Prevalence and reasons for the occurrence of missed nursing care in medical and surgical departments: A cross-sectional study
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Abstract
Background & Aim: Missed care is a serious problem in healthcare. This study aimed to measure the prevalence of missed nursing care and determine the reasons and risk factors for its occurrence in surgical and medical departments.
Methods & Materials: A cross-sectional design was used. All registered nurses who had worked for more than six months were included. The MISSEDCARE survey tool was used to determine missed nursing care (Part A) and the reasons for its occurrence (Part B). Logistic regression was used to determine risk factors for missed nursing care. The significance level was set at p<0.05.
Results: A total of 165 nurses were included. The response rate was 81.2%. The prevalence of missing nursing care ranged from 4.8% to 84.8%. Nurses with a high turnover intention had a great risk of the following missed nursing care: ‘medications administered within 30 min before or after the scheduled time’ [OR=11.60, CI 95%: 3.76-35.75; p<0.0001], ‘assess the effectiveness of medications’ [OR=3.79, CI 95%: 1.79-8.04; p<0.0001]. Urgent patient situations were the main reasons for missing patient-specific reassessment to verify improvement or deterioration during the shift [OR=6.82, CI 95%:1.84-25.26; p =0.008] and assess the effectiveness of medications.
Conclusions: This study showed a high prevalence of missed nursing care in surgical and medical departments. Urgent patient situations and unexpected increases in patient volume and acuity in the unit increased the reasons for missed nursing care. Nursing managers can promote the adoption of care models such as Primary nursing to reduce and manage missed nursing care.
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11. Huang TL, Wu CN, Lee IC, Wong AM, Shyu YI, Ho LH, Liao GY, Teng CI. How robots impact nurses' time pressure and turnover intention: A two‐wave study. Journal of Nursing Management. 2022 Nov;30(8):3863-73.
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14. Bragadóttir H, Kalisch BJ. Comparison of reports of missed nursing care: Registered Nurses vs. practical nurses in hospitals. Scandinavian Journal of Caring Sciences. 2018 Sep;32(3):1227-36.
15. Campagna S, Conti A, Clari M, Basso I, Sciannameo V, Di Giulio P, Dimonte V. Factors associated with missed nursing care in nursing homes: A multicentre cross-sectional study. International Journal of Health Policy and Management. 2022 Aug;11(8):1334.
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18. Cho E, Lee NJ, Kim EY, Kim S, Lee K, Park KO, et al. Nurse staffing level and overtime associated with patient safety, quality of care, and care left undone in hospitals: A cross-sectional study. International Journal of Nursing Studies. 2016 Aug;60:263–71.
19. Haftu M, Girmay A, Gebremeskel M, Aregawi G, Gebregziabher D, Robles C. Commonly missed nursing cares in the obstetrics and gynecologic wards of Tigray general hospitals; Northern Ethiopia. Watson B, editor. PLoS ONE. 2019 Dec 23;14(12):e0225814.
20. Gravante F, Giannarelli D, Pucci A, Pisani L, Latina R. Calibration of the PREdiction of DELIRium in ICu Patients (PRE-DELIRIC) Score in a Cohort of Critically Ill Patients: A Retrospective Cohort Study. Dimensions of Critical Care Nursing. 2023 Jul 1;42(4):187-95.
21. Kalisch BJ, Tschannen D, Lee KH. Do staffing levels predict missed nursing care?. International Journal for Quality in Health Care. 2011 Jun 1;23(3):302-8.
22. Wohlrab M, Klenk J, Delgado-Ortiz L, Chambers M, Rochester L, Zuchowski M, Schwab M, Becker C, Jaeger SU. The value of walking: a systematic review on mobility and healthcare costs. European Review of Aging and Physical Activity. 2022 Dec;19(1):31.
23. Li C, Cui X, Zhao Y, Xin Y, Pan W, Zhu Y. Missed nursing care as a mediator in the relationship between career calling and turnover intention. International Nursing Review. 2024 Mar;71(1):62-8.
24. Xu G, Zeng X, Wu X. Global prevalence of turnover intention among intensive care nurses: A Meta‐Analysis. Nursing in Critical Care. 2023 Mar;28(2):159-66.
25. Sasso L, Bagnasco A, Zanini M, Catania G, Aleo G, Santullo A, et al. The general results of the RN4CAST survey in Italy. Journal of Advanced Nursing. 2017 Sep;73(9):2028–30.
26. Gravante F, Lombardi A, Cecere L, Russo G, De Rosa F, Gagliardi AM, et al. [Emergency nurses and workplace violence: a cross-sectional study in Campania, South Italy]. Prof Inferm. 2020;73(2):89–97.
27. Gravante F, Toscano G, Cecere L, Lombardi A, Gili A, Ramacciati N. Quality of life, Stress, and Burnout of Italian nurses during the outbreak of COVID-19: A cross-sectional study. Prof Inferm. 2023 Apr 1;75(1):28–38.
28. Cho SH, Kim YS, Yeon KN, You SJ, Lee ID. Effects of increasing nurse staffing on missed nursing care. International Nursing Review. 2015 Jun;62(2):267-74.
29. Najafi Ghezeljeh T, Gharasoflo S, Haghani S. The relationship between missed nursing care and teamwork in emergency nurses: A predictive correlational study. Nursing Practice Today. 2020;8(2):103-112.
30. Piscotty RJ, Kalisch B, Gracey-Thomas A, Yarandi H. Electronic Nursing Care Reminders: Implications for Nursing Leaders. JONA: The Journal of Nursing Administration. 2015 May;45(5):239–42.
2. Bragadóttir H, Kalisch BJ, Tryggvadóttir GB. Correlates and predictors of missed nursing care in hospitals. Journal of Clinical Nursing. 2017 Jun;26(11–12):1524–34.
3. Zárate-Grajales RA, Benítez-Chavira LA, Serván-Mori E, Hernández-Corral S, Cadena-Estrada JC, Nigenda G. Sociodemographic and work environment correlates of missed nursing care at highly specialized hospitals in Mexico: A cross-sectional study. International Journal of Nursing Studies. 2022 Feb;126:104140.
4. He M, Zhu X, Dong Y, Zhang S, Fang S, Wang W, et al. Exploring the role of communication in missed nursing care: A systematic review. Journal of Advanced Nursing. 2022 Dec;78(12):4019–33.
5. Palese A, Ambrosi E, Prosperi L, Guarnier A, Barelli P, Zambiasi P, Allegrini E, Bazoli L, Casson P, Marin M, Padovan M. Missed nursing care and predicting factors in the Italian medical care setting. Internal and Emergency Medicine. 2015 Sep;10:693-702.
6. Sist L, Contini C, Bandini A, Bandini S, Massa L, Zanin R, Maricchio R, Gianesini G, Bassi E, Tartaglini D, Palese A. MISSCARE Survey-Italian Version: Findings from an Italian validation study. Igiene e sanita pubblica. 2017 Jan 1;73(1):29-45.
7. Lake ET, Germack HD, Viscardi MK. Missed nursing care is linked to patient satisfaction: a cross-sectional study of US hospitals. BMJ Quality & Safety. 2016 Jul 1;25(7):535-43.
8. Zeleníková R, Gurková E, Friganovic A, Uchmanowicz I, Jarošová D, Žiaková K, Plevová I, Papastavrou E. Unfinished nursing care in four central European countries. Journal of Nursing Management. 2020 Nov;28(8):1888-900.
9. Andersson I, Eklund AJ, Nilsson J, Bååth C. Prevalence, type, and reasons for missed nursing care in municipality health care in Sweden–A cross sectional study. BMC Nursing. 2022 Apr 24;21(1):95.
10. Campagna S, Basso I, Vercelli E, Ranfone M, Dal Molin A, Dimonte V, Di Giulio P. Missed nursing care in a sample of high-dependency Italian nursing home residents: description of nursing care in action. Journal of Patient Safety. 2021 Dec 1;17(8):e1840-5.
11. Huang TL, Wu CN, Lee IC, Wong AM, Shyu YI, Ho LH, Liao GY, Teng CI. How robots impact nurses' time pressure and turnover intention: A two‐wave study. Journal of Nursing Management. 2022 Nov;30(8):3863-73.
12. Stemmer R, Bassi E, Ezra S, Harvey C, Jojo N, Meyer G, Özsaban A, Paterson C, Shifaza F, Turner MB, Bail K. A systematic review: Unfinished nursing care and the impact on the nurse outcomes of job satisfaction, burnout, intention‐to‐leave and turnover. Journal of Advanced Nursing. 2022 Aug;78(8):2290-303.
13. Kalisch BJ, Williams RA. Development and psychometric testing of a tool to measure missed nursing care. JONA: The Journal of Nursing Administration. 2009 May 1;39(5):211-9.
14. Bragadóttir H, Kalisch BJ. Comparison of reports of missed nursing care: Registered Nurses vs. practical nurses in hospitals. Scandinavian Journal of Caring Sciences. 2018 Sep;32(3):1227-36.
15. Campagna S, Conti A, Clari M, Basso I, Sciannameo V, Di Giulio P, Dimonte V. Factors associated with missed nursing care in nursing homes: A multicentre cross-sectional study. International Journal of Health Policy and Management. 2022 Aug;11(8):1334.
16. Daniel WW. Biostatistics: a foundation for analysis in the health sciences. 7th ed. New York: Wiley; 1999. 755 p. (Wiley series in probability and statistics. Applied probability and statistics section).
17. Al‐Faouri I, Obaidat DM, AbuAlRub RF. Missed nursing care, staffing levels, job satisfaction, and intent to leave among Jordanian nurses. Nursing Forum. 2021 Apr;56(2):273–83.
18. Cho E, Lee NJ, Kim EY, Kim S, Lee K, Park KO, et al. Nurse staffing level and overtime associated with patient safety, quality of care, and care left undone in hospitals: A cross-sectional study. International Journal of Nursing Studies. 2016 Aug;60:263–71.
19. Haftu M, Girmay A, Gebremeskel M, Aregawi G, Gebregziabher D, Robles C. Commonly missed nursing cares in the obstetrics and gynecologic wards of Tigray general hospitals; Northern Ethiopia. Watson B, editor. PLoS ONE. 2019 Dec 23;14(12):e0225814.
20. Gravante F, Giannarelli D, Pucci A, Pisani L, Latina R. Calibration of the PREdiction of DELIRium in ICu Patients (PRE-DELIRIC) Score in a Cohort of Critically Ill Patients: A Retrospective Cohort Study. Dimensions of Critical Care Nursing. 2023 Jul 1;42(4):187-95.
21. Kalisch BJ, Tschannen D, Lee KH. Do staffing levels predict missed nursing care?. International Journal for Quality in Health Care. 2011 Jun 1;23(3):302-8.
22. Wohlrab M, Klenk J, Delgado-Ortiz L, Chambers M, Rochester L, Zuchowski M, Schwab M, Becker C, Jaeger SU. The value of walking: a systematic review on mobility and healthcare costs. European Review of Aging and Physical Activity. 2022 Dec;19(1):31.
23. Li C, Cui X, Zhao Y, Xin Y, Pan W, Zhu Y. Missed nursing care as a mediator in the relationship between career calling and turnover intention. International Nursing Review. 2024 Mar;71(1):62-8.
24. Xu G, Zeng X, Wu X. Global prevalence of turnover intention among intensive care nurses: A Meta‐Analysis. Nursing in Critical Care. 2023 Mar;28(2):159-66.
25. Sasso L, Bagnasco A, Zanini M, Catania G, Aleo G, Santullo A, et al. The general results of the RN4CAST survey in Italy. Journal of Advanced Nursing. 2017 Sep;73(9):2028–30.
26. Gravante F, Lombardi A, Cecere L, Russo G, De Rosa F, Gagliardi AM, et al. [Emergency nurses and workplace violence: a cross-sectional study in Campania, South Italy]. Prof Inferm. 2020;73(2):89–97.
27. Gravante F, Toscano G, Cecere L, Lombardi A, Gili A, Ramacciati N. Quality of life, Stress, and Burnout of Italian nurses during the outbreak of COVID-19: A cross-sectional study. Prof Inferm. 2023 Apr 1;75(1):28–38.
28. Cho SH, Kim YS, Yeon KN, You SJ, Lee ID. Effects of increasing nurse staffing on missed nursing care. International Nursing Review. 2015 Jun;62(2):267-74.
29. Najafi Ghezeljeh T, Gharasoflo S, Haghani S. The relationship between missed nursing care and teamwork in emergency nurses: A predictive correlational study. Nursing Practice Today. 2020;8(2):103-112.
30. Piscotty RJ, Kalisch B, Gracey-Thomas A, Yarandi H. Electronic Nursing Care Reminders: Implications for Nursing Leaders. JONA: The Journal of Nursing Administration. 2015 May;45(5):239–42.
| Issue | Articles in Press | |
| Section | Original Article(s) | |
| Keywords | ||
| nurses; missed nursing care; management; patient safety; quality of care | ||
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How to Cite
1.
Gravante F, Longobucco Y, Leone C, Lombardi A, Bambi S. Prevalence and reasons for the occurrence of missed nursing care in medical and surgical departments: A cross-sectional study. NPT. 2025;:X-X.
