Missed nursing care: a snapshot case study in a medical ward in Australia
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.
To investigate the nature of missed nursing care and influencing factors in a general medical ward in an acute care hospital in Brisbane, Australia.
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.
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.
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).
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