Multi-level model of missed nursing care in the context of hospital merger.

The aim of this study was to delineate the multi-level relationships of individual registered nurse (RN) and nursing unit factors on missed nursing care. This was a quantitative model-building study using a descriptive, cross-sectional design. Surveys (N = 553) and administrative unit records from nurses in one hospital system undergoing merger were included. The results showed that 36% of the variation in missed nursing care is due to the unit context, with a corresponding 64% due to individual nurse differences. At the unit level, workload, skill mix, and critical unit type affected the amount of missed nursing care. At the individual nurse level, more experience, supplies problems, communication problems, and involvement in errors of commission all increased the perception of the amount of missed nursing care. Education level was not related to the amount of missed nursing care. The findings highlight the importance of unit- and individual-level interventions to redesign hospital nursing care.

Measuring nursing error: psychometrics of MISSCARE and practice and professional issues items.

BACKGROUND AND PURPOSE: Health care error causes inpatient morbidity and mortality. This study pooled the items from preexisting nursing error questionnaires and tested the psychometric properties of modified subscales from these item combinations. METHODS: Items from MISSCARE Part A, Part B, and the Practice and Professional Issues were collected from 556 registered nurses. Principal component analyses were completed for items measuring (a) nursing error and (b) antecedents to error. RESULTS: Acceptable factor loadings and internal consistency reliability (.70-.89) were found for subscales Acute Care Missed Nursing Care, Errors of Commission, Workload, Supplies Problems, and Communication Problems. CONCLUSIONS: The findings support the use of 5 subscales to measure nursing error and antecedents to error in various inpatient unit types with acceptable validity and reliability. The Activities of Daily Living (ADL) Omissions subscale is not appropriate for all inpatient unit types.

Closing the gap between research and clinical practice.

Evidence-based practice and the application of research findings to practice is a major focus of attention in health care today. The quantification of variations in service delivery and the economic implications of these variations contribute to the pressure on clinicians to provide evidence-based care whenever possible. Awareness of the development of evidence-based practice (EBP), the need for EBP, factors that affect EBP, the methods used to translate research into practice, EBP quality indicators, barriers to EBP, and benefits of EBP will assist clinicians in the effective use of evidence-based information in the care of their patients.

Reshaping clinical nursing education: an academic-service partnership.

This article describes the conceptualization and implementation of an academic-service partnership for a baccalaureate nursing program. The partnership began its fifth year in the fall of 2002; 107 students have entered the partnership since its inception. The partnership goals were to develop and implement clinical training experiences that teach students key skills for community-based practice settings, and to develop and evaluate an innovative and collaborative model for community-based clinical education. Students in the partnership have a unique opportunity for learning the art and science of nursing in a complex, integrated health care system with a strong emphasis on quality of environment, providers, and care delivery. A longitudinal program evaluation is underway, based on an American Association of Colleges of Nursing publication, the vision and goals of the School of Nursing, and the construct of organizational socialization.