Missed nursing care in a long-term rehabilitation setting: findings from a cross-sectional study

Background: There is a growing amount of literature that links missed nursing care (MNC) to negative patient outcomes, reduced patient safety and poor quality of care. However, only few studies have investigated this phenomenon in long-term rehabilitation settings. Aim: To explore MNC occurrence, type, reasons and predictors in three rehabilitation units. Design: A cross-sectional study was performed between August and September 2017. Method: 95 registered nurses and nursing assistants completed section A (interventions missed) and section B (perceived reasons for MNC) of the MISSCARE Survey tool. Descriptive, bivariate and linear regression analyses were performed. Findings: The top missed elements were patient ambulation (score 2.4 out of 5, Standard Deviation [SD] 0.8), mouth care (2.3, SD 0.8) and participation to multidisciplinary meetings (2.3, SD 1.1). Lack of personnel was the most frequent reason reported for MNC with a score of 2.9 out of 4 (SD 0.9). At the linear regression analysis, advanced nursing education (beta = 3.58, CI 95% 1.32-5.84) and inadequate handovers (beta = 3.64, CI 95% 0.37-6.91) both increased the perception of MNC occurrence. Conclusion: MNC occurrence in rehabilitation settings appears to be lower than in other contexts; however, the most commonly missed elements are similar to those reported in other settings. As good strategies to detect the difference between expected nursing care and the one delivered to patients, advanced education and good quality handovers seem beneficial. Further research is needed to establish more evidence on predictors by developing longitudinal study designs.

Automated summary

Missed nursing care in long-term rehabilitation settings is linked to negative patient outcomes. The most commonly missed elements include patient ambulation, mouth care, and participation in multidisciplinary meetings. Lack of personnel is a frequent reason for missed care. Advanced nursing education and good quality handovers are associated with increased perception of missed care occurrence. More research is needed to identify predictors of missed nursing care.