| 1. |
- Amritzer, Maria, et al.
(author)
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A new perspective of missed nursing care – the emergency department context: a descriptive, cross-sectional study
- 2024
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In: Journal of Emergency Nursing. - 0099-1767 .- 1527-2966. ; 50:3, s. 392-402
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Journal article (peer-reviewed)abstract
- Introduction: This descriptive cross-sectional study describes missed nursing care, quality of care, and patient safety rated by nursing staff in emergency departments. Required patient care that is omitted or delayed (missed nursing care) is associated with poorer quality of care and increased risk for adverse events, but studies are scarce in the emergency setting. Methods: Emergency registered nurses and nursing assistants (N=126) at 2 Swedish emergency departments participated in the study. The MISSCARE survey -Swedish version was used for data collection. Results: Emergency nursing staff assessed that nursing care is frequently missed in the emergency department. More than half of the 24 nursing care items were reported as missed by over 50% of the participants, and registered nurses rated most items significantly higher compared to nursing assistants. Half of the nursing staff perceived quality of care to be good, but nearly the same proportion perceived patient safety as poor. Registered nurses viewed both quality and safety worse than nursing assistants. Discussion: The present study found very high levels of missed nursing care in most nursing items. Results indicate that nursing staff in emergency departments need to prioritize between the tasks and that some tasks may not be relevant in the context. The emergency setting focuses primarily on identifying signs of urgency, assessing patients, performing interventions, and diagnostics. However, even items that seemed to be prioritized, such as reassessment of vital signs, had a surprisingly high level of missed nursing care in comparison to in -hospital wards.
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| 2. |
- Falk, Ann-Charlotte, et al.
(author)
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Missed nursing care in relation to registered nurses' level of education and self-reported evidence-based practice
- 2023
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In: Worldviews on Evidence-Based Nursing. - 1545-102X .- 1741-6787. ; 20:6, s. 550-558
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Journal article (peer-reviewed)abstract
- BACKGROUND: Patient safety is one of the cornerstones of high-quality healthcare systems. Evidence-based practice is one way to improve patient safety from the nursing perspective. Another aspect of care that directly influences patient safety is missed nursing care. However, research on possible associations between evidence-based practice and missed nursing care is lacking.AIM: The aim of this study was to examine associations between registered nurses' educational level, the capability beliefs and use of evidence-based practice, and missed nursing care.METHODS: This study had a cross-sectional design. A total of 228 registered nurses from adult inpatient wards at a university hospital participated. Data were collected with the MISSCARE Survey-Swedish version of Evidence-Based Practice Capabilities Beliefs Scale.RESULTS: Most missed nursing care was reported within the subscales Basic Care and Planning. Nurses holding a higher educational level and being low evidence-based practice users reported significantly more missed nursing care. They also scored significantly higher on the Evidence-based Practice Capabilities Beliefs Scale. The analyses showed a limited explanation of the variance of missed nursing care and revealed that being a high user of evidence-based practice indicated less reported missed nursing care, while a higher educational level meant more reported missed nursing care.LINKING EVIDENCE TO ACTION: Most missed nursing care was reported within the subscales Planning and Basic Care. Thus, nursing activities are deprioritized in comparison to medical activities. Nurses holding a higher education reported more missed nursing care, indicating that higher education entails deeper knowledge of the consequences when rationing nursing care. They also reported varied use of evidence-based practice, showing that higher education is not the only factor that matters. To decrease missed nursing care in clinical practice, and thereby increase the quality of care, educational level, use of evidence-based practice, and organizational factors must be considered.
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| 3. |
- Falk, Ann-Charlotte, et al.
(author)
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Missed nursing care in the critical care unit, before and during the COVID-19 pandemic : A comparative cross-sectional study
- 2022
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In: Intensive & Critical Care Nursing. - : Elsevier BV. - 0964-3397 .- 1532-4036. ; 72
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Journal article (peer-reviewed)abstract
- OBJECTIVES: Todescribe and evaluate reported missed nursing care in the critical care context during different phases of the COVID-19 pandemic in Sweden.RESEARCH METHODOLOGY: A comparative cross-sectional design was used, comparing missed nursing care in three samples: before the COVID-19 pandemic in 2019, during the second wave of the pandemic in spring 2020, and during the third wave of the pandemic in fall 2021.SETTING: The study was conducted at critical care units at a university hospital, Sweden.MAIN OUTCOME MEASURES: The MISSCARE Survey-Swedish version was used to collect data along with two study-specific questions concerning perception of patient safety and quality of care.RESULTS: Significantly more overtime hours and number of days absent due to illness were reported during the pandemic. The nurse/patient ratio was above the recommended level at all data collection time points. Most missed nursing care was reported in items concerning basic care. The most reported reasons for missed nursing care in all samples concerned inadequate staffing, urgent situations, and a rise in patient volume. Most nurses in all samples perceived the level of patient safety and quality of care as good, and the majority had no intention to leave their current position.CONCLUSION: The pandemic had a great impact on the critical care workforce but few elements of missed nursing care were affected. To measure and use missed nursing care as a quality indicator could be valuable for nursing managers, to inform them and improve their ability to meet changes in patient needs with different workforce approaches in critical care settings.
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| 4. |
- Granström, Johanna, et al.
(author)
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Perceptions of delay when afflicted by an acute myocardial infarction during the first wave of the COVID-19 pandemic
- 2023
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In: European Journal of Cardiovascular Nursing. - : Oxford University Press (OUP). - 1474-5151 .- 1873-1953. ; 22:1, s. 89-97
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Journal article (peer-reviewed)abstract
- AIMS: To describe the perceptions of delay in medical care-seeking, when afflicted by an acute myocardial infarction (AMI) during the first wave of the pandemic.METHODS AND RESULTS: A qualitative descriptive study with an inductive approach. Fourteen semi-structured interviews were conducted, analysed by qualitative content analysis with a manifest approach. One category and six sub-categories emerged. The decision was reached when the health threat was perceived as critical, which made the earlier thoughts of the pandemic fade away. The risk of infection during medical visits caused fear of contracting the disease. This resulted in hesitation, neglect of symptoms, and avoidance of healthcare visits. Following recommendations from authorities and media about personal responsibility was motivated by fear, affecting the care-seeking.CONCLUSION: It appears that the COVID-19 pandemic raised the threshold for deciding to seek medical care when presenting with an AMI. The pandemic led to increased patient delay due to several reasons among which fear of contracting the disease was prominent. The emotion of fear was related to the external threat to one's own health, due to COVID-19, and not fear of symptoms related to an AMI. The media reporting the healthcare system as overloaded increased insecurity and may have had an influence on delay.
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| 5. |
- Nymark, Carolin
(author)
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Afflicted by an acute myocardial infarction : patients' thoughts, feelings and actions prior to care-seeking
- 2015
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Doctoral thesis (other academic/artistic)abstract
- Introduction: Acute myocardial infarction (AMI) is the most prevalent cause of death in Europe. The primary aim of early medical contact when afflicted by an AMI is to be able to treat fatal arrhythmias and to save heart muscle and thereby decreasing morbidity and mortality. In Sweden, the delay from symptom onset to medical treatment has decreased over time, with a currant median delay time of 170 min. This means that almost half of the patients have a longer delay than three hours. Huge efforts to improve pre-hospital care have been performed. However, the initial patient delay seems hard to counteract. Aim: The overall aim of this thesis was to increase the knowledge of patients’ behavioural responses that may influence the decision to seek medical care when afflicted by an acute myocardial infarction. Methods: Studies I and II have a qualitative design using focus group discussions and semi-structured individual interviews respectively as data collection methods. The analysis of the group discussion data was conducted using a theoretical model – the Self-Regulatory Model of illness behaviour. The interview data was analysed using qualitative content analysis. Study III had a cross-sectional design with development and psychometric testing of the Patients’ Appraisal, emotions and action tendencies (PA-AMI) questionnaire. The questionnaire was validated using exploratory factor analysis and principal component analysis. Study IV had a cross-sectional design using the developed questionnaire (PA-AMI) as data collection method. The impact of the subscales and individual items on patient delay was analysed by Projection to Latent Structures (PLS) regression. Results: Study I showed that patients had difficulty in clarifying the exact time point of symptom onset. A pertinent shift in appraisal was identified, the turning point, when the patients change from self-regulative illness behaviour to care-seeking. This shift seems to be affected by several partly contradictory influences and it takes a considerable time for the patients to reach this point. Study II showed that patients’ emotional reactions are important and may influence the patients’ pre-hospital behaviour. Study III showed satisfactory psychometric properties of the PA-AMI questionnaire. Three core dimensions emerged: ‘symptom appraisal’, ‘perceived inability to act’ and ‘autonomy preservation’. In study IV, the subscales ‘symptom appraisal’ and ‘perceived inability to act’ and their items had a major influence on patient delay. Conclusions: The thesis contributes with knowledge on the influence of patients’ appraisal of symptoms and behavioural responses on patient delay when afflicted by an AMI. It is important that this knowledge should be used in the primary and secondary prevention of patients with risk for, or an already manifest coronary heart disease. An altering in patients’ behavioural response when afflicted by an AMI should have a great potential to reduce patient delay and thereby reduce heart muscle loss and mortality.
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| 6. |
- Nymark, Carolin, et al.
(author)
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Development and validation of an instrument to assess patients' appraisal, emotions and action tendencies preceding care-seeking in acute myocardial infarction : The PA-AMI questionnaire.
- 2017
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In: European Journal of Cardiovascular Nursing. - : Oxford University Press. - 1474-5151 .- 1873-1953. ; 16:3, s. 240-248
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Journal article (peer-reviewed)abstract
- BACKGROUND: Reducing patient delay for patients afflicted by an acute myocardial infarction is a task of great complexity, which might be alleviated if more factors that influence this delay could be identified. Although a number of self-reported instruments associated with patient delay exist, none of these taps the content of the appraisal process related to patients' subjective emotions.AIM: The aim of this study was to develop and validate a questionnaire aimed at assessing patients' appraisal, emotions and action tendencies when afflicted by an acute myocardial infarction.METHODS: An item pool was generated based on themes conceptualized in a recent qualitative study of acute myocardial infarction patients' thoughts, feelings and actions preceding the decision to seek medical care. The 'Think-Aloud Protocol' and test-retest analysis at item level were performed. The modified item pool was administered to 96 patients when treated for acute myocardial infarction. Explorative factor analysis and principal component analysis with the non-linear iterative partial least squares algorithm were performed to examine the underlying factor structure of the items.RESULTS: The findings indicated three core dimensions corresponding to three subscales, namely, 'symptom appraisal'; 'perceived inability to act'; 'autonomy preservation'. The results demonstrated acceptable measures of reliability and validity CONCLUSIONS: The PA-AMI questionnaire demonstrated satisfactory psychometric properties. Assessment of the included core dimensions may contribute to greater understanding of the appraisal processes for patients afflicted by an acute myocardial infarction.
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| 7. |
- Nymark, Carolin, et al.
(author)
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Differences between registered nurses and nurse assistants around missed nursing care : An observational, comparative study
- 2023
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In: Scandinavian Journal of Caring Sciences. - 0283-9318 .- 1471-6712. ; 37:4, s. 1028-1037
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Journal article (peer-reviewed)abstract
- BACKGROUND: From a nursing perspective, tasks that are not carried out, and the consequences of this, have been studied for over a decade. The difference between Registered Nurses (RNs) and nurse assistants (NAs) regarding qualifications and work tasks, and the profound knowledge around RN-to-patient ratios, warrants investigating missed nursing care (MNC) for each group rather than as one (nursing staff).AIM: To describe and compare RNs and NAs ratings of and reasons for MNC at in-hospital wards.METHODS: A cross-sectional study with a comparative approach. RNs and NAs at in-hospital medical and surgical wards for adults were invited to answer the MISSCARE Survey-Swedish version, including questions on patient safety and quality of care.RESULTS: A total of 205 RNs and 219 NAs answered the questionnaire. Quality of care and patient safety was rated as good by both RNs and NAs. Compared to NAs, RNs reported more MNC, for example, in the item 'Turning patient every 2 h' (p < 0.001), 'Ambulation three times per day or as ordered' (p = 0.018), and 'Mouth care' (p < 0.001). NAs reported more MNC in the items 'Medications administered within 30 min before or after scheduled time' (p = 0.005), and 'Patient medication requests acted on within 15 min' (p < 0.001). No significant differences were found between the samples concerning reasons for MNC.CONCLUSION: This study demonstrated that RNs' and NAs' ratings of MNC to a large extent differed between the groups. RNs and NAs should be viewed as separate groups based on their different knowledge levels and roles when caring for patients. Thus, viewing all nursing staff as a homogenous group in MNC research may mask important differences between the groups. These differences are important to address when taking actions to reduce MNC in the clinical setting.
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| 8. |
- Nymark, Carolin, et al.
(author)
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Inability to act was associated with an extended delay prior to care-seeking, in patients with an acute myocardial infarction
- 2019
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In: European Journal of Cardiovascular Nursing. - : Oxford University Press. - 1474-5151 .- 1873-1953. ; 18:6, s. 512-520
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Journal article (peer-reviewed)abstract
- BACKGROUND: The out-of-hospital mortality in patients with acute myocardial infarction remains unchanged in contrast to a decrease in inhospital mortality. Interventions aiming to shorten patient delay have been largely unsuccessful. A deeper understanding is apparently needed on patients' appraisal prior to care-seeking.AIM: To investigate whether appraisal processes influence patient delay, and if the questionnaire 'Patients' appraisal, emotions and action tendencies preceding care seeking in acute myocardial infarction' (PA-AMI) could discriminate between patients with prolonged care-seeking and those with a short delay.METHODS: A cross-sectional study including 326 acute myocardial infarction patients filling out the validated questionnaire PA-AMI. The impact of subscales on delay was analysed by projection to latent structures regression. Discrimination opportunities between patients with short and long delays were analysed by projection to latent structures discriminant analysis.RESULTS: The subscales 'perceived inability to act' and 'symptom appraisal' had a major impact on patient delay ( P<0.0001). 'Perceived inability to act' had its main influence in patients with a delay exceeding 12 hours, and 'symptom appraisal' had its main influence in patients with a delay shorter than one hour.CONCLUSION: Appraisal processes influence patient delay. Acute myocardial infarction patients with a prolonged delay were, besides a low perceived symptom severity and urgency to seek medical care, characterised by a perceived loss of control and ability to act. Therefore, future interventions aimed at decreasing delay should pay attention to appraisal processes, and perceived inability to act may be a sign of a health threat and therefore a signal to seek medical care.
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| 9. |
- Nymark, Carolin, et al.
(author)
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Patient safety, quality of care and missed nursing care at a cardiology department during the COVID-19 outbreak
- 2022
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In: Nursing Open. - : Wiley. - 2054-1058. ; 9:1, s. 385-393
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Journal article (peer-reviewed)abstract
- AIM: To evaluate missed nursing care and patient safety during the first wave of the COVID-19 pandemic at in-patient cardiology wards.DESIGN: A cross-sectional design with a comparative approach.METHOD: Registered nurses and nurse assistants at a cardiology department were invited to answer the MISSCARE Survey-Swedish version, and questions on patient safety and quality of care during the COVID-19 pandemic. The data were compared with a reference sample.RESULTS: A total of 43 registered nurses and nurse assistants in the COVID-19 sample and 59 in the reference sample participated. The COVID-19 sample reported significantly more overtime hours and more absence from work due to illness in comparison with the reference sample. The patient safety and quality of care were perceived significantly worse, 76.7% (N = 33) versus 94.7% (N = 54), and 85.7% (N = 36) versus 98.3% (N = 58, respectively. The COVID-19 sample reported more missed nursing care in wound care and in basic nursing.
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| 10. |
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