The aim was to synthesize the findings of empirical research about the unmet nursing care needs of older people, mainly from their point of view, from all settings, focusing on (1) methodological approaches, (2) relevant concepts and terminology and (3) type, nature and ethical issues raised in the investigations. A scoping review after Arksey and O’Malley. Two electronic databases, MEDLINE/PubMed and CINAHL (from earliest to December 2019) were used. Systematic search protocol was developed using several terms for unmet care needs and missed care. Using a three-step retrieval process, peer-reviewed, empirical studies concerning the unmet care needs of older people in care settings, published in English were included. An inductive content analysis was used to analyse the results of the included studies (n = 53). The most frequently used investigation method was the questionnaire survey seeking the opinions of older people, informal caregivers or healthcare professionals. The unmet care needs identified using the World Health Organization classification were categorized as physical, psychosocial and spiritual, and mostly described individuals’ experiences, though some discussed unmet care needs at an organizational level. The ethical issues raised related to the clinical prioritization of tasks associated with failing to carry out nursing care activities needed. The unmet care needs highlighted in this review are related to poor patient outcomes. The needs of institutionalized older patients remain under-diagnosed and thus, untreated. Negative care outcomes generate a range of serious practical issues for older people in care institutions, which, in turn, raises ethical issues that need to be addressed. Unmet care needs may lead to marginalization, discrimination and inequality in care and service delivery. Further studies are required about patients’ expectations when they are admitted to hospital settings, or training of nurses in terms of understanding the complex needs of older persons.

The related phenomena of missed, rationed and unfinished care represent a critical global threat to patient safety and quality of nursing care. It has been established that in the provision of nursing care, unfinished care may lead to negative patient outcomes (Jones, Hamilton, & Murry, 2015) and a reduction in the quality of nursing care and patient safety (Griffiths et al., 2018). Nurses want to provide patient care that is both safe and of high quality and are required by professional standards to provide their patients with appropriate and courteous care while maintaining the quality and safety of that care (Vryonides, Papastavrou,

Unfinished nursing care (UNC) is a well-recognized global problem often discussed within health professionals concerning the patient safety and quality of care. The phenomenon is referred to other related and interchangeably concepts emerging from contemporary nursing research (such as missed nursing care and implicit rationing). A great deal of international research groups (e.g., RN4CAST; RANCARE; MISSCARE STUDY GROUP) investigating the prevalence, predictors and outcomes of this phenomenon has been increasing extensively in the last decade. The terminology used by research teams varies with instruments implemented in the studies, and this fact might have substantial contributions to the inconsistencies in the terminology and measurement.

Aims:To evaluate the psychometric properties of the Perceived Implicit Rationing of Nursing Care (PIRNCA) instrument and to report the prevalence of rationed care at university and faculty hospitals. Design:A cross-sectional study. Methods:The study was carried out at two university and five faculty hospitals in the Slovak Republic. Participants were 895 Registered Nurses recruited by the purposive sampling method between December 2017-July 2018. Data were collected using the PIRNCA instrument. Construct validity and reliability of the instrument were tested. Results:The prevalence of rationed care at university and faculty hospitals was identified as being 42.1%. Furthermore, 87.6% of nurses reported rationing one or more nursing care activities. Using both statistical methods when evaluating the PIRNCA resulted in the confirmation that the tool is valid and reliable. Conclusion:Rationed care is a common phenomenon at university and faculty hospitals.The PIRNCA is a suitable instrument to measure the phenomenon in adult acute care units because of its high reliability and validity. We recommend using the instrument in different contexts, not only for specific conditions that were presented for this study.

Aim: This literature review aims to describe, analyze and compare approaches to the phenomenon of missed/rationed/unfinished nursing care, in order to better our understanding of it. Design: A narrative literature review. Methods: A method of content analysis of studies published in the scientific databases PubMed, ScienceDirect, ProQuest, and Wiley Library Online was used. Studies were selected using a set of criteria and keywords for the period 2000-2018. Twentyone studies were analyzed in the processing of the literature review. Results: We identified the four most common approaches or conceptual frameworks used to describe the phenomenon from the available literature -Missed Care, Implicit Rationing of Nursing Care, Task Undone and the theoretical proposition, Failure to Maintain, each of which explicitly describes a particular aspect of the phenomenon, and provides us with a theoretical framework and structure. Conclusion: This review contributes to the overview of particular approaches or theoretical frameworks used to understand the phenomenon. It is necessary to understand the terminology, and to use it appropriately. All approaches identified associations between the phenomenon and negative outcomes for patients as a quality-of-care indicator.