Understanding the Decision-Making Experiences of Missed Nursing Care for Emergency Nurses: A Qualitative Study

Missed nursing care is prevalent in emergency departments and threatens patient safety and nursing quality. Understanding emergency nurses' decision-making processes is crucial for decreasing missed nursing care and improving nursing quality; however, studies addressing this topic remain limited. Therefore, this study aimed to explore emergency nurses' decision-making experiences regarding missed nursing care.

A descriptive qualitative study was employed. Participant recruitment was conducted from February to May 2023 in Northeastern China. Maximum variation sampling and purposive sampling were used to identify potential participants. Data were collected through participative observation of the complete work shifts of 9 emergency nurses, followed by face-to-face semistructured interviews with 20 emergency nurses. Thematic analysis was used to identify potential themes.

Four themes were generated to capture emergency nurses' decision-making experiences regarding missed nursing care: (1) the context for decision-making, (2) the driving factors for decision-making, (3) the emotional and moral impact of decision-making, and (4) adaptive responses to missed nursing care.

In emergency care settings with limited resources and systemic obstacles, nurses must make trade-offs and prioritize tasks, which can cause significant emotional and moral distress. In response, nurses adopt adaptive strategies during the decision-making process to reduce the occurrence of missed nursing care. Emergency nurses must meet immediate needs while also bearing long-term emotional costs, highlighting the necessity of supportive intervention measures.