The association of nurse caring behaviours on missed nursing care, adverse patient events and perceived quality of care: A cross-sectional study
Corresponding Author
Leodoro J. Labrague CHSE, DM, MAN, RN
College of Nursing, Sultan Qaboos University, Muscat, Oman
Correspondence
Leodoro J. Labrague, College of Nursing, Sultan Qaboos University, Muscat, Oman.
Email: [email protected]
Search for more papers by this authorJanet Alexis A. De los Santos MSN, RN
College of Nursing, Visayas State University, Baybay City, Philippines
Search for more papers by this authorKonstantinos Tsaras PhD, RN
Nursing Department, Technological Educational Institute of Thessaly, Larissa, Greece
Search for more papers by this authorJolo R. Galabay MSN, RN
College of Nursing and Midwifery, Isabela State University, Ilagan Campus, Philippines
Search for more papers by this authorCharlie C. Falguera MAN, RM, RN
School of Health Sciences, University of the Philippines Manila, Manila, Philippines
Search for more papers by this authorRheajane A. Rosales DM, MAN, RN
College of Nursing, Samar State University, Catbalogan City, Philippines
Search for more papers by this authorCarmen N. Firmo MAN, MHS, PhD, RN
School of Health Sciences, University of the Philippines Manila, Manila, Philippines
Search for more papers by this authorCorresponding Author
Leodoro J. Labrague CHSE, DM, MAN, RN
College of Nursing, Sultan Qaboos University, Muscat, Oman
Correspondence
Leodoro J. Labrague, College of Nursing, Sultan Qaboos University, Muscat, Oman.
Email: [email protected]
Search for more papers by this authorJanet Alexis A. De los Santos MSN, RN
College of Nursing, Visayas State University, Baybay City, Philippines
Search for more papers by this authorKonstantinos Tsaras PhD, RN
Nursing Department, Technological Educational Institute of Thessaly, Larissa, Greece
Search for more papers by this authorJolo R. Galabay MSN, RN
College of Nursing and Midwifery, Isabela State University, Ilagan Campus, Philippines
Search for more papers by this authorCharlie C. Falguera MAN, RM, RN
School of Health Sciences, University of the Philippines Manila, Manila, Philippines
Search for more papers by this authorRheajane A. Rosales DM, MAN, RN
College of Nursing, Samar State University, Catbalogan City, Philippines
Search for more papers by this authorCarmen N. Firmo MAN, MHS, PhD, RN
School of Health Sciences, University of the Philippines Manila, Manila, Philippines
Search for more papers by this authorAbstract
Aim
This study evaluated the role of nurse caring in predicting missed nursing care, adverse patient events and the quality of nursing care.
Background
Missed nursing care is an issue essential in health care, as it is associated with adverse patient events. While studies have previously examined factors that result in missed nursing care activities and adverse events, the role of nurse caring itself in this context has not yet been explored.
Methods
A cross-sectional research design was adopted, employing a convenience sample of 549 registered nurses from six hospitals in the Philippines identified between October 2018 and January 2019. Four self-report scales were used in this study as follows: the caring behaviour inventory, the missed nursing care scale, the adverse patient events scale and a single-item scale to measure the quality of nursing care.
Results
Comforting or talking with patients and changing patients' positioning in bed were the most frequently missed care tasks, while patient/family complaints and patient/family verbal abuse were the most frequently reported adverse events. Nurse caring strongly predicted the quality of care, missed nursing care and patient adverse events.
Conclusion
Fostering caring behaviours among nurses has a profound effect on nurses' decision to omit or provide nursing care as well as on reducing adverse events and promoting quality nursing care.
Implications for nursing management
The adoption of strategies to improve caring behaviours among nurses is critically important to prevent or reduce the occurrence of errors and adverse events.
REFERENCES
- Aiken, L. H., Sloane, D., Griffiths, P., Rafferty, A. M., Bruyneel, L., McHugh, M., … Sermeus, W. (2017). Nursing skill mix in European hospitals: Cross-sectional study of the association with mortality, patient ratings, and quality of care. BMJ Quality and Safety, 26(7), 559–568. https://doi.org/10.1136/bmjqs-2016-005567
- Ausserhofer, D., Zander, B., Busse, R., Schubert, M., De Geest, S., Rafferty, A. M., … Schwendimann, R. (2014). Prevalence, patterns and predictors of nursing care left undone in European hospitals: Results from the multicountry cross-sectional RN4CAST study. BMJ Quality and Safety, 23(2), 126–135. https://doi.org/10.1136/bmjqs-2013-002318
- Ball, J. E., Bruyneel, L., Aiken, L. H., Sermeus, W., Sloane, D. M., Rafferty, A. M., … RN4Cast Consortium. (2018). Post-operative mortality, missed care and nurse staffing in nine countries: A crosssectional study. International journal of nursing studies, 78, 10–15.
- Ball, J. E., Griffiths, P., Rafferty, A. M., Lindqvist, R., Murrells, T., & Tishelman, C. (2016). A cross-sectional study of ‘care left undone’ on nursing shifts in hospitals. Journal of Advanced Nursing, 72(9), 2086–2097. https://doi.org/10.1111/jan.12976
- Blackman, I., Henderson, J., Willis, E., Hamilton, P., Toffoli, L., Verrall, C., … Harvey, C. (2015). Factors influencing why nursing care is missed. Journal of Clinical Nursing, 24(1–2), 47–56.
- Blackman, I., Papastavrou, E., Palese, A., Vryonides, S., Henderson, J., & Willis, E. (2018). Predicting variations to missed nursing care: A three-nation comparison. Journal of Nursing Management, 26(1), 33–41. https://doi.org/10.1111/jonm.12514
- Bragadóttir, H., & Kalisch, B. J. (2018). Comparison of reports of missed nursing care: Registered nurses vs. practical nurses in hospitals. Scandinavian Journal of Caring Sciences, 32(3), 1227–1236.
- Bragadóttir, H., Kalisch, B. J., & Tryggvadóttir, G. B. (2017). Correlates and predictors of missed nursing care in hospitals. Journal of Clinical Nursing, 26(11–12), 1524–1534. https://doi.org/10.1111/jocn.13449
- Burtson, P. L., & Stichler, J. F. (2010). Nursing work environment and nurse caring: Relationship among motivational factors. Journal of Advanced Nursing, 66(8), 1819–1831. https://doi.org/10.1111/j.1365-2648.2010.05336.x
- Cabanda, E., & Chou, M. H. (2019 ). Designing the Export of Nurses: Whither “Asian Values” in the Emigration Policies of the Philippines?. In H. M. Grimm (Ed.), Public Policy Research in the Global South (pp. 197–213). Cham: Springer.
10.1007/978-3-030-06061-9_11 Google Scholar
- Cara, C. M., Nyberg, J. J., & Brousseau, S. (2011). Fostering the coexistence of caring philosophy and economics in today's health care system. Nursing Administration Quarterly, 35(1), 6–14.
- Drach-Zahavy, A., & Srulovici, E. (2019). The personality profile of the accountable nurse and missed nursing care. Journal of Advanced Nursing, 75(2), 368–379. https://doi.org/10.1111/jan.13849
- Duffy, J. R., Brewer, B. B., & Weaver, M. T. (2014). Revision and psychometric properties of the caring assessment tool. Clinical Nursing Research, 23(1), 80–93. https://doi.org/10.1177/1054773810369827
- Duffy, J. R., Culp, S., & Padrutt, T. (2018). Description and factors associated with missed nursing care in an acute care community hospital. JONA: The Journal of Nursing Administration, 48(7/8), 361–367. https://doi.org/10.1097/NNA.0000000000000630
- Edvardsson, D., Watt, E., & Pearce, F. (2017). Patient experiences of caring and person-centredness are associated with perceived nursing care quality. Journal of Advanced Nursing, 73(1), 217–227. https://doi.org/10.1111/jan.13105
- Gallagher, T. H., & Mazor, K. M. (2015). Taking complaints seriously: Using the patient safety lens. BMJ Quality and Safety, 24(6), 352–355.
- Gardner, D. G., Cummings, L. L., Dunham, R. B., & Pierce, J. L. (1998). Single-item versus multiple-item measurement scales: An empirical comparison. Educational and Psychological Measurement, 58(6), 898–915. https://doi.org/10.1177/0013164498058006003
- Geyer, N. M., Coetzee, S. K., Ellis, S. M., & Uys, L. R. (2018). Relationship of nurses' intrapersonal characteristics with work performance and caring behaviors: A cross-sectional study. Nursing and Health Sciences, 20(3), 370–379. https://doi.org/10.1111/nhs.12416
- Griffiths, P., Recio-Saucedo, A., Dall'Ora, C., Briggs, J., Maruotti, A., Meredith, P., … Missed Care Study Group (2018). The association between nurse staffing and omissions in nursing care: A systematic review. Journal of Advanced Nursing, 74(7), 1474–1487. https://doi.org/10.1111/jan.13564
- Harrison, R., Walton, M., Healy, J., Smith-Merry, J., & Hobbs, C. (2016). Patient complaints about hospital services: Applying a complaint taxonomy to analyse and respond to complaints. International Journal for Quality in Health Care, 28(2), 240–245.
- Hsu, T. C., Chiang-Hanisko, L., Lee-Hsieh, J., Lee, G. Y., Turton, M. A., & Tseng, Y. J. (2015). Effectiveness of an online caring curriculum in enhancing nurses' caring behavior. The Journal of Continuing Education in Nursing, 46(9), 416–424. https://doi.org/10.3928/00220124-20150821-04
- Jones, T. L., Hamilton, P., & Murry, N. (2015). Unfinished nursing care, missed care, and implicitly rationed care: State of the science review. International Journal of Nursing Studies, 52(6), 1121–1137.
- Kalisch, B. J., Landstrom, G. L., & Hinshaw, A. S. (2009). Missed nursing care: A concept analysis. Journal of Advanced Nursing, 65(7), 1509–1517. https://doi.org/10.1111/j.1365-2648.2009.05027.x
- Kalisch, B., Tschannen, D., & Lee, H. (2011). Does missed nursing care predict job satisfaction? Journal of Healthcare Management, 56(2), 117–134. https://doi.org/10.1097/00115514-201103000-00007
- Kalisch, B. J., & Xie, B. (2014). Errors of omission: Missed nursing care. Western Journal of Nursing Research, 36(7), 875–890. https://doi.org/10.1177/0193945914531859
- Kalisch, B. J., Xie, B., & Dabney, B. W. (2014). Patient-reported missed nursing care correlated with adverse events. American Journal of Medical Quality, 29(5), 415–422. https://doi.org/10.1177/1062860613501715
- Karlou, C., Papathanassoglou, E., & Patiraki, E. (2015). Caring behaviours in cancer care in Greece. Comparison of patients', their caregivers' and nurses' perceptions. European Journal of Oncology Nursing, 19(3), 244–250.
- King, B. M., Linette, D., Donohue-Smith, M., & Wolf, Z. R. (2019). Relationship between perceived nurse caring and patient satisfaction in patients in a psychiatric acute care setting. Journal of Psychosocial Nursing and Mental Health Services, 57(7), 29–38. https://doi.org/10.3928/02793695-20190225-01
- Labrague, L. J. (2012). Caring competencies of baccalaureate nursing students of Samar State University. Journal of Nursing Education and Practice, 2(4), 105–113. https://doi.org/10.5430/jnep.v2n4p105
10.5430/jnep.v2n4p105 Google Scholar
- Lake, E. T., de Cordova, P. B., Barton, S., Singh, S., Agosto, P. D., Ely, B., … Aiken, L. H. (2017). Missed nursing care in pediatrics. Hospital Pediatrics, 7(7), 378–384. https://doi.org/10.1542/hpeds.2016-0141
- Lake, E. T., Germack, H. D., & Viscardi, M. K. (2016). Missed nursing care is linked to patient satisfaction: A cross-sectional study of US hospitals. BMJ Quality and Safety, 25(7), 535–543. https://doi.org/10.1136/bmjqs-2015-003961
- Laschinger, H. K. S., & Leiter, M. P. (2006). The impact of nursing work environments on patient safety outcomes: The mediating role of burnout engagement. JONA: The Journal of Nursing Administration, 36(5), 259–267. https://doi.org/10.1097/00005110-200605000-00019
- Leyva, E. W. A., Peralta, A. B., Tejero, L. M. S., & Santos, M. A. (2015). Global perspectives on caring: An integrative review. International Journal for Human Caring, 19(4), 7–29.
- Lucero, R. J., Lake, E. T., & Aiken, L. H. (2010). Nursing care quality and adverse events in US hospitals. Journal of Clinical Nursing, 19(15–16), 2185–2195.
- Orique, S. B., Patty, C. M., & Woods, E. (2016). Missed nursing care and unit-level nurse workload in the acute and post-acute settings. Journal of Nursing Care Quality, 31(1), 84–89. https://doi.org/10.1097/NCQ.0000000000000140
- Palese, A., Tomietto, M., Suhonen, R., Efstathiou, G., Tsangari, H., Merkouris, A., … Papastavrou, E. (2011). Surgical patient satisfaction as an outcome of nurses' caring behaviors: A descriptive and correlational study in six European countries. Journal of Nursing Scholarship, 43(4), 341–350. https://doi.org/10.1111/j.1547-5069.2011.01413.x
- Papastavrou, E., Andreou, P., & Efstathiou, G. (2014). Rationing of nursing care and nurse–patient outcomes: A systematic review of quantitative studies. The International Journal of Health Planning and Management, 29(1), 3–25. https://doi.org/10.1002/hpm.2160
- Papastavrou, E., Andreou, P., Tsangari, H., Schubert, M., & De Geest, S. (2014). Rationing of nursing care within professional environmental constraints: A correlational study. Clinical Nursing Research, 23(3), 314–335.
- Park, S. H., Hanchett, M., & Ma, C. (2018). Practice environment characteristics associated with missed nursing care. Journal of Nursing Scholarship, 50(6), 722–730. https://doi.org/10.1111/jnu.12434
- Patiraki, E., Karlou, C., Efstathiou, G., Tsangari, H., Merkouris, A., Jarosova, D., … Papastavrou, E. (2014). The relationship between surgical patients and nurses' characteristics with their perceptions of caring behaviors: A European survey. Clinical Nursing Research, 23(2), 132–152. https://doi.org/10.1177/1054773812468447
- Porter, C. A., Cortese, M., & Fitzpatrick, J. J. (2018). Nurse caring behaviors following implementation of a relationship centered care professional practice model. In K. Bauce, & J. L. Fitzpatrick (Eds), Nursing Research Critiques: A Model for Excellence (p. 111), New York, NY: Springer.
10.1891/9780826175410.0006 Google Scholar
- Reader, T. W., Gillespie, A., & Roberts, J. (2014). Patient complaints in healthcare systems: A systematic review and coding taxonomy. BMJ Quality and Safety, 23(8), 678–689. https://doi.org/10.1136/bmjqs-2013-002437
- Saqer, T. J., & AbuAlRub, R. F. (2018). Missed nursing care and its relationship with confidence in delegation among hospital nurses. Journal of Clinical Nursing, 27(13–14), 2887–2895. https://doi.org/10.1111/jocn.14380
- Skålén, C., Nordgren, L., & Annerbäck, E. M. (2016). Patient complaints about health care in a Swedish County: Characteristics and satisfaction after handling. Nursing Open, 3(4), 203–211. https://doi.org/10.1002/nop2.54
- Skär, L., & Söderberg, S. (2018). Patients' complaints regarding healthcare encounters and communication. Nursing Open, 5(2), 224–232. https://doi.org/10.1002/nop2.132
- Smith, J. G., Morin, K. H., Wallace, L. E., & Lake, E. T. (2018). Association of the nurse work environment, collective efficacy, and missed care. Western Journal of Nursing Research, 40(6), 779–798. https://doi.org/10.1177/0193945917734159
- Srulovici, E., & Drach-Zahavy, A. (2017). Nurses' personal and ward accountability and missed nursing care: A cross-sectional study. International Journal of Nursing Studies, 75, 163–171. https://doi.org/10.1016/j.ijnurstu.2017.08.003
- Suhonen, R., Papastavrou, E., Efstathiou, G., Tsangari, H., Jarosova, D., Leino-Kilpi, H., … Merkouris, A. (2012). Patient satisfaction as an outcome of individualised nursing care. Scandinavian Journal of Caring Sciences, 26(2), 372–380. https://doi.org/10.1111/j.1471-6712.2011.00943.x
- Tubbs-Cooley, H. L., Pickler, R. H., Younger, J. B., & Mark, B. A. (2015). A descriptive study of nurse-reported missed care in neonatal intensive care units. Journal of Advanced Nursing, 71(4), 813–824. https://doi.org/10.1111/jan.12578
- Van Bogaert, P., Clarke, S., Willems, R., & Mondelaers, M. (2013). Nurse practice environment, workload, burnout, job outcomes, and quality of care in psychiatric hospitals: A structural equation model approach. Journal of Advanced Nursing, 69(7), 1515–1524. https://doi.org/10.1111/jan.12010
- Wang, X., Liu, K. E., You, L. M., Xiang, J. G., Hu, H. G., Zhang, L. F., … Zhu, X. W. (2014). The relationship between patient safety culture and adverse events: A questionnaire survey. International Journal of Nursing Studies, 51(8), 1114–1122. https://doi.org/10.1016/j.ijnurstu.2013.12.007
- Watson, J. (1997). The theory of human caring: Retrospective and prospective. Nursing Science Quarterly, 10(1), 49–52. https://doi.org/10.1177/089431849701000114
- Wolf, Z. R., Dillon, P. M., Townsend, A. B., & Glasofer, A. (2017). Caring behaviors inventory-24 revised: CBI-16 validation and psychometric properties. International Journal of Human Caring, 21(4), 185–192. https://doi.org/10.20467/1091-5710.21.4.185
10.20467/1091-5710.21.4.185 Google Scholar