Missed Nursing Care in Patients With Dementia: A Qualitative Study.

BACKGROUND

Patients with dementia face challenges in participating in their care, making decisions, and expressing needs, increasing the risk of missed nursing care (MNC).

AIM

To explore the MNC experiences of nurses providing care to patients with dementia.

METHOD

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.

FINDINGS

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.

CONCLUSION

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.

IMPLICATIONS FOR NURSING POLICY

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.