Educating nurses on prioritization: insights from a mixed-methods study on unfinished nursing care

Area of Science:

• Nursing Science
• Healthcare Management
• Medical Education

Background:

• Unfinished Nursing Care (UNC) is influenced by various factors, but decision-making patterns remain stable, necessitating a deeper understanding of underlying criteria.
• Existing evidence highlights a need to refine nursing education to address persistent patterns in Unfinished Nursing Care.

Purpose of the Study:

• To investigate the criteria nurses use to prioritize care, leading to Unfinished Nursing Care.
• To explore the relationship between these prioritization criteria and the actual instances of Unfinished Nursing Care.

Main Methods:

• A sequential, explanatory, mixed-methods design combining a national survey of 1,977 nurses across 15 hospitals with qualitative descriptive focus groups.
• Quantitative data on Unfinished Nursing Care incidence was collected using the Unfinished Nursing Care Survey.
• Qualitative data from focus groups explained the quantitative findings, using the explaining joint technique.

Main Results:

• 1,400 nurses reported Unfinished Nursing Care incidence ranging from 1.92 to 2.48 on a 5-point scale.
• A key theme, "The rules of engagement," emerged, with sub-themes: "Addressing biomedical needs," "Physicians' expectations come first," "Signing for/audited activities," and "It depends; human dignity counts."
• Prioritization criteria directly correlated with the care elements most frequently left unfinished by nurses.

Conclusions:

• Nurses' prioritization decisions are guided by specific rules, balancing patient needs, physician expectations, organizational demands, and professional nursing values.
• Findings underscore the need for nursing educators to integrate these insights into curricula, emphasizing supportive clinical environments.
• Empowering students to prioritize within their scope of practice is recommended for effective clinical placements.