Occurrence of hospital-acquired infections in relation to missed nursing care: a literature review

Abstract

Aim: To find an association between missed nursing care and hospital-acquired infections or other adverse events. Design: A literature review. Methods: The literature review included full texts of articles published in English in 2009-2018 and obtained by searching the following bibliographic databases: PubMed, Bibliographia Medica Čechoslovaca and ProQuest Central. Twenty-six articles were assessed for eligibility, of which nine articles meeting all the criteria were analyzed in detail. Results: The analyzed studies have confirmed that missed nursing care is associated with hospital-acquired infections, with bloodstream infections, urinary tract infections and pneumonia being most frequent. Apart from hospital-acquired infections and missed nursing care, other adverse events were reported such as pressure ulcers, patient falls and medication error; moreover, patient dissatisfaction rose. Lower levels of missed nursing care were associated with a lower incidence of hospital-acquired infections and other adverse events. Conclusion: Tackling the issue of missed nursing care would contribute to a lower incidence of hospital-acquired infections that harm patient health, prolong hospital stays and considerably increase healthcare costs.

Missed nursing care: An overview of reviews

“…Authors came from a wide variety of countries with four from Europe, 7,26–28 two from North America, 23,29 and one from South East Asia 30 . Three reviews only searched two English language databases, 23,27,28 and only two reviews included the Cochrane Library in their search 7,29 . The number of papers included in these reviews ranged widely from 9 to 57 (median 21; interquartile range 40).…”

“…The number of papers included in these reviews ranged widely from 9 to 57 (median 21; interquartile range 40). Four reviews used recognized quality appraisal tools 7,27,28,30 and three did not report assessing the quality of the studies included in the review 23,26,29 . Some reviews included a synthesis of conceptual and/or measurement issues as part of their results, 23,26,29,30 suggesting that while their reviews were systematic, they were also broad.…”

“…For example, Jones et al 23 explicitly labeled their review a state of the science review and Vincelette et al 29 have used the systematic review process to identify conceptual and methodological challenges when studying missed nursing care. An additional three author groups titled their reviews literature reviews 26–28 but were included in this overview because they used the systematic review process in their approach. The overwhelming majority of studies reviewed in all of these reviews were cross‐sectional and descriptive in nature, relying on self‐reports.…”

“…Thus, what we understand about kinds and frequency of missed care is directly related to approach used to collect data. According to Bagnasco et al 9 themes, the following categories of care were missed: (a) communication and information sharing 27 ; (b) self‐management, autonomy and education including care planning, discharge planning and decision making 7,23,27,29,30 ; (c) fundamental physical care 7,27,29,30 ; and (d) emotional and psychological care including spiritual support 7,23,30 . One review identified other groups of care that was missed including: symptom management, patient surveillance, medication administration and nurse initiated independent interventions 29 …”

“…Factors that were found to be associated with missed care were related to staffing levels and/or labor resources, 7,23,30 skill mix, 7 material resources not being available, 23 patient acuity 23,30 and teamwork/communication 23,26,30 . Outcomes of missed nursing care included less/poorer overall quality of patient care, 23,30 poorer patient satisfaction, 23,28,30 and poorer nurses' job satisfaction, 23,30 increased patient adverse events, 23,27,30 and increased hospital length of stay 23 and increased hospital readmission 23 …”