Evaluation of nurse-reported missed care in a post-anesthesia care unit: A mixed-methods study

IF 2.4 3区医学 Q1 NURSING Journal of Nursing Scholarship Pub Date : 2024-04-16 DOI:10.1111/jnu.12975

Laura Mun Tze Heng BSc, RN, Darshini Devi Rajasegeran BSc, RN, Siew Hoon Lim PhD, RN

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Abstract

Background

Nurse-reported missed care (NRMC) is considered as any significant delay or omission in provision of nursing care.

Aim

(i) Evaluate the frequency, types, and reasons for NRMC in the Post-anesthesia Care Unit (PACU). (ii) Evaluate associations between nurse demographic and workload factors with NRMC. (iii) Explore nurses' perception of NRMC in the PACU.

Methods

A cross-sectional study was conducted in the PACU in a tertiary acute care hospital over 3 months. Full-time PACU nurses were conveniently sampled to complete an anonymous survey after their daily shift over different shifts. It contained three sections: (i) nurse demographics; (ii) elements of NRMC; and (iii) reasons for NRMC. Qualitative interviews employed a semi-structured guide to explore perceptions and experiences of NRMC. Descriptive, inferential statistics, and thematic analyses were applied.

Results

Sixty-six survey responses were collected. 48.5% of respondents indicated at least one NRMC activity. Activities more clinically sensitive were less missed. Eight nurses were interviewed. Four main themes were identified: (i) communication with patients; (ii) communication and teamwork with colleagues; (iii) dual role of documentation; and (iv) staffing inadequacy. Language barriers made communication challenging. Staff shortage exacerbates workload but effective teamwork and documentation facilitates nursing care.

Conclusion

Communication and staffing concerns aggravate NRMC. Teamwork and personal contentment were satisfactory. Nurses' turnover intention may worsen staffing.

Clinical Relevance

Timeliness and quality of nursing care is impacted by elements such as manpower, allocation of resources, work processes, and workplace environmental or interpersonal factors such as culture and language fit. Re-evaluation of nursing resources and work processes may assist post-anesthesia care unit nurses in fulfilling their role, decreasing the prevalence of nurse-reported missed care.

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对麻醉后护理病房护士报告的遗漏护理进行评估：混合方法研究

背景护士报告的护理遗漏（NRMC）是指在提供护理服务时出现的任何重大延误或遗漏。目的(i) 评估麻醉后护理病房（PACU）中出现 NRMC 的频率、类型和原因。(ii) 评估护士人口统计和工作量因素与 NRMC 之间的关联。(iii) 探讨护士对 PACU 中 NRMC 的看法。方法：在一家三级急症护理医院的 PACU 中进行了为期 3 个月的横断面研究。研究人员方便地抽取了 PACU 的全职护士，让她们在每天轮班后填写一份匿名调查问卷。调查包括三个部分：(i) 护士人口统计；(ii) NRMC 要素；(iii) NRMC 原因。定性访谈采用了半结构化指南，以探讨对 NRMC 的看法和体验。结果共收集到 66 份调查回复。48.5% 的受访者表示至少参加过一次 NRMC 活动。临床敏感性较高的活动较少被错过。八名护士接受了访谈。确定了四大主题：(i) 与病人的沟通；(ii) 与同事的沟通和团队合作；(iii) 文件记录的双重作用；以及 (iv) 人手不足。语言障碍使沟通具有挑战性。人员短缺加剧了工作量，但有效的团队合作和文件记录有利于护理工作。团队合作和个人满意度令人满意。临床相关性护理服务的及时性和质量受到人力、资源分配、工作流程、工作环境或人际因素（如文化和语言适应性）等因素的影响。重新评估护理资源和工作流程可帮助麻醉后护理病房的护士履行其职责，减少护士报告的护理遗漏率。

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来源期刊

Journal of Nursing Scholarship 医学-护理

CiteScore

6.30

自引率

5.90%

发文量

审稿时长

6-12 weeks

期刊介绍： This widely read and respected journal features peer-reviewed, thought-provoking articles representing research by some of the world’s leading nurse researchers. Reaching health professionals, faculty and students in 103 countries, the Journal of Nursing Scholarship is focused on health of people throughout the world. It is the official journal of Sigma Theta Tau International and it reflects the society’s dedication to providing the tools necessary to improve nursing care around the world.