DOI: 10.5176/2315-4330_WNC14.77
Authors: Eileen Willis, Patti Hamilton, Julie Henderson, Ian Blackman, Luisa Toffoli, Clare Harvey, Elizabeth Abery and Claire Verrall
Abstract: This paper reports on a study that extended Kalisch’s work on missed nursing care to the South Australian context. Data were collected through the administration of the MISSCARE Survey with permission to administer the Survey obtained from Beatrice Kalisch. Our Australian-based international team modified the demographic section of the survey to better fit with local terminology and work environments and added separate questions to capture differences in missed care across all three shifts. The survey was administered using the online survey tool, Survey Monkey. Recruitment occurred through the Australian Nursing and Midwifery Federation (SA Branch) [ANMFSA]. Participants were asked to indicate on a five point scale where 1 is never omitted and 5 is always omitted, the frequency in which different aspects of care were missed. The tasks that are most frequently reported as being omitted are ambulation of patients (3.26) and mouth care (2.84). At the other end of the scale the tasks reported as least often omitted are blood glucose monitoring (1.99); hand washing (2.14); and IV/central line care (2.29) and providing PRN medication within 15 minutes (2.32). Given that bathing patients (2.30) and providing PRN medication within 15 minutes (2.32) are reported as being missed less frequently suggests that when nursing time is rationed priority is given to clinical and basic nursing care over tasks which may be less immediately important for patient well-being. Nurses were also asked to provide explanations for why care might be missed. ‘Unexpected rise in patient volume or acuity’ (54.2{6e6090cdd558c53a8bc18225ef4499fead9160abd3419ad4f137e902b483c465}), ‘heavy admission and discharge activity’ (44.8{6e6090cdd558c53a8bc18225ef4499fead9160abd3419ad4f137e902b483c465}); ‘inadequate numbers of staff’ (43.4{6e6090cdd558c53a8bc18225ef4499fead9160abd3419ad4f137e902b483c465}), ‘urgent patient situation’ (39.8{6e6090cdd558c53a8bc18225ef4499fead9160abd3419ad4f137e902b483c465}), and ‘inadequate number of assistive and/or clerical personnel’ (40.2{6e6090cdd558c53a8bc18225ef4499fead9160abd3419ad4f137e902b483c465}) were identified as significant reasons for missed care. A path analysis indicated a strong relationship between these four reasons and a lack of human and physical resources that compounds work intensification and missed care. This paper is the base line study for the International Network for the Study of Rationalisation of Nursing Care (INSRNC) and points to increasing work intensification for nurses.
Keywords: Australia, missed nursing care, nursing, Path analysis, workforce
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