness, missed care, and polychronicity in the operating theater context. By enhancing job embeddedness and fostering polychronicity among nurses, healthcare organizations can reduce perioperative missed care and ultimately improve patient care outcomes in this critical healthcare setting.
10.1186/s12912-023-01628-8
Missed nursing care: a qualitative study.
Kalisch Beatrice J
Journal of nursing care quality
The purpose of this study was to determine nursing care regularly missed on medical-surgical units and reasons for missed care. Nine elements of regularly missed nursing care (ambulation, turning, delayed or missed feedings, patient teaching, discharge planning, emotional support, hygiene, intake and output documentation, and surveillance) and 7 themes relative to the reasons for missing this care were reported by nursing staff.
10.1097/00001786-200610000-00006
Missed nursing care in emergency departments: A scoping review.
International emergency nursing
BACKGROUND:Patient safety is a global health priority. Errors of omission, such as missed nursing care in hospitals, are frequent and may lead to adverse events. Emergency departments (ED) are especially vulnerable to patient safety errors, and the significance missed nursing care has in this context is not as well known as in other contexts. AIM:The aim of this scoping review was to summarize and disseminate research about missed nursing care in the context of EDs. METHOD:A scoping review following the framework suggested by Arksey and O'Malley was used to (1) identify the research question; (2) identify relevant studies; (3) select studies; (4) chart the data; (5) collate, summarize, and report the results; and (6) consultation. RESULTS:In total, 20 themes were derived from the 55 included studies. Missed or delayed assessments or other fundamental care were examples of missed nursing care characteristics. EDs not staffed or dimensioned in relation to the patient load were identified as a cause of missed nursing care in most included studies. Clinical deteriorations and medication errors were described in the included studies in relation to patient safety and quality of care deficiencies. Registered nurses also expressed that missed nursing care was undignified and unsafe. CONCLUSION:The findings from this scoping review indicate that patients' fundamental needs are not met in the ED, mainly because of the patient load and how the ED is designed. According to registered nurses, missed nursing care is perceived as undignified and unsafe.
10.1016/j.ienj.2023.101296
Missed nursing care: a concept analysis.
Kalisch Beatrice J,Landstrom Gay L,Hinshaw Ada Sue
Journal of advanced nursing
AIM:This paper is a report of the analysis of the concept of missed nursing care. BACKGROUND:According to patient safety literature, missed nursing care is an error of omission. This concept has been conspicuously absent in quality and patient safety literature, with individual aspects of nursing care left undone given only occasional mention. METHOD:An 8-step method of concept analysis - select concept, determine purpose, identify uses, define attributes, identify model case, describe related and contrary cases, identify antecedents and consequences and define empirical referents - was used to examine the concept of missed nursing care. The sources for the analysis were identified by systematic searches of the World Wide Web, MEDLINE, CINAHL and reference lists of related journal articles with a timeline of 1970 to April 2008. FINDINGS:Missed nursing care, conceptualized within the Missed Nursing Care Model, is defined as any aspect of required patient care that is omitted (either in part or in whole) or delayed. Various attribute categories reported by nurses in acute care settings contribute to missed nursing care: (1) antecedents that catalyse the need for a decision about priorities; (2) elements of the nursing process and (3) internal perceptions and values of the nurse. Multiple elements in the nursing environment and internal to nurses influence whether needed nursing care is provided. CONCLUSION:Missed care as conceptualized within the Missed Care Model is a universal phenomenon. The concept is expected to occur across all cultures and countries, thus being international in scope.
10.1111/j.1365-2648.2009.05027.x
Missed nursing care: An overview of reviews.
Chaboyer Wendy,Harbeck Emma,Lee Bih-O,Grealish Laurie
The Kaohsiung journal of medical sciences
Missed nursing care is care that is delayed, partially completed, or not completed at all. The aim of this overview of reviews was to identify the nursing care that is missed, the factors that influence missed nursing care and the outcomes from it. To be included, reviews had to use the systematic review process and focus on hospital care. Databases were searched from inception until August sixth, 2020. One author screened the papers and extracted data on included reviews and a second checked this. Two authors independently assessed the quality of the reviews. Seven reviews were included in this overview. Categories of care missed included: (a) communication and information sharing; (b) self-management, autonomy, and education including care planning, discharge planning and decision; (c) fundamental physical care; and (d) emotional and psychological care including spiritual support. Factors associated with missed care were related to staffing levels and/or labor resources skill mix, material resources not being available, patient acuity and teamwork/communication. Outcomes of missed nursing care included: less/poorer quality of patient care, patient satisfaction, and nurses' job satisfaction, increased patient adverse events, and the organizational outcomes of increasing hospital length of stay and hospital readmission. In-depth qualitative and mixed methods research is needed to better understand how nurses prioritize care and why care is missed. Longitudinal and experimental research is required to better clarify if these relationships between missed care and negative patient outcomes are likely cause and effect.
10.1002/kjm2.12308