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Missed nursing care and predicting factors in the Italian medical care setting

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Abstract

Missed nursing care (MNC), such as nursing care omitted or delayed, has not been measured in the Italian context where several cost containment interventions affect the care offered in medical units. The aim of the study is to identify the amount, type, and reasons for MNC in the Italian medical care setting and to explore the factors that affect the occurrence of MNC. A 3-month longitudinal survey was carried out followed by a cross-sectional study design in 12 north eastern acute medical units. A total of 314 nursing staff members were involved. Multivariate logistic regression was performed to identify the predictors of MNC. Patient ambulation (91.4 %), turning the patient every 2 h (74.2 %), and right timing in administering medications (64.6 %) were the most perceived MNC. Among the most frequent reasons were the unexpected rise in patient volume or critical conditions (95.2 %), inadequate numbers of staff (94.9 %), and large numbers of admissions/discharges (93.3 %). The R 2 33.2 % of the variance in MNC were explained by a full-time position (OR 4.743, 95 % CI 1.146–19.629), communication tensions between Registered Nurses and Nurses’ Aides (OR 1.601, 95 % CI 1.020–2.515), the amount of experience in medical unit (OR 1.564, 95 % CI 1.021–2.397), and the amount of daily care offered by Nurses’ Aides (1.039, 95 % CI 1.011–1.067). A substantial amount of basic and clinically relevant nursing interventions was perceived to be missed, and this may lead to an increase in negative outcomes for patients admitted to a medical unit. Appropriate standards of nursing care should be adopted urgently in medical units aiming to protect frail patients.

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Statement of human and animal rights

An appropriate approval from the Ethical Committee of the Coordinator Centre (Ospedale of Verona, Italy) has been obtained.

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The written informed consent was also collected from patients and their reference caregiver.

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Authors and Affiliations

  1. Udine University, Viale Ungheria 20, 33100, Udine, Italy

    Alvisa Palese

  2. Verona University, Verona, Italy

    Elisa Ambrosi, Letizia Prosperi, Oliva Marognolli, Federica Canzan, Silvia Gonella & Luisa Saiani

  3. Azienda per i Servizi Sanitari Provincia, Trento, Italy

    Annamaria Guarnier, Paolo Barelli & Paola Zambiasi

  4. Azienda Ospedaliera, Verona, Italy

    Elisabetta Allegrini

  5. Servizio Infermieristico e Tecnico Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy

    Letizia Bazoli

  6. Servizio per le Professioni Sanitarie Azienda ULSS n. 9, Treviso, Italy

    Paola Casson

  7. Servizio Infermieristico Aziendale Azienda per i Servizi Sanitari n. 2 “Isontina”, Gorizia, Italy

    Meri Marin

  8. Servizio Professioni Sanitarie Azienda ULSS n. 6, Vicenza, Italy

    Marisa Padovan

  9. Servizio per le Professioni Sanitarie Azienda per i Servizi Sanitari n.4 “Medio Friuli”, Udine, Italy

    Michele Picogna

  10. Servizio Infermieristico, Tecnico Riabilitativo Azienda Osped.-Univ. S.Orsola Malpighi, Bologna, Italy

    Patrizia Taddia

  11. Fondazione Zancan, Padua, Italy

    Daniele Salmaso

  12. Bologna University, Bologna, Italy

    Paolo Chiari

Authors
  1. Alvisa Palese
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  2. Elisa Ambrosi
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  7. Elisabetta Allegrini
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  9. Paola Casson
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  10. Meri Marin
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  11. Marisa Padovan
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  12. Michele Picogna
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  13. Patrizia Taddia
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  14. Daniele Salmaso
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  15. Paolo Chiari
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  16. Oliva Marognolli
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  17. Federica Canzan
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  18. Silvia Gonella
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  19. Luisa Saiani
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Corresponding author

Correspondence to Alvisa Palese.

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On behalf of ESAMED Group.

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Palese, A., Ambrosi, E., Prosperi, L. et al. Missed nursing care and predicting factors in the Italian medical care setting. Intern Emerg Med 10, 693–702 (2015). https://doi.org/10.1007/s11739-015-1232-6

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  • DOI: https://doi.org/10.1007/s11739-015-1232-6

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