Unfinished nursing care reasons as perceived by nurses at different levels of nursing services: Findings of a qualitative study

Chiappinotto, Stefania; Palese, Alvisa

doi:10.1111/jonm.13800

Cited by 10 publications

(43 citation statements)

References 32 publications

(56 reference statements)

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“…18,19 During emergency and disaster situations, clinical events that involve urgent patient situations, such as deterioration in patient conditions and sudden changes in patients' vital signs, were often given the highest priority over other care activities, such as ambulation, turning of patients, and feeding. [9][10][11] This review identified a potential distinction between types of missed nursing care before and during the pandemic. Before the pandemic, missed nursing care activities aimed to optimize patients' overall health and well-being.…”

Section: Discussionmentioning

confidence: 99%

“…[5][6][7] Unfavorable working conditions, poor collegial relations, negative safety culture, poor ethical climate, and lack of management and organizational support were likewise associated with an increased incidence of nursing care left undone. 8,9 Missed nursing care, recognized as a threat to patient safety, has been consistently cited as a precursor to serious adverse events, 10 increased re-hospitalization and mortality rates, 11 and an overall decline in nursing care qual-ity. 6 It is often linked with an increase in nurses' dissatisfaction 5 and eventual turnover.…”

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confidence: 99%

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A Global Overview of Missed Nursing Care During the COVID-19 Pandemic: A Systematic Review

Labrague,

T. Kostovich

2023

West J Nurs Res

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The coronavirus disease 2019 (COVID-19) pandemic has placed unparalleled pressure on many countries’ healthcare systems, impacting the delivery of health and nursing care services. Despite the growing number of missed care studies during the pandemic, a broader perspective is essential when designing theory-driven strategies to improve nursing care delivery. This review aimed to synthesize evidence of missed nursing care during the COVID-19 pandemic in acute care settings through a systematic review and narrative synthesis. An electronic search of articles published since the emergence of the pandemic was conducted using 5 databases (Scopus, PubMed, Web of Science, CINAHL, and PsycINFO). A total of 470 articles were identified during the initial search, and 10 articles were included in the review. The sample sizes of the studies ranged from 37 to 536 nurses. Results of the content analysis were grouped into 5 categories: (1) prevalence of missed care, (2) frequency of missed care, (3) reasons for missed care, (4) nurses’ and organizational variables contributing to missed care, and (5) work environment elements contributing to missed care. The review’s findings revealed a shift in the nature of missed nursing care during the pandemic, with an emphasis on nursing care tasks vital for the recovery of patients with COVID-19. Despite the unique circumstances brought about by the pandemic, an inadequate nursing workforce continued to be identified as the primary reason for missed care, consistent with the pre-pandemic period.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

A Global Overview of Missed Nursing Care During the COVID-19 Pandemic: A Systematic Review

Labrague,

T. Kostovich

2023

West J Nurs Res

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“…At the overall level, reasons for UNC have emerged at the healthcare system, unit, nurse and at patient level; previous studies investigating the perceptions of nurses 34 , 35 , 36 have identified the reasons at the system, unit, nurse manager, clinical nurse and patient levels, thus suggesting that patients are able to identify the reasons for UNC at all levels, mirroring the perceptions of nurses.…”

Section: Discussionmentioning

confidence: 99%

“…According to the only study available that collected patients' perceptions about UNC with a qualitative approach, 12 and considering the most recent studies investigating reasons for UNC as perceived by nurses, 34 , 35 , 36 a semistructured interview was designed. The interview was composed of the following open‐ended questions:…”

Section: Methodsmentioning

confidence: 99%

What are the reasons for unfinished nursing care as perceived by hospitalized patients? Findings from a qualitative study

Chiappinotto

Coppe

Palese

2022

Health Expectations

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Introduction Unfinished nursing care (UNC), as the care required by patients that delayed or not delivered, has been investigated mainly from the perspective of nurses, while little is still known from the side of patients. Some studies have involved patients to measure which elements of care are mostly unfinished (e.g., mouth care), whereas a few studies have investigated the reasons for UNC as perceived by them. Their involvement in understanding the reasons for UNC is crucial to advance the knowledge and co‐develop possible strategies to prevent or minimize UNC. Methods This is a descriptive qualitative study performed according to COnsolidated criteria for REporting Qualitative research guidelines in 2022. A purposeful sample of Italian hospitalized patients in two medical and two surgical units was involved. A face‐to‐face semistructured interview was used to merge reasons for UNC. Qualitative content analysis was conducted to merge subthemes and themes as factors leading to UNC according to the experience of patients. Results A total of 23 patients (12 surgical and 11 medical) were involved (12/23 male) with an age average of 66.2 years, educated mainly at secondary school, and with previous hospitalizations (20/23), and dependent on nursing care in daily activities (14/23). Reasons for UNC have been identified at four levels: (1) ‘New health‐care system priorities’ and ‘Pre‐existing frailty of health‐care facilities’ were reasons identified at the health‐care system level; (2) ‘Lack of resources attributed to wards’, ‘Ineffective ward organization’ and ‘Leadership’ were identified at the unit level; (3) ‘Nurses' attitudes and behaviour’ were reported at the nurses' level and (4) ‘Increased nursing care expectations’ were pinpointed at the patient level. Conclusion Patients can be involved in identifying UNC, but also in recognizing the underlying reasons. Engaging them in such investigations might broaden our understanding of the phenomenon and the possibility of identifying strategies to minimize and prevent UNC. Patient or Public Contribution Patients from four hospital units (two medical and two surgical) were involved in face‐to‐face interviews to merge the reasons perceived by them as triggering UNC. All factors (as themes and subthemes) have derived from their words, thus enhancing the evidence available from the side of the patients.

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“…Other researchers have called the phenomenon of missed nursing care as cutting corners, referring to doing partial or omitting parts of patient care, delaying some types of care and doing things incorrectly (Jones et al, 2016). Chiappinotto and Palese (2022) study highlighted the complexity of nursing care that includes care units overflowing with high acuity patients, nurses with high workload demands, a lack material resources, systems which demand nursing time spent on documentation systems and management who have become accustomed to missed nursing care. Given these challenges it is not surprising that nurses are drawing on fast thinking in their day to day work.…”

Section: Dang Er S Of Nur S E S Thinking Fa S T With Older Patientsmentioning

confidence: 99%

Fast thinking: How unconscious bias and binary language contribute to rationing of care to older persons

Hunter

Dahlke

2023

Int J Older People Nursing

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Background Binary or categorical thinking is a way of thinking in which the brain unconsciously sorts the masses of information it receives into categories. This helps us to quickly process information and keeps us safe through pattern recognition of possible threats. However, it can also be influenced by unconscious and conscious biases that inform our judgements of other people and situations. Objectives To examine nursing practice with older people through the lens of unconscious bias. Methods In this critical analysis, using Kahneman's fast and slow thinking, we argue that nurses working with hospitalised older people often rely on thinking quickly in hectic work environments, which can contribute to unconscious and conscious bias, use of binary language to describe older persons and nursing tasks, and ultimately rationing of care. Results Binary language describes older persons and their care simplistically as nursing tasks. A person is either heavy or light, continent or incontinent, confused or orientated. Although these descriptions are informed in part by nurses' experiences, they also reflect conscious and unconscious biases that nurses hold towards older patients or nursing tasks. We draw on explanations of fast (intuitive) and slow (analytical) to explain how nurses gravitate to thinking fast as a survival mechanism in environments where they are not supported or encouraged to think slow. Conclusions Nurses survival efforts in getting through the shift using fast thinking, which can be influenced by unconscious and conscious biases, can lead to use of shortcuts and the rationing of care. We believe that it is of paramount importance that nurses be encouraged and supported to think slowly and analytically in their clinical practice. Implications for practice Implications Nurses can engage in journaling and reflecting on their practice with older people to examine possible unconscious bias. Managers can support reflective thinking by supporting nurses through staffing models and encouraging conversations about person‐centered care in unit practices.

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Unfinished nursing care reasons as perceived by nurses at different levels of nursing services: Findings of a qualitative study

Cited by 10 publications

References 32 publications

A Global Overview of Missed Nursing Care During the COVID-19 Pandemic: A Systematic Review

A Global Overview of Missed Nursing Care During the COVID-19 Pandemic: A Systematic Review

What are the reasons for unfinished nursing care as perceived by hospitalized patients? Findings from a qualitative study

Fast thinking: How unconscious bias and binary language contribute to rationing of care to older persons

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