Missed nursing care and predicting factors in the Italian medical care setting

Abstract

Missed nursing care (MNC), such as nursing care omitted or delayed, has not been measured in the Italian context where several cost containment interventions affect the care offered in medical units. The aim of the study is to identify the amount, type, and reasons for MNC in the Italian medical care setting and to explore the factors that affect the occurrence of MNC. A 3-month longitudinal survey was carried out followed by a cross-sectional study design in 12 north eastern acute medical units. A total of 314 nursing staff members were involved. Multivariate logistic regression was performed to identify the predictors of MNC. Patient ambulation (91.4 %), turning the patient every 2 h (74.2 %), and right timing in administering medications (64.6 %) were the most perceived MNC. Among the most frequent reasons were the unexpected rise in patient volume or critical conditions (95.2 %), inadequate numbers of staff (94.9 %), and large numbers of admissions/discharges (93.3 %). The R (2) 33.2 % of the variance in MNC were explained by a full-time position (OR 4.743, 95 % CI 1.146-19.629), communication tensions between Registered Nurses and Nurses' Aides (OR 1.601, 95 % CI 1.020-2.515), the amount of experience in medical unit (OR 1.564, 95 % CI 1.021-2.397), and the amount of daily care offered by Nurses' Aides (1.039, 95 % CI 1.011-1.067). A substantial amount of basic and clinically relevant nursing interventions was perceived to be missed, and this may lead to an increase in negative outcomes for patients admitted to a medical unit. Appropriate standards of nursing care should be adopted urgently in medical units aiming to protect frail patients.

The association between nurse staffing and omissions in nursing care: A systematic review

“…The most frequently missed aspect of care reported on the MISSCARE survey was patient ambulation (ranked 1/24). This was reported as always, frequently or occasionally missed by between 76% of nurses in the USA (Kalisch, Tschannen, Lee, Friese, ) and 91% of nurses in Italy (Palese, et al., ). Other commonly missed elements of care included assessment of newly admitted patients (2/32) and set up of care plans (3/34) [BERNCA], mouth care (2/24) and attending interdisciplinary care conferences (3/24) [MISSCARE] and documenting nursing care (3/13) [RN4CAST].…”

“…Staffing levels were reported as patient:nurse ratio (12 studies), nursing hours per patient day (NHPPD or RNHPPD) (three studies) or number of patients cared for in last shift (three studies). Four studies explored aspects of skill mix (Ball et al., ; Ball et al., ; Dabney & Kalisch, ; Palese et al., ). Seven studies used data derived from the RN4Cast study, with four single country analyses from England (Ball, et al., ), Germany (Zander et al., ), Sweden (Ball, et al., ) and Switzerland (Schubert et al., ) plus three multi‐country analyses (Ausserhofer et al., ; Bruyneel, et al., ; Griffiths, Dall'Ora, et al, 2014).…”

“…In all studies missed care was assessed by a survey completed by nurses or, for two studies, patients (Dabney & Kalisch, ; Weiss, Yakusheva, & Bobay, ). Eight studies (Cho, Kim, Yeon, You, & Lee, ; Dabney & Kalisch, ; Friese, Kalisch, & Lee, ; Kalisch, Tschannen, & Lee, ; Kalisch, Tschannen, Lee, & Friese, ; Kalisch et al., ; Orique et al., ; Palese et al., ) reported using a version of the MISSCARE survey (Kalisch & Williams, ); seven studies (Al‐Kandari & Thomas, ; Ausserhofer, et al., ; Ball, et al., ; Ball, et al., ; Bruyneel, et al., ; Griffiths, Dall'Ora, et al., ; Zander et al., ) used a survey developed for the Registered Nurse Forecasting (RN4Cast) study (Sermeus et al., ). One used the Basel Extent of Rationing Nursing Care Assessment (BERNCA) revised (Schubert et al., ), a version of the International Hospital Outcomes Survey (IHOS) (Al‐Kandari & Thomas, ) and one the Quality of Discharge Teaching Scale (QTDS) content delivered sub‐scale (Weiss et al., ).…”

Post-hoc validation of the Conley Scale in predicting the risk of falling with older in-hospital medical patients: findings from a multicentre longitudinal study

“…It involved 12 acute medical units in northeast Italy, selected on a voluntary basis from a panel of units belonging to the research network ESAMED (outcomes sensible to nursing care in medical units) [24,25]. The Ethical Committee of the Coordinator Centre [Azienda Ospedaliero-Universitaria, Verona (Italy)] approved the research protocol.…”

Nursing student plans for the future after graduation: a multicentre study

“…; Palese et al. ), the findings reflect plans based upon current policies; the potential impact of the ‘Brexit’ strategy on international nursing recruitment in the UK, which is unknown but widely debated, may change migration paths among new graduates. Future research based on follow‐up study designs, capable of monitoring actual plans after graduation and compare them with intentions, may fill this gap.…”