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.

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.

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Work interruptions (WIs)-breaks in the sequence of task performance of a human activity, causing a temporary pause of task continuity-are common in nurses' work environment and considered to contribute significantly to nurses' errors, delays and omissions of tasks (Getnet & Bifftu, 2017;Johnson et al., 2017;Schutijser et al., 2019). Recently, the nursing literature has demonstrated growing interest in the phenomenon of missed nursing care (MNC), defined as any omission, delay or failure to complete necessary patient care (Kalisch et al., 2009(Kalisch et al., , 2013. This concept has, on other occasions, been termed care left undone (Jones et al., 2015) or implicit care rationing (Schubert et al., 2013). Although both WIs and MNC refer to the delay or omission of tasks/care, they have been studied in parallel, and no study to date has explored their joint mechanism.Thus, the current study suggests illuminating the role of WI in MNC.Specifically, the study aims to understand those WIs that are more associated with MNC compared with those that are not. | Background | Missed nursing careMNC usually occurs because of time scarcity and resource shortages that lead to harmful consequences for patients, nurses and