‘Care left undone’ during nursing shifts: associations with workload and perceived quality of care
Identifieur interne : 000327 ( Pmc/Curation ); précédent : 000326; suivant : 000328‘Care left undone’ during nursing shifts: associations with workload and perceived quality of care
Auteurs : Jane E. Ball [Royaume-Uni] ; Trevor Murrells [Royaume-Uni] ; Anne Marie Rafferty [Royaume-Uni] ; Elizabeth Morrow [Royaume-Uni] ; Peter Griffiths [Royaume-Uni]Source :
- BMJ Quality & Safety [ 2044-5415 ] ; 2013.
Abstract
There is strong evidence to show that lower nurse staffing levels in hospitals are associated with worse patient outcomes. One hypothesised mechanism is the omission of necessary nursing care caused by time pressure—‘missed care’.
To examine the nature and prevalence of care left undone by nurses in English National Health Service hospitals and to assess whether the number of missed care episodes is associated with nurse staffing levels and nurse ratings of the quality of nursing care and patient safety environment.
Cross-sectional survey of 2917 registered nurses working in 401 general medical/surgical wards in 46 general acute National Health Service hospitals in England.
Most nurses (86%) reported that one or more care activity had been left undone due to lack of time on their last shift. Most frequently left undone were: comforting or talking with patients (66%), educating patients (52%) and developing/updating nursing care plans (47%). The number of patients per registered nurse was significantly associated with the incidence of ‘missed care’ (p<0.001). A mean of 7.8 activities per shift were left undone on wards that are rated as ‘failing’ on patient safety, compared with 2.4 where patient safety was rated as ‘excellent’ (p <0. 001).
Nurses working in English hospitals report that care is frequently left undone. Care not being delivered may be the reason low nurse staffing levels adversely affects quality and safety. Hospitals could use a nurse-rated assessment of ‘missed care’ as an early warning measure to identify wards with inadequate nurse staffing.
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DOI: 10.1136/bmjqs-2012-001767
PubMed: 23898215
PubMed Central: 3913111
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">‘Care left undone’ during nursing shifts: associations with workload and perceived quality of care</title><author><name sortKey="Ball, Jane E" sort="Ball, Jane E" uniqKey="Ball J" first="Jane E" last="Ball">Jane E. Ball</name><affiliation wicri:level="1"><nlm:aff id="af1"><addr-line>National Nursing Research Unit</addr-line>,<institution>Florence Nightingale School of Nursing and Midwifery, King's College London</institution>,<addr-line>London</addr-line>,<country>UK</country></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Murrells, Trevor" sort="Murrells, Trevor" uniqKey="Murrells T" first="Trevor" last="Murrells">Trevor Murrells</name><affiliation wicri:level="1"><nlm:aff id="af1"><addr-line>National Nursing Research Unit</addr-line>,<institution>Florence Nightingale School of Nursing and Midwifery, King's College London</institution>,<addr-line>London</addr-line>,<country>UK</country></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Rafferty, Anne Marie" sort="Rafferty, Anne Marie" uniqKey="Rafferty A" first="Anne Marie" last="Rafferty">Anne Marie Rafferty</name><affiliation wicri:level="1"><nlm:aff id="af2"><institution>Florence Nightingale School of Nursing and Midwifery, King's College London</institution>,<addr-line>London</addr-line>,<country>UK</country></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Morrow, Elizabeth" sort="Morrow, Elizabeth" uniqKey="Morrow E" first="Elizabeth" last="Morrow">Elizabeth Morrow</name><affiliation wicri:level="1"><nlm:aff id="af1"><addr-line>National Nursing Research Unit</addr-line>,<institution>Florence Nightingale School of Nursing and Midwifery, King's College London</institution>,<addr-line>London</addr-line>,<country>UK</country></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Griffiths, Peter" sort="Griffiths, Peter" uniqKey="Griffiths P" first="Peter" last="Griffiths">Peter Griffiths</name><affiliation wicri:level="1"><nlm:aff id="af3"><addr-line>Faculty of Health Sciences</addr-line>,<institution>University of Southampton</institution>,<addr-line>London</addr-line>,<country>UK</country></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">23898215</idno><idno type="pmc">3913111</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3913111</idno><idno type="RBID">PMC:3913111</idno><idno type="doi">10.1136/bmjqs-2012-001767</idno><date when="2013">2013</date><idno type="wicri:Area/Pmc/Corpus">000327</idno><idno type="wicri:Area/Pmc/Curation">000327</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">‘Care left undone’ during nursing shifts: associations with workload and perceived quality of care</title><author><name sortKey="Ball, Jane E" sort="Ball, Jane E" uniqKey="Ball J" first="Jane E" last="Ball">Jane E. Ball</name><affiliation wicri:level="1"><nlm:aff id="af1"><addr-line>National Nursing Research Unit</addr-line>,<institution>Florence Nightingale School of Nursing and Midwifery, King's College London</institution>,<addr-line>London</addr-line>,<country>UK</country></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Murrells, Trevor" sort="Murrells, Trevor" uniqKey="Murrells T" first="Trevor" last="Murrells">Trevor Murrells</name><affiliation wicri:level="1"><nlm:aff id="af1"><addr-line>National Nursing Research Unit</addr-line>,<institution>Florence Nightingale School of Nursing and Midwifery, King's College London</institution>,<addr-line>London</addr-line>,<country>UK</country></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Rafferty, Anne Marie" sort="Rafferty, Anne Marie" uniqKey="Rafferty A" first="Anne Marie" last="Rafferty">Anne Marie Rafferty</name><affiliation wicri:level="1"><nlm:aff id="af2"><institution>Florence Nightingale School of Nursing and Midwifery, King's College London</institution>,<addr-line>London</addr-line>,<country>UK</country></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Morrow, Elizabeth" sort="Morrow, Elizabeth" uniqKey="Morrow E" first="Elizabeth" last="Morrow">Elizabeth Morrow</name><affiliation wicri:level="1"><nlm:aff id="af1"><addr-line>National Nursing Research Unit</addr-line>,<institution>Florence Nightingale School of Nursing and Midwifery, King's College London</institution>,<addr-line>London</addr-line>,<country>UK</country></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author><author><name sortKey="Griffiths, Peter" sort="Griffiths, Peter" uniqKey="Griffiths P" first="Peter" last="Griffiths">Peter Griffiths</name><affiliation wicri:level="1"><nlm:aff id="af3"><addr-line>Faculty of Health Sciences</addr-line>,<institution>University of Southampton</institution>,<addr-line>London</addr-line>,<country>UK</country></nlm:aff><country xml:lang="fr">Royaume-Uni</country><wicri:regionArea># see nlm:aff country strict</wicri:regionArea></affiliation></author></analytic><series><title level="j">BMJ Quality & Safety</title><idno type="ISSN">2044-5415</idno><idno type="eISSN">2044-5423</idno><imprint><date when="2013">2013</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>There is strong evidence to show that lower nurse staffing levels in hospitals are associated with worse patient outcomes. One hypothesised mechanism is the omission of necessary nursing care caused by time pressure—‘missed care’.</p></sec><sec><title>Aim</title><p>To examine the nature and prevalence of care left undone by nurses in English National Health Service hospitals and to assess whether the number of missed care episodes is associated with nurse staffing levels and nurse ratings of the quality of nursing care and patient safety environment.</p></sec><sec><title>Methods</title><p>Cross-sectional survey of 2917 registered nurses working in 401 general medical/surgical wards in 46 general acute National Health Service hospitals in England.</p></sec><sec><title>Results</title><p>Most nurses (86%) reported that one or more care activity had been left undone due to lack of time on their last shift. Most frequently left undone were: comforting or talking with patients (66%), educating patients (52%) and developing/updating nursing care plans (47%). The number of patients per registered nurse was significantly associated with the incidence of ‘missed care’ (p<0.001). A mean of 7.8 activities per shift were left undone on wards that are rated as ‘failing’ on patient safety, compared with 2.4 where patient safety was rated as ‘excellent’ (p <0. 001).</p></sec><sec><title>Conclusions</title><p>Nurses working in English hospitals report that care is frequently left undone. Care not being delivered may be the reason low nurse staffing levels adversely affects quality and safety. 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<front><journal-meta><journal-id journal-id-type="nlm-ta">BMJ Qual Saf</journal-id><journal-id journal-id-type="iso-abbrev">BMJ Qual Saf</journal-id><journal-id journal-id-type="hwp">qhc</journal-id><journal-id journal-id-type="publisher-id">bmjqs</journal-id><journal-title-group><journal-title>BMJ Quality & Safety</journal-title></journal-title-group><issn pub-type="ppub">2044-5415</issn><issn pub-type="epub">2044-5423</issn><publisher><publisher-name>BMJ Publishing Group</publisher-name><publisher-loc>BMA House, Tavistock Square, London, WC1H 9JR</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">23898215</article-id><article-id pub-id-type="pmc">3913111</article-id><article-id pub-id-type="publisher-id">bmjqs-2012-001767</article-id><article-id pub-id-type="doi">10.1136/bmjqs-2012-001767</article-id><article-categories><subj-group subj-group-type="hwp-journal-coll"><subject>1506</subject></subj-group><subj-group subj-group-type="heading"><subject>Original Research</subject></subj-group></article-categories><title-group><article-title>‘Care left undone’ during nursing shifts: associations with workload and perceived quality of care</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Ball</surname><given-names>Jane E</given-names></name><xref ref-type="aff" rid="af1">1</xref></contrib><contrib contrib-type="author"><name><surname>Murrells</surname><given-names>Trevor</given-names></name><xref ref-type="aff" rid="af1">1</xref></contrib><contrib contrib-type="author"><name><surname>Rafferty</surname><given-names>Anne Marie</given-names></name><xref ref-type="aff" rid="af2">2</xref></contrib><contrib contrib-type="author"><name><surname>Morrow</surname><given-names>Elizabeth</given-names></name><xref ref-type="aff" rid="af1">1</xref></contrib><contrib contrib-type="author"><name><surname>Griffiths</surname><given-names>Peter</given-names></name><xref ref-type="aff" rid="af3">3</xref></contrib></contrib-group><aff id="af1"><label>1</label><addr-line>National Nursing Research Unit</addr-line>,<institution>Florence Nightingale School of Nursing and Midwifery, King's College London</institution>,<addr-line>London</addr-line>,<country>UK</country></aff><aff id="af2"><label>2</label><institution>Florence Nightingale School of Nursing and Midwifery, King's College London</institution>,<addr-line>London</addr-line>,<country>UK</country></aff><aff id="af3"><label>3</label><addr-line>Faculty of Health Sciences</addr-line>,<institution>University of Southampton</institution>,<addr-line>London</addr-line>,<country>UK</country></aff><author-notes><corresp><label>Correspondence to</label> Jane E Ball, National Nursing Research Unit, Florence Nightingale School of Nursing and Midwifery, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, UK; <email>Jane.ball@kcl.ac.uk</email></corresp></author-notes><pub-date pub-type="ppub"><month>2</month><year>2014</year></pub-date><pub-date pub-type="epub"><day>29</day><month>7</month><year>2013</year></pub-date><volume>23</volume><issue>2</issue><fpage>116</fpage><lpage>125</lpage><history><date date-type="received"><day>18</day><month>12</month><year>2012</year></date><date date-type="rev-recd"><day>3</day><month>6</month><year>2013</year></date><date date-type="accepted"><day>6</day><month>6</month><year>2013</year></date></history><permissions><copyright-statement>Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions</copyright-statement><copyright-year>2014</copyright-year><license license-type="open-access"><license-p>This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: <ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by-nc/3.0/">http://creativecommons.org/licenses/by-nc/3.0/</ext-link></license-p></license></permissions><self-uri xlink:title="pdf" xlink:type="simple" xlink:href="bmjqs-2012-001767.pdf"></self-uri><related-article id="d35e179" related-article-type="companion" ext-link-type="doi" xlink:href="10.1136/bmjqs-2013-002489"></related-article><abstract><sec><title>Background</title><p>There is strong evidence to show that lower nurse staffing levels in hospitals are associated with worse patient outcomes. One hypothesised mechanism is the omission of necessary nursing care caused by time pressure—‘missed care’.</p></sec><sec><title>Aim</title><p>To examine the nature and prevalence of care left undone by nurses in English National Health Service hospitals and to assess whether the number of missed care episodes is associated with nurse staffing levels and nurse ratings of the quality of nursing care and patient safety environment.</p></sec><sec><title>Methods</title><p>Cross-sectional survey of 2917 registered nurses working in 401 general medical/surgical wards in 46 general acute National Health Service hospitals in England.</p></sec><sec><title>Results</title><p>Most nurses (86%) reported that one or more care activity had been left undone due to lack of time on their last shift. Most frequently left undone were: comforting or talking with patients (66%), educating patients (52%) and developing/updating nursing care plans (47%). The number of patients per registered nurse was significantly associated with the incidence of ‘missed care’ (p<0.001). A mean of 7.8 activities per shift were left undone on wards that are rated as ‘failing’ on patient safety, compared with 2.4 where patient safety was rated as ‘excellent’ (p <0. 001).</p></sec><sec><title>Conclusions</title><p>Nurses working in English hospitals report that care is frequently left undone. Care not being delivered may be the reason low nurse staffing levels adversely affects quality and safety. Hospitals could use a nurse-rated assessment of ‘missed care’ as an early warning measure to identify wards with inadequate nurse staffing.</p></sec></abstract><kwd-group><kwd>Nurses</kwd><kwd>Patient safety</kwd><kwd>Risk management</kwd><kwd>Health policy</kwd></kwd-group><custom-meta-group><custom-meta><meta-name>special-feature</meta-name><meta-value>unlocked</meta-value></custom-meta></custom-meta-group></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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