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What impact does nursing care left undone have on patient outcomes? Review of the literature

What impact does nursing care left undone have on patient outcomes? Review of the literature
What impact does nursing care left undone have on patient outcomes? Review of the literature
Aims and objectives: systematic review of the impact of missed nursing care on outcomes in adults, on acute hospital wards and in nursing homes.

Background: a considerable body of evidence support the hypothesis that lower levels of registered nurses on duty increases the likelihood of patients dying on hospital wards, and the risk of many aspects of care being either delayed or left undone (missed). However, the direct consequence of missed care remains unclear.

Design: systematic review.

Methods: we searched Medline (via Ovid), CINAHL (EBSCOhost) and Scopus for studies examining the association of missed nursing care and at least one patient outcome. Studies regarding registered nurses, healthcare assistants/support workers/nurses’ aides were retained. Only adult settings were included. Because of the nature of the review, qualitative studies, editorials, letters and commentaries were excluded. PRISMA guidelines were followed in reporting the review.

Results: fourteen studies reported associations between missed care and patient outcomes. Some studies were secondary analyses of a large parent study. Most of the studies used nurse or patient reports to capture outcomes, with some using administrative data. Four studies found significantly decreased patient satisfaction associated with missed care. Seven studies reported associations with one or more patient outcomes including medication errors, urinary-tract infections (UTIs), patient falls, pressure ulcers, critical incidents, quality of care, and patient readmissions. Three studies investigated whether there was a link between missed care and mortality and from these results no clear associations emerged.

Conclusions: the review shows the modest evidence base of studies exploring missed care and patient outcomes generated mostly from nurse and patient self-reported data. In order to support the assertion that nurse staffing levels and skill mix are associated with adverse outcomes as a result of missed care. More research that uses objective staffing and outcome measures is required.
0962-1067
2248-2259
Recio Saucedo, Alejandra
d05c4e43-3399-466d-99e0-01403a04b467
Dall'ora, Chiara
4501b172-005c-4fad-86da-2d63978ffdfd
Maruotti, Antonello
7096256c-fa1b-4cc1-9ca4-1a60cc3ee12e
Ball, Jane
85ac7d7a-b21e-42fd-858b-78d263c559c1
Briggs, J.
27c1eb37-e6e6-41f6-b5b8-9c97c48b7f52
Meredith, Paul
d0a0e287-ad7f-41cb-9347-94d7a0e957c1
Redfern, Oliver C.
82443bac-293a-466c-bcef-389088aeb7bd
Kovacs, Caroline
c4972e5c-08ca-4557-8fcf-882eeac78abd
Prytherch, David
25d4b81a-b4e5-413c-b95b-a63669899c44
Smith, Gary B.
9713f86e-b7d6-4ccb-a81d-ee6c4e76e4c2
Griffiths, Peter
ac7afec1-7d72-4b83-b016-3a43e245265b
Recio Saucedo, Alejandra
d05c4e43-3399-466d-99e0-01403a04b467
Dall'ora, Chiara
4501b172-005c-4fad-86da-2d63978ffdfd
Maruotti, Antonello
7096256c-fa1b-4cc1-9ca4-1a60cc3ee12e
Ball, Jane
85ac7d7a-b21e-42fd-858b-78d263c559c1
Briggs, J.
27c1eb37-e6e6-41f6-b5b8-9c97c48b7f52
Meredith, Paul
d0a0e287-ad7f-41cb-9347-94d7a0e957c1
Redfern, Oliver C.
82443bac-293a-466c-bcef-389088aeb7bd
Kovacs, Caroline
c4972e5c-08ca-4557-8fcf-882eeac78abd
Prytherch, David
25d4b81a-b4e5-413c-b95b-a63669899c44
Smith, Gary B.
9713f86e-b7d6-4ccb-a81d-ee6c4e76e4c2
Griffiths, Peter
ac7afec1-7d72-4b83-b016-3a43e245265b

Recio Saucedo, Alejandra, Dall'ora, Chiara, Maruotti, Antonello, Ball, Jane, Briggs, J., Meredith, Paul, Redfern, Oliver C., Kovacs, Caroline, Prytherch, David, Smith, Gary B. and Griffiths, Peter (2018) What impact does nursing care left undone have on patient outcomes? Review of the literature. Journal of Clinical Nursing, 27 (11-12), 2248-2259. (doi:10.1111/jocn.14058).

Record type: Article

Abstract

Aims and objectives: systematic review of the impact of missed nursing care on outcomes in adults, on acute hospital wards and in nursing homes.

Background: a considerable body of evidence support the hypothesis that lower levels of registered nurses on duty increases the likelihood of patients dying on hospital wards, and the risk of many aspects of care being either delayed or left undone (missed). However, the direct consequence of missed care remains unclear.

Design: systematic review.

Methods: we searched Medline (via Ovid), CINAHL (EBSCOhost) and Scopus for studies examining the association of missed nursing care and at least one patient outcome. Studies regarding registered nurses, healthcare assistants/support workers/nurses’ aides were retained. Only adult settings were included. Because of the nature of the review, qualitative studies, editorials, letters and commentaries were excluded. PRISMA guidelines were followed in reporting the review.

Results: fourteen studies reported associations between missed care and patient outcomes. Some studies were secondary analyses of a large parent study. Most of the studies used nurse or patient reports to capture outcomes, with some using administrative data. Four studies found significantly decreased patient satisfaction associated with missed care. Seven studies reported associations with one or more patient outcomes including medication errors, urinary-tract infections (UTIs), patient falls, pressure ulcers, critical incidents, quality of care, and patient readmissions. Three studies investigated whether there was a link between missed care and mortality and from these results no clear associations emerged.

Conclusions: the review shows the modest evidence base of studies exploring missed care and patient outcomes generated mostly from nurse and patient self-reported data. In order to support the assertion that nurse staffing levels and skill mix are associated with adverse outcomes as a result of missed care. More research that uses objective staffing and outcome measures is required.

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Accepted/In Press date: 22 August 2017
e-pub ahead of print date: 31 August 2017
Published date: June 2018

Identifiers

Local EPrints ID: 414198
URI: http://eprints.soton.ac.uk/id/eprint/414198
ISSN: 0962-1067
PURE UUID: fdf525e1-ff96-4fe4-8c82-a665d42e9743
ORCID for Alejandra Recio Saucedo: ORCID iD orcid.org/0000-0003-2823-4573
ORCID for Chiara Dall'ora: ORCID iD orcid.org/0000-0002-6858-3535
ORCID for Jane Ball: ORCID iD orcid.org/0000-0002-8655-2994
ORCID for Peter Griffiths: ORCID iD orcid.org/0000-0003-2439-2857

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Date deposited: 18 Sep 2017 16:31
Last modified: 18 Feb 2021 17:33

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Contributors

Author: Chiara Dall'ora ORCID iD
Author: Antonello Maruotti
Author: Jane Ball ORCID iD
Author: J. Briggs
Author: Paul Meredith
Author: Oliver C. Redfern
Author: Caroline Kovacs
Author: David Prytherch
Author: Gary B. Smith
Author: Peter Griffiths ORCID iD

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