Factors Associated With Missed Nursing Care in Nursing Homes: A Multicentre Cross-sectional Study

Abstract

Background: Despite its association with patient safety, few studies on missed nursing care have been conducted in nursing homes. We aimed to describe individual and environmental factors in a sample of registered nurses (RNs) reporting missed nursing care in nursing homes, and to explore the association between these factors and missed nursing care. Methods: In the present, multicentre cross-sectional study, 217 RNs from 43 nursing homes in Northern Italy reported all episodes of missed nursing care (ie, any aspect of required care that was omitted or delayed) that occurred in the 20 most dependent residents (according to RNs’ judgement; 860 residents in total) over 3 consecutive days. Multilevel multivariable logistic regression models were used to test possible explanatory factors of missed nursing care (individual, work-related, organisational, and work environment factors), which were entered in a step-wise manner. Results: Younger RNs (P=.026), freelance RNs (P=.046), RNs with a permanent contract (P=.035), and those working in publicly-owned nursing homes reported more episodes of missed nursing care (P<.012). Public ownership (odds ratio [OR]=9.88; 95% CI 2.22–44.03; P=.003), a higher proportion of residents with severe clinical conditions (OR=2.45; 95% CI 1.12–5.37; P=.025), a lower proportion of RNs (OR=2.24; 95% CI 1.10–4.54; P=.026), and perceived lack of time to care for residents (OR=2.33; 95% CI 1.04–5.26; P=.041) were statistically significantly associated with missed nursing care. Conclusion: Factors associated with missed nursing care are similar in hospitals and nursing homes, and include heavy workload and perceived lack of time for care. Because missed nursing care in nursing homes represents tasks performed specifically by RNs, missed nursing care in this setting should be measured in terms of these tasks. An optimal skill mix is crucial to guarantee not only comfort and basic care for nursing home residents, but also good outcomes for residents with severe clinical conditions.

The Impact of the COVID-19 Pandemic on Nursing Care: A Cross-Sectional Survey-Based Study

“…Healthcare systems should maintain, and be prepared to implement, plans for pandemic events, and hospital managers should draw up specific emergency plans that define the human resources required in case of a long-term pandemic with recurrent waves, based on competencies, skill mix (e.g., of experienced and novice nurses), and job rotations. Nurse staffing should be proportionate to the clinical complexity of patients and to the organizational complexities to individualize care, minimizing the risk of missed care and patient death [38]. These actions would improve the healthcare system's response and alleviate the stress imposed by crises, although maintaining the highest standard of nursing care delivered.…”

Legitimizing neglect - a qualitative study among nursing home staff in Norway

“…This study is based on the fact that neglect, as defined by researchers, is common in Norwegian nursing homes [4]. Prior research presents a numerous examples of and causal explanations for neglect happening in nursing homes based on the outsiders' perspectives on this phenomenon [14,[35][36][37][38][39][40][41]. We add to this knowledge by studying the meaning making efforts of the nursing home staff.…”

“…Hence findings from acute care may not be generalizable to nursing homes [9]. Campagna, et al (2022) on the other hand, concluded that missed care in hospital environments are relevant for nursing homes due to similarities such as patients with severe and complex clinical conditions, high perceived workload, and less qualified staff [41].…”

Lived experiences of end‐of‐life communication among nursing home staff: An interpretive phenomenological study

“…As such, nurses may take these aspects for granted and thus not report them (Coffey et al, 2019). It is also possible that chronic understaffing, compounded by the pandemic, forced NH nurses to focus on more practical issues when communicating (Campagna et al, 2021). This issue deserves further investigation.…”