Bayram Aysun, Özsaban Aysel
Fundamentals of Nursing Department, Faculty of Health Sciences, Karadeniz Technical University, Trabzon, Türkiye.
Int Nurs Rev. 2025 Sep;72(3):e70082. doi: 10.1111/inr.70082.
Patients with dementia face challenges in participating in their care, making decisions, and expressing needs, increasing the risk of missed nursing care (MNC).
To explore the MNC experiences of nurses providing care to patients with dementia.
This phenomenological study involved 13 clinic nurses with at least one year of experience in neurology clinics and care for patients with dementia. Data were collected through semi-structured interviews in May-June 2024. Data were analyzed using reflexive thematic analysis with an inductive approach. The ethical committee approval and institutional permission were obtained to conduct this study. The Consolidated Criteria for Reporting Qualitative Research was followed in reporting this study.
Study findings were classified into five subthemes under the two main themes: (1) structuring the care process: (i) establishing authentic relationships with patients with dementia and caregivers and (ii) preparation of caregivers as "wild card"; and (2) MNC process: (i) key contributors of MNC, (ii) occurrence of MNC, and (iii) suggestions for prevention of MNC. The nurses identified that they constructed a trust-based relationship between themselves and patients with dementia and their caregivers by providing increased attention, demonstrating patience, and allocating sufficient time for care. Most participants reported facing numerous challenges that led to MNC in the care of patients with dementia, such as feelings of inadequacy, communication gaps, lack of cooperation between caregivers and nurses, and lack of teamwork. Moreover, all nurses reported experiencing MNC in the care of patients with dementia, including leaving the care to caregivers or physicians, ignoring the autonomy of patients with dementia, delaying care, and not maintaining authentic communication.
The challenges nurses encounter in caring for patients with dementia have led them to MNCs.Nurses strive to build trust-based relationships with both patients and caregivers, yet systemic barriers, such as insufficient teamwork, communication challenges, and feelings of professional inadequacy-often compromise care delivery. These findings underscore the urgent need to address the structural and interpersonal dynamics that perpetuate MNC in dementia care settings.
To reduce the risk of MNC and improve the quality of care for patients with dementia, nursing policies must prioritise both the empowerment of nurses and systemic institutional reforms. This includes enhancing dementia-specific training, fostering collaborative team-based approaches, ensuring adequate staffing and support, and promoting policies that uphold the autonomy and personhood of individuals with dementia. By addressing these areas, healthcare systems can create more resilient care environments that support nurses and safeguard vulnerable patient populations.
痴呆症患者在参与自身护理、做决策和表达需求方面面临挑战，这增加了护理缺失（MNC）的风险。
探讨为痴呆症患者提供护理的护士的护理缺失经历。
这项现象学研究纳入了13名在神经科诊所至少有一年工作经验且护理痴呆症患者的临床护士。2024年5月至6月通过半结构化访谈收集数据。采用归纳法的反思性主题分析法对数据进行分析。获得了伦理委员会批准和机构许可来开展本研究。本研究遵循《定性研究报告的统一标准》进行报告。
研究结果分为两个主要主题下的五个子主题：（1）构建护理流程：（i）与痴呆症患者及其照护者建立真实的关系，以及（ii）将照护者培养为“百搭牌”；（2）护理缺失过程：（i）护理缺失的关键促成因素，（ii）护理缺失的发生情况，以及（iii）预防护理缺失的建议。护士们发现，他们通过增加关注、展现耐心和分配充足的护理时间，在自己与痴呆症患者及其照护者之间构建了基于信任的关系。大多数参与者报告称，在护理痴呆症患者时面临诸多导致护理缺失的挑战，比如感到能力不足、沟通障碍、照护者与护士之间缺乏合作以及缺乏团队协作。此外，所有护士都报告在护理痴呆症患者时经历过护理缺失，包括将护理工作留给照护者或医生、忽视痴呆症患者的自主权、延迟护理以及未能保持真实的沟通。
护士在护理痴呆症患者时遇到的挑战导致了护理缺失。护士努力与患者和照护者建立基于信任的关系，但诸如团队协作不足、沟通挑战以及职业能力不足感等系统性障碍往往会影响护理服务的提供。这些发现凸显了迫切需要解决在痴呆症护理环境中持续存在护理缺失的结构和人际动态问题。
为降低护理缺失风险并提高痴呆症患者的护理质量，护理政策必须优先考虑增强护士的能力以及进行系统性的机构改革。这包括加强痴呆症专项培训、培养基于团队的协作方法、确保充足的人员配备和支持，以及推行维护痴呆症患者自主权和人格尊严的政策。通过解决这些方面的问题，医疗系统可以营造更具韧性的护理环境，以支持护士并保护脆弱的患者群体。
