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Critique of Missed Nursing Care: A Qualitative Study April 03, 2011

Critique of Missed Nursing Care, A Qualitative Study Introduction and Purpose Delivering the highest quality care to patients is one of the most important aspects of nursing. There are many reasons nursing care may be missed. Nine areas of frequently missed nursing care were identified and studied in the research article from the Journal of Nursing Care Quality titled Missed nursing care: a qualitative study (Kalisch, 2006). The purpose of this study was clearly stated in the abstract of the article. The purpose was to determine nursing care regularly missed on medical-surgical units and reasons for missed care (Kalisch, 2006, p. 306). Along with the nine areas of missed nursing care, this study also identified seven common reasons for missed care. This study set out to answer the following two research questions: 1. What nursing care is regularly missed on medical-surgical units in acute care hospitals? and 2. What are the reasons nursing staff give for not completing theses particular aspects of care? (Kalisch, 2006, p. 306). The research from this study can be used by nurses and managers to improve the quality of care and patient outcomes. If reasons for missed care can be identified and avoided, then patient outcomes will improve due to higher quality nursing care. Review of the Literature The researcher cited findings from several other studies in the introduction that show the relationship between the staffing level of nurses and patient mortality, falls, infection, length of hospitalization, skin breakdown, post-op complications, satisfaction scores, and other adverse events. The author clearly states that a literature review identified there were no research studies that showed specific areas where nursing care is missed and the reasons why. The author cites other research studies to clarify the impact of the missed areas of nursing care on patient

outcomes. She greatly strengthened her study by including the already proven impacts of missed nursing care from studies previously performed. Study Design The research study is a qualitative study that applied the grounded theory. According to Polit & Beck, 2010, in grounded theory, both the research problem and the process used to resolve it are discovered during the study (p. 270). The researcher in this study clearly was seeking to point out areas of missed nursing care but she also sought to identify reasons why the care was missed in an effort to resolve the problem. Methods The researcher used focus group interviews to collect data for this study. There were 25 focus groups. One advantage of using the group format is that a large amount of data is generated in a short amount of time (Polit & Beck, 2010). The focus groups were divided based on job title. For example, the registered nurses (RNs) were all grouped together, the licensed practical nurses (LPNs) were all together and the nursing assistants (NAs) were all together. The focus group interviews were audio recorded by tape then transcribed. The interview transcripts were initially reviewed by a research associate and then individually by the author. Sampling The author chose to interview nursing staff on medical-surgical units in two hospital facilities. This population was chosen because they are the subject of the research question for this study. The focus groups were comprised of a total of 107 RNs, 15 LPNs and 51 NAs. There was a total of 25 focus groups and they were divided by job title. This meant that focus groups only contained members of the same job title. The authors reasoning for this was to maximize communication within the groups. There was no discussion within the research article

of informed consent by participants. The author discusses confidentiality commitments by participants so there would be no discussion of comments made within the discussion group outside of the interview. This was done to encourage participants to be honest and give full disclosure of information within the focus group interviews. This study was based on grounded theory, therefore the data collection, data analysis and sampling of participants occurs simultaneously (Polit & Beck, 2010, p. 270). After analysis showed the same themes generated from the first and second analyses there was no further sampling required. Data Collection The author used a semi-structured design for the focus group interviews. The focus groups were 90 to 120 minutes and only members with the same job title were in the group. The researcher made it known that she believed that if the focus groups included members of differing job titles then members would be reluctant to openly respond to the research questions. Data Analysis The focus group interviews were audio recorded then transcribed. The transcripts were analyzed by a research associate. Then the author analyzed the interviews independently using a qualitative analysis software called NVivo. She applied the grounded theory by which empirical data are thematically categorized by induction (Kalisch, 2006, p. 307). The same issues appeared as themes from both first and second analyses which served as confirmation of grounding. The data analysis process was not described adequately enough within the research paper. There could have been a little more elaboration on the process and the steps taken to establish trust in the data. Conclusions

The results of this study indicated that nine areas of nursing care that are routinely missed are ambulation, turning, delayed or missing feedings, patient education, discharge planning, emotional support, hygiene, intake and output documentation, and surveillance. Each of these areas of missed nursing care may play a role in detrimental patient outcomes. The study also identified seven reasons for missing care as follows: too few staff, length of intervention time, poor use of resources, its not my job syndrome, ineffective delegation, bad habits, and denial (Kalisch, 2006). The author did an excellent job linking missed nursing care to poor patient outcomes and supported her arguments with other research articles. The results of this study can be used by nurses and managers alike to decrease the occurrence of missed nursing care. By identifying the areas to blame for missed care and working to eliminate them units will improve the care delivered to patients and patient outcomes. There were also several operational problems that once addressed nurses will be able to have additional time to spend with patients providing the care that is often missed. Future research should be done to validate the findings of this research because it was only performed in two hospital facilities. There is a need for the data generated from this study to be quantitatively studied. This would require a way to measure the occurrence of missed care and reasons why the care is missed. A good study would be to quantify the relationship between understaffing and missed care.

References Kalisch, B. J. (2006). Missed nursing care: a qualitative study. Journal of Nursing Care Quality, 21(4), 306-315. Polit, D. F., & Beck, C. T. (2010). Essentials of nursing research Appraising evidence for nursing practice (7th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.