Interventions to prevent or reduce rationing or missed nursing care: A scoping review

Abstract

Aims: To collate and synthesize published research on interventions developed and tested to prevent or reduce the rates of rationed or missed nursing care in healthcare institutions. Background: Rationed and missed nursing care has been widely studied, including its predictors and associations with patient and nurse outcomes. Design: Scoping review. Data sources: We searched for eligible studies, published between 1980-2019, in six electronic databases. Review methods: Researchers independently screened the abstracts of the retrieved studies using the inclusion and exclusion criteria. The decision of whether or not to include any given study was consensus-based. Results: The search yielded 1,815 records, of which 13 were included. Three studies reported structural interventions, namely increased nurse staffing and improved nursing teamwork, both resulted in significant reductions in the rates of rationed or missed nursing care. The remaining 10 studies reported on process interventions: four concerned reminders (via technology or designated persons) and seven described interventions to change or optimize the relevant care processes. All 10 process interventions contributed to significant reductions in the rates of missed nursing care. Conclusions: The results of the scoping review indicate that specific interventions can positively influence the performance of a selected nursing care activity, for example fall prevention. There is no evidence of a global reduction of rationed and missed nursing care through these interventions. Impact: Clinicians, managers and researchers can use the results for adapting and implementing interventions to reduce rationed and missed nursing care. K E Y W O R D S decision-making, interventions, nurse staffing, nursing care, prevention, quality of care, rationed and missed nursing care, scoping review, teamwork | 551 SCHUBERT ET al.

Strategies to prevent missed nursing care: An international qualitative study based upon a positive deviance approach

“…After more than two decades of studies in this research field (Schubert et al, 2020), a few recommendations have been established to date (Patient Safety Network, 2019) and more research is needed regarding this issue (Schubert et al, 2020). Moreover, to date studies performed in the MNC field have moved from a specific context/country to the international scenario (Schubert et al, 2020): we have, instead, conducted an opposite approach by developing an international study merging a macro summary of strategies enacted on a daily basis. Furthermore, emphasis of studies has been devoted to shortages (e.g.…”

“…After more than two decades of studies in this research field (Schubert et al, 2020) is needed regarding this issue (Schubert et al, 2020). Moreover, to date studies performed in the MNC field have moved from a specific context/country to the international scenario (Schubert et al, 2020):…”

“…Facilitating an open discussion on PS issues and learning through experience, improving nursing teamwork (Papastavrou et al., 2014) and implementing electronic and verbal reminders for pressure ulcer prevention and tools aimed at preventing missed information regarding fall assessments have all been reported (Schubert et al, 2020) to prevent MNC (Smith et al., 2018). However, NMs are supported by only limited evidence‐based recommendations (Schubert et al, 2020; Patient Safety Network, 2019) in order to prevent MNC occurrence: to date, MNC has been widely studied regarding its underlying mechanisms, antecedents and consequences (e.g. Kalisch, 2006; Schubert et al., 2007), as well as in validating instruments capable of measuring the phenomenon (Schubert et al, 2020).…”

“…Although important, nursing shortages (Cho et al., 2020) have been documented as only partly contributing to MNC (Griffiths et al., 2018), while leadership and other aspects of the professional and nursing work environment have been reported as factors preventing MNC (Smith et al., 2018). Facilitating an open discussion on PS issues and learning through experience, improving nursing teamwork (Papastavrou et al., 2014) and implementing electronic and verbal reminders for pressure ulcer prevention and tools aimed at preventing missed information regarding fall assessments have all been reported (Schubert et al, 2020) to prevent MNC (Smith et al., 2018). However, NMs are supported by only limited evidence‐based recommendations (Schubert et al, 2020; Patient Safety Network, 2019) in order to prevent MNC occurrence: to date, MNC has been widely studied regarding its underlying mechanisms, antecedents and consequences (e.g.…”

“…However, NMs are supported by only limited evidence‐based recommendations (Schubert et al, 2020; Patient Safety Network, 2019) in order to prevent MNC occurrence: to date, MNC has been widely studied regarding its underlying mechanisms, antecedents and consequences (e.g. Kalisch, 2006; Schubert et al., 2007), as well as in validating instruments capable of measuring the phenomenon (Schubert et al, 2020). Despite the lack of evidence documented, different strategies to improve PS by reducing MNC are implemented daily by NMs according to the resources available, suggesting that a body of tacit, practical and wise knowledge (Mcadam et al., 2007) is already in place.…”