Factors Associated With Missed Nursing Care in Nursing Homes: A Multicentre Cross-sectional Study

Background  Despite its association with patient safety, few studies on missed nursing care have been conducted in nursing homes. We aimed to describe individual and environmental factors in a sample of registered nurses (RNs) reporting missed nursing care in nursing homes, and to explore the association between these factors and missed nursing care. Methods  In the present, multicentre cross-sectional study, ۲۱۷ RNs from ۴۳ nursing homes in Northern Italy reported all episodes of missed nursing care (ie, any aspect of required care that was omitted or delayed) that occurred in the ۲۰ most dependent residents (according to RNs’ judgement; ۸۶۰ residents in total) over ۳ consecutive days. Multilevel multivariable logistic regression models were used to test possible explanatory factors of missed nursing care (individual, work-related, organisational, and work environment factors), which were entered in a step-wise manner. Results  Younger RNs (P = .۰۲۶), freelance RNs (P = .۰۴۶), RNs with a permanent contract (P = .۰۳۵), and those working in publicly-owned nursing homes reported more episodes of missed nursing care (P < .۰۱۲). Public ownership (odds ratio [OR] = ۹.۸۸; ۹۵% CI ۲.۲۲–۴۴.۰۳; P = .۰۰۳), a higher proportion of residents with severe clinical conditions (OR = ۲.۴۵; ۹۵% CI ۱.۱۲–۵.۳۷; P = .۰۲۵), a lower proportion of RNs (OR = ۲.۲۴; ۹۵% CI ۱.۱۰–۴.۵۴; P = .۰۲۶), and perceived lack of time to care for residents (OR = ۲.۳۳; ۹۵% CI ۱.۰۴–۵.۲۶; P = .۰۴۱) were statistically significantly associated with missed nursing care. Conclusion  Factors associated with missed nursing care are similar in hospitals and nursing homes, and include heavy workload and perceived lack of time for care. Because missed nursing care in nursing homes represents tasks performed specifically by RNs, missed nursing care in this setting should be measured in terms of these tasks. An optimal skill mix is crucial to guarantee not only comfort and basic care for nursing home residents, but also good outcomes for residents with severe clinical conditions.

Keywords:

Missed Nursing Care , Nursing Home , Staffing , Work Factors , Italy