Abstract Background: Frail older adults who are hospitalized, are more likely to experience missed nursing care (MNC) due to high care needs, communication problems, and complexity of nursing care. We conducted a qualitative study to examine the factors affecting MNC among hospitalized frail older adults in the medical units. Methods: This qualitative study was carried using the conventional content analysis approach in three teaching hospitals. Semi-structured interviews were conducted with 17 nurses through purposive and snowball sampling. The inclusion criteria for the nurses were: at least two years of clinical work experience on a medical ward, caring for frail older people in hospital and willingness to participate. Data were analyzed in accordance with the process described by Graneheim and Lundman. In addition, trustworthiness of the study was assessed using the criteria proposed by Lincoln and Guba. Results: In general, 20 interviews were conducted with nurses. A total of 1320 primary codes were extracted, which were classified into two main categories: MNC aggravating and moderating factors. Factors such as “age-unfriendly structure,” “inefficient care,” and “frailty of older adults” could increase the risk of MNC. In addition, factors such as “support capabilities” and “ethical and legal requirements” will moderate MNC. Conclusions: Hospitalized frail older adults are more at risk of MNC due to high care needs, communication problems, and nursing care complexity. Nursing managers can take practical steps to improve the quality of care by addressing the aggravating and moderating factors of MNC. In addition, nurses with a humanistic perspective who understand the multidimensional problems of frail older adults and pay attention to their weakness in expressing needs, can create a better experience for them in the hospital and improve patient safety.
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Nurses today experience an increasingly heavy workload and overload of daily tasks that force them to prioritize their care activities. Missed nursing care, which refers to nurses not being able to complete all necessary care, may lead to a serious threat to patient safety in hospitals. Nursing leadership may be seen as an essential factor in reducing missed nursing care. However, no research has of yet been done to determine how nurses practice leadership by influencing missed nursing care on their wards. Therefore, this study aims to explore how nurses practice leadership in dealing with missed nursing care in hospitals. Method. Nurses (n=16) were selected by purposive sampling from general wards in Dutch hospitals. Data were collected through semi-structured in-depth interviews. Thematic analysis was conducted. Five themes were identified in the descriptions of nurses’ experiences of missed nursing care: dealing with unexpected and busy situations; being a patient advocate in decision-making; accepting the impossibility of completing all essential care; creating a safe, positive work environment; and taking control over one’s own tasks and workload. Nurses in this study experienced pressure to guarantee good-quality patient care in daily practice, and they have several ways of dealing with missed nursing care. Conclusion: The study revealed that nurses recognize a need to develop certain leadership competencies for dealing with missed nursing care. Focused nurse leadership development will help ensure that nurses are well-equipped to meet the challenges of preventing missed nursing care in health care both now and in the future.
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Nationwide and across the globe, the quality, affordability, and accessibility of home-based healthcare are under pressure. This issue stems from two main factors: the rapidly growing ageing population and the concurrent scarcity of healthcare professionals. Older people aspire to live independently in their homes for as long as possible. Additionally, governments worldwide have embraced policies promoting “ageing in place,” reallocating resources from institutions to homes and prioritising home-based services to honour the desire of older people to continue living at home while simultaneously addressing the rising costs associated with traditional institutional care.Considering the vital role of district nursing care and the fact that the population of older people in need of assistance at home is growing, it becomes clear that district nursing care plays a crucial role in primary care. The aim of this thesis is twofold: 1) to strengthen the evidence base for district nursing care; and 2) to explore the use of outcomes for learning and improving in district nursing care. The first part of this thesis examines the current delivery of district nursing care and explores its challenges during the COVID-19 pandemic to strengthen the evidence base and get a better understanding of district nursing care. Alongside the goal of strengthening the evidence for district nursing care, the second part of this thesis explores the use of patient outcomes for learning and improving district nursing care. It focuses on nurse-sensitive patient outcomes relevant to district nursing care, their current measurement in practice, and what is needed to use outcomes for learning and improving district nursing practice.
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