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

Abstract

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 | 1493 PALESE Et AL.

An overview of 5‐year patterns and trends in the Journal of Nursing Management

“…It is true that many of the other facets of the leadership role (Table , 4–15) inform and influence day‐to‐day practice; however, most of these elements of the role also require long‐term planning and as such are concerned with strategic development of nursing, nursing management and health care. In keeping with current awareness within health care on care left undone, missed care and rationalizing care (Palese et al, ), it is possible that some of these activities would likely not be missed (if not executed correctly) in the day‐to‐day environment and therefore less likely to be prioritized from either a practical or research perspective and this could perhaps explain why they have received less attention.…”

“…In terms of the gaps in research and dissemination related to policy, Palese et al (), a group including nurse clinicians/managers, recently demonstrated a novel focus on policy in the Journal by outlining the process and outcomes of a consensus approach to developing policies and actions in response to missed care in Italy. Such policy work is vital in contemporary nursing.…”

Performed and missed nursing care in Swiss acute care hospitals: Conceptual considerations and psychometric evaluation of the German MISSCARE questionnaire

“…A vast majority (89%) of the published literature is based upon the three following approaches (Jones et al., 2015): (a) nursing care tasks left undone due to lack of time (Aiken et al., 2001); (b) implicitly rationed care, that is ‘the withholding of or failure to carry out necessary nursing measures for patients due to a lack of nursing resources (staffing, skill mix, time)’ (Schubert, Glass, Clarke, Schaffert‐Witvliet, & De Geest, 2007); and (c) missed nursing care, that is ‘any aspect of required patient care that is omitted (partly or entirely) or delayed’ (Kalisch, Landstrom, & Hinshaw, 2009). Numerous articles focus on these approaches, but few distinguish clearly between them (Jones et al., 2015; Palese et al., 2019). Yet, attempts for international collaboration are underway to develop standard terminology (Jones, Hamilton, Carryer, Sportsman, & Gemeinhardt, June 2014; Jones, Willis, Amorim‐Lopes, & Drach‐Zahavy, 2019; Zeleníková et al, 2019).…”

“…As a nurse‐sensitive performance indicator, the measurement and monitoring of performed and missed nursing care supply crucial information for nurse leaders concerning change and intervention targeting evidence‐based decision‐making and, ultimately, patient care quality (Kontio, Lundgren‐laine, Kontio, Korvenranta, & Salanterä, 2013; Lowe & Baker, 1997; Spirig et al., 2014; VanFosson, Jones, & Yoder, 2016). Despite attempts to conceptualize, define, operationalize and measure the phenomenon, no gold standard yet exists (Palese et al., 2019).…”

A qualitative descriptive inquiry of the influences on nurses’ missed care decision‐making processes in acute hospital paediatric care

“…It is widely acknowledged that missed care is widespread across acute hospital environments (Kalisch & Xie, 2014) despite ongoing concerns about safety and a commitment to quality care (O'Donovan, Ward, De, Brún, & McAuliffe, 2018; Woodward, 2016). While actions are underway to consider policy to prevent missed care across health care settings internationally (Palese et al, 2019; Rancare, 2018a, 2018b), there is an emerging discourse that missed care is no longer deemed ethically correct, urging ethical and professional action by nurses to rectify the situation (Suhonen & Scott, 2018). Thus, reports on nurses’ missed care appear to be assuming a lack of conscientiousness, or that nurses are being overwhelmed with resource issues, without consideration of particular influences that may underpin their missed care decisions.…”