Experience of missed nursing care: A mixed method study

Area of Science:

• Nursing Science
• Healthcare Management
• Patient Safety

Background:

• Missed nursing care is a global issue impacting patient safety and care quality.
• The nurse's working environment is a significant factor in missed nursing care incidents.

Purpose of the Study:

• To investigate the relationship between environmental constraints and missed nursing care within the Indian healthcare system.
• To understand how factors in the work environment contribute to nurses not completing essential patient care tasks.

Main Methods:

• A convergent mixed-method design was employed, combining quantitative and qualitative data collection.
• Quantitative data were gathered from 205 nurses using Kalisch's MISSCARE survey in Indian tertiary care hospitals.
• Qualitative data were obtained through in-depth interviews with 12 nurses to explore their experiences with missed care.

Main Results:

• Nurses prioritize curative tasks over communication, discharge teaching, and emotional support, leading to missed care.
• Human resource constraints and communication issues explained 40.6% of the variance in missed nursing care.
• Inadequate staffing during high workloads and interruptions from medical staff were key reasons for missed care.

Conclusions:

• Nursing leaders must implement policies for flexible staffing aligned with situational workloads.
• Adopting staffing models sensitive to workload, such as Nursing Hours Per Patient Day (NHPPD), is recommended over fixed nurse-patient ratios.
• Enhancing teamwork and interprofessional cooperation can minimize task interruptions and reduce missed nursing care.