References

Australian Institute of Health and Welfare. Australia's hospitals 2014–15 at a glance. 2016. https://tinyurl.com/bdrfpxmz (accessed 21 June 2022)

Asta S, Özcan E, Curtois T. A tensor based hyper-heuristic for nurse rostering. Knowledge-Based Systems. 2016; 98:185-199 https://doi.org/10.1016/j.knosys.2016.01.031

Ball JE, Murrells T, Rafferty AM, Morrow E, Griffiths P. ‘Care left undone’ during nursing shifts: associations with workload and perceived quality of care. BMJ Qual Saf. 2014; 23:(2)116-125 https://doi.org/10.1136/bmjqs-2012-001767

Blackman I, Lye CY, Darmawan IGN Modeling missed care: implications for evidence--based practice. Worldviews Evid Based Nurs. 2018a; 15:(3)178-188 https://doi.org/10.1111/wvn.12285

Blackman I, Papastavrou E, Palese A, Vryonides S, Henderson J, Willis E. Predicting variations to missed nursing care: A three-nation comparison. J Nurs Manag. 2018b; 26:(1)33-41 https://doi.org/10.1111/jonm.12514

Blay N, Duffield CM, Gallagher R. Patient transfers in Australia: implications for nursing workload and patient outcomes. J Nurs Manag. 2012; 20:(3)302-310 https://doi.org/10.1111/j.1365-2834.2011.01279.x

Promoting patient safety through minimising missed nursing care. A recommended good practice guidance for nurse managers. 2020. https://tinyurl.com/bdhfrmpu (accessed 21 June 2022)

Denzin NK, Lincoln YS. The Sage handbook of qualitative research.Thousand Oaks (CA): Sage; 2011

Duffield C, Diers D, O'Brien-Pallas L Nursing staffing, nursing workload, the work environment and patient outcomes. Appl Nurs Res. 2011; 24:(4)244-255 https://doi.org/10.1016/j.apnr.2009.12.004

Duffield C, Roche M, Merrick ET. Methods of measuring nursing workload in Australia. Collegian. 2006; 13:(1)16-22 https://doi.org/10.1016/S1322-7696(08)60512-0

Field A. Discovering statistics using IBM SPSS statistics.London: Sage Publications; 2013

The Mid Staffordshire NHS Foundation Trust public inquiry. Final report. 2013. https://tinyurl.com/p2ebw82 (accessed 21 June 2022)

Friesen MA, Hughes RG, Zorn M. Communication: patient safety and the nursing work environment. Nebr Nurse. 2007; 40:(4)11-12

Ghezeljeh TN, 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

Goulding L, Adamson J, Watt I, Wright J. Patient safety in patients who occupy beds on clinically inappropriate wards: a qualitative interview study with NHS staff. BMJ Qual Saf. 2012; 21:(3)218-224 https://doi.org/10.1136/bmjqs-2011-000280

Goulding L, Adamson J, Watt I, Wright J. Lost in hospital: a qualitative interview study that explores the perceptions of NHS inpatients who spent time on clinically inappropriate hospital wards. Health Expect. 2015; 18:(5)982-994 https://doi.org/10.1111/hex.12071

Healthcare Commission Investigation into Mid Staffordshire NHS Foundation Trust. 2009. https://tinyurl.com/saya6xxv (accessed 21 June 2022)

Higgs M, Fernandez R, Polis S, Manning V. Similarities and Differences in Nurse-Reported Care Rationing Between Critical Care, Surgical, and Medical Specialties. J Patient Saf. 2020; 16:(3)e162-e168 https://doi.org/10.1097/PTS.0000000000000295

Independent Hospital Pricing Authority. Australian refined diagnosis related groups. 2019. https://tinyurl.com/2p8kcj9n (accessed 21 June 2022)

Jenson H, Maddux S, Waldo M. Improving oral care in hospitalized non-ventilated patients: standardizing products and protocol. Medsurg Nursing. 2018; 27:38-46

Jones TL, Hamilton P, Murry N. Unfinished nursing care, missed care, and implicitly rationed care: state of the science review. Int J Nurs Stud. 2015; 52:(6)1121-1137 https://doi.org/10.1016/j.ijnurstu.2015.02.012

Kalisch BJ, Williams RA. Development and psychometric testing of a tool to measure missed nursing care. J Nurs Adm. 2009; 39:(5)211-219 https://doi.org/10.1097/NNA.0b013e3181a23c

Kalisch B, Tschannen D, Lee H. Does missed nursing care predict job satisfaction?. J Healthc Manag. 2011a; 56:(2)117-134 https://doi.org/10.1097/00115514-201103000-00007

Kalisch BJ, Tschannen D, Lee KH. Do staffing levels predict missed nursing care?. Int J Qual Health Care. 2011b; 23:(3)302-308 https://doi.org/10.1093/intqhc/mzr009

Kalisch BJ, Friese CR, Choi SH, Rochman M. Hospital nurse staffing: choice of measure matters. Med Care. 2011c; 49:(8)775-779 https://doi.org/10.1097/MLR.0b013e318222a6df

Kalisch BJ, Xie B, Dabney BW. Patient-reported missed nursing care correlated with adverse events. Am J Med Qual. 2014; 29:(5)415-422 https://doi.org/10.1177/1062860613501715

Kauppi W, Proos M, Olausson S. Ward nurses' experiences of the discharge process between intensive care unit and general ward. Nurs Crit Care. 2018; 23:(3)127-133 https://doi.org/10.1111/nicc.12336

Keegan AD. Hospital bed occupancy: more than queuing for a bed. Med J Aust. 2010; 193:(5)291-293 https://doi.org/10.5694/j.1326-5377.2010.tb03910.x

Kol E, Arıkan F, Ilaslan E, Akıncı MA, Koçak MC. A quality indicator for the evaluation of nursing care: determination of patient satisfaction and related factors at a university hospital in the Mediterranean Region in Turkey. Collegian. 2018; 25:(1)51-56 https://doi.org/10.1016/j.colegn.2017.03.006

Kulshrestha A, Singh J. Inter-hospital and intra-hospital patient transfer: recent concepts. Indian J Anaesth. 2016; 60:(7)451-457 https://doi.org/10.4103/0019-5049.186012

Kyburz-Graber R. Does case-study methodology lack rigour? The need for quality criteria for sound case-study research, as illustrated by a recent case in secondary and higher education. Environmental Education Research. 2004; 10:(1)53-65 https://doi.org/10.1080/1350462032000173706

Lake ET, Germack HD, Viscardi MK. Missed nursing care is linked to patient satisfaction: a cross-sectional study of US hospitals. BMJ Qual Saf. 2016; 25:(7)535-543 https://doi.org/10.1136/bmjqs-2015-003961

Lees L. Patient transfers. Principles for the safe transfer and handover of patients from acute medical units.London: Society for Acute Medicine; 2013

Lima JC, Silva AEBC, Caliri MHL. Omission of nursing care in hospitalization units. Rev Lat Am Enfermagem. 2020; 28 https://doi.org/10.1590/1518-8345.3138.3233

Lopez-Dicastillo O, Zabaleta-del-Olmo E, Mujika A, Antoñanzas-Baztán E, Hernantes N, Pumar-Méndez MJ. ‘Missed nursing care’ in health promotion: raising awareness. J Nurs Manag. 2020; 28:(8)1997-2000 https://doi.org/10.1111/jonm.13016

Mantovan F, Muzzana C, Schubert M, Ausserhofer D. ‘It's about how we do it, not if we do it’. Nurses' experiences with implicit rationing of nursing care in acute care hospitals: a descriptive qualitative study. Int J Nurs Stud. 2020; 109 https://doi.org/:10.1016/j.ijnurstu.2020.103688

McAlister FA, Shojania KG. Inpatient bedspacing: could a common response to hospital crowding cause increased patient mortality?. BMJ Qual Saf. 2018; 27:(1)1-3 https://doi.org/10.1136/bmjqs-2017-007524

Min A, Scott LD. Evaluating nursing hours per patient day as a nurse staffing measure. J Nurs Manag. 2016; 24:(4)439-448 https://doi.org/10.1111/jonm.12347

Najafi F, Nikbakht Nasrabadi A, Mardanian Dehkordi L. Exploring the Lived Experience of Missed Nursing Care in Postgraduate Nursing Students in Iran. Int J Community Based Nurs Midwifery. 2021; 9:(1)44-54 https://doi.org/10.30476/ijcbnm.2020.85865.1344

Palese A, Longhini J, Danielis M. To what extent Unfinished Nursing Care tools coincide with the discrete elements of the Fundamentals of Care Framework? A comparative analysis based on a systematic review. J Clin Nurs. 2021; 30:(1-2)239-265 https://doi.org/10.1111/jocn.15543

Reeves S, Ross F, Harris R. Fostering a ‘common culture’? Responses to the Francis Inquiry demonstrate the need for an interprofessional response. Journal of Interprofessional Care. 2014; 28:(5)387-398

Why public hospitals are overcrowded: Ten points for policymakers. 2009. https://tinyurl.com/3jw8jeke (accessed 21 June 2022)

Santamaria JD, Tobin AE, Anstey MH, Smith RJ, Reid DA. Do outlier inpatients experience more emergency calls in hospital? An observational cohort study. Med J Aust. 2014; 200:(1)45-48 https://doi.org/10.5694/mja12.11680

Schreuders LW, Geelhoed E, Bremner A, Finn J, Twigg D. Feasibility of using payroll data to estimate hospital nurse staffing. Collegian. 2017; 24:(4)345-350 https://doi.org/10.1016/j.colegn.2016.07.004

Scott IA. Public hospital bed crisis: too few or too misused?. Aust Health Rev. 2010; 34:(3)317-324 https://doi.org/10.1071/AH09821

Occupancy data: unravelling the mystery. 2011. https://tinyurl.com/j729v4fu (accessed 21 June 2022)

Stylianou N, Fackrell R, Vasilakis C. Are medical outliers associated with worse patient outcomes? A retrospective study within a regional NHS hospital using routine data. BMJ Open. 2017; 7:(5) https://doi.org/10.1136/bmjopen-2016-015676

Thomas G. A typology for the case study in social science following a review of definition, discourse, and structure. Qualitative Inquiry. 2011; 17:(6)511-521 https://doi.org/10.1177/1077800411409884

Tubbs-Cooley HL, Mara CA, Carle AC, Mark BA, Pickler RH. Association of nurse workload with missed nursing care in the Neonatal Intensive Care Unit. JAMA Pediatr. 2019; 173:(1)44-51 https://doi.org/10.1001/jamapediatrics.2018.3619

Twigg D, Duffield C. A review of workload measures: A context for a new staffing methodology in Western Australia. Int J Nurs Stud. 2009; 46:(1)132-140 https://doi.org/10.1016/j.ijnurstu.2008.08.005

Twigg DE, Gelder L, Myers H. The impact of understaffed shifts on nurse-sensitive outcomes. J Adv Nurs. 2015; 71:(7)1564-1572 https://doi.org/10.1111/jan.12616

Vetrano DL, Landi F, De Buyser SL Predictors of length of hospital stay among older adults admitted to acute care wards: a multicentre observational study. Eur J Intern Med. 2014; 25:(1)56-62 https://doi.org/10.1016/j.ejim.2013.08.709

West E, Barron DN, Reeves R. Overcoming the barriers to patient-centred care: time, tools and training. J Clin Nurs. 2005; 14:(4)435-443 https://doi.org/10.1111/j.1365-2702.2004.01091.x

World Health Organization. Nursing and midwifery. Key facts. 2022. https://tinyurl.com/mr2djc7v (accessed 21 June 2022)

Yin RK. Case study research and applications. Design and methods.Thousand Oaks (CA): Sage Publications; 2003

Missed nursing care: a snapshot case study in a medical ward in Australia

07 July 2022
17 min read
Volume 31 · Issue 13

Abstract

Background:

Missed nursing care is a global issue in acute healthcare settings. It is a complex phenomenon that refers to nursing care that is required by patients but left undone or significantly delayed.

Aim:

To investigate the nature of missed nursing care and influencing factors in a general medical ward in an acute care hospital in Brisbane, Australia.

Method:

This is a descriptive case study. The study was carried out in a 29-bed inpatient general medical/cardiology/telemetry ward in an acute care tertiary hospital.

Results:

The study ward has been identified as a high complexity unit. The survey data found that the most frequent nursing care elements missed, as reported by the patients, were oral care, response to machine beep, and response to call light. The most frequent nurse-reported missed care items were ambulation, monitoring fluid intake/output and attendance at interdisciplinary conferences.

Conclusion:

Despite mandating nurse-to-patient ratios in the study ward, inadequate staffing was still perceived as being problematic and one of the most frequent reasons leading to missed nursing care. This possible disconnect between mandated staffing ratios and the persistence of perceived missed care suggests a more complex relationship than can be managed by macro (large-scale) resourcing formulas alone.

Missed nursing care, also termed omission of nursing care (Lima et al, 2020), unfinished nursing care (Palese et al, 2021), or even rationing of nursing care (Mantovan et al, 2020), is a global healthcare issue (Jones et al, 2015; Najafi et al, 2021). It is characterised by leaving at least one task undone by nurses in a shift (Jones et al, 2015). It is a complex often hidden problem that leads to disruption of nursing duties (Lopez-Dicastillo et al, 2020) and diminished quality of nursing care (Ghezeljeh et al, 2021). Missed nursing care has been presented as a common and frequent issue due to systemic factors (Lake et al, 2016). It care is generally thought to result from an excessive nurse workload and is an evolving measure of nursing processes that may partially elucidate the impact of workload on outcomes (Tubbs-Cooley et al, 2019). Nurses frequently relate leaving care unfinished to lower nurse-to-patient ratios (Ball et al, 2014). Omitted care also has significance for nurses such as dissatisfaction with their jobs and absenteeism (Kalisch et al, 2011a).

Register now to continue reading

Thank you for visiting British Journal of Nursing and reading some of our peer-reviewed resources for nurses. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to clinical or professional articles

  • Unlimited access to the latest news, blogs and video content