Missed nursing care and healthcareassociated infections seem to share many of the same contributing factors including poor nurse working conditions , low nursepatient ratio , low nurse staffing levels , high nurse burnout , high nurse workload , high bed occupancy and high patient .”
with three antecedents : human resources , material resources , and communication .” The researchers add , “ We argue that adverse events arise from the failure to perform standard precautions but also from failure to perform basic care activities . We further argue that it is often not a single event but a series of failures to perform activities that operate within standards which converge to create cascade iatrogenesis and HAI and implicate staff beyond the nurse . To address the missed care related to infection control and the consequent cascade iatrogenesis , teams and organizations need to work together to interpret and enact the governing health standards of their country . Prioritization of care does occur , and consequently policy and audit language need to enable clinicians to do their job as professional decision makers rather than punishing them for noncompliant behaviors . The tension between evidence-based practice and reasoned rationing .” Other researchers have come to similar conclusions . For example , Henderson , et al . ( 2020 ) explored missed infection control activities through the lens of missed or rationed care and found that four factors were identified as contributing to infection control activities being missed : “ These are systemic factors such as poor staffing and skill mix which contribute to time constraints and difficulties with identifying signs of infection ; environmental factors such as ward layout and access to personal protective equipment ( PPE ); organizational factors including lack of managerial support and interprofessional relationships ; and personal factors , primarily the priority given to infection control by the nurse and knowledge , understanding and application of the principles of infection control .”
The researchers point to time pressures as driving much of the missed care : “ Underpinning this approach is the belief that when time poor , nurses will ration care , delivering care which addresses imminent clinical concerns first over other issues such as patient emotional needs , or perhaps infection control issues . This is not new . Experienced nurses have always rationed care according to patient need , resources and time . What is new in the last two decades is the extensive research on missed or rationed care in the light of the major healthcare budget cuts introduced in most developed economies in both public and private healthcare systems . Evidence suggests that essential care may be missed or incomplete because of lack of resources , or , because of austerity measures arising from the global financial crisis .”
Henderson , et al . ( 2020 ) note further that “… nursing care is often missed due to too few staff , time required for nursing interventions ( time scarcity ), poor use of existing staff resources , ‘ it ’ s not my job ’ syndrome , ineffective delegation , habit , and , sometimes , sheer denial .”
Some researchers believe missed care is a part of lack of compliance . McCauley , et al . ( 2021 ) observe that , “ Missed nursing care in infection prevention and control , overlaps significantly with the research area of infection prevention and control non-compliance . This suggests that rather than being approached as separate or distinct entities , these research areas should be acknowledged as related or overlapping , enabling more focused attention to reducing levels of both .”
The researchers remind us that “ Nurses are key players in patient safety and the work nurses do clearly impacts on measurable core patient safety outcomes ... Effective infection prevention and control practices remain a longstanding tenet of modern nursing practice and have come under the microscope during the COVID-19 pandemic of 2020-21 . Standard precautions and transmission-based precautions are the fundamental tiers of infection prevention and control guidelines , designed to protect both patients and healthcare workers from infection in healthcare settings . Compliance with these guidelines by health workers , including nurses , is increasingly important , and where non-compliance occurs , the reasons must be understood and addressed .”
The medical literature has demonstrated that infections have been associated with missed nursing care , specifically with missed care being associated with increased bloodstream infections , IV cannula infections , urinary tract infections and pneumonia . As McCauley , et al . ( 2021 ) note , “ Missed nursing care and healthcare-associated infections seem to share many of the same contributing factors including poor nurse working conditions , low nurse-patient ratio , low nurse staffing levels , high nurse burnout , high nurse workload , high bed occupancy and high patient . Additionally , positive leadership in healthcare settings seems to be a prerequisite for effective infection control activities and in reducing levels of associated missed care . These similarities and associations solidify missed infection prevention and control as an important and significant component of missed nursing care in general .”
In their review , McCauley , et al . ( 2021 ) outlined the most pertinent factors leading to missed nursing care . Regarding nursing staffing and resources :
• Systemic issues such as funding and health policy as contributing factors to missed infection prevention and control activities
• Factors related to how nursing is organized at the hospital or system levels . Studies suggest that poor staffing levels or skill mix , and associated lack of time , along with lack of availability of appropriate equipment , can lead to infection control activities being missed , or to poor compliance with guidelines . These staffing and resource issues were found to reduce the capacity of nurses to carry out core nursing tasks , and also created difficulties in identifying signs of infection .
• Increased workloads were often due to staffing issues , and that substitute staffing was essential for smooth workflow and the implantation of infection prevention and control policies .
• Time as a resource in relation to infection prevention and control compliance is important , specifically the time taken to don PPE , including glove changes between patients . In emergency settings nurses reported that they frequently prioritize emergency care above infection prevention and control precautions . Shah , et al . ( 2015 ) reported that healthcare workers knowingly cut corners due to competing demands and resourcing-related constraints .