Search

Negli ultimi anni è emerso un crescente interesse per le missed nursing care anche nel contesto italiano grazie a diversi fattori tra i quali la partecipazione al progetto RANCARE insieme a 28 paesi Europei e non, l’opportunità di organizzare scambi internazionali, di condurre revisioni sistematiche e progetti di ricerca specifici nel campo. Per affrontare questioni metodologiche specifiche emerse via via nel nostro percorso di ricerca e diffusione dei risultati sulle missed nursing care nella pratica italiana, abbiamo organizzato una consensus conference dopo aver realizzato una revisione preliminare della letteratura sul concetto e sulle proprietà psicometriche delle scale disponibili per migliorare la conoscenza del concetto di missed nursing care, le sue implicazioni per la pratica, il management, la formazione e la ricerca. Alla fine della conferenza, durata due giorni, oltre 200 infermieri partecipanti hanno approvato una serie di raccomandazioni sulle missed nursing care e la pratica infermieristica italiana. Questo documento riporta i risultati preliminari del consenso raggiunto.

This study sought to identify factors that influenced the perceived complexity of providing nursing care to others (who were dependent on alcohol and tobacco) and the confidence of undergraduate student nurses to carry out this care. The research project was designed to explore whether there was a difference between the perceived complexities of 57 different nursing tasks and skills as understood by student nurses and their differing ages, gender and types of first language used. By using a probabilistic measurement approach (Rasch model), the study sought to assess whether a scale of performance for learning could be constructed based on the difficulty of nursing care required and the self-rated capacity of the undergraduate nursing students to provide the nursing care. Outcomes of the study suggest that nursing students do differ significantly both in how they view the complexity of providing nurse care and their capacity to provide that nursing care. Recommendations are made for informing nursing education programs, in a bid to make nursing care as it relates to others who are substance dependent, more effective. [Author abstract]

A hypothetical model was formulated to explore factors that influenced academic and clinical achievement for graduate-entry medical students completing their third year of university studies. Nine latent variables were considered including the students' background, previous successes with their undergraduate and postgraduate studies and their assessed ability to study graduate-entry medicine based on their scholastic aptitude and their interview selection scores. The academic and clinical achievement of 99 graduate-entry medical students were estimated by measuring their performance on two separate assessment procedures, a 150 item multiple choice examination and a 20 item objectively structured clinical evaluation (OSCE) test. These two assessments were taken across two years (to include two student groups) and were equated using Rasch scaling procedures. Models identifying causal pathways leading to academic and clinical achievement were tested using Partial Least Squares Path Analysis (PLSPAT). The study's results suggest that medical student achievement can be predicted by variables, which account for 6 to 22 percent of the variance of scores that assess academic achievement and clinical performance at the third year level respectively. The most significant predictors and those which had direct influence on graduate-entry medical student achievement were: (a) student gender, undergraduate grade point average scores, type of undergraduate studies undertaken, and where those studies were carried out that were related to the OSCE scores, and (b) whether or not the graduate-entry medical students had pursued other studies prior to undertaking the medical course and age that were both negatively related to achievement on the multiple choice examination. Measures of performance at interview and student scores for GAMSAT that were used in the selection process were not related to the performance outcomes assessed. [Author abstract]

A hypothetical model is developed to examine factors influencing nurses' achievement in a range of mental health nursing skills. The latent variables examined fall in four broad areas including the students': background (gender, predominant language used, age, prior education, previous nursing experience); previous successes with other undergraduate nursing topics (physical sciences, nursing and psychosocial sciences study areas); attitudes toward mental health nursing and mental illness causation; and relationship between learning environment and achievement (consists of such factors as the type of venues used for mental health nursing experience and teacher influence in topic delivery). Student achievement in mental health nursing skills is estimated by measuring student's self-rated level of confidence to undertake 20 nursing related tasks (undertaken before and after a unit of mental health studies was completed by students) and scores achieved using a 50 item multiple choice tests mental health nursing. The model examining student pathways to achievement is tested using Latent Variable Partial Least Square analysis (LVPLS). [Author abstract]

Aim To support the development of appropriate policies and actions in the field of missed nursing care (MNC). Background There has been an ever-growing international debate on MNC, interventions that nurses have identified as necessary for their patients, but which for various reasons they are unable to provide or are forced to delay. Despite MNC's relevance, its translation into policies and actions has not been documented to date. Method A consensus development method was employed involving (a) a nominal group composed of experts in the field, policymakers and the President of the Regional Nursing Professional Boards, and (b) 218 nurses appointed primarily at the managerial levels. Results A total of eight consensus statements were approved and organized in a series of sub-statements designed to (1) render the concept of MNC culturally acceptable in the Italian context, with the agreement that compromised nursing care (CNC) is the best term to be used in this field, as a synonym for MNC; (2) measure CNC as a strategy to increase patient safety; (3) select an appropriate CNC measurement tool; (4) optimize CNC measurement; (5) conduct effective CNC data analysis; (6) design and implement interventions to prevent and/or minimize CNC; (7) assess and disseminate findings on interventions' effectiveness; and (8) provide final remarks on the way to move forward. Conclusions We developed a process to introduce the phenomenon of MNC in the Italian culture and agreed firstly on the term compromised nursing care, which better reflects MNC's meaning according to the context and facilitates an open discussion on the phenomenon both within and outside the profession. The following consensus statements emerged represent a systematic approach, starting from the measurement and finishing with the re-measurement of the occurrence of MNC after having implemented concrete actions. Implications for nursing management The approved consensus statements can guide decision-makers to develop concrete policies and actions that promote the improvement of quality of care and patients' safety by minimizing and/or preventing MNC's occurrence.

Background Research on missed nursing care reveals individual and systems failure. Research on infection control missed care is minimal. Aims Investigate nurse perceptions of missed infection control. Design Qualitative in-depth interviews with 11 Australian infection control nurse experts. Methods Participants were asked whether nursing and hospital-wide care tasks fundamental to infection control were missed, and what were the underlying causes and contributing factors for these omissions. Qualitative data was mapped against fundamental nursing practice and Australian infection control guidelines. Findings Omission of infection control care occur at the individual clinician and organisational level. Nurses describe failure to perform standard precautions as well as failure to perform basic care activities. Participants identified a range of institutional and cultural factors which contributed to cascade iatrogenesis resulting in healthcare associated infections for patients. Some factors are outside nurses’ control and include: environmental cleanliness; ward layout; ward culture; resourcing and staffing; integration of infection control into clinical governance; action following audit results; and reviewing evidence base of protocols. Discussion Care occurs in complex and conflicted settings, with prioritisation essential. Potentially harmful practices are generally done with the intention of care. Nurses are key, but not sole performers in the creation of quality infection control. Conclusion Mapping missed care related to infection control against standard frameworks of nursing practice revealed “gaps in the chain of infection” that contribute to “cascade iatrogenesis” with negative outcomes for patients.

The Australian government has reduced restrictions on ownership of residential aged care facilities (RACF) as part of aged care reform enabling the growth of private-for-profit ownership. This study explores the impact of private-for-profit ownership through comparison of perceptions of the volume of missed care in government, private-not-profit and for-profit RACF in Australia. Data were collected through development and administration of a MISSCARE survey to3,206 nurses and personal care workers (PCW) working in RACF and hospitals providing aged care services. Employees working within government owned facilities reported levels of missed care that are significantly lower than privately owned facilities on six activities: moving patients who cannot walk; assisting residents’ toileting within 5 min of request; assisting resident mouth care; assessing skin integrity; answering call bells within 5 min and wound care. Staffing levels were identified as the most common reason for missed care across all settings. Of the 27 factors identified as causing missed care, government employees reported significantly lower scores for 16 items. Further research is needed on the impact of facility ownership upon capacity of nurses and personal care workers to deliver care. Refereed/Peer-reviewed

This article examines missed care through dialogues examining the perceptions of nurses in regard to missed care occasions. Using a critical discourse analysis (CDA), the study explores the truth claims of participants who describe the challenges they encounter in daily attempts to deliver what they consider effective patient care. These are compared to the mandates of state and organisational policy prescribing clinical practice. The boundaries of tension that are expressed by nurses within the milieu of missed care are explored through in-depth interviews. CDA is interested in social organisation and the interplay of people's activities within it, the focus being on how they construe and internalise such activity. Nurses' perceptions and realities become central to any investigation because they are often organised by more than their own intentions or motivations, with influences such as professional standards or organisational rules subconsciously locating their reality. Instead of identifying occasions of omitted care, nurses spoke of constraints related to budget, staffing, skill mix and mandated policy as constraining their ability to complete care activities. Factors emerged that suggest that missed care is the consequence of routinised and standardised practice, cited as cost effective care, at the expense of professional autonomy. Refereed/Peer-reviewed

Background: There is a growing nursing literature that views missed care as an inevitable consequence of work intensification associated with the rationing of nursing and material resources available to deliver care. Global studies recognize that missed care is now ubiquitous, although studies tend to be conducted in one region, rather than nationwide. This study seeks to understand the Australian context of missed care. Aims: To explore self-reported reasons for missed care and to identify the main factors for predicting missed care within a sample of Australian nurses and midwives working in public and private hospitals in New South Wales, Victoria, Tasmania, and South Australia. Methods: A nonexperimental, descriptive method using Kalisch's (2006) MISSCARE survey was used. Responses from 1,195 nursing and midwifery staff with differing qualifications, English language skills, and Australian employment settings were analyzed using Rasch analysis and then modeled using the Structural Equation Modeling. Results: The frequency of missed care on the morning shift directly impacted on higher priority care missed during the afternoon shift. Staff skill mix imbalances and perceived inadequacy of staff numbers for the work demands further exacerbated all aspects of care during afternoon shifts. Other major factors associated with missed care were the different clinical work settings and staff to patient ratios. Linking Evidence to Action: The incidences, types, and reasons behind missed care are a multidimensional construct which can be predicted when known significant factors behind missed care are simultaneously accounted for. Refereed/Peer-reviewed

Background and Purpose: Current measures of missed nursing care employ inventories of tasks which are rated for the frequency with which each is missed. These lists have shortcomings for research and clinical evaluation. There is a need for measures with less response burden, wider generalizability, and greater sensitivity and specificity for identifying poor quality care. Methods: We tested a single-item, global, measure using data from a large study of missed care in Australia. We employed traditional and innovative analysis techniques such as receiver operating characteristic curve and item response theory. Results: The single-item measure had adequate concurrent and convergent validity when compared to one list-format measure of missed care and strong sensitivity and specificity for identifying poor quality care. Conclusions: A well-crafted single-item measure, such as the one tested, can be useful for measuring missed nursing care. Refereed/Peer-reviewed

Aims and objectives This study explores the reasons nurses identify missed care and what factors account for this variance in nursing practice. Second, the study seeks to understand if the identified reasons behind missed care interact with one another and form a multidimensional construct. Background This study draws on the results of previous research conducted by Kalisch in developing the MISSCARE research survey tool and now applies it to an Australian context. Design This study engages a nonexperimental exploratory approach where 16 latent variables are identified and estimated using structural equation modelling to determine the capacity each of these factors has in predicting the reasons for reported missed nursing care. Methods Data were obtained from an electronic survey sent to nursing members of the Australian Nursing and Midwifery Federation of South Australia. A self-report, Likert-type instrument was used to capture the strength and direction of consensus derived from a sample of 289 nurses and midwives. Results/Findings Eight variables were identified as having direct predictor effects as to why nursing care was being missed, and included shift type, nursing resource allocation, health professional communication, workload intensity, workload predictability, the nurses' satisfaction with their current job and their intention to remain working. Additional indirect effects of other variables explained 34% of the variance of the total scores for why nursing care was reported as being missed. Conclusion Historically, the MISSCARE survey has identified and quantified what types of nursing care is missed. This paper takes this concept further by producing an interactional model identifying the effects different variables have on why nursing care is missed. Relevance to clinical practice These Australian findings not only contribute to other international studies that identify why nursing care is omitted, it provides a framework for why reported episodes of missed care can be predicted and subsequently addressed.

Australia, along with other countries, has introduced New Public Management (NPM) into public sector hospitals in an effort to contain healthcare costs. NPM is associated with outsourcing of service provision, the meeting of government performance indicators, workforce flexibility and rationing of resources. This study explores the impact of rationing of staffing and other resources upon delivery of care outside of business hours. Data was collected through semistructured interviews conducted with 21 nurses working in 2 large Australian metropolitan hospitals. Participants identified four strategies associated with NPM which add to workload after-hours and impacted on the capacity to deliver nursing care. These were functional flexibility, vertical substitution of staff, meeting externally established performance indicators and outsourcing. We conclude that cost containment alongside of the meeting of performance indicators has extended work traditionally performed during business hours beyond those hours when less staffing and material resources are available. This adds to nursing workload and potentially contributes to incomplete nursing care. Refereed/Peer-reviewed

This study was undertaken in response to findings by the Productivity Commission (2011b) that aged care sector organisations were experiencing difficulties in attracting and retaining a workforce due to lack of competitive wages, limited or poor educational opportunities, lack of opportunitiesfor career development, poor management of Residential Aged Care facilities, and excessive regulation of scope of practice (Productivity Commission 2011b: 347). The recommendations of the Productivity Commission were largely limited to addressing education and training opportunities. Strategies for dealing with workplace conditions and the retention of aged care workers identified in the report have not yet been systematically addressed. There is evidence that Residential Aged Care in Australia is facing issues arising from reduced staffing levels, fewer licensed nursing staff, and increased resident acuity (Allard 2014; Chenoweth et al., 2014; Gao et al., 2014; Henderson et al., 2016a; King et al., 2013). Recent budget decisions, along with the implementation of consumer directed care from 2017 onwards are likely to further reduce the funds available under the Aged Care Funding Instrument (ACFI)(Ansell, Cox & Cartwright 2016). This report addresses the issue of reduced staffing levels and skills mix in Residential Aged Care, identified by the Productivity Commission report (2011a) and reported by the National Institute of Labour Studies (King et al., 2013). This is the second stage of a two-part study that has collected evidence relating to the need for a staffing methodology that considers both staffing levels and skills mix for Residential Aged Care. Refereed/Peer-reviewed

There is a growing nursing literature that views missed nursing care as an inevitable consequence of work intensification associated with the rationing of the human and material resources required to deliver care. A modified MISSCARE survey was administered to 4431 nurses and midwives in New South Wales in November 2014. This paper reports on 947 responses to an open question contained in the survey which asked respondents 'Is there anything else you would like to tell us about missed care?' Responses were analysed using qualitative content analysis and focused upon both the causes and impact of missed care. Analysis identified two major causes of missed care: the impact of work intensification and staffing issues. Participants associated work intensification with patient acuity and cost containment, while the staffing issues identified included: undermining prescribed staffing ratios; skill mix; changing workloads across shifts; and poor support from other staff. Respondents identified insufficient resources, albeit staffing or other resources, to meet patient care needs reflecting findings in similar studies. Missed or delayed nursing care in this context is associated with resource issues leading nurses to ration the care they can provide. While work intensification is not a new phenomenon, its increasing use in the public hospital sector across a number of OECD countries has become a major consequence of new public management (NPM) strategies aimed at cost containment. Refereed/Peer-reviewed

In this study, we argue that contemporary nursing care has been overtaken by new public management strategies aimed at curtailing budgets in the public hospital sector in Australia. Drawing on qualitative interviews with 15 nurses from one public acute hospital with supporting documentary evidence, we demonstrate what happens to nursing work when management imposes rounding as a risk reduction strategy. In the case study outlined rounding was introduced across all wards in response to missed care, which in turn arose as a result of work intensification produced by efficiency, productivity, effectiveness and accountability demands. Rounding is a commercially sponsored practice consistent with new public management. Our study illustrates the impact that new public management strategies such as rounding have on how nurses work, both in terms of work intensity and in who controls their labour. Refereed/Peer-reviewed

Work intensification is assumed to incorporate either longer working hours or a quickening of the pace or speed of work. In this paper, we argue that ‘missed care’ is a proxy for work intensification or work effort in nursing. Using Kalisch’s MISSCARE survey tool, with modifications to suit the South Australian context we surveyed 354 registered and enrolled nurses between October and December 2012. Survey participants were recruited through the Australian Nursing and Midwifery Federation (SA Branch). The MISSCARE survey tool presents participants with a 5-point scale where 1 is never omitted care and 5 is always omitted care. Survey findings suggest that the tasks most often missed are ambulation of patients and mouth care. Tasks lest likely to be missed are blood glucose monitoring; hand washing; IV/central line care and providing PRN medication within 15 minutes. These findings suggest that when nurses are forced to ration care, priority is given to clinical tasks that will impact on immediate patient outcomes. In identifying the reasons why they missed care, nurses reported that while staffing often appeared adequate, sudden and unexpected rises in patient volume, heavy admissions and discharges, and inadequate numbers of staff or clerical support were key indicators of missed care. These unpredictable events resulted in an increase in work intensity and pace that was independent of extended working hours or overtime. We argue that one of the outcomes of work intensification is missed care. Refereed/Peer-reviewed

In May to July 2015, 1683 nurses, midwives and personal care workers (PCW) and Assistants in Nursing (AiN) employed in public and private health facilities in Victoria completed the MISSCARE survey. This represents around 3 percent of the total number of nurses and midwives employed in the state of Victoria. The survey was administered via Survey Monkey by a research team from Flinders University in collaboration with the Victorian branch of the Australian Nursing and Midwifery Federation (ANMF Vic Branch). The Victorian MISSCARE survey is a modification on the original design developed by Beatrice Kalisch (2006). It contains eleven demographic questions, 23 questions dealing with working conditions including questions on staffing tools, 21 questions concerning missed care (care that is omitted, postponed, or incomplete) and 20 questions addressing reasons why care is omitted in the settings in which the nurse/midwives practice. Data from this survey indicates that staffing is viewed as less likely to cause missed care by nurses working within the public sector in Victoria than it is in other states. Victoria is the only state in Australia to have mandated nurse-patient ratios. Despite, this, staffing is still viewed as problematic, particularly when unexpected events occur which leave insufficient time for basic nursing care. Respondents from Victoria also cited greater issues with teamwork and communication than nurses in other jurisdictions, with teamwork identified as a direct cause of missed care in Victoria. This contrasts with responses from nurses in New South Wales and South Australia who cite workload unpredictability and resource issues as contributing to missed care.

Introduction A one-level hypothetical model was formulated to explore factors that influenced the selfreported readiness of workplace managers to engage in workplace (vocational) rehabilitation of past-injured workers attending their workplaces. Methods Seven supervisor latent variables were considered, using 270 supervisors self-rated self-efficacy measures, estimating their ability to pursue four related roles associated with vocational rehabilitation in the workplace. Models identifying supervisor self-efficacy pathways leading to their readiness to engage in vocational rehabilitation in their workplaces were tested using Partial Least Square Analysis (PLSPATH). Results The study's outcomes suggest that supervisor readiness to engage in workplace vocational rehabilitation with rehabilitating employees can be directly associated with four variables. Together, these variables accounted for 41 per cent of the variance of the supervisors' self-efficacy scores, defining their readiness to engage in workplace vocational rehabilitation. Significant predictors which had a direct influence on supervisor readiness to engage in vocational rehabilitation were: their perceived financial and liaison roles associated with vocational rehabilitation and their concern with meeting legal aspects of this process. The capacity of the supervisor to interact with others within the workplace organisation when engaging in vocational rehabilitation was also seen as a significant determinant of their readiness to engage in rehabilitation activities. The gender of the supervisor or the number of employees for whom the supervisor was responsible for, were found to have no significant influence on their self-efficacy levels. Conclusions Statistically significant supervisory readiness to engage in vocational workplace rehabilitation is subject to their self-rated abilities to undertake multiple roles involved with the rehabilitation process and a more reflective approach is warranted to prepare supervisors for this role. Refereed/Peer-reviewed