Prevalence, patterns and predictors of nursing care left undone in European hospitals: results from the multicountry cross-sectional RN4CAST study

Abstract

Background Little is known of the extent to which nursing-care tasks are left undone as an international phenomenon. Aim The aim of this study is to describe the prevalence and patterns of nursing care left undone across European hospitals and explore its associations with nurse-related organisational factors. Methods Data were collected from 33 659 nurses in 488 hospitals across 12 European countries for a large multicountry cross-sectional study. Results Across European hospitals, the most frequent nursing care activities left undone included 'Comfort/talk with patients' (53%), 'Developing or updating nursing care plans/care pathways' (42%) and 'Educating patients and families' (41%). In hospitals with more favourable work environments (B=−2.19; p<0.0001), lower patient to nurse ratios (B=0.09; p<0.0001), and lower proportions of nurses carrying out nonnursing tasks frequently (B=2.18; p<0.0001), fewer nurses reported leaving nursing care undone. Conclusions Nursing care left undone was prevalent across all European countries and was associated with nurse-related organisational factors. We discovered similar patterns of nursing care left undone across a cross-section of European hospitals, suggesting that nurses develop informal task hierarchies to facilitate important patient-care decisions. Further research on the impact of nursing care left undone for patient outcomes and nurse well-being is required.

RN4Cast Study in Portugal: Nurses and care left undone

“…The literature reveals the terms "Missed care", "Missing care" and "Care left undone", [1,2] but despite this variety and as mentioned by Ausserhofer et al, [3] they all refer to nursing care activities that are partially or totally skipped.…”

“…Nurses build a list of priority activities that are always carried out and other activities that, because they regard them as less valuable, are more frequently discarded. [3] The activities left undone by nurses are listed by several authors: the two activities most frequently overlooked are "Psychosocial care" and "Paperwork related to care", [3] but this group also includes "Comfort patient" and "Educating patient". [2] On the other hand, activities related to "Physical care" and "Monitoring" are the ones that are less frequently left undone.…”

Missed Nursing Care in Hospitalized Patients

“…When these essential elements of care are not offered to the patient, it is known as missed nursing care or errors of omission (3,4). Previous studies show missed nursing care and errors of omission can be frequent at hospitals that attend to patients with acute health problems.…”

Primary Care Providers’ Perspectives on Errors of Omission

“…Even the 2016 review above specifically excluded errors of omission, which it defined as those incidents occurring when there was a lapse in the quality of care. 2 Other researchers have conceptualized these acts of omission as "care omission," "tasks left undone," "missed care" or "gaps in care" [11][12][13][14][15][16][17][18] , and many refer to them as errors of omission. 21,22 Errors of omission outnumber errors of commission 2 to 1 19 ; yet, they are not well investigated or categorized, precluding their informing quality improvement strategies or designing safety systems to prevent these errors before they harm patients.…”