Developing policies and actions in response to missed nursing care: A consensus process.

AIM: To support the development of appropriate policies and actions in the field of missed nursing care (MNC). BACKGROUND: There has been an ever-growing international debate on MNC, interventions that nurses have identified as necessary for their patients, but which for various reasons they are unable to provide or are forced to delay. Despite MNC's relevance, its translation into policies and actions has not been documented to date. METHOD: A consensus development method was employed involving (a) a nominal group composed of experts in the field, policymakers and the President of the Regional Nursing Professional Boards, and (b) 218 nurses appointed primarily at the managerial levels. RESULTS: A total of eight consensus statements were approved and organized in a series of sub-statements designed to (1) render the concept of MNC culturally acceptable in the Italian context, with the agreement that compromised nursing care (CNC) is the best term to be used in this field, as a synonym for MNC; (2) measure CNC as a strategy to increase patient safety; (3) select an appropriate CNC measurement tool; (4) optimize CNC measurement; (5) conduct effective CNC data analysis; (6) design and implement interventions to prevent and/or minimize CNC; (7) assess and disseminate findings on interventions' effectiveness; and (8) provide final remarks on the way to move forward. CONCLUSIONS: We developed a process to introduce the phenomenon of MNC in the Italian culture and agreed firstly on the term compromised nursing care, which better reflects MNC's meaning according to the context and facilitates an open discussion on the phenomenon both within and outside the profession. The following consensus statements emerged represent a systematic approach, starting from the measurement and finishing with the re-measurement of the occurrence of MNC after having implemented concrete actions. IMPLICATIONS FOR NURSING MANAGEMENT: The approved consensus statements can guide decision-makers to develop concrete policies and actions that promote the improvement of quality of care and patients' safety by minimizing and/or preventing MNC's occurrence.

[Missed nursing care and italian nursing practice: preliminary finding of a consensus conference]. / Missed nursing care e pratica infermieristica italiana:risultati preliminari di una consensus conference.

. Missed nursing care and italian nursing practice: preliminary findings of a consensus conference. In recent years in Italy there has been renewed interest in missed nursing care due to various factors, such as participation in the RANCARE project, with 28 European and non-EU countries, the opportunity to develop international exchanges, specific projects and field based research. We explored a range of ideas and processes, culminating in a conference designed to address specific issues relating to missed nursing care, in the Italian nursing practice. After a preliminary review of the literature on the psychometric properties of the available tools, with the intent of further deepening our understanding of the concept of missed nursing care, its implications for practice, management, education and research. After two days of presentations and discussions, the more than participating nurses agreed on a set of preliminary recommendations regarding missed nursing care and Italian nursing practice. This paper reports on the preliminary consensus findings from the conference.

Nursing effectiveness in Italy: findings from a grounded theory study.

AIM: The aim of the present study was to conceptualize the basic social process by which nursing intervention affects patient outcomes in Italian daily practice. BACKGROUND: Different frameworks explain the relationship between nursing care and patient outcomes. However, several authors have suggested the need to develop further theory in order to understand this relationship. METHOD: A qualitative study based on a grounded theory approach was undertaken to generate a conceptual description of nursing care in Italy and its relationship to patient outcomes. Data collection and analysis processes were conducted simultaneously in an Italian Teaching Hospital from 2007 to 2009. FINDINGS: Nursing effectiveness (the core variable) expresses the positive effects of the nursing system on patient outcomes, on patient safety and on the multi-disciplinary outcomes. The two interdependent social processes that assure nursing effectiveness are: creating a supportive environment for potentially effective nursing (causative factors); and performing organizational, clinical and collaborative intervention (nursing strategies and consequences). CONCLUSIONS: The factors determining a potentially supportive environment for nursing effectiveness are similar to those documented in the literature but the need for clinical nurses to compensate systematically when this support is not available seems to be unique. IMPLICATIONS FOR NURSING MANAGEMENT: Understanding the basic processes involved in the determination of nursing effectiveness in one country has implications for nursing leaders' decision-making, on National Health Service policy recommendations and on professional development both at national and international levels.

[Criteria for delegating the safe hospital administration of drug therapy via natural route to nurses aids in hospital]. / I criteri per affidare in sicurezza la somministrazione della terapia per via naturale agli operatori sanitari con formazione complementare in ospedale.

AIM: To assess if and how many patients admitted to hospital could receive the drug therapy via natural route by specialized nurses aids (OSSc). METHODS: Focus group to identify the items of an assessment instrument to select patients eligible to receive drug therapy from OSSc, validation (face validity, test retest, interrater reliability and factorial analysis) and implementation on 227 patients admitted to medical and surgical wards. RESULTS: During admission 106/227 patients (46.5%) could receive the therapy from OSSc for at least one day: 21 (9.2%) at admission, 73 (32.1%) after 4 days and 12 (11.3%) in the following days, but 29/106 (27.3%) formerly eligible patients change their condition and therapy should be administered by nurses. On average in medical wards 7.7 patients/day would be eligible while only 2.6 in surgery. CONCLUSIONS: The delegation of drug therapy in acute hospitals to OSSc seems unlikely for patients complexity and the need of daily assessments and adjustments. Nurses should each time select eligible patients guaranteeing the necessary supervision. This extra workload is not affordable.

[The concept of missed care: a literature review]. / Il concetto di missed nursing care: una revisione narrativa della letteratura.

AIM: To describe the concept and consequences of missed nursing care. METHODS: A literature review was conducted searching on Medline, Trip Database, Cinahl, Cochrane, with the following key words: missed care, missed nursing care. RESULTS: Any needed nursing intervention omitted (totally or in part) or postponed is considered missed care. The causes of missed care are the scarcity of human resources, of equipment or communication, but also the criteria for setting priorities and the relationships with nurses aids may also have an impact. The missed care may be measured with the Misscare tool: those more frequently missed are deambulation, passive mobilization, hygiene and oral care. CONCLUSIONS. A description of the interventions omitted or only postponed at international level, a measurement of the variability of missed care according to the number of nurses, and their impact on patients'outcomed could improve a better understanding of this problem.