A scoping review of the methodological approaches used in retrospective chart reviews to validate adverse event rates in administrative data.

Patient safety is a key quality issue for health systems. Healthcare acquired adverse events (AEs) compromise safety and quality; therefore, their reporting and monitoring is a patient safety priority. Although administrative datasets are potentially efficient tools for monitoring rates of AEs, concerns remain over the accuracy of their data. Chart review validation studies are required to explore the potential of administrative data to inform research and health policy. This review aims to present an overview of the methodological approaches and strategies used to validate rates of AEs in administrative data through chart review. This review was conducted in line with the Joanna Briggs Institute methodological framework for scoping reviews. Through database searches, 1054 sources were identified, imported into Covidence, and screened against the inclusion criteria. Articles that validated rates of AEs in administrative data through chart review were included. Data were extracted, exported to Microsoft Excel, arranged into a charting table, and presented in a tabular and descriptive format. Fifty-six studies were included. Most sources reported on surgical AEs; however, other medical specialties were also explored. Chart reviews were used in all studies; however, few agreed on terminology for the study design. Various methodological approaches and sampling strategies were used. Some studies used the Global Trigger Tool, a two-stage chart review method, whilst others used alternative single-, two-stage, or unclear approaches. The sources used samples of flagged charts (n = 24), flagged and random charts (n = 11), and random charts (n = 21). Most studies reported poor or moderate accuracy of AE rates. Some studies reported good accuracy of AE recording which highlights the potential of using administrative data for research purposes. This review highlights the potential for administrative data to provide information on AE rates and improve patient safety and healthcare quality. Nonetheless, further work is warranted to ensure that administrative data are accurate. The variation of methodological approaches taken, and sampling techniques used demonstrate a lack of consensus on best practice; therefore, further clarity and consensus are necessary to develop a more systematic approach to chart reviewing.

Nursing students' perceptions of unfinished nursing care: A cross-sectional study.

AIM: To investigate the prevalence, patterns and reasons for unfinished nursing care as perceived by nursing students. BACKGROUND: Unfinished nursing care (UNC) is a frequently observed phenomenon in the acute care setting. To date, studies have focused primarily on the perspective of nurses or patients, but another important perspective is that of nursing students who provide nursing care in all healthcare settings. DESIGN: A descriptive cross-sectional study. METHODS: The study included 738 undergraduate nursing students from nine Slovak universities. Data were collected between September 2022 and February 2023 using the Slovak version of the Unfinished Nursing Care Survey tool (UNCS). Data were analyzed using descriptive and inferential statistics. RESULTS: The mean composite score of UNCS was 2.48 (SD=0.68). In general, 100% of nursing students reported that nurses missed at least one or more nursing care activities during their last clinical placement. The average number of missed nursing care activities was 11.2 per nurse as perceived by nursing students during their last clinical placement. Nursing students reported that the most frequently omitted nursing care activity was spending time with patients and their caregivers (3.15 ± 1.11; 92.9%). The most frequently reported reason for UNC was an inadequate number of nurses on the ward (4.31 ± 1.01; 98.1%). In the study, reported UNC could be predicted by previous experience in healthcare, previous clinical rotation, number of patients per shift, perceived staff adequacy and outcome expectations (p <0.05). CONCLUSIONS: The findings reveal that UNC is a widespread phenomenon and all nursing students report this phenomenon during their clinical placements. Spending time with patients and their caregivers emerged as the most frequently omitted nursing care activity, highlighting the importance of patient-centered care. The primary reason cited for UNC was an inadequate number of nurses, highlighting staffing issues as a significant contributing factor. These findings emphasize the need for targeted interventions to address staff shortages and improve nursing education to prepare students to address UNC in their future practice.

Examining the Perspectives of Nurse Managers on Missed Nursing Care in Surgical Units.

OBJECTIVE: To examine nurse managers' perspectives on missed nursing care (MNC) on surgical units. BACKGROUND: The phenomenon of MNC is an important concern for nurse researchers. However, the reality of how it is experienced by clinical nurse managers is largely unexplored. Understanding nurse managers' experiences with MNC could help develop useful approaches to reducing levels of MNC. METHODS: A descriptive qualitative study was conducted between December and June 2020, using face-to-face semistructured interviews with 10 nurse managers. RESULTS: Five themes were identified: 1) awareness of MNC; 2) rationale for MNC; 3) consequences of MNC; 4) questions of reporting; and 5) management of MNC. CONCLUSIONS: Nurse managers must use their positions and leadership skills to expect appropriate staffing approaches and material resources for surgical units, effective process for newly hired nurses, and the establishment of a reporting system for MNC to reduce the phenomenon in practice.

Undergraduate nursing students' experiences of rationed nursing care - A qualitative study.

BACKGROUND: Nursing students are required to spend a significant portion of their educational preparation in clinical practice. Because of the prevalence of missed or rationed care, it seems irrefutable that students are exposed to rationed care during their practice placement, or that they contribute to its prevalence either actively or passively. OBJECTIVES: The study aimed to discover how nursing students interpret the concept of rationed care, and their experiences of rationing in practice. DESIGN: A descriptive qualitative study. PARTICIPANTS: Eighteen final year nursing students from three universities within the Slovak Republic. METHODS: Semistructured face-to-face interviews were conducted (n = 18). Data were analyzed using thematic analysis which resulted in the development of themes and subthemes. RESULTS: We identified three meaningful themes focused on the phenomenon of rationed care from the perspective of nursing students, namely Incomplete care is normalized; Provision of impersonal patient care; and the Existence of a hidden curriculum for practice placements. CONCLUSIONS: Student nurses were quite demanding about the learning experience during their clinical training. They are often frustrated by inconsistencies between their theoretical preparation and the realities of practice. They recognise difficulties for registered nurses in providing safe, high quality care in constrained circumstances, and although they are critical of this, they acknowledge their own acceptance of the situation. Based on this, students must establish an understanding of the theory behind, and reasons for rationed care before commencing clinical placement. A greater understanding would enable students to develop strategies for coping with inconsistencies and voicing concerns.

The factors contributing to missed care and non-compliance in infection prevention and control practices of nurses: A scoping review.

Background: There is growing concern about missed nursing care and its negative impacts on patient care and nursing and organisational outcomes. Research in the area continues to grow, with a greater focus on reliable measurement, evidence-based interventions and sensitive outcomes. The relationship between missed care and adverse patient outcomes is undeniable, including increased mortality levels, and hospital acquired infections. The link between hospital acquired infections and non-compliance with infection prevention and control guidelines is also widely acknowledged. The idea of non-compliance as an element of missed nursing care has not been closely examined and this relationship is explored in this review. Objectives: The aim of this study is to identify the shared factors related to both nurse non-compliance with infection prevention and control practices and the recognised research field of missed nursing care, here in relation to infection prevention and control. Methods: A scoping review methodology was selected to help explore and map the research evidence on non-compliance with infection prevention and control practices, and missed nursing care in relation to infection prevention and control. Results: Five key themes were identified which impact on both missed nursing care and non-compliance in the area of infection prevention and control. These included (1) Organisation of Nursing Staff and Resources; (2) Workplace Environment; (3) Nursing Care Context; (4) Managerial and Inter-Professional Relationships; and (5) Individual Nurse Factors. These shared themes underline the relationship between the concepts and suggest a shared research area. Conclusion: Missed nursing care in the area of infection prevention and control, overlaps significantly with the research area of infection prevention and control non-compliance. This suggests that rather than being approached as separate or distinct entities, these research areas should be acknowledged as related or overlapping, enabling more focused attention to reducing levels of both.Tweetable abstractMissed nursing care in the area of infection control, overlaps significantly with the research area of non-compliance with infection prevention and control guidelines.Contribution of the PaperWhat is already known about the topic?• Missed nursing care has been linked over many years with increased rates of Healthcare Associated Infection rates.• Healthcare Associated Infections can result in higher rates of morbidity and mortality, but they are largely preventable.• Infection prevention and control guidelines are designed to protect both patients and healthcare workers from infection in healthcare settings, but non-compliance with these guidelines is an on-going concern.What this paper adds?• Factors influencing missed nursing care in general, and specifically missed infection prevention and control care, are similar to factors influencing non-compliance rates with infection prevention and control guidelines.• The concepts of missed nursing care in infection prevention and control, and non-compliance with infection prevention and control guidelines are essentially the same thing and should be treated as such by nurses, researchers, and healthcare organisations. This would enable a more focused and strategic response to infection prevention and control practices, ultimately helping to reduce preventable healthcare associated infections.

Contextualising missed care in two healthcare inquiries using a socio-ecological systems approach.

AIMS AND OBJECTIVES: To examine missed care within two patient safety public inquiries using a socio-ecological model. BACKGROUND: Missed care is a care which has been omitted or rendered incomplete. Possible outcomes of missed care have been identified including poor patient outcomes such as higher mortality rates, reduced care quality and lower patient satisfaction, job dissatisfaction, staff burnout and higher attrition rates. DESIGN: A qualitative design, specifically document analysis, was used to review two serious case reviews. METHODS: Between August-December 2018, two public patient safety inquiries were examined using a document analysis method. Both inquiries are based in acute hospital care settings of nursing (UK) and midwifery (Ireland). The Standards for Reporting Qualitative Research checklist provided a framework to report the study methods, context, findings, analysis and interpretation. RESULTS: Findings highlighted instances of missed care related to practice which contributed to poor patient outcomes. Missed care was located within contingency factors, such as unintended negative patient health and safety outcomes in multiple system levels which resulted in care deficits. CONCLUSIONS: A socio-ecological model enabled consideration of how multi-system deficits combine to impact nursing and midwifery care delivery. To tackle current and future practice challenges, broader contextual issues that influence front-line cases should be identified and addressed before they create conditions which result in substandard care. RELEVANCE TO CLINICAL PRACTICE: This paper adds to the scholarship on missed care by incorporating a greater contextual lens. Findings suggest that some factors contributing to missed care events may be systemic in origin. Practice, policy, research and education should foster nurses' and midwives' review of the totality of influencing factors impacting missed care and care deficits. Consequently, early warning signs and proactive responses at a system level should be inherent in all settings that nurses' and midwives' practice.

A SCOPING REVIEW: The role of the nurse manager as represented in the missed care literature.

AIM: To examine how the nurse manager role is represented in the literature on missed nursing care and what is known about the impact of the nurse manager on missed care levels. BACKGROUND: The literature to date on missed nursing care is focused primarily on structural and organizational antecedents, and on outcomes for patients, nurses and organizations. Very little research exists on the role of the nurse manager in relation to missed care. EVALUATION: A scoping review using studies from four databases was conducted in 2019. KEY ISSUES: Nurse managers have a role to play in relation to missed nursing care. Greater transparency around missed care, effective leadership skills and supportive relationships with staff can help reduce missed care. CONCLUSION: Nurse managers are ideally placed to influence levels of missed care. How they enact their leadership and management roles can help reduce incidents. By paying attention to nurses' concerns, managers may be better placed to understand levels of missed care. IMPLICATIONS FOR NURSE MANAGERS: Guidance for nurse managers on monitoring levels of missed care, and the skills required to influence levels within their units are necessary.

Missed, rationed or unfinished nursing care: A scoping review of patient outcomes.

AIMS: To collate evidence about patient outcomes resulting from the phenomenon of incomplete nursing care described in the literature variously as missed, rationed, or unfinished nursing care. BACKGROUND: Nursing care which is not completed is known to have a negative impact on patients. However, to date, there has been no thorough exploration of the extent and potential seriousness of patient outcomes. METHODS: The search was performed in four scientific databases; 44 studies were included in the final content analysis. RESULTS: Missed, rationed and unfinished care negatively influence the patient outcomes in the context of patient safety and quality of nursing care. Despite the differences among concepts, the negative association with patient outcomes was significant and common for all concepts. CONCLUSION: Awareness of potential harm of the phenomena to patient outcomes may help the management to develop preventive strategies to reduce or eliminate its actual occurrence. IMPLICATIONS FOR NURSING MANAGEMENT: Hospital management should consider the phenomenon as an indicator of the quality of nursing care as well as establish the routine monitoring of the phenomena in the assessment of patient safety in healthcare facilities.

Regulation and current status of patient safety content in pre-registration nurse education in 27 countries: Findings from the Rationing - Missed nursing care (RANCARE) COST Action project.

Patient safety, as a contemporary health care concern, must remain a priority for nurse educators. This on-line consultation, carried out within the RANCARE COST Action project, determined to establish how patient safety teaching is incorporated into pre-registration education of nurses across 27 countries. How nursing is regulated within countries was examined, along with national guidelines related to nurse education. HEIs were asked to provide details of pre-registration nurse training and how patient safety is taught within programmes. The results confirm that the topic of patient safety is generally not explicitly taught, rather it remains a hidden element within the curriculum, taught across many subjects. Variation in how nursing is regulated exists across the countries also, with the professionalization of nursing remaining a challenge in some states. No guidelines exist at EU level which address how patient safety should be taught to nursing students, and as yet regulatory bodies have not put forward criteria on the subject. As a result individual HEIs determine how patient safety should be taught. The WHO guidelines for teaching patient safety are currently underutilized in nurse education, but could offer a structure and standard which would address the deficits identified in this work.

Validation of Polish version of the Basel Extent of Rationing of Nursing Care revised questionnaire.

Development of simple, valid and reliable instruments to determine nursing care rationing is a subject of ongoing research. One such instrument, which is gaining popularity worldwide and has significant research applicability, is the Basel Extent of Rationing of Nursing Care (BERNCA) and its revised version, the BERNCA-R. The aim of this study was to translate and adapt the BERNCA-R into a Polish-language version and to assess its reliability and validity in evaluating the level of implicit rationing of nursing care in Poland. Standard methodological requirements were followed during translation and cultural adaptation of the English version of the BERNCA-R questionnaire into Polish. The cross-sectional validation study was conducted between May and September 2017, which included 175 nurses undergoing specialisation and qualification courses at the European Postgraduate Education Centre in Wroclaw, Poland. Cronbach's alpha and inter-item correlations were used to analyse the internal consistency of the Polish BERNCA-R questionnaire. The mean total BERNCA-R score was 1.9 points (SD = 0.74) on a scale of 0-4. Cronbach's alpha for the unidimensional scale was 0.96. The mean inter-item correlation was 0.4 (range 0.1-0.84), which indicates high internal consistency. A single-factor solution demonstrated stable loadings above 0.5 for almost all items of the Polish BERNCA-R questionnaire. The study using the Polish BERNCA-R questionnaire demonstrated that the instrument is valid and reliable for use in investigating care rationing in groups of Polish nurses.

Planning and Selecting Evaluation Designs for Leadership Training: A Toolkit for Nurse Managers and Educators.

Leadership development training and education for nurses is a priority in modern health care systems. Consequently, effective evaluation of nurse leadership development programs is essential for managers and educators in health care organizations to determine the impact of such programs on staff behaviors and patient outcomes. Our team has identified a framework for the evaluation of the design and implementation of such programs. Following this, we provide practical tools for the selection of evaluation methodologies for leadership development programs for use by health care educators and program commissioners.

What is nursing in the 21st century and what does the 21st century health system require of nursing?

It is frequently claimed that nursing is vital to the safe, humane provision of health care and health service to our populations. It is also recognized however, that nursing is a costly health care resource that must be used effectively and efficiently. There is a growing recognition, from within the nursing profession, health care policy makers and society, of the need to analyse the contribution of nursing to health care and its costs. This becomes increasingly pertinent and urgent in a situation, such as that existing in Ireland, where the current financial crisis has lead to public sector employment moratoria, staff cuts and staffing deficits, combined with increased patient expectation, escalating health care costs, and a health care system restructuring and reform agenda. Such factors, increasingly common internationally, make the identification and effective use of the nursing contribution to health care an issue of international importance. This paper seeks to explore the nature of nursing and the function of the nurse within a 21st century health care system, with a focus on the Irish context. However, this analysis fits into and is relevant to the international context and discussion regarding the nursing workforce. This paper uses recent empirical studies exploring the domains of activity and focus of nursing, together with nurses perceptions of their role and work environment, in order to connect those findings with core conceptual questions about the nature and function of nursing.

The impact of the work environment of nurses on patient safety outcomes: a multi-level modelling approach.

BACKGROUND: Patient safety is a priority for health services in all countries. The importance of the nurse's role in patient safety has been established. Effective nurse staffing levels, nurse education levels, and a positive work environment for nurses are factors which are known to impact on patient safety outcomes. OBJECTIVES: This study sought to explore the relationship between the ward environment in which nurses practice and specific patient safety outcomes, using ward level variables as well as nurse level variables. The outcomes were nurse-reported patient safety levels in the wards in which they work, and numbers of formal adverse events reports submitted by nurses in the last year. DESIGN: This cross-sectional quantitative study was carried out within a European FP7 project: Nurse Forecasting: Human Resources Planning in Nursing (RN4CAST) project. SETTINGS: 108 general medical and surgical wards in 30 hospitals throughout Ireland. PARTICIPANTS: All nurses in direct patient care in the study wards were invited to participate. Data from 1397 of these nurses were used in this analysis. METHODS: A nurse survey was carried out using a questionnaire incorporating the Practice Environment Scale of the Nursing Work Index (PES-NWI). Ethical approval was obtained from the authors' institution and all ethics committees representing the 30 study hospitals. Multilevel modelling was carried out to examine the impact of ward level factors on patient safety. These included proportions of nurses on the ward educated to degree level, and aggregated ward-level mean for PES-NWI scores. RESULTS: The study results support other research findings indicating that a positive practice environment enhances patient safety outcomes. Specifically at ward level, factors such as the ward practice environment and the proportion of nurses with degrees were found to significantly impact safety outcomes. The models developed for this study predicted 76% and 51% of the between-ward variance of these outcomes. The results can be used to enhance patient safety within hospitals by demonstrating factors at ward-level which enable nurses to effectively carry out this aspect of their role. CONCLUSIONS: The importance of ward-level nurse factors such as nurse education level and the work environment should be recognised and manipulated as important influences on patient safety.

Safe transfusion of blood and blood components.

Nurses are integral to the blood transfusion process. This article, which forms part of Nursing Standards clinical skills series, outlines the role of the nurse in evidence-based transfusion practice. Patient assessment, preparation, pre-transfusion checks, documentation and adverse reactions are discussed.