Nurses and midwives perceptions of missed nursing care – A South Australian study

Author version made available in accordance with the publisher's policy for non-mandated open access submission. Under Elsevier's copyright, non-mandated authors are permitted to make work available in an institutional repository. NOTICE: this is the author’s version of a work that was accepted for publication in Collegian. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in COLLEGIAN, [2014] DOI:10.1016/ j.colegn.2014.09.001Background Budgetary restrictions and shorter hospital admission times have increased demands upon nursing time leading to nurses missing or rationing care. Previous research studies involving perceptions of missed care have predominantly occurred outside of Australia. This paper reports findings from the first South Australian study to explore missed nursing care. Aim To determine and explore nurses’ perceptions of reasons for missed care within the South Australian context and across a variety of healthcare settings. Method The survey was a collaborative venture between the Flinders University of South Australia, After Hours Nurse Staffing Work Intensity and Quality of Care project team and the Australian Nursing and Midwifery Federation, SA Branch. Electronic invitations using Survey Monkey were sent to randomly selected nurses and midwives and available online for two months. Three hundred and fifty four nurses and midwives responded. Recurring issues were identified from qualitative data within the survey and three main reasons for missed care emerged. Findings Three main reasons for missed care were determined as: competing demands that reduce time for patient care; ineffective methods for determining staffing levels; and skill mix including inadequate staff numbers. These broad issues represented respondents’ perceptions of missed care. Conclusion Issues around staffing levels, skill mix and the ability to predict workload play a major role in the delivery of care. This study identified the increasing work demands on nurses/midwifes. Solutions to the rationing of care need further exploration

Portable Wearable Upper Limb Exoskeletons on Activities of Daily Living and Motor Function After Stroke: A Systematic Review and Meta-Analysis

Aim: To summarise, appraise, and analyse current literature to determine the effectiveness of portable wearable exoskeletons in improving activities of daily living and gross motor function in the upper limb of stroke survivors. Design: Systematic review and meta-analysis. Method: A systematic review of the literature was conducted using four databases to evaluate portable wearable exoskeletons on activities of daily living and gross motor function. Included studies were independently reviewed, and data was extracted and synthesized as per the PRIMSA guidelines. Studies with similar data points were compared with a meta-analysis. Results: Eleven articles, 147 participants, were included in this review. Two studies used the same exoskeleton whereas nine studies used different exoskeletons. The methodological critically appraisal ranged from poor to good. Six studies used elbow exoskeletons and five studies used hand exoskeletons. Meta-analysis showed statistically significant improvements in gross motor function and range of motion for elbow exoskeletons, and positive trends were seen for hand exoskeletons. No significant changes were demonstrated for activities of daily living outcomes. Conclusion: When using portable wearable exoskeletons for post-stroke upper limb rehabilitation can aid the gross motor recovery. However, no significant changes were seen for activities of daily livings. Key Practice Points: Following a stroke, thousands of movement repetitions are needed for recovery. Utilizing an exoskeleton with stroke survivors could allow them to complete their therapy in the comfort of their homes or outside of structured therapy. Clinicians prescribing exoskeletons of the elbow will observe an improvement in gross motor function

Devices used for shoulder subluxation in a stroke population: a systematic review

Aim: This systematic review aims to examine the current literature for the common devices used to manageshoulder subluxation following stroke and whether the effectiveness of these devices is short or long-ter

Mapping social processes at work in nursing knowledge development

In this paper, we suggest a blueprint for combining bibliometrics and critical analysis as a way to review published scientific works in nursing. This new approach is neither a systematic review nor meta-analysis. Instead, it is a way for researchers and clinicians to understand how and why current nursing knowledge developed as it did. Our approach will enable consumers and producers of nursing knowledge to recognize and take into account the social processes involved in the development, evaluation, and utilization of new nursing knowledge. We offer a rationale and a strategy for examining the socially-sanctioned actions by which nurse scientists signal to readers the boundaries of their thinking about a problem, the roots of their ideas, and the significance of their work. These actions - based on social processes of authority, credibility, and prestige - have bearing on the careers of nurse scientists and on the ways the knowledge they create enters into the everyday world of nurse clinicians and determines their actions at the bedside, as well as their opportunities for advancement. © 2014 Wiley Publishing Asia Pty Ltd

Factors influencing why nursing care is missed

Aims and objectives: This study explores the reasons nurses identify missed care and what factors account for this variance in nursing practice. Second, the study seeks to understand if the identified reasons behind missed care interact with one another and form a multidimensional construct. Background: This study draws on the results of previous research conducted by Kalisch in developing the MISSCARE research survey tool and now applies it to an Australian context. Design: This study engages a nonexperimental exploratory approach where 16 latent variables are identified and estimated using structural equation modelling to determine the capacity each of these factors has in predicting the reasons for reported missed nursing care. Methods: Data were obtained from an electronic survey sent to nursing members of the Australian Nursing and Midwifery Federation of South Australia. A self-report, Likert-type instrument was used to capture the strength and direction of consensus derived from a sample of 289 nurses and midwives. Results/Findings: Eight variables were identified as having direct predictor effects as to why nursing care was being missed, and included shift type, nursing resource allocation, health professional communication, workload intensity, workload predictability, the nurses' satisfaction with their current job and their intention to remain working. Additional indirect effects of other variables explained 34% of the variance of the total scores for why nursing care was reported as being missed. Conclusion: Historically, the MISSCARE survey has identified and quantified what types of nursing care is missed. This paper takes this concept further by producing an interactional model identifying the effects different variables have on why nursing care is missed. Relevance to clinical practice: These Australian findings not only contribute to other international studies that identify why nursing care is omitted, it provides a framework for why reported episodes of missed care can be predicted and subsequently addressed. © 2014 John Wiley & Sons Ltd

The psychometric properties of the MISSCARE nursing tool

Since 2006, US nurse Beatrice Kalisch has explored the relationships among the work environment, patient care demands and staffing issues on nursing outcomes (Kalisch 2006). Subsequently, the MISSCARE (Kalisch and Williams 2009) tool was developed to quantify what types and how frequently nursing care was missed and why omissions occurred. The MISSCARE survey has become one measure in the transactions of nursing, which refers to any aspect of care that is entirely or partially omitted or deferred. The tool comprises two portions: the elements of missed nursing care, containing 24 items where nurse participants are asked to rate how often each care aspect was missed with the options ranging from “rarely,” “occasionally,” “frequently,” and “always” missed. The second component explores the reasons for missed nursing care, with 17 varied reasons for why nursing care was missed within their work area. The scale used offered four options indicating degrees of intensity for why care was missed: if it was a “significant reason,” “moderate reason,” “minor reason,” or “not a reason” for missed care

Priced to care: Factors underpinning missed care

This article examines missed care through dialogues examining the perceptions of nurses in regard to missed care occasions. Using a critical discourse analysis (CDA), the study explores the truth claims of participants who describe the challenges they encounter in daily attempts to deliver what they consider effective patient care. These are compared to the mandates of state and organisational policy prescribing clinical practice. The boundaries of tension that are expressed by nurses within the milieu of missed care are explored through in-depth interviews. CDA is interested in social organisation and the interplay of people's activities within it, the focus being on how they construe and internalise such activity. Nurses' perceptions and realities become central to any investigation because they are often organised by more than their own intentions or motivations, with influences such as professional standards or organisational rules subconsciously locating their reality. Instead of identifying occasions of omitted care, nurses spoke of constraints related to budget, staffing, skill mix and mandated policy as constraining their ability to complete care activities. Factors emerged that suggest that missed care is the consequence of routinised and standardised practice, cited as cost effective care, at the expense of professional autonomy. © 2016, © Australian Labour and Employment Relations Association (ALERA), SAGE Publications Ltd, Los Angeles, London, New Delhi, Singapore and Washington DC

Nurses and midwives perceptions of missed nursing care: A South Australian study

Background: Budgetary restrictions and shorter hospital admission times have increased demands upon nursing time leading to nurses missing or rationing care. Previous research studies involving perceptions of missed care have predominantly occurred outside of Australia. This paper reports findings from the first South Australian study to explore missed nursing care. Aim: To determine and explore nurses' perceptions of reasons for missed care within the South Australian context and across a variety of healthcare settings. Method: The survey was a collaborative venture between the Flinders University of South Australia, After Hours Nurse Staffing Work Intensity and Quality of Care project team and the Australian Nursing and Midwifery Federation, SA Branch.Electronic invitations using Survey Monkey were sent to randomly selected nurses and midwives and available online for two months. Three hundred and fifty-four nurses and midwives responded. This paper reports qualitative data from answers to the open questions. Findings: Three main reasons for missed care were determined as: competing demands that reduce time for patient care; ineffective methods for determining staffing levels; and skill mix including inadequate staff numbers. These broad issues represented participants' perceptions of missed care. Conclusion: Issues around staffing levels, skill mix and the ability to predict workload play a major role in the delivery of care. This study identified the increasing work demands on nurses/midwifes. Solutions to the rationing of care need further exploration. © 2014 Australian College of Nursing Ltd