Quali sono le ragioni delle Missed Care? Risultato di uno studio bilaterale. Ragioni delle Missed Care.

BACKGROUND: Evidence of missed nursing care in clinical practice has been well documented; however, fewer studies highlighting why care is missed have been conducted and this prevents effective interventions aimed at minimizing the missed care. METHODS: A secondary analysis of two cross-sectional study designs was performed to capture the direction and strength of 1,114 Italian and Australian nurses' perceptions about why care was missed in their hospitals. The MISSCARE survey was used to collect data and the specific section aimed at estimating the reasons for missed nursing care was used. Data were analysed using structural equation modelling. RESULTS: Six significant variables emerged as predictors of why care is missed, and these were: workplace miscommunication; increased work intensity; inadequate physical and human resources for care work; nurses' age; and years of clinical experience. CONCLUSIONS: Australian and Italian findings contribute to growing international studies as to why nursing care is missed and provides a framework for understanding precipitating factors, such as incomplete workplace communication, unpredictable workflows, staffing and material resources issues might contribute to why care is missed and must thus be addressed/improved.

Perceived Stress Related to Nursing Education and Its Influence on Nursing Students’ Academic and Clinical Performance

Stress has a negative effect on student nurses well-being and can impede learning or motivate them and is conducive to learning. This study examined the perceived stress and factors that influenced daily students’ life among both the Diploma and Bachelor of Nursing students. A total of 241 nursing students were involved in this research project. Findings of this study indicated that junior nursing students (<21 years) of both cohorts perceived significantly more stress than older (≥21 years) nursing students. Second year students of the Diploma group claimed being more stressed than their peers (1st and 3rd years). Personal problems were the main issue of concern among the second year Diploma students. Workload of nursing education and fear of failing the nursing programme were the major stressors among the first year nursing students of the Bachelor cohort as compared to their seniors. A mixture of negatively and positively significant correlations was observed between academic work and clinical scores among the Diploma and Bachelor of Nursing students respectively. Both the Diploma and Bachelor of Nursing students’ stress did not influence their GPA scores. Negatively significant correlation was noted between stress and clinical scores among the Diploma of Nursing students. A negatively significant correlation was found between age and CGPA scores among the Bachelor cohort. Both male and female Diploma and Bachelor nursing students perceived no differences in stress related to their academic work. The findings of this study provide important information for nursing education at the institute examined in this study, and have implications for future research.

Equity in access to exercise tolerance testing, coronary angiography, and coronary artery bypass grafting by age, sex and clinical indications.

OBJECTIVES: To assess whether patients with heart disease in a single UK hospital have equitable access to exercise testing, coronary angiography, and coronary artery bypass graft surgery (CABG). METHOD: Retrospective analysis of patients' medical case notes (n = 1790), tracking each case back 12 months and forward 12 months from the patient's date of entry to the study. SETTING: Single UK district hospital in the Thames Region. PATIENTS: Patients (elective and emergency) with a cardiac ICD inpatient code at discharge or death, or who were referred to cardiology or care of the elderly unit over a 12 month period in 1996-7 (new episodes) were included. RESULTS: Analysis of 1790 hospital case notes revealed that, despite having indications for intervention identical to those of younger patients, older patients (that is, those aged > 75 years) and women, independently, were significantly less likely to undergo exercise tolerance testing (exercise ECG) and cardiac catheterisation. The similar trends for age and access to CABG did not achieve significance. While clinical priority scores also independently predicted access to cardiac catheterisation and CABG, considerable numbers of patients in high clinical priority groups were not referred for either procedure. CONCLUSIONS: The management and treatment of older patients and women with cardiac disease may be different from that of younger patients and men. Given the similarity of the indications for treatment and the lack of significant contraindications or comorbidities as a cause for these differences, one possible explanation is that these patients are being discriminated against principally because of their age and sex. Although clinical priority scores independently predicted access to catheterisation and CABG, large proportions of patients in high priority groups were not referred. This implies that the New Zealand priority scoring system may be more equitable than UK practice. The cost implications of redressing these inequities in service provision would be considerable.