Journal of Qualitative Research in Health Sciences

Document Type : Original Article

Authors

1 Nursing Faculty, Meybod Nursing School, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

2 Nursing Faculty, College of Nursing and Midwifery, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

3 Children Growth Disorder Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

4 Master Nursing Student, College of Nursing and Midwifery, Sharekord University of Medical Sciences, Yazd, Iran

10.34172/jqr.2023.33

Abstract

Background: Pediatric nurses are responsible for caring for children and their families; thus, investigating missed care in the pediatric ward is important and helps to improve the quality of care. Accordingly, this study aimed to explain the perceptions of pediatric nurses about missed care.
Methods: This study was conducted using content analysis on 15 pediatric nurses selected by purposive sampling. The data were collected through in-depth semi-structured interviews. After obtaining informed consent, interviews were audio-recorded and transcribed verbatim. MAXQDA software (version 10) was used to facilitate coding and thematic analysis.
Results: Four main categories emerged from the data analysis, including missed family-centered care, unsafe care, predisposing factors, and adverse outcomes.
Conclusion: The findings showed that from the perspective of pediatric nurses, missed care occurs in different dimensions, including psychological support, communication, education, assessment, drug treatment, and infection control, and it can ultimately lead to mother’s dissatisfaction and bring about adverse effects on the child’s recovery besides harming the nurse.

Highlights

Atena Dadgari (Google Scholar) (PubMed)

Imane Bagheri (Google Scholar) (PubMed)

Naiire Salmani (Google Scholar) (PubMed)

Mojgan Barati (Google Scholar) (PubMed)

Keywords

  1. da Silva SC, Morais BX, Munhoz OL, Ongaro JD, de Souza Urbanetto J, de Souza Magnago TS. Patient safety culture, missed nursing care and its reasons in obstetrics. Rev Lat Am Enfermagem. 2021;29:e3461. doi: 10.1590/1518- 8345.4855.3461.
  2. Srulovici E, Drach-Zahavy A. Nurses’ personal and ward accountability and missed nursing care: a cross-sectional study. Int J Nurs Stud. 2017;75:163-71. doi: 10.1016/j. ijnurstu.2017.08.003.
  3. Valles JH, Monsiváis MG, Guzmán MG, Arreola LV. Nursing care missed in patients at risk of or having pressure ulcers. Rev Lat Am Enfermagem. 2016;24:e2817. doi: 10.1590/1518- 8345.1462.2817.
  4. Kowinsky AM, Shovel J, McLaughlin M, Vertacnik L, Greenhouse PK, Martin SC, et al. Separating predictable and unpredictable work to manage interruptions and promote safe and effective work flow. J Nurs Care Qual. 2012;27(2):109- 15. doi: 10.1097/NCQ.0b013e3182385df1.
  5. Recio-Saucedo A, Dall’Ora C, Maruotti A, Ball J, Briggs J, Meredith P, et al. What impact does nursing care left undone have on patient outcomes? Review of the literature. J Clin Nurs. 2018;27(11-12):2248-59. doi: 10.1111/jocn.14058.
  6. Bogossian F, Winters-Chang P, Tuckett A. “The pure hard slog that nursing is . . .”: a qualitative analysis of nursing work. J Nurs Scholarsh. 2014;46(5):377-88. doi: 10.1111/jnu.12090.
  7. Jones TL, Hamilton P, Murry N. Unfinished nursing care, missed care, and implicitly rationed care: state of the science review. Int J Nurs Stud. 2015;52(6):1121-37. doi: 10.1016/j. ijnurstu.2015.02.012.
  8. Hessels AJ, Flynn L, Cimiotti JP, Cadmus E, Gershon RR. The impact of the nursing practice environment on missed nursing care. Clin Nurs Stud. 2015;3(4):60-5. doi: 10.5430/ cns.v3n4p60.
  9. Ausserhofer D, Zander B, Busse R, Schubert M, De Geest S, Rafferty AM, et al. Prevalence, patterns and predictors of nursing care left undone in European hospitals: results from the multicountry cross-sectional RN4CAST study. BMJ Qual Saf. 2014;23(2):126-35. doi: 10.1136/bmjqs-2013-002318.
  10. Ball JE, Bruyneel L, Aiken LH, Sermeus W, Sloane DM, Rafferty AM, et al. Post-operative mortality, missed care and nurse staffing in nine countries: a cross-sectional study. Int J Nurs Stud. 2018;78:10-5. doi: 10.1016/j.ijnurstu.2017.08.004.
  11. Alshammari MH, Pacheco H, Pasay-An E, Alshammari F, Alsharari A, Felemban E, et al. Nurses’ perspectives on the degree of missed nursing care in the public hospitals in Hail city, Kingdom of Saudi Arabia. Belitung Nurs J. 2020;6(6):190- 5. doi: 10.33546/bnj.1233.
  12. Henderson J, Willis E, Blackman I, Toffoli L, Verrall C. Causes of missed nursing care: qualitative responses to a survey of Australian nurses. Labour and Industry. 2016;26(4):281-97. doi: 10.1080/10301763.2016.1257755.
  13. Ogboenyiya AA, Tubbs-Cooley HL, Miller E, Johnson K, Bakas T. Missed nursing care in pediatric and neonatal care settings: an integrative review. MCN Am J Matern Child Nurs. 2020;45(5):254-64. doi: 10.1097/nmc.0000000000000642.
  14. Zeleníková R, Jarošová D, Plevová I, Janíková E. Nurses’ perceptions of professional practice environment and its relation to missed nursing care and nurse satisfaction. Int J Environ Res Public Health. 2020;17(11):3805. doi: 10.3390/ ijerph17113805.
  15. Glasper EA. Does a shortage of specially trained nurses pose a threat to the provision of optimum care for sick children in hospital? Compr Child Adolesc Nurs. 2017;40(1):1-5. doi: 10.1080/24694193.2017.1289740.
  16. Purdy IB, Craig JW, Zeanah P. NICU discharge planning and beyond: recommendations for parent psychosocial support. J Perinatol. 2015;35(Suppl 1):S24-8. doi: 10.1038/jp.2015.146.
  17. Lake ET, de Cordova PB, Barton S, Singh S, Agosto PD, Ely B, et al. Missed nursing care in pediatrics. Hosp Pediatr. 2017;7(7):378-84. doi: 10.1542/hpeds.2016-0141.
  18. da Lima JC, de Camargo Silva AF, Caliri MH. Omission of nursing care in hospitalization units. Rev Lat Am Enfermagem. 2020;28:e3233. doi: 10.1590/1518-8345.3138.3233.
  19. Tubbs-Cooley HL, Gurses AP. Missed nursing care: understanding and improving nursing care quality in pediatrics. Hosp Pediatr. 2017;7(7):424-6. doi: 10.1542/ hpeds.2017-0083.
  20. Dizon JM, Machingaidze S, Grimmer K. To adopt, to adapt, or to contextualise? The big question in clinical practice guideline development. BMC Res Notes. 2016;9(1):442. doi: 10.1186/s13104-016-2244-7.
  21. Chegini Z, Jafari-Koshki T, Kheiri M, Behforoz A, Aliyari S, Mitra U, et al. Missed nursing care and related factors in Iranian hospitals: a cross-sectional survey. J Nurs Manag. 2020;28(8):2205-15. doi: 10.1111/jonm.13055.
  22. Rezaee S, Baljani E, Feizi A. Missed nursing care in educational, private and social welfare hospitals. Nurs Midwifery J. 2019;17(4):300-8. [Persian].
  23. Ebadi J, Najafi E, Aghamohammadi V, Saeeidi S, Nasiri K. Missed nursing care and its related factors in Ardabil and Khalkhal educational and medical centers in 2020. J Health Care. 2021;23(1):78-87. doi: 10.52547/jhc.23.1.78. [Persian].
  24. Khajooee R, Bagherian B, Dehghan M, Azizzadeh Forouzi M. Missed nursing care and its related factors from the points of view of nurses affiliated to Kerman University of Medical Sciences in 2017. Hayat. 2019;25(1):11-24. [Persian].
  25. Austin Z, Sutton J. Qualitative research: getting started. Can J Hosp Pharm. 2014;67(6):436-40. doi: 10.4212/cjhp.v67i6.1406.
  26. Graneheim UH, Lindgren BM, Lundman B. Methodological challenges in qualitative content analysis: a discussion paper. Nurse Educ Today. 2017;56:29-34. doi: 10.1016/j. nedt.2017.06.002.
  27. Cypress BS. Rigor or reliability and validity in qualitative research: perspectives, strategies, reconceptualization, and recommendations. Dimens Crit Care Nurs. 2017;36(4):253- 63. doi: 10.1097/dcc.0000000000000253.
  28. Almasi S, Cheraghi F, Roshanaei G, Khalili A, Dehghani M. Relation of nursing support from parents with meeting the needs of mothers of children hospitalized in Besat hospital, Hamadan. Avicenna J Nurs Midwifery Care. 2018;26(5):323- 32. doi: 10.30699/sjhnmf.26.a5.323. [Persian].
  29. Tandberg BS, Sandtrø HP, Vårdal M, Rønnestad A. Parents of preterm evaluation of stress and nursing support. J Neonatal Nurs. 2013;19(6):317-26. doi: 10.1016/j.jnn.2013.01.008.
  30. Khajeh M, Dehghan-Nayeri N, Bahramnezhad F, Sadat Hoseini AS. Family centered care of hospitalized children: a hybrid concept analysis in Iran. Health Promot Perspect. 2017;7(4):210-5. doi: 10.15171/hpp.2017.37.
  31. Shamsi A, Azizzadeh Forouzi M, Iranmanesh S. Psychosocial risks among parents of children with cancer. J Pediatr Nurs. 2016;2(3):44-55. [Persian].
  32. Mehdizadeh S, Abbasi S, Payami Bousari B. Nursing support and premature s infants in neonatal intensive care units: the views of mothers. Payesh. 2017;16(2):231-8. [Persian].
  33. Zakerimoghadam M, Ghiasvandian S, Salahshoor P, Kazemnezhad A. The effect of supportive nursing program on depression, anxiety and stress of family members of patients during coronary artery bypass graft (CABG) surgery. Iran J Cardiovasc Nurs. 2014;3(1):50-8. [Persian].
  34. Kaur B. Interpersonal communications in nursing practice-key to quality health care. Arch Nurs Pract Care. 2020;6(1):19-22. doi: 10.17352/2581-4265.000044.
  35. Nobahar M. Professional communication among nurses, patients, and physicians in intensive cardiac care units: a content analysis. J Qual Res Health Sci. 2020;4(3):351-62. [Persian].
  36. Salmani N, Abbaszadeh A, Rassouli M, Hasanvand S. Exploring the experiences of parents of hospitalized children regarding trust barriers to nursing care. J Qual Res Health Sci. 2020;4(4):385-94. [Persian].
  37. Salmani N, Abbaszadeh A, Rassouli M. Factors creating trust in hospitalized children’s mothers towards nurses. Iran J Pediatr. 2014;24(6):729-38.
  38. Salmani N, Dabirifard M, Maghsoudi Z, Dabirifard A, Karjo Z. Comparing perception of nurse-mother communication between neonatal intensive care nurses and mothers of hospitalized neonates. Hayat. 2016;22(3):291-9. [Persian].
  39. Cheraghi F, Sanahmadi A, Soltanian A, Sadeghi A. The survey of nurses’ communication skills with mothers and hospitalized children during nursing cares in children wards. Avicenna J Nurs Midwifery Care. 2016;24(3):193-200. doi: 10.21859/nmj-24037. [Persian].
  40. Sepehri Nia M, Rassouli M, Alaee Karahroudi F, Zayeri F, Zagheri Tafreshi M. Comparing perception of nurse - mother communication between nurses and mothers’ hospitalized children. Quarterly Journal of Nersing Management. 2013;2(3):52-9. [Persian].
  41. See MTA, Chee S, Rajaram R, Kowitlawakul Y, Liaw SY. Missed nursing care in patient education: a qualitative study of different levels of nurses’ perspectives. J Nurs Manag. 2020;28(8):1960-7. doi: 10.1111/jonm.12983.
  42. Goh ML, Ang EN, Chan YH, He HG, Vehviläinen-Julkunen K. Patient satisfaction is linked to nursing workload in a Singapore hospital. Clin Nurs Res. 2018;27(6):692-713. doi: 10.1177/1054773817708933.
  43. Qureshi SM, Purdy N, Mohani A, Neumann WP. Predicting the effect of nurse-patient ratio on nurse workload and care quality using discrete event simulation. J Nurs Manag. 2019;27(5):971-80. doi: 10.1111/jonm.12757.
  44. Moreno-Monsiváis MG, Moreno-Rodríguez C, Interial- Guzmán MG. Missed nursing care in hospitalized patients. Aquichan. 2015;15(3):318-28. doi: 10.5294/aqui.2015.15.3.2.
  45. Pater CM, Sosa TK, Boyer J, Cable R, Egan M, Knilans TK, et al. Time series evaluation of improvement interventions to reduce alarm notifications in a paediatric hospital. BMJ Qual Saf. 2020;29(9):717-26. doi: 10.1136/bmjqs-2019-010368.
  46. Huynh N, Snyder R, Vidal JM, Sharif O, Cai B, Parsons B, et al. Assessment of the nurse medication administration workflow process. J Healthc Eng. 2016;2016:6823185. doi: 10.1155/2016/6823185.
  47. Ausserhofer D, Schubert M, Desmedt M, Blegen MA, De Geest S, Schwendimann R. The association of patient safety climate and nurse-related organizational factors with selected patient outcomes: a cross-sectional survey. Int J Nurs Stud. 2013;50(2):240-52. doi: 10.1016/j.ijnurstu.2012.04.007.
  48. Maloney S, Fencl JL, Hardin SR. Is nursing care missed? A comparative study of three North Carolina hospitals. Medsurg Nurs. 2015;24(4):229-35.
  49. Jones TL, Schlegel C. Can real time location system technology (RTLS) provide useful estimates of time use by nursing personnel? Res Nurs Health. 2014;37(1):75-84. doi: 10.1002/nur.21578.
  50. Dehghan-Nayeri N, Shali M, Navabi N, Ghaffari F. Perspectives of oncology unit nurse managers on missed nursing care: a qualitative study. Asia Pac J Oncol Nurs. 2018;5(3):327-36. doi: 10.4103/apjon.apjon_6_18.
  51. Phelan A, McCarthy S, Adams E. Examining the context of community nursing in Ireland and the impact of missed care. Br J Community Nurs. 2018;23(1):34-40. doi: 10.12968/ bjcn.2018.23.1.34.
  52. Bundgaard K, Sørensen EE, Delmar C. TIME - MAKING THE BEST OF IT! A fieldwork study outlining time in endoscopy facilities for short-term stay. Open Nurs J. 2016;10:15-25. doi: 10.2174/1874434601610010015.
  53. Chan EA, Jones A, Wong K. The relationships between communication, care and time are intertwined: a narrative inquiry exploring the impact of time on registered nurses’ work. J Adv Nurs. 2013;69(9):2020-9. doi: 10.1111/jan.12064.
  54. Protzko J, Zedelius CM, Schooler JW. Rushing to appear virtuous: time pressure increases socially desirable responding. Psychol Sci. 2019;30(11):1584-91. doi: 10.1177/0956797619867939.
  55. Nelson ST, Flynn L. Relationship between missed care and urinary tract infections in nursing homes. Geriatr Nurs. 2015;36(2):126-30. doi: 10.1016/j.gerinurse.2014.12.009.
  56. Blackman I, Papastavrou E, Palese A, Vryonides S, Henderson J, Willis E. Predicting variations to missed nursing care: a three-nation comparison. J Nurs Manag. 2018;26(1):33-41. doi: 10.1111/jonm.12514.
  57. Dehghan-Nayeri N, Ghaffari F, Shali M. Exploring Iranian nurses’ experiences of missed nursing care: a qualitative study: a threat to patient and nurses’ health. Med J Islam Repub Iran. 2015;29:276.
  58. Hübner U, Przysucha M. Patient handovers - cognitively demanding: does the handover EHR meet this challenge? Stud Health Technol Inform. 2017;245:1302.
  59. Saunders A. Standardizing handoff decreases episodes of missed care. Respir Care. 2018;63(Suppl 10):3005678.
  60. Wieczorek CC, Nowak P, Frampton SB, Pelikan JM. Strengthening patient and family engagement in healthcare - The New Haven Recommendations. Patient Educ Couns. 2018;101(8):1508-13. doi: 10.1016/j.pec.2018.04.003.
  61. Curtis P, Northcott A. The impact of single and shared rooms on family-centred care in children’s hospitals. J Clin Nurs. 2017;26(11-12):1584-96. doi: 10.1111/jocn.13485.
  62. de Oliveira Pinheiro de Melo EM, Ferreira PL, de Lima RA, de Mello DF. The involvement of parents in the healthcare provided to hospitalzed children. Rev Lat Am Enfermagem. 2014;22(3):432-9. doi: 10.1590/0104-1169.3308.2434.
  63. Bragadóttir H, Kalisch BJ, Tryggvadóttir GB. Correlates and predictors of missed nursing care in hospitals. J Clin Nurs. 2017;26(11-12):1524-34. doi: 10.1111/jocn.13449.
  64. Al Muharraq EH, Alallah SM, Alkhayrat SA, Jahlan AG. An overview of missed nursing care and its predictors in Saudi Arabia: a cross-sectional study. Nurs Res Pract. 2022;2022:4971890. doi: 10.1155/2022/4971890.
  65. Purabdollah M, Mokhtari M, Moghadam Tabrizi F, Khorami Markani A, Emami S. Correlation of Nurses’ Social Responsibility with the Missed Nursing Care. Health Educ Health Promot. 2022;10(4):763-9.
  66. Borzou SR, Anoosheh M, Mohammadi E, Kazemnejad A. Exploring perception and experience of patients from nursing care behaviors for providing comfort during hemodialysis. J Qual Res Health Sci. 2020;3(1):1-13. [Persian].
  67. Srulovici E, Drach-Zahavy A. Nurses’ personal and ward accountability and missed nursing care: a cross-sectional study. Int J Nurs Stud. 2017;75:163-71. doi: 10.1016/j. ijnurstu.2017.08.003.
  68. Lake ET, Staiger D, Edwards EM, Smith JG, Rogowski JA. Nursing care disparities in neonatal intensive care units. Health Serv Res. 2018;53(Suppl 1):3007-26. doi: 10.1111/1475-6773.12762.
  69. Carthon JM, Lasater KB, Sloane DM, Kutney-Lee A. The quality of hospital work environments and missed nursing care is linked to heart failure readmissions: a cross-sectional study of US hospitals. BMJ Qual Saf. 2015;24(4):255-63. doi: 10.1136/bmjqs-2014-003346.
  70. Plevová I, Zeleníková R, Jarošová D, Janíková E. The relationship between nurse’s job satisfaction and missed nursing care. Med Pr. 2021;72(3):231-7. doi: 10.13075/ mp.5893.01035.
  71. Kalisch BJ, Xie B, Dabney BW. Patient-reported missed nursing care correlated with adverse events. Am J Med Qual. 2014;29(5):415-22. doi: 10.1177/1062860613501715.
  72. Suhonen R, Stolt M, Habermann M, Hjaltadottir I, Vryonides S, Tonnessen S, et al. Ethical elements in priority setting in nursing care: a scoping review. Int J Nurs Stud. 2018;88:25- 42. doi: 10.1016/j.ijnurstu.2018.08.006.