Priced to care: Factors underpinning missed care

Abstract

This article examines missed care through dialogues examining the perceptions of nurses in regard to missed care occasions. Using a critical discourse analysis (CDA), the study explores the truth claims of participants who describe the challenges they encounter in daily attempts to deliver what they consider effective patient care. These are compared to the mandates of state and organisational policy prescribing clinical practice. The boundaries of tension that are expressed by nurses within the milieu of missed care are explored through in-depth interviews. CDA is interested in social organisation and the interplay of people's activities within it, the focus being on how they construe and internalise such activity. Nurses' perceptions and realities become central to any investigation because they are often organised by more than their own intentions or motivations, with influences such as professional standards or organisational rules subconsciously locating their reality. Instead of identifying occasions of omitted care, nurses spoke of constraints related to budget, staffing, skill mix and mandated policy as constraining their ability to complete care activities. Factors emerged that suggest that missed care is the consequence of routinised and standardised practice, cited as cost effective care, at the expense of professional autonomy.

Resource allocation and rationing in nursing care: A discussion paper

“…23 Rationing results in nurses not being able to carry out their core work, that is the provision of effective and safe care appropriate to patient need, based on a skilled clinical (as distinct from a financial) assessment. 24,25…”

“…This has also been reflected in other studies, where nurses identified lack of time to carry out their work. 25,36 These findings suggest that we need to engage in discussion regarding allocation of the nursing resource (i.e. the number of nursing staff required at institutional and unit level, based on the dominant models of care delivery is use) and rationing in nursing.…”

The evaluation of nurse navigators in chronic and complex care

“…Influences on the lack of continuity of care include increased pressure on staffing related to reduced human resource allocations and skills mix, and generalized cost constraints (Bergh, Friberg, Persson, & Dahlborg-Lyckhage, 2015;Chadban et al, 2010;Phelan & McCarthy, 2016). Additionally, in the work intensified environment, integrating care has been hampered by inadequate communication between departments/providers, poor or ineffective handover between services, and poor or absent discharge planning and patient education (Finlayson, Sheridan, Cumming, & Fowler, 2012;Harvey et al, 2016;Henderson, Willis, Toffoli, Hamilton, & Blackman, 2016;Willis et al, 2015). Often care gets missed, or misunderstood, and there are unnecessary duplications between services (Finlayson et al, 2012).…”

Measuring the validity and reliability of the Lithuanian missed nursing care in infection prevention and control scales using Rasch analysis

“…The same or very similar issues (i.e. insufficient human and material resources or lack of support) in addition to factors relating to the work environment itself are now recognized as the main predictors of missed nursing care (Aiken, Sloane, Bruyneel, Heede, & Sermeus, 2013; Harvey et al, 2016; Schubert et al, 2013).…”