School of Public Health and Social Work and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.
School of Medicine, Griffith University, Gold Coast, QLD, Australia.
Int J Health Plann Manage. 2019 Oct;34(4):e1820-e1832. doi: 10.1002/hpm.2898. Epub 2019 Aug 26.
Missed nursing care (MNC) is a significant health care issue that impacts on the quality of health care and patient safety. It refers to delayed or omitted aspects of nursing care (totally or partially). MNC is an under-researched area in the Australian health care context.
This research sought to further explore the MNC phenomenon in the context of an acute care hospital and to identify its common elements and the factors influencing its occurrence.
A convergent parallel mixed methods design was employed involving secondary analysis of routinely collected hospital data and a survey of 44 nursing staff using the MISSCARE survey instrument. The two sources of data were converged to address the objective.
The study found that the most common elements of missed nursing care include failure of patient ambulation, emotional support for patients and/or family, and the provision of full documentation. These elements are consistent with previous international studies conducted in acute care hospital settings. This study identified that local context impacting on MNC was also important and included interruptions to workflow, "perceived" lack of management support, poor handover, and communication breakdown between the nursing team and medical staff.
Consideration of the local health care context is foundational in understanding the MNC phenomenon. The findings of this research may help nursing managers mitigate the possible effects of MNC and therefore improve patient safety in their acute care environment. Additional multisite studies are required to further explore factors associated with MNC in both general and local contexts.
护理缺如（MNC）是一个重大的医疗保健问题，影响医疗保健质量和患者安全。它是指护理延迟或遗漏（全部或部分）。在澳大利亚的医疗保健背景下，MNC 是一个研究不足的领域。
本研究旨在进一步探讨急性护理医院的 MNC 现象，并确定其常见要素和影响其发生的因素。
采用汇聚平行混合方法设计，包括对常规收集的医院数据进行二次分析，以及使用 MISSCARE 调查工具对 44 名护理人员进行调查。这两种数据源汇聚在一起以达到研究目的。
该研究发现，护理缺如的最常见要素包括患者活动能力的丧失、对患者和/或家属的情感支持，以及提供完整的文件记录。这些要素与之前在急性护理医院环境中进行的国际研究一致。本研究还发现，影响 MNC 的当地医疗保健背景也很重要，包括工作流程中断、“感知”缺乏管理层支持、交接班不良以及护理团队与医务人员之间的沟通障碍。
考虑当地医疗保健背景对于理解 MNC 现象至关重要。本研究的结果可能有助于护理管理人员减轻 MNC 的可能影响，从而提高其急性护理环境中的患者安全性。需要进行更多的多地点研究，以进一步探讨一般和本地背景下与 MNC 相关的因素。
