Missed nursing care - a nurse's perspective: an exploratory study into the who, what and why of missed care

Abstract

BACKGOUND: Exploration of missed or delayed nursing care has become increasingly prevalent in international nursing literature over the past ten years. Evidence demonstrates that missed nursing care, or care that is left undone or passed on to the following shift, is common and the factors that lead to missed care are complex and numerous. Critically, patients report poorer experiences of care in hospitals where more nursing care is left undone. Despite strong international evidence, there has been little research to explore missed nursing care in Australia, and no papers focusing specifically on missed nursing care in the cancer setting. The aims of this study were to (i) explore nurses’ perceptions of what care is missed in one haematology/oncology in-patient setting in Victoria, Australia, and (ii) to identify factors contributing to missed care.

METHODS: This study employed an exploratory mixed-methods approach that included an on-line survey of nurses’ views of missed care and factors leading to missed care, a description of the environment of care during the data collection period, and focus groups to explore, in depth, factors nurses believe result in missed care.

RESULTS: Survey data were collected from 17 of 50 eligible nurses (34%) working on a haematology/oncology ward over a three week period in September, 2015. During the data collection period, 103 patients were cared for on the ward. The most common areas of missed care reported were: talking to patients (n=15, 88.2%), developing and updating nursing care plans (n=13, 76.5%), and educating patients and family (n=11, 64.7%). Data from the focus groups indicated acute awareness of missed care and multiple factors leading to missed care were identified. These included staff skill mix, organisation of nursing work, and non-nursing duties that detracted from time with patients. During the focus groups, nurses described considerable discomfort at being unable to provide emotional care they wanted to deliver to patients and their families. They also talked about the inability to take care of themselves.

CONCLUSION: This preliminary, exploratory study offers an insight into missed nursing care and its consequences on patients and nurses in one Australian cancer setting. Data reflect the findings of earlier international studies and indicated potentially modifiable factors for reduction of missed nursing care. Multi-site research is needed to further explore missed care in cancer settings to better understand and make recommendations for optimal environments of care, caring and staff wellbeing.