cover story
Missed Nursing Care and the Ramifications for Infection Prevention
By Kelly M . Pyrek
Editor ’ s note
This is part one of a two-part series on missed nursing care and ramifications for infection prevention .
Missed nursing care is often defined as care that is delayed , partially completed , or not completed at all . The phenomena of missed nursing care takes on new meaning during and after the pandemic , when healthcare personnel who were already stretched thin are struggling with burnout from too high a patient load and too few resources , and who are now taking it upon themselves to decide what care practices to leave undone . This problematic trend that jeopardizes patient safety has clear ramifications for infection prevention and control .
AHRQ ( 2019 ) says that missed nursing care is a subset of
the category known as error of omission and that it “ not only constitutes a form of medical error that may affect safety , but has been deemed to be a unique type of medical underuse .”
Prevalence of Missed Nursing Care
The scope of the problem is sweeping . For example , Jones , et al . ( 2015 ) reported that 98 percent of the nurses they interviewed admitted they often leave at least one of their tasks undone per shift . Consequently , as Lake , et al . ( 2016 ) note , “ Patients have poorer care experiences in hospitals where more nurses miss required nursing care .” Dabney and Kalisch ( 2015 ) emphasize that a high level of readmission can be the result of missed care .
In their review , Bragadottir , et al . ( 2016 ) found in some studies that the estimates of the frequency with which some care was left undone on the last nursing shift ranged from 75 percent in England to 93 percent in Germany , with an overall estimate of 88 percent across 12 European countries .
The researchers discovered that emotional and psychological support was reported as most often missed . For example , 41 percent of nurses in Switzerland identified this as a task that was sometimes or often withheld due to inadequate staffing . Comforting / talking to patients was the task most often reported as left undone in studies , with prevalence ranging between 46 percent in England and 82 percent in Germany . Conversation and educating / counselling patients and family were also among the most frequently reported aspects of care missed in these studies .
Bragadottir , et al . ( 2016 ) report further that the most frequently missed aspect of care reported was patient ambulation , reported as always , frequently or occasionally missed by between 76 percent of nurses in the U . S . and 91 percent of nurses in Italy . Other commonly missed elements of care included assessment of newly admitted patients and set up of care plans , mouth care , and attending interdisciplinary care conferences and documenting nursing care . The researchers add , “ While clinical care was less often reported as missed , the rates of omission were still substantial . Monitoring of vital signs was one of the least likely aspects to be reported as missed in studies , however , omissions of care in this area were still relatively frequent , ranging between 16 percent and 35 percent . Studies found up to 37 percent of nurses reporting some care missed on the last shift while patient