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      Situações e razões para a omissão do cuidado de enfermagem em unidades de clínica médica e cirúrgica Translated title: Situations and reasons for missed nursing care in medical and surgical clinic units Translated title: Situaciones y razones para la omisión del cuidado de enfermería en unidades de clínica médica y quirúrgica

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          Abstract

          RESUMO Objetivo Avaliar a frequência e as razões da omissão do cuidado de enfermagem e verificar se as razões de omissão diferem entre categorias profissionais. Método Estudo quantitativo e transversal realizado nas unidades de internação adulto de hospital público de uma instituição de ensino. A coleta de dados foi realizada no período de fevereiro a abril de 2017, por meio de uma ficha de caracterização pessoal e profissional e pelo instrumento MISSCARE-BRASIL. Resultados Participaram do estudo 58 profissionais de enfermagem responsáveis pela assistência direta ao paciente, dos quais 74,1% relataram pelo menos uma atividade de enfermagem omitida no turno de trabalho. As principais razões atribuídas à omissão do cuidado foram o dimensionamento inadequado dos profissionais, as situações de urgência com os pacientes durante o turno de trabalho e a não disponibilidade de medicamentos, materiais ou equipamentos quando necessário. Conclusão A maioria dos cuidados foi “sempre” ou “frequentemente” realizada, e as razões atribuídas para a omissão do cuidado estão relacionadas aos recursos laborais, materiais e estilo de gestão. Os enfermeiros diferem dos técnicos quanto às razões para a não realização dos cuidados.

          Translated abstract

          ABSTRACT Objective To evaluate the frequency and reasons for missed nursing care and to verify whether the reasons for omission differ between professional categories. Method A quantitative and cross-sectional study carried out in the adult hospitalization units of a public hospital of a teaching institution. Data collection was performed from February to April 2017, through a personal and professional characterization form and the MISSCARE-BRASIL instrument. Results Fifty-eight (58) nursing professionals responsible for direct patient care participated in the study, of which 74.1% reported at least one missed nursing care activity during the work shift. The main reasons attributed to missed care situations were an inadequate amount of professionals, urgent situations with the patients during the work shift, and the non-availability of medicine, materials or equipment when necessary. Conclusion Most care was “always” or “often” performed, and the reasons given for missed care are related to work resources, materials, and management style. Nurses differ from the technicians as to the reasons for not performing care.

          Translated abstract

          RESUMEN Objetivo Evaluar la frecuencia y las razones de la omisión del cuidado de enfermería y verificar si las razones de omisión difieren entre categorías profesionales. Método Estudio cuantitativo y transversal llevado a cabo en las unidades de hospitalización de adultos de un hospital público de un centro de enseñanza. La recolección de datos fue realizada en el período de febrero a abril de 2017, mediante una ficha de caracterización personal y profesional y por el instrumento MISSCARE-BRASIL. Resultados Participaron en el estudio 58 profesionales de enfermería responsables de la asistencia directa al paciente, de los que el 74,1% relataron por lo menos una actividad de enfermería omitida en el turno de trabajo. Las principales razones atribuidas a la omisión del cuidado fueron el dimensionamiento inadecuado de los profesionales, las situaciones de urgencias con los pacientes durante el turno de trabajo y la no disponibilidad de fármacos, materiales o equipos cuando necesario. Conclusión La mayoría de los cuidados fue “siempre” o “a menudo” realizada, y las razones atribuidas para la omisión del cuidado están relacionadas con los recursos laborales, materiales y estilo de gestión. Los enfermeros difieren de los técnicos en cuanto a las razones para la no realización de los cuidados.

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          Most cited references12

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          Errors of Omission: Missed Nursing Care.

          A series of studies on missed nursing care (i.e., required standard nursing care that is not completed) is summarized. Missed nursing care is substantial and similar levels are found across hospitals. Reasons for missed nursing care are staffing resources, material resources, and communication and these are also similar across hospitals. The higher the staffing levels, the fewer occurrences of missed nursing care. Magnet status and higher levels of teamwork are associated with less missed nursing care, and more missed care leads to a lower level of staff satisfaction. Missed nursing care has been found to be a mediator between staffing levels and patient falls. Patient identified missed nursing care predicts adverse events (i.e., falls, pressure ulcers, new infections etc.).
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            Missed nursing care is linked to patient satisfaction: a cross-sectional study of US hospitals

            Background As nurses are the principal care provider in the hospital setting, the completion or omission of nursing care is likely to have a sizable impact on the patient care experience. However, this relationship has not been explored empirically. Aim To describe the prevalence and patterns of missed nursing care and explore their relationship to the patient care experience. Methods This cross-sectional study used secondary nurse and patient survey data from 409 adult non-federal acute care US hospitals in four states. Descriptive statistics were calculated and linear regression models were conducted at the hospital level. Regression models included controls for hospital structural characteristics. Results In an average hospital, nurses missed 2.7 of 12 required care activities per shift. Three-fourths (73.4%) of nurses reported missing at least one activity on their last shift. This percentage ranged from 25 to 100 across hospitals. Nurses most commonly reported not being able to comfort or talk with patients (47.6%) and plan care (38.5%). 6 out of 10 patients rated hospitals highly. This proportion ranged from 33% to 90% across hospitals. At hospitals where nurses missed more care (1 SD higher=0.74 items), 2.2% fewer patients rated the hospital highly (p<0.001); a coefficient equivalent to a one-quarter SD change. Conclusions Missed nursing care is common in US hospitals and varies widely. Most patients rate their hospital care experience highly, but this also varies widely across hospitals. Patients have poorer care experiences in hospitals where more nurses miss required nursing care. Supporting nurses’ ability to complete required care may optimise the patient care experience. As hospitals face changing reimbursement landscapes, ensuring adequate nursing resources should be a top priority.
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              Effects of increasing nurse staffing on missed nursing care.

              Inadequate nurse staffing has been reported to lead nurses to omit required nursing care. In South Korea, to reduce informal caregiving by patient families and sitters and to improve the quality of nursing care, a public hospital operated by the Seoul Metropolitan Government has implemented a policy of increasing nurse staffing from 17 patients per registered nurse to 7 patients per registered nurse in 4 out of 13 general nursing units since January 2013.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Journal
                reeusp
                Revista da Escola de Enfermagem da USP
                Rev. esc. enferm. USP
                Universidade de São Paulo, Escola de Enfermagem (, SP, Brazil )
                0080-6234
                1980-220X
                2019
                : 53
                : e03470
                Affiliations
                [1] Campinas São Paulo orgnameUniversidade Estadual de Campinas orgdiv1Faculdade de Enfermagem Brazil
                Article
                S0080-62342019000100457
                10.1590/s1980-220x2017050203470
                31433012
                5120e3f2-dfeb-488d-bb0b-b069d78f4863

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 04 January 2018
                : 28 February 2019
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 16, Pages: 0
                Product

                SciELO Brazil


                Atención de Enfermería,Evaluación del Resultado de la Atención al Paciente,Seguridad del Paciente,Evaluación em Salud,Cuidados de Enfermagem,Avaliação de Resultados da Assistência ao Paciente,Segurança do Paciente,Avaliação em Saúde,Nursing Care,Patiente Outcome Assessment,Patient Safety,Health Evaluation

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