Missed Nursing Care in a Sample of High-Dependency Italian Nursing Home Residents: Description of Nursing Care in Action

Abstract

The aim of the study was to describe omitted or delayed nursing care (i.e., missed nursing care [MNC]) in a sample of Italian nursing homes (NHs).Methods: Nurses from 50 NHs located in Northern Italy selected the 20 most dependent residents in their care and reported instances of MNC for three to five consecutive shifts. They described the type of MNC, its cause(s), management, recurrence, and severity of possible consequences for the resident. Information on the residents and the NH was also collected. The instances of MNC were classified as potentially avoidable/ preventable or not.Results: Overall, 266 (85.3%) of 312 nurses participated and 1000 residents were observed during 381 shifts (164 mornings, 164 afternoons, and 53 nights); 101 (38%) nurses reported 223 instances of MNC among 175 residents (17.5%). Ninety-seven omissions and 109 delays occurred during the day shift (56 omissions were delegated to the next shift). The most frequent MNC was drug administration (n = 71, 34.5%). In 24 (44.4%) of 54 instances of delayed drug administration, the delay was less than 30 minutes. Nurses rated approximately 20% of MNC (n = 41) as highly severe because of the discomfort caused to the resident, the clinical impact, or the repetitiveness of the situation. Nurses ascribed almost half of MNC (n = 100, 48.5%) to inadequate staffing, and they categorized 26 (11.6%) instances of MNC as unavoidable. Conclusions:The number of nurse-reported instances of MNC we reported was much lower than that previously collected with available instruments. Most MNC did not impact the comfort and safety of residents. A certain proportion of MNC was unavoidable.

Self-assessment of Rationing and Quality of Nursing Care

“…Perhaps, the need for multitasking forces nurses to select implicitly those areas of nursing care that prevent harm due to the quality of care and patient safety. Once again, these findings confirm that nurses cannot finish all of the planned nursing care and highlight the adverse effects this phenomenon can have on the quality of health care and treatment outcomes 32…”

“…Once again, these findings confirm that nurses cannot finish all of the planned nursing care and highlight the adverse effects this phenomenon can have on the quality of health care and treatment outcomes. 32 The present study showed that only the sociodemographic factor of education affected the level of care rationing. Nurses with a vocational school education rationed nursing activities significantly less than nurses with a bachelorʼs degree.…”

Satisfaction With Life, Satisfaction With Job, and the Level of Care Rationing Among Polish Nurses—A Cross-Sectional Study

“…This study reveals that nurses most frequently ration the activities related to the first and second stage of the caring process (diagnosing the bio-psycho-social condition of the patient and planning activities aimed at solving the problems of patients), which finally translates into lower quality of provided care and worse treatment outcomes for patients (Campagna et al, 2020 ). In contrast, the positive aspect is that, as has been demonstrated, the least frequently rationed activities include applying necessary disinfection measures and preparation of patients for planned tests or therapies, which is also confirmed by other authors (Schubert et al, 2013 ; Uchmanowicz et al, 2019a ).…”

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

“…Descriptive data on missed nursing care are presented in the parent study. 21 Individual factors, including RNs' gender, age, work experience (in their role and in the nursing home), and educational background were assessed. Work-related factors, ie, working shift (day shift vs alternate day and night shift), employment status (agency staff, public/private sector employment, freelancer), and weekly working hours were also considered.…”

“…Only one study investigated the severity of missed nursing care in nursing homes, as reported by a sample of RNs; results showed that RNs classified about 25% of missed nursing care as severe due to the clinical consequences and the discomfort caused to residents. 21 Missed nursing care has been associated with individual, work-related, organisational, and work environment factors; however, studies on the factors related to missed nursing care in nursing homes are lacking. In a sample of nurse aides, Knopp-Sihota et al found an association between missed nursing care and individual factors (younger age and low level of experience), work-related factors (working on the day shift), organisational factors (low number of beds and public ownership of nursing homes in rural areas), and poor work environment in terms of leadership, culture, staffing, and time for care.…”