Possibility over time: sustaining interdisciplinary practice in the zones of possibility

The lure of practice beyond disciplinary ordinance lies in potential for thinking beyond established paradigms. Belgian philosopher of science, Isabelle Stengers claims that things already impinge across disciplinary boundaries; that an “ecology of practices” is possible in the “event” of interdisciplinary transaction. This paper investigates insights from one art practice that links to other practices for particular durations. It thereby enters zones dependent on temporal aggregation and attentive dialogues, enunciating a chain of potentially generative and sustaining production for those involved

Missed care in residential aged care in Australia: An exploratory study

Background The phenomena of missed nursing care is usually measured through quantitative surveys that detail the specific tasks that are rationed or delayed, and the reasons why this is so. These studies report high levels of agreement within and across countries between the two major measures employed; the Kalisch's MISSCARE tool and the RN4Cast Basel Extent of Rationing of Nursing Care (BERNCA) instrument. Most of these studies have been conducted in acute care settings and demonstrate the impact of lack of human and other resources upon decisions to omit care. Less in known about missed care in residential aged care Aim To explore the frequency and causes of missed care in residential aged care in three Australian states: New South Wales, Victoria and South Australia. Methods Quantitative and qualitative data from 922 respondents working in residential aged care to the MISSCARE survey were bought together to identify the tasks missed in aged care and reasons for this. Findings Respondents report the omission of unplanned care (toileting and answering bells) and rehabilitative care. The primary reasons for missed care are staffing shortages and difficulties in meeting residents’ complex health care needs due to demands arising from increased resident acuity and fewer skilled nurses to meet this demand. Conclusion Resident care is missed in residential aged care with staffing numbers identified as a key cause

Nurses' perceptions of the impact of the aged care reform on services for residents in multi-purpose services and residential aged care facilities in rural Australia

Aim: To understand nurses' perceptions of the impact of the aged care reform on care and services for residents in multi-purpose services (MPS) and residential aged care facilities (RACF) in rural South Australia. Methods: An interpretative study using semi-structured interviews. Participants comprised registered and enrolled nurses working with aged care residents in rural South Australia. Eleven nurses were interviewed, of these seven worked in MPS and four in RACF. Results: Data were analysed for similarities and differences in participants' experiences of care delivery between MPS and RACF. Common issues were identified relating to funding and resource shortfalls, staffing levels, skill mix and knowledge deficits. Funding and staffing shortfalls in MPS were related by participants to the lower priority given to aged care in allocating resources within MPS. Nurses in these services identified limited specialist knowledge of aged care and care deficits around basic nursing care. Nurses in RACF identified funding and staffing shortfalls arising from empty beds due to the introduction of the accommodation payment. Dependence upon care workers was associated with care deficits in complex care such as pain management, medication review and wound care. Conclusion: Further research is needed into the impact of recent reforms on the capacity to deliver quality aged care in rural regions

The impact of rationing of health resources on capacity of Australian public sector nurses to deliver nursing care after-hours: A qualitative study

Australia, along with other countries, has introduced New Public Management (NPM) into public sector hospitals in an effort to contain healthcare costs. NPM is associated with outsourcing of service provision, the meeting of government performance indicators, workforce flexibility and rationing of resources. This study explores the impact of rationing of staffing and other resources upon delivery of care outside of business hours. Data was collected through semistructured interviews conducted with 21 nurses working in 2 large Australian metropolitan hospitals. Participants identified four strategies associated with NPM which add to workload after-hours and impacted on the capacity to deliver nursing care. These were functional flexibility, vertical substitution of staff, meeting externally established performance indicators and outsourcing. We conclude that cost containment alongside of the meeting of performance indicators has extended work traditionally performed during business hours beyond those hours when less staffing and material resources are available. This adds to nursing workload and potentially contributes to incomplete nursing care

Causes of missed nursing care: Qualitative responses to a survey of Australian nurses

There is a growing nursing literature that views missed nursing care as an inevitable consequence of work intensification associated with the rationing of the human and material resources required to deliver care. A modified MISSCARE survey was administered to 4431 nurses and midwives in New South Wales in November 2014. This paper reports on 947 responses to an open question contained in the survey which asked respondents ‘Is there anything else you would like to tell us about missed care?’ Responses were analysed using qualitative content analysis and focused upon both the causes and impact of missed care. Analysis identified two major causes of missed care: the impact of work intensification and staffing issues. Participants associated work intensification with patient acuity and cost containment, while the staffing issues identified included: undermining prescribed staffing ratios; skill mix; changing workloads across shifts; and poor support from other staff. Respondents identified insufficient resources, albeit staffing or other resources, to meet patient care needs reflecting findings in similar studies. Missed or delayed nursing care in this context is associated with resource issues leading nurses to ration the care they can provide. While work intensification is not a new phenomenon, its increasing use in the public hospital sector across a number of OECD countries has become a major consequence of new public management (NPM) strategies aimed at cost containment

Comparing infection control and ward nurses' views of the omission of infection control activities using the Missed Nursing Care Infection Prevention and Control (MNCIPC) Survey

Aim: To compare the perceptions of nurses with infection control expertise and ward nurses as to what infection control activities are missed and the reasons why these activities are omitted. Background: Infection prevention activities are viewed as important for reducing health care-acquired infections (HAIs) but are often poorly performed. Methods: Data were collected through the Missed Nursing Care Infection Prevention and Control (MNCIPC) Survey delivered to 500 Australian nurses prior to COVID-19. Results: Significant differences were found on the mean scores between infection control and other nurses on ten items. In eight cases, five relating to hand hygiene, infection control specialists viewed the activity as more likely to be missed. Factors viewed as having greater contribution to omission of infection control prevention were as follows: 'Patients have to share bathrooms', 'Urgent patient situation' and 'Unexpected rise in patient volume and/or acuity on the ward/unit'. Infection control nurses were more likely to highlight the role of organisational and management factors in preventing effective infection control. Conclusions: Differences in response between nurses suggest that the extent of omission of infection control precautions may be under-estimated by ward nurses. Implications for Nursing Management: Infection control specialists are more likely to identify organisational barriers to effective infection control than other nurses. Work demands arising from pandemic management may contribute to infection control precautions being missed

Missed infection control care and healthcare associated infections: A qualitative study

Background: Research on missed nursing care reveals individual and systems failure. Research on infection control missed care is minimal. Aims: Investigate nurse perceptions of missed infection control. Design: Qualitative in-depth interviews with 11 Australian infection control nurse experts. Methods: Participants were asked whether nursing and hospital-wide care tasks fundamental to infection control were missed, and what were the underlying causes and contributing factors for these omissions. Qualitative data was mapped against fundamental nursing practice and Australian infection control guidelines. Findings: Omission of infection control care occur at the individual clinician and organisational level. Nurses describe failure to perform standard precautions as well as failure to perform basic care activities. Participants identified a range of institutional and cultural factors which contributed to cascade iatrogenesis resulting in healthcare associated infections for patients. Some factors are outside nurses’ control and include: environmental cleanliness; ward layout; ward culture; resourcing and staffing; integration of infection control into clinical governance; action following audit results; and reviewing evidence base of protocols. Discussion: Care occurs in complex and conflicted settings, with prioritisation essential. Potentially harmful practices are generally done with the intention of care. Nurses are key, but not sole performers in the creation of quality infection control. Conclusion: Mapping missed care related to infection control against standard frameworks of nursing practice revealed “gaps in the chain of infection” that contribute to “cascade iatrogenesis” with negative outcomes for patients

Rounding, work intensification and new public management

In this study, we argue that contemporary nursing care has been overtaken by new public management strategies aimed at curtailing budgets in the public hospital sector in Australia. Drawing on qualitative interviews with 15 nurses from one public acute hospital with supporting documentary evidence, we demonstrate what happens to nursing work when management imposes rounding as a risk reduction strategy. In the case study outlined rounding was introduced across all wards in response to missed care, which in turn arose as a result of work intensification produced by efficiency, productivity, effectiveness and accountability demands. Rounding is a commercially sponsored practice consistent with new public management. Our study illustrates the impact that new public management strategies such as rounding have on how nurses work, both in terms of work intensity and in who controls their labour

The impact of facility ownership on nurses’ and care workers’ perceptions of missed care in Australian residential aged care

The Australian government has reduced restrictions on ownership of residential aged care facilities (RACF) as part of aged care reform enabling the growth of private-for-profit ownership. This study explores the impact of private-for-profit ownership through comparison of perceptions of the volume of missed care in government, private-not-profit and for-profit RACF in Australia. Data were collected through development and administration of a MISSCARE survey to 3,206 nurses and personal care workers (PCW) working in RACF and hospitals providing aged care services. Employees working within government owned facilities reported levels of missed care that are significantly lower than privately owned facilities on six activities: moving patients who cannot walk; assisting residents’ toileting within 5 min of request; assisting resident mouth care; assessing skin integrity; answering call bells within 5 min and wound care. Staffing levels were identified as the most common reason for missed care across all settings. Of the 27 factors identified as causing missed care, government employees reported significantly lower scores for 16 items. Further research is needed on the impact of facility ownership upon capacity of nurses and personal care workers to deliver care