Aim: The primary aim of this study was to compare differences, if any, in missed infection prevention and control (IPC) activities before and after the pandemic, along with the related predictors. The secondary aim was to identify relationships between missed IPC activities and unfinished nursing care. Methods: A repeated cross-sectional design was conducted in 2019 (pre-pandemic, 184 nurses) and 2024 (post-pandemic, 240 nurses) in a large academic hospital following the Checklist for Reporting of Survey Studies guidelines. The Missed Nursing Care in Infection Prevention and Control Survey (MNC-IPC) (Part A: missed activities, Part B: reasons), the Unfinished Nursing Care Survey (UNCS), and professional data were collected homogeneously across both periods. Findings: Self-reported missed IPC activities decreased from 2.15 out of 5 (95% confidence interval (CI), 2.05-2.25) to 1.51 (95% CI, 1.45-1.58) (P<0.0005), as did the related reasons, which decreased from 2.35 out of 4 (95% CI, 2.24-2.46) to 2.20 (95% CI, 2.11-2.30) (P1/40.046). The total variance in the MNC-IPC overall scores was explained by 22.8% (pre-) and 20.7% (post-pandemic) by different predictors: system-level issues (estimated value 0.409, P 1 / 4 0.008) and nurses' intention to leave (0.107, P 1 / 4 0.023) in the pre-pandemic and by the number of patients admitted in the last shift (0.015, P 1 / 4 0.053), organizational issues (0.186, P< 0.0005) and priority-setting issues (0.092, P 1 / 4 0.053) in the post-pandemic period. MNC-IPC and UNCS scores have reported significant correlations in both periods. Conclusions: Missed IPC activities were less likely in the post-pandemic period possibly due to system efforts and lessons learned during the pandemic, which may have routinized IPC practices among nurses. Overall, predictors of missed IPC care changed after the pandemic, suggesting new patterns and the need for innovative interventions, particularly at the unit level and targeting younger nurses. The correlations between UNCS and MNC-IPC suggest that targeted improvements in one area are likely to yield positive outcomes in the other. However, despite their commonalities, these represent two distinct phenomena. 2024 The Author(s). Published by Elsevier Ltd on behalf of The Healthcare Infection Society. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

AIMS:The aim of this study is to reliably estimate why midwifery care is missed and to crystallize those factors that have causal links to it.BACKGROUND:Studies involving the incidences and types of missed midwifery care are sparsely described. The rationales behind these deficits in care are even less well researched.METHODS:A non-experimental, descriptive method using a Likert developed MISSCARE scale was used to measure consensus estimates made by Australian midwives. Data analysis was undertaken using both Rasch analysis and Structural Equation Modeling.RESULTS:Midwives' rationales behind why Australian midwifery care is missed can be quantified based on consensus estimates of participating midwives and the variances in the total scores of how important each contributing factor was in accounting for why midwifery care was missed, can be both explained and predicted.CONCLUSIONS:Ten latent variables have significant predictor effects on why midwifery care was missed. These include insufficient human and physical care resources, increased work intensity and issues with workplace communication. These factors are further exacerbated by the midwives' teamwork satisfaction levels, work roster preferences and other midwife demographic variables. The age of midwife, their highest qualification achieved and where they obtained their midwifery credentials had no influence on their consensus estimates as to why midwifery care was missed.IMPLICATIONS FOR NURSING MANAGEMENT:While this study confines itself to the Australian midwifery context, outcomes are informative for an international midwifery management audience. While the setting of the midwifery practice (be it private or public hospitals) is not significant in predicting why midwifery care is missed, resource allocation for care of mothers and their babies remains instrumental, as a factor contributing to care omissions. Midwife demographic factors including age, type of midwifery qualification and where the credentials were obtained from exerted no influence as to why care was omitted. Midwifery recruitment should focus instead on re-dressing skills and skills mix shortages. Teamwork skills within the midwifery sector requires strengthening, as problems arising from workplace communication, coupled with decreased midwifery staffing numbers and increased work intensity, are strongly thought to be significant reason for missed care.

AIMS:This study quantifies the types and frequencies of missed care identified by nurses and measures its impact on their capacity to demonstrate mandatory practice standards as future hospital staff.BACKGROUND:Considerable literature exists as to the nature of missed care but there is a paucity of findings about how missed care impacts on learning firstly as a student and then as a graduate nurse employed in a hospital setting. Additionally, there is little emphasis as to how staff development for nurses exposed to missed care may be implemented.METHODS:A non-experimental research design using self-audit data was selected to collect information about the types and frequencies of missed care from nurses engaging in clinical experience. A convenience sample of 471 nursing students completing their undergraduate nursing degree programme was explored. A multi-variate statistical approach was used to apply and then model the consensus scores of undergraduate nurses' beliefs about the frequency of missed care. Implications for their developing competence in critical thinking, therapeutic communication and maintaining capacity for professional practice has been considered.RESULTS:Eight variables directly affect student's total scores underpinning their understanding of missed care and their ability to meet professional standards of practice, given their exposure to care omission. These factors reflect differing nurse attributes, the nature of the clinical venues and shift times, preceptor type, student satisfaction with work teams and staffing adequacy.CONCLUSIONS:Modelling outcomes suggest possible changes to hospital staff development learning programme content, learning processes and how it may be better delivered through to minimize episodes of missed care.IMPLICATIONS FOR NURSING MANAGEMENT:Staff development needs to note that nursing staff believe missed care occurs across all three-patient acuity domains with patient observation, education, support, and timely medication administration being most frequently omitted. Different clinical venues within the hospital sector and shift times vary in nurses' exposure with missed care. Student nurses' learning and associated development of practice standards is impacted by prior exposure to missed care during clinical placement. Non-native English-speaking nurses require greatest learning support in the presence of missed care. As missed care can be predicted, remedial changes to the nurse staff development program content and learning processes can be orchestrated.

AIM First, to identify which aspects of missed care accurately define the integration of care and context of care dimensions of the Fundamentals of Care Framework. Second, to test the Framework for validity and reliability and lastly, to explore how leadership influences care integration. DESIGN A non-experimental research design using self-audit data collected information about variations in nursing care as exemplars for dimensions of the Framework. METHODS A multi-variate approach using path analysis was used to apply the consensus scores of 3079 Australian residential care nurses and carers to define the dimensions of the Framework. RESULTS/FINDINGS In the Australian residential care setting, the factors that define both the contexts of care and the integration of care dimensions constructs are now empirically established. The most direct predictor for the integration of care dimension arises from both the leadership and resource allocation variables, while the remaining context of care factors have indirect but significant effects. The integration of psychosocial care in the residential care sector is not influenced by any of the Framework's context-based factors. CONCLUSION The component variables of the Framework show both good reliability and convergent validity. These findings confirm a predictive relationship exists between the elements of the context of care and the different types of nursing activities that form the integration of the care dimension, including organizational leadership.

Abstract Aim This study aimed to quantify types and frequencies of missed infection control care and to develop a theoretical model for estimating nurses’ consensus scores about this form of missed care. Design A non‐experimental research design using self‐audit data was selected to collect information about the types and frequencies of missed infection control care from nurses employed in hospitals located in three different countries. Data collection commenced mid‐year 2018. Methods A multivariate approach was used to apply the consensus scores of 1.911 internationally based nurses in the missed opportunities for maintaining infection control. Results/findings Thirteen variables exert direct effects on the nurses’ total scores underpinning missed infection control care. These include the methods used to prevent hospital‐acquired infections, surveillance and hand hygiene practices. Significant nurses’ demographic factors also included their countries of origin, employment status, employer type, job retention intentions, work intensity, length of clinical experience and staff development attendance. Conclusion In magnitude of importance and having the largest effect on missed infection control care is missed care related to reducing hospital‐acquired infections followed closely by surveillance. Missed infection control care can be quantified, and variances in its practices can be accounted by exploring the nurses’ differing demographic factors, including the nurses’ country of origin. Impact Variations in missed infection control care can be accounted for across three countries. While ward hygiene is underestimated by staff as a mechanism to minimize nosocomial infections, infection control surveillance remains the key to reducing hospital‐acquired infections. The study's outcomes invite the use of an ongoing, whole‐of‐organization approach to infection control with scrutiny being needed for improved staff adherence particularly with hand hygiene.

BackgroundResearch on missed nursing care reveals individual and systems failure. Research on infection control missed care is minimal.AimsInvestigate nurse perceptions of missed infection control.DesignQualitative in-depth interviews with 11 Australian infection control nurse experts.MethodsParticipants were asked whether nursing and hospital-wide care tasks fundamental to infection control were missed, and what were the underlying causes and contributing factors for these omissions. Qualitative data was mapped against fundamental nursing practice and Australian infection control guidelines.FindingsOmission of infection control care occur at the individual clinician and organisational level. Nurses describe failure to perform standard precautions as well as failure to perform basic care activities. Participants identified a range of institutional and cultural factors which contributed to cascade iatrogenesis resulting in healthcare associated infections for patients. Some factors are outside nurses’ control and include: environmental cleanliness; ward layout; ward culture; resourcing and staffing; integration of infection control into clinical governance; action following audit results; and reviewing evidence base of protocols.DiscussionCare occurs in complex and conflicted settings, with prioritisation essential. Potentially harmful practices are generally done with the intention of care. Nurses are key, but not sole performers in the creation of quality infection control.ConclusionMapping missed care related to infection control against standard frameworks of nursing practice revealed “gaps in the chain of infection” that contribute to “cascade iatrogenesis” with negative outcomes for patients.

AIM:To compare the perceptions of nurses with infection control expertise and ward nurses as to what infection control activities are missed and the reasons why these activities are omitted.BACKGROUND:Infection prevention activities are viewed as important for reducing health care-acquired infections (HAIs) but are often poorly performed.METHODS:Data were collected through the Missed Nursing Care Infection Prevention and Control (MNCIPC) Survey delivered to 500 Australian nurses prior to COVID-19.RESULTS:Significant differences were found on the mean scores between infection control and other nurses on ten items. In eight cases, five relating to hand hygiene, infection control specialists viewed the activity as more likely to be missed. Factors viewed as having greater contribution to omission of infection control prevention were as follows: 'Patients have to share bathrooms', 'Urgent patient situation' and 'Unexpected rise in patient volume and/or acuity on the ward/unit'. Infection control nurses were more likely to highlight the role of organisational and management factors in preventing effective infection control.CONCLUSIONS:Differences in response between nurses suggest that the extent of omission of infection control precautions may be under-estimated by ward nurses.IMPLICATIONS FOR NURSING MANAGEMENT:Infection control specialists are more likely to identify organisational barriers to effective infection control than other nurses. Work demands arising from pandemic management may contribute to infection control precautions being missed.

Background and PurposeOnly a limited number of items involved in missed nursing care inventories specifically focused on infection control practices. The study aimed to adapt and evaluate psychometric properties of the Czech and Slovak version of the Infection Control Missed Care survey; and to assess and compare the amount, type,and reasons for missed nursing care in infection prevention and control amongCzech and Slovak nurses.MethodsThe convenience sample of 1459 nurses from the Czechand Slovak republic was recruited. Analysis of the nurses’ responses to both subscales of the surveys and validation of their data was undertaken using the item response theory (Rasch scaling).ResultsThe now-modified Czech version consists only of 20 items measuring the type and frequency of missed care and 11 items focusing on the reasons for missed care. The now modified Slovak version consists of 34 items measuring the type and frequency of missed care and 17 items measuring the reasons for missed care. Reliability estimates with the removal of unreliable items showed acceptable reliability estimates for both sub-scales of the instrument.ConclusionsWith modification to the two subscales used in the survey (removal of poorly fitting items) it should be reliable, and the resulting data could be used for further investigation such as factor analysis or modelling. The modified Infection Control Missed Care survey could be useful in further research investigating a relationship between nurse staffing, skill mix, and infection control outcomes in acute care hospitals.

Introduction The incidences and types of missed nursing care in the acute care and community sectors are both ubiquitous and quantifiable, however, there are few research studies relating to the type and frequency of missed maternity-based care for mothers and families. The aim of this study is to estimate the incidences and types of Australian missed midwifery care and to identify those factors that have causal links to it. Methods A non-experimental, descriptive method using a Likert developed MISSCARE scale was used to ascertain consensus estimates made by Australian midwives. Electronic invitations were extended to their membership using an inclusive link to the MISSCARE survey. Inclusion criteria were all ANMF members who were midwives and currently employed within the Australian public and private healthcare systems. Data analysis was undertaken using both Rasch analysis and Structural Equation Modelling. Results The type and frequency of missed Australian midwifery care can be quantified and several demographic factors are significant predictor variables for overall missed midwifery care. The most prevalent aspects of missed care in the Australian midwifery setting are midwives’ hand hygiene, supportive care, perinatal education, and surveillance type midwifery practices. Conclusions As the frequencies and types of missed midwifery care in Australia have been identified, it is possible for midwives to be mindful of minimising care omissions related to hand hygiene, providing supportive care and education to mothers as well as surveillance-type midwifery practices.

THE AIM was to translate and validate the Missed Nursing Care in Infection Prevention and Control Survey for its use in the Lithuanian context. METHODS A convenience sample of 331 nurses was surveyed. The study instrument explored missed care in the context of infection prevention and control practices. Rasch analysis was undertaken using Winsteps® Rasch measurement computer program and the Generalised item response modelling software. RESULTS The Missed Nursing Care in Infection Prevention and Control Survey in the Lithuanian language demonstrated unidimensionality and provided evidence of item fit to the modified instrument. The reliability of both sub-scales was 0.78 and 0.98, respectively. Differing consensus between the nurses, based on their perceived frequencies and reasons of missed care was demonstrated. CONCLUSIONS The final Lithuanian version of the Missed Nursing Care in Infection Prevention and Control Survey consists of 29 items that assess type and frequency of missed care and 17 items that identify reasons for missed care. IMPLICATIONS FOR NURSING MANAGEMENT Unit managers will be able to use the modified scales to generate evidence as to the sources of missed infection control practices in their clinical areas and the rationale for the breaks in the hierarchy of mandatory infection prevention.

[This corrects the article DOI: 10.1016/j.heliyon.2020.e03428.].

BACKGROUND:Evidence of missed nursing care in clinical practice has been well documented; however, fewer studies highlighting why care is missed have been conducted and this prevents effective interventions aimed at minimizing the missed care.METHODS:A secondary analysis of two cross-sectional study designs was performed to capture the direction and strength of 1,114 Italian and Australian nurses' perceptions about why care was missed in their hospitals. The MISSCARE survey was used to collect data and the specific section aimed at estimating the reasons for missed nursing care was used. Data were analysed using structural equation modelling.RESULTS:Six significant variables emerged as predictors of why care is missed, and these were: workplace miscommunication; increased work intensity; inadequate physical and human resources for care work; nurses' age; and years of clinical experience.CONCLUSIONS:Australian and Italian findings contribute to growing international studies as to why nursing care is missed and provides a framework for understanding precipitating factors, such as incomplete workplace communication, unpredictable workflows, staffing and material resources issues might contribute to why care is missed and must thus be addressed/improved.

Background: Needle insertions are painful, yet they are frequently performed for adults and children without using local anaesthetic (LA) to minimise pain and anxiety. Objectives: A hypothetical model was formulated to explore the factors related to Saudi nurses' self-reported readiness to use LA prior to undertaking parenteral procedures in their workplaces. Design: This was an exploratory, cross-sectional study. Methods: Four hundred seventy-five nurses were recruited from one hospital in Saudi Arabia. We considered eighteen latent variables related to nurses' attitudes and ability to pursue six roles associated with LA before needle procedures. A model was created to identify the staff attitudes and self-efficacy pathways influencing readiness to use LA. Results: The nurses' readiness to use LA before needle procedures was directly predicted by organisational factors (e.g., hospital policy, doctors' orders), procedural time constraints, underestimation of needle pain, patient characteristics and medical conditions, nurses' knowledge and skills related to LA, and parenteral procedure practices. Conclusions: Nurses' readiness to use LA was influenced by their beliefs about certain aspects of their practice and the nature of patients' presenting problems. Impact statement: Identifying factors that affect LA use helps us understand this issue and may assist policymakers in developing nursing practice.

Aims To estimate and model the types and frequencies of care that nurses and carers self-identify as being missed in the Australian residential aged care sector. Background The study advances missed care research to explore how the care of elderly Australians is compromised. Methods A multi-variate approach was used to apply the consensus scores of 2,467 staff to missed opportunities for resident health promotion and restorative care. Results Eight latent care variables have direct predictor effects on missed Australian residential aged care, all of which are largely under the control of residential care management, with the exception of the physical locality of the aged care settings. Conclusion Missed care, associated with maximizing the residents’ life potential, relieving their distress and maintaining their current health can be quantified and predicted. Implications for Nursing Management Aged care policies that maximize adequate staffing numbers with appropriate levels of skill are paramount to minimizing missed Australian residential care.

Aim To support the development of appropriate policies and actions in the field of missed nursing care (MNC). Background There has been an ever-growing international debate on MNC, interventions that nurses have identified as necessary for their patients, but which for various reasons they are unable to provide or are forced to delay. Despite MNC's relevance, its translation into policies and actions has not been documented to date. Method A consensus development method was employed involving (a) a nominal group composed of experts in the field, policymakers and the President of the Regional Nursing Professional Boards, and (b) 218 nurses appointed primarily at the managerial levels. Results A total of eight consensus statements were approved and organized in a series of sub-statements designed to (1) render the concept of MNC culturally acceptable in the Italian context, with the agreement that compromised nursing care (CNC) is the best term to be used in this field, as a synonym for MNC; (2) measure CNC as a strategy to increase patient safety; (3) select an appropriate CNC measurement tool; (4) optimize CNC measurement; (5) conduct effective CNC data analysis; (6) design and implement interventions to prevent and/or minimize CNC; (7) assess and disseminate findings on interventions' effectiveness; and (8) provide final remarks on the way to move forward. Conclusions We developed a process to introduce the phenomenon of MNC in the Italian culture and agreed firstly on the term compromised nursing care, which better reflects MNC's meaning according to the context and facilitates an open discussion on the phenomenon both within and outside the profession. The following consensus statements emerged represent a systematic approach, starting from the measurement and finishing with the re-measurement of the occurrence of MNC after having implemented concrete actions. Implications for Nursing Management The approved consensus statements can guide decision-makers to develop concrete policies and actions that promote the improvement of quality of care and patients' safety by minimizing and/or preventing MNC's occurrence.

The Australian government has reduced restrictions on ownership of residential aged care facilities (RACF) as part of aged care reform enabling the growth of private-for-profit ownership. This study explores the impact of private-for-profit ownership through comparison of perceptions of the volume of missed care in government, private-not-profit and for-profit RACF in Australia. Data were collected through development and administration of a MISSCARE survey to 3,206 nurses and personal care workers (PCW) working in RACF and hospitals providing aged care services. Employees working within government owned facilities reported levels of missed care that are significantly lower than privately owned facilities on six activities: moving patients who cannot walk; assisting residents' toileting within 5 min of request; assisting resident mouth care; assessing skin integrity; answering call bells within 5 min and wound care. Staffing levels were identified as the most common reason for missed care across all settings. Of the 27 factors identified as causing missed care, government employees reported significantly lower scores for 16 items. Further research is needed on the impact of facility ownership upon capacity of nurses and personal care workers to deliver care.

BackgroundThere is a growing nursing literature that views missed care as an inevitable consequence of work intensification associated with the rationing of nursing and material resources available to deliver care. Global studies recognize that missed care is now ubiquitous, although studies tend to be conducted in one region, rather than nationwide. This study seeks to understand the Australian context of missed care. AimsTo explore self-reported reasons for missed care and to identify the main factors for predicting missed care within a sample of Australian nurses and midwives working in public and private hospitals in New South Wales, Victoria, Tasmania, and South Australia. MethodsA nonexperimental, descriptive method using Kalisch's (2006) MISSCARE survey was used. Responses from 1,195 nursing and midwifery staff with differing qualifications, English language skills, and Australian employment settings were analyzed using Rasch analysis and then modeled using the Structural Equation Modeling. ResultsThe frequency of missed care on the morning shift directly impacted on higher priority care missed during the afternoon shift. Staff skill mix imbalances and perceived inadequacy of staff numbers for the work demands further exacerbated all aspects of care during afternoon shifts. Other major factors associated with missed care were the different clinical work settings and staff to patient ratios. Linking Evidence to ActionThe incidences, types, and reasons behind missed care are a multidimensional construct which can be predicted when known significant factors behind missed care are simultaneously accounted for.

. Missed nursing care and italian nursing practice: preliminary findings of a consensus conference. In recent years in Italy there has been renewed interest in missed nursing care due to various factors, such as participation in the RANCARE project, with 28 European and non-EU countries, the opportunity to develop international exchanges, specific projects and field based research. We explored a range of ideas and processes, culminating in a conference designed to address specific issues relating to missed nursing care, in the Italian nursing practice. After a preliminary review of the literature on the psychometric properties of the available tools, with the intent of further deepening our understanding of the concept of missed nursing care, its implications for practice, management, education and research. After two days of presentations and discussions, the more than participating nurses agreed on a set of preliminary recommendations regarding missed nursing care and Italian nursing practice. This paper reports on the preliminary consensus findings from the conference.

AIMS:To measure and model Australian, Cypriot and Italian nurses' beliefs about what care is missed and how frequently it occurs within their settings.BACKGROUND:This study expands on previous MISSCARE research but now applies and predicts missed care within three countries.METHODS:Multivariate analysis was performed to estimate 1,896 nurses' consensus scores about missed care activities based on Alfaro-Lefevre's conceptual framework of care priorities.RESULTS:Five latent variables have direct predictor effects on missed care frequencies. Another four variables including the nurses' age, highest qualifications, absenteeism rate and workplace type, contributed to explaining the overall variance of missed care scores. The nurses' gender had no influence on missed care.CONCLUSION:Cross country comparisons of missed nursing care allow for a more refined identification of strategies for remediation for both managers and clinicians.IMPLICATIONS FOR NURSING MANAGEMENT:Reliable consensus estimates about the types and frequencies of missed care can be scaled with variables identified to predict missed care across three different countries. Comparative international studies build on the foundations for understanding missed care in terms of nursing practices, policies and related social policies.