Missed nursing care and complexity theory : a conceptual paper

Background: Missed nursing care is a complex healthcare problem. Extant literature in this area identifies several interventions that can be used in acute hospital settings to minimise the impact of missed nursing care. However, controversy still exists as to the effectiveness of these interventions on reducing the occurrence of missed nursing care. Aim: This theoretical paper aimed to provide a conceptual understanding of missed nursing care using complexity theory. Methods: The method utilised for this paper is based on a literature review on missed care and complexity theory in healthcare. Results: We found that the key virtues of complexity theory relevant to the missed nursing care phenomenon were adaptation and self-organisation, non-linear interactions and history. It is suggested that the complex adaptive systems approach may be more useful for nurse managers to inform and prepare nurses to meet uncertain encounters in their everyday clinical practice and therefore reduce instances of missed care. Conclusions: This paper envisions that it is time that methods used to explore missed care changed. Strategies proposed in this paper may have an important impact on the ability of nursing staff to provide quality and innovative healthcare in the modern healthcare system.</p

Risk factors for in-hospital patient falls: A retrospective analysis

Background/Aims: Falls are a key patient safety concern because of the associated physical injuries, emotional impact and financial burden on patients and the healthcare system. This study aimed to describe the characteristics of falls and assess the potential risk factors among hospitalised patients in a medium-sized acute care hospital in Queensland, Australia. Methods: This was a retrospective descriptive study using routinely collected information. The study was conducted in a medium-sized public hospital in Queensland, Australia. Characteristics of patients, their fall risk classification and circumstances of patient falls were extracted from the incident report provided by the hospital. Data were analysed using descriptive statistics. Results: A total of 677 patient fall incidents were documented on the hospital's electronic incident system from 2015-17. The majority of falls (98%) occurred in inpatient units and caused no or minimal harm to patients. Older age groups (75-84 years and 85-94 years) made up the greatest proportion of patients who fell. Falls were largely related to toileting activities. The most common locations for inpatient falls were the bed, bedside trolley or treatment chair. Conclusions: Intervention studies are needed to develop and evaluate procedures to prevent falls, particularly for activities with a high risk of falls, such as toileting, and for older patients.</p

A Cross-sectional Study Evaluating the Association Between the Nursing Practice Environment and Missed Nursing Care in Medical and Surgical Wards in Jordan

BACKGROUND: Missed nursing care can jeopardize the safety of patients. The practice environment contains various elements that may impact nursing staff's capability to provide appropriate care. PURPOSE: To examine the association between the practice environment and missed nursing care in Jordanian hospitals. METHODS: A cross-sectional design, including the MISSCARE survey and the Practice Environment Scale of the Nursing Work Index, was used for this study. RESULTS: Data were gathered from 672 nurses working in 10 hospitals between March and July 2021. Findings revealed significant negative correlations between nurses' participation in hospital affairs ( r = -0.077, P = .046), nursing foundations for quality of care ( r = -0.139, P < .001), and missed nursing care. CONCLUSION: Information from this study can help nursing leaders modify practice environment elements that impact missed nursing care occurrences, which will help improve the quality of care provided to patients

Examining the reasons for missed nursing care from the viewpoints of nurses in public, private, and university hospitals in Jordan : A cross-sectional research

Background: Missed nursing care is an indicator of quality nursing care. It is a significant healthcare delivery problem, especially given increased demand and limited resources worldwide, including in Jordan. It is paramount to identify the reasons for missed care in hospital settings. Aim: To identify the perceptions of registered nurses for missed nursing care in medical and surgical wards in Jordanian hospitals. We also aimed to identify differences in the reported reasons for missed nursing care across three healthcare sectors: public, private, and university. Methods: A quantitative approach utilising a cross-sectional design was conducted by surveying registered nurses at 10 hospitals in Jordan. This study employed the MISSCARE Survey tool. The data collection was performed between March and July 2021. Descriptive statistics and analysis of variance were used to address the objectives. Findings: A sample of 672 registered nurses working in medical and surgical wards in 10 acute care hospitals in Jordan were recruited. The major reason for missed nursing care was inadequate number of staff. Communication issues were more important to missed nursing care in university hospitals than public and private hospitals. Conclusion: A study of Jordanian registered nurses revealed that a perceived shortage of human resources is the principal reason for missed nursing care in medical and surgical wards. Comparing the reasons for missed nursing care between the three hospital sectors could help nursing administrators to tailor operational interventions to mitigate the effect of these causes. Therefore, reducing missed nursing care.</p

Missed Nursing Care in Medical and Surgical Wards in Jordan: A Cross-Sectional Study

Missed nursing care is a multifaceted patient safety issue receiving increased attention among healthcare scholars worldwide. There is limited research on missed nursing care in the Jordanian healthcare context. The current study sought to examine the perceptions of Jordanian nurses toward the amount and types of missed nursing care in medical and surgical wards. We also examined the differences in missed care items between public, private, and university hospitals in Jordan. This was a cross-sectional study using the MISSCARE Survey tool. Data collection spanned 4 months between March and July 2021. The final study sample consisted of 672 registered nurses employed in five public, three private, and two university hospitals in Jordan. Data were analyzed using descriptive statistics, Analysis of variance, and Pearson correlation coefficent test. Of the 672 registered nurses who participated, the majority were females (n = 421; 62.6%). Most participants held a bachelor's degree in nursing (n = 577; 85.9%). The three most common missed nursing activities in the participating hospitals were: ambulation, oral care, and emotional support. Nurses working in public hospitals reported the highest missed nursing care. The age and number of patients under care significantly correlated with missed nursing care. The findings could help nursing managers develop plans to reduce missed nursing care in their healthcare institutions.</p

Assessment of patient safety culture in two emergency departments in Australia: a cross sectional study

Purpose: Patient safety culture is a vital element to create patient safety in healthcare organisations. Emergency department (ED) professionals operate in unstable conditions that may pose risk to patient safety on day-to-day basis. The aim of this study was to assess the status of patient safety culture and to quantify the dimensions of safety culture in the ED setting. Design/methodology/approach: This was a descriptive cross sectional study that used a validated questionnaire distributed to the staff working in the nominated EDs. Perceptions on various dimensions of safety culture were reported and the frequency of positive responses for each dimension was calculated. Findings: “Teamwork” is the only dimension that rated positive by over 70% of participants. Other dimensions rated below 50%, except for “Organisational learning–continuous improvement” which rated 51.2%. Areas that rated the lowest were “Handover and transitions”, “Staffing”, “Non-punitive response to error” and “Frequency of event reporting” with average positive response rate of 15.4%, 26%, 26.8% and 27.6%, respectively. Originality/value: This study displayed a concerning perceptions held by participants about the deficiency of patient safety culture in their EDs. Moreover, it provided a baseline finding giving a clearer vision of the areas of patient safety culture that need improvement.</p

sj-docx-1-wjn-10.1177_01939459241227768 – Supplemental material for Factors Influencing Medication Administration Errors as Perceived by Nurses in Pediatric Units in a Jordanian Tertiary Hospital: A Qualitative Descriptive Study

Supplemental material, sj-docx-1-wjn-10.1177_01939459241227768 for Factors Influencing Medication Administration Errors as Perceived by Nurses in Pediatric Units in a Jordanian Tertiary Hospital: A Qualitative Descriptive Study by Muhammad Ahmed Alshyyab, Muna A. L. Ebbini, Asma’a Alslewi, James Hughes, Erika Borkoles, Gerard FitzGerald and Rania Ali Albsoul in Western Journal of Nursing Research</p

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research