Factors influencing missed nursing care in public hospitals in Australia: An exploratory mixed methods study

Abstract

Summary Background Missed nursing care (MNC) is a significant health care issue that impacts on the quality of health care and patient safety. It refers to delayed or omitted aspects of nursing care (totally or partially). MNC is an under‐researched area in the Australian health care context. Objective This research sought to further explore the MNC phenomenon in the context of an acute care hospital and to identify its common elements and the factors influencing its occurrence. Design A convergent parallel mixed methods design was employed involving secondary analysis of routinely collected hospital data and a survey of 44 nursing staff using the MISSCARE survey instrument. The two sources of data were converged to address the objective. Findings The study found that the most common elements of missed nursing care include failure of patient ambulation, emotional support for patients and/or family, and the provision of full documentation. These elements are consistent with previous international studies conducted in acute care hospital settings. This study identified that local context impacting on MNC was also important and included interruptions to workflow, “perceived” lack of management support, poor handover, and communication breakdown between the nursing team and medical staff. Conclusion Consideration of the local health care context is foundational in understanding the MNC phenomenon. The findings of this research may help nursing managers mitigate the possible effects of MNC and therefore improve patient safety in their acute care environment. Additional multisite studies are required to further explore factors associated with MNC in both general and local contexts.

Are data on missed nursing care useful for nursing leaders? The RN4CAST@IT cross‐sectional study

“…A recent study identified that about one‐third of the nursing staff was not satisfied with their work environment, where 17% have no confidence in the field of management and the lack of support from nursing leadership was a cause for the omission of treatment. This study concluded by reflecting on the paradox of a system that, by using a managerial approach that mainly pursues efficiency, generates lack of trust on the part of the staff towards the managerial system itself (Albsoul, FitzGerald, Finucane, & Borkoles, 2019). A crucial role, in this constant tension between organisational efficiency and meeting patients' needs, is played by the charge nurse and the nursing leaders, who constantly have to balance resources to obtain positive outcomes to achieve the effectiveness and efficiency of nursing interventions (Ingwell‐Spolan, 2018).…”

Barreiras para comunicação eficaz em saúde

“…Outros autores evidenciaram os problemas com a documentação do prontuário do paciente entre as causas de eventos adversos de medicação (Manias et al, 2019) A literatura reforça a importância disso, ao passo que a transferência de informações e compreensão compartilhadas são umas das principais causas de falha de comunicação entre enfermeiros e médicos extraídos de relatórios de incidentes (Elizabeth Umberfield, Amir A Ghaferi, Sarah L Krein, 2019). Não se detendo apenas a relação médico enfermeiro, problemas de omissão e atrasos na assistência de enfermagem são impactados pela transferência de informação deficiente (Albsoul et al, 2019).…”

“…Em consonância a isso, um estudo examinou as tendências de erros de medicação, em que médicos e farmacêuticos tiveram chances reduzidas de cometerem falhas em comparação com enfermeiros, a diferença entre as disciplinas se deu na frequência de interrupções e distrações no qual os enfermeiros são submetidos (Manias et al, 2019). As interrupções no fluxo de trabalho são responsáveis por atrasos e omissões na assistência em enfermagem (Albsoul et al, 2019).…”

“…Em conformidade, enquanto barreira, a falta de familiaridade com determinados procedimentos de enfermagem causou erros de medicação (Albsoul et al, 2019). Este último achado, vem ao encontro da execução de cuidados assistenciais sem o senso crítico, citado por muitos participantes da pesquisa como automatização de tarefas, em função da confiança em pessoas, gerando a reprodução de erros, quebra técnica e violações.…”

Fatores Ambientais Relacionados À Omissão Dos Cuidados De Enfermagem

“…Ball J E (19) 2014 Transversal PES -NWI Recursos humanos inadequados (2.917 enfermeiros). Albsoul R (20) 2019 Exploratório Métodos mistos MISSCARE Interrupção do trabalho, gerência ausente e equipe mal relacionada (44 enfermeiros).…”