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

Abstract

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.

The Reasons for Unfinished Nursing Care during the COVID-19 Pandemic: An Integrative Review

“…A total of 171 studies were identified and four were included [ 16 ] ( Figure 1 ). These were all primary studies ( Supplementary Material Table S4 )—three based on a qualitative design [ 20 , 21 , 22 ] and one based on a cross-sectional design with an open-ended final question [ 23 ]. The studies were conducted in Italy [ 20 , 21 ], Finland [ 22 ] and Iran [ 23 ] in acute hospital settings [ 20 , 21 , 22 ].…”

“…These were all primary studies ( Supplementary Material Table S4 )—three based on a qualitative design [ 20 , 21 , 22 ] and one based on a cross-sectional design with an open-ended final question [ 23 ]. The studies were conducted in Italy [ 20 , 21 ], Finland [ 22 ] and Iran [ 23 ] in acute hospital settings [ 20 , 21 , 22 ]. The perspectives investigated were those of both healthcare professionals [ 20 , 22 , 23 ] and patients [ 21 ] involving from 14 [ 22 ] to 29 [ 20 ] participants in the qualitative studies and 462 [ 23 ] in the quantitative one.…”

“…The studies were conducted in Italy [ 20 , 21 ], Finland [ 22 ] and Iran [ 23 ] in acute hospital settings [ 20 , 21 , 22 ]. The perspectives investigated were those of both healthcare professionals [ 20 , 22 , 23 ] and patients [ 21 ] involving from 14 [ 22 ] to 29 [ 20 ] participants in the qualitative studies and 462 [ 23 ] in the quantitative one. All studies were intended to explore the reasons for UNC as perceived during the pandemic, in the first months of 2021 [ 20 , 22 , 23 ] and between April and July 2022 [ 21 ], with well-designed and -conducted research methodologies.…”

“…At this level, available studies have identified the following reasons for UNC: New priorities of the health system. The healthcare system has undergone major reorganisation, related to the drastic changes due to the COVID-19 pandemic, which has further reduced resources by exacerbating the pre-existing issues of the system [ 20 , 22 ] and leading to cost restraints in some sectors to rendering available resources to others [ 21 ]. Pre-existing frailty of healthcare structures and processes.…”

Missed Nursing Care in Medical and Surgical Wards in Jordan: A Cross-Sectional Study

“…Furthermore, MNC may hurt nurses' job satisfaction (Al-Faouri et al, 2021). Thus, the healthcare literature has recently demonstrated a substantial and enduring interest in investigating the phenomenon of MNC (Chiappinotto et al, 2021).…”