Factors influencing missed nursing care for older people following fragility hip fracture

BackgroundOlder people suffering fragility hip fractures are among the most fragile and vulnerable hospital patients. They often have complex care needs due to pre-existing and chronic conditions which may exacerbate as a consequence of surgery and hospitalisation. When deviations from best practice occur, care can be missed.AimTo identify factors that influence missed care for the older person with a hip fracture; inform recommendations for change and highlight the need for further research to achieve best practice nursing care for older people following a fragility hip fracture.MethodsA scoping review was conducted using databases Cumulative Index to Nursing and Allied Health Literature, Medline and Scopus, using a combination of keywords.FindingsTwenty-two relevant papers published between 2010-2018 were identified illustrating areas where nursing care was missed for either patients with hip fractures, older patients or both.DiscussionThis paper has reviewed literature related to nursing care for older people following a hip fracture to determine what nursing care may be missed; why it is missed and to identify strategies to improve outcomes through reducing the impact of missed nursing care for this population. Existing missed care literature usually focusses upon structural and organisational issues to the detriment of other factors.ConclusionMissed nursing care for the hospitalised older person with a hip fracture can be organised under three broad themes: organisational factors, nurse and patient characteristics.     

Predicting variations to missed nursing care: A three‐nation comparison

Aims

To measure and model Australian, Cypriot and Italian nurses’ beliefs about what care is missed and how frequently it occurs within their settings.

Background

This study expands on previous MISSCARE research but now applies and predicts missed care within three countries.

Methods

Multivariate analysis was performed to estimate 1,896 nurses’ consensus scores about missed care activities based on Alfaro‐Lefevre's conceptual framework of care priorities.

Results

Five latent variables have direct predictor effects on missed care frequencies. Another four variables including the nurses’ age, highest qualifications, absenteeism rate and workplace type, contributed to explaining the overall variance of missed care scores. The nurses’ gender had no influence on missed care.

Conclusion

Cross country comparisons of missed nursing care allow for a more refined identification of strategies for remediation for both managers and clinicians.

Implications for Nursing Management

Reliable consensus estimates about the types and frequencies of missed care can be scaled with variables identified to predict missed care across three different countries. Comparative international studies build on the foundations for understanding missed care in terms of nursing practices, policies and related social policies.     

Agonizing care: care ethics,agonistic feminism and a political theory of care

'Care' is central to nursing theory and practice, and has been described in a variety of ways. Intense conversations about care have been developing in other fields of study as well, from the social sciences to the humanities. Care ethics has grown out of intellectual exchange between feminist thought, moral theory and the critique of traditional western political philosophy. However, care ethics is not without its critics, as these accounts of care have also sparked vigorous challenges. This paper traces the construct of care through nursing theory, care ethics, feminist critiques of moral and political theory and agonistic feminism to outline a set of problematics that a political theory of care should engage. It discusses how care is conventionally posited in more or less essentialist, universalizing and naturalizing terms. It introduces the ideas of feminist theorists who resist dichotomizing care and the political, and situate care in the context of power and politics. The tensions between care feminism and agonistic feminism are highlighted in order to explore the potential of theorizing both care and nursing in political terms.     

Missed nursing care: a concept analysis

Title.  Missed nursing care: a concept analysis.
Aim.  This paper is a report of the analysis of the concept of missed nursing care.
Background.  According to patient safety literature, missed nursing care is an error of omission. This concept has been conspicuously absent in quality and patient safety literature, with individual aspects of nursing care left undone given only occasional mention.
Method.  An 8-step method of concept analysis – select concept, determine purpose, identify uses, define attributes, identify model case, describe related and contrary cases, identify antecedents and consequences and define empirical referents – was used to examine the concept of missed nursing care. The sources for the analysis were identified by systematic searches of the World Wide Web, MEDLINE, CINAHL and reference lists of related journal articles with a timeline of 1970 to April 2008.
Findings.  Missed nursing care, conceptualized within the Missed Nursing Care Model, is defined as any aspect of required patient care that is omitted (either in part or in whole) or delayed. Various attribute categories reported by nurses in acute care settings contribute to missed nursing care: (1) antecedents that catalyse the need for a decision about priorities; (2) elements of the nursing process and (3) internal perceptions and values of the nurse. Multiple elements in the nursing environment and internal to nurses influence whether needed nursing care is provided.
Conclusion.  Missed care as conceptualized within the Missed Care Model is a universal phenomenon. The concept is expected to occur across all cultures and countries, thus being international in scope.     

Missed nursing care as an ‘art form’: The contradictions of nurses as carers

This article draws on the free‐text commentaries from trans‐Tasman studies that used the MISSCARE questionnaire to explore the reasons why nurses miss care. In this paper, we examine the idea that nurses perpetuate a self‐effacing approach to care, at the expense of patient care and professional accountability, using what they describe as the art of nursing to frame their claims of both nursing care and missed nursing care. We use historical dialogue alongside a paradigmatic analysis to examine why nurses allow themselves to continue working within settings that put their professional/personal selves aside in an attempt to deliver care within constraints that make completing care an impossible task. The findings suggest an ambivalence and conflict confront nurses attempting to provide care within the New Public Management environment. This can be seen in the tensions that draw a line between care as an art, and care as a financial target, juxtaposed with the inherent clash of values arising from the way nursing care is conceptualised within two contradictory paradigms.