Low nurse staffing levels in hospitals have been linked to adverse patient outcomes, including mortality, but the causal link remains uncertain. It has been suggested that missed nursing care-that is, when care is omitted or delayed-can be an important indicator of the quality of hospital nursing care and may be the mechanism behind the link between low staffing levels and mortality rates.
Researchers conducted a systematic review to identify the nursing care tasks most often missed on acute hospitals' adult inpatient units and to determine the association between this missed care and nurse staffing levels. The review included studies exploring the association between nurse staffing levels and missed care, which was measured as scores or frequencies of nursing tasks, procedures, or aspects of care that were missed or substantially delayed, on acute care hospital units. All 18 studies that met the inclusion criteria, which included studies from the United States, Europe, Korea, and Kuwait, relied on recall and subjective judgment regarding missed care.
The authors' review of European studies revealed that between 75% of nurses in England and 93% of nurses in Germany reported some missed care, with an estimate of 88% in 12 European countries overall. Care classified as planning and communication was missed more often than clinical care, but the omission rates for the latter were still substantial. Fourteen studies showed a significant association between low nurse staffing levels and higher levels of missed care. Adding support workers generally didn't reduce the level of missed nursing care and may even have increased it.
None of the studies reviewed included any objective measure of care, and the authors noted that it isn't clear to what extent nursing reports of missed care correlate with actual omissions of care. They conclude that the incidence and prevalence of missed care may be indicators of the quality of care patients receive and that maintaining adequate staffing levels is one way of avoiding such missed care.-KR
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