Examination of The Relationship Between Nurses’ Autonomy Levels and Missed Nursing Care
Year 2026,
Volume: 9 Issue: 1
,
96
-
106
,
25.04.2026
Yıldız Denat
,
Güler Karaoğlan
Abstract
Objective: The aim of this study is to examine the relationship between nurses' autonomy levels and missed nursing care.
Methods: The sample of this analytical cross-sectional study consisted of 160 nurses working in adult inpatient clinics and intensive care units of a university hospital in western Turkey. Data were collected using the “Personal Information Form,” the “Dempster Practice Behavior Scale,” and the “Missed Nursing Care Needs Scale.”
Results: No significant relationship was found between the scores of the Dempster Practice Behavior Scale, which measures nurses' autonomy-related behaviors, and the mean scores of missed care services (p>0.05). However, a positive and significant relationship was identified between the reasons for missed care services and both the total scale score and the subscale scores for professional behavior and decision-making (p<0.05).
Conclusion: Nurses' autonomy-related behaviors are not related to missed nursing care but are related to the reasons for missed nursing care.
References
-
Aiken LH, Sloane DM, Lake ET. (2013). Hospital nurses’ reports on hospital quality and safety: An analysis of the 2004 National Survey of Registered Nurses. International Journal of Nursing Studies, 50(3), 305-314.
-
Alghamdi R, Albloushi M, Alzahrani E, Aldawsari A, Alyousef S. (2019). Nursing education challenges from Saudi nurse educators’ and leaders’ perspectives: A qualitative descriptive study. International Journal of Nursing Education Scholarship, 16(1). doi:10.1515/ijnes-2018-0027
-
Ball JE, Bruyneel L, Aiken LH, Sermeus W, Sloane DM, Rafferty AM, et al. (2018). Post-operative mortality, missed care and nurse staffing in nine countries: A cross-sectional study. International Journal of Nursing Studies, 78, 10-15. doi: 10.1016/j.ijnurstu.2017.08.004
-
Blackman I, Henderson J, Willis E, Hamilton P, Toffoli L, Verrall C, et al. (2014). Factors influencing why nursing care is missed. Journal of Clinical Nursing, 24, 47-56. doi: 10.1111/jocn.12688
-
Bragadóttir H, Kalisch BJ. (2018). Comparison of reports of missed nursing care: Registered Nurses vs. practical nurses in hospitals. Scandinavian Journal of Caring Sciences, 32(3), 1227-1236.
-
Bruyneel A, Dello S, Sermeus W. (2025). Prevalence and risk factors for burnout, missed nursing care, and intention-to-leave the job among intensive care unit and general ward nurses: A cross-sectional study across six European countries in the COVID-19 era. Intensive and Critical Care Nursing, 77, 103430. doi: 10.1016/j.iccn.2023.103430
-
Cihangiroğlu N, Uzuntarla Y, Özata M. (2015). Otonomi ve kararlara katılımın örgütsel bağlılık üzerindeki etkisinin analizi. Bartın Üniversitesi İktisadi ve İdari Bilimler Fakültesi Dergisi, 6(12), 39-52.
-
Dutra CKDR, Salles BG, Guirardello EDB. (2019). Situations and reasons for missed nursing care in medical and surgical clinic units. Revista da Escola de Enfermagem da USP, 53, e03470.
-
Finn CP. (2001). Autonomy: An important component nurses’ job satisfaction. International Journal of Nursing Studies, 38(3), 349-354.
-
Griffiths P, Ball J, Bloor K, Briggs J, Iongh A De, Jones J, et al. (2018). Nurse staffing levels, missed vital signs and mortality in hospitals: Retrospective longitudinal observational study. Health Services and Delivery Research, 6(38). doi: 10.3310/hsdr06380
-
Gurková E, Adamkovič M, Jones T, Kurucová R, Kalánková D, Žiaková K. (2020). Factor analysis, validity of the perceived implicit rationing of nursing care instrument and prevalence and patterns of unfinished nursing care in Slovakia. Journal of Nursing Management, 28(8), 2036-2047.
-
Haftu M, Girmay A, Gebremeskel M, Aregawi G, Gebregziabher D, Robles C. (2019). Commonly missed nursing cares in the obstetrics and gynecologic wards of Tigray general hospitals; Northern Ethiopia. PLoS ONE, 14(12), 1-11. doi: 10.1371/journal.pone.0225814
-
Hedman M, Haggström E, Mamhidir AG, Pöder U. (2019). Caring in nursing homes to promote autonomy and participation. Nursing Ethics, 26(1), 280-292. doi: 10.1177/0969733017703698
-
Henderson J, Willis E, Xiao L, Blackman I. (2017). Missed care in residential aged care in Australia: An exploratory study. Collegian, 24(5), 411-416.
-
Jiang H, Li C, Gu Y, Lu H, Ye W. (2015). Status of nurse staffing and nursing care delivery in Pudong, Shanghai. Contemporary Nurse, 50(1), 104-114. doi: 10.1080/10376178.2015.1010255
-
Jones TL, 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 BJ, Landstrom GL, Hinshaw AS. (2009). Missed nursing care: A concept analysis. Journal of Advanced Nursing, 65(7), 1509-1517.
-
Kalisch BJ, Terzioglu F, Duygulu S. (2012a). The MISSCARE Survey-Turkish: Psychometric properties and findings. Nursing Economics, 30(1), 29.
-
Kalisch BJ, Tschannen D, Lee KH. (2012b). Missed nursing care, staffing and patient falls. Journal of Nursing Care Quality, 27(1), 6-12. doi: 10.1097/NCQ.0b013e318225aa23
-
Kalisch BJ, Williams RA. (2009). Development and psychometric testing of tool to measure missed nursing care. JONA, 39(5), 211-219.
-
Kalisch BJ, Xie B, Dabney BW. (2014). Patient-reported missed nursing care correlated with adverse events. American Journal of Medical Quality, 29(5), 415-422. doi: 10.1177/1062860613501715
-
Karagözoğlu Ş. (2008). Hemşirelikte bireysel ve profesyonel özerklik. Hemşirelikte Araştırma Geliştirme Dergisi, 10(3), 41-50.
-
Karagözoğlu Ş. (2009). Nursing students’ level of autonomy: A study from Turkey. Nurse Education Today, 29(2), 176-187.
-
Kaya N, Aştı T, Acaroğlu R, Kaya H, Şendir M. (2006). Hemşire öğrencilerin sosyotropik-otonomik kişilik özellikleri ve ilişkili faktörlerin incelenmesi. C.Ü. Hemşirelik Yüksekokulu Dergisi, 10(3), 1-11.
-
Mantovan F, Muzzana C, Schubert M, Ausserhofer D. (2020). “It's about how we do it, not if we do it”. Nurses’ experiences with implicit rationing of nursing care in acute care hospitals: A descriptive qualitative study. International Journal of Nursing Studies, 109, 103688.
-
Mrayyan MT. (2005). The influence of standardized languages on nurses’ autonomy. Journal of Nursing Management, 13(3), 238-241.
-
Orique SB, Patty CM, 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.
-
Palese A, Ambrosi E, Prosperi L, Guarnier A, Barelli P, Zambiasi P, et al. (2015). Missed nursing care and predicting factors in the Italian medical care setting. Internal and Emergency Medicine, 10(6), 693-702. doi: 10.1007/s11739-015-1232-6
-
Papastavrou E, Charalambous A, Vryonides S, Eleftheriou C, Merkouris A. (2016). To what extent are patients' needs met on oncology units? The phenomenon of care rationing. European Journal of Oncology Nursing, 21, 48-56.
-
Recio‐Saucedo A, Dall'Ora C, Maruotti A, Ball J, Briggs J, Meredith P, et al. (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.
-
Schubert M, Clarke SP, Glass TR, Schaffert-witvliet B, De Geest S. (2009). Identifying thresholds for relationships between impacts of rationing of nursing care and nurse- and patient-reported outcomes in Swiss hospitals: A correlational study. International Journal of Nursing Studies, 46(7), 884-893. doi: 10.1016/j.ijnurstu.2008.10.008
-
Schubert M, Sean P, Aiken LH, De Geest S. (2012). Associations between rationing of nursing care and inpatient mortality in Swiss hospitals. International Journal for Quality in Health Care, 24(3), 230-238.
-
Sönmez B, Bacaksız FE, Yıldırım A. (2016). Otonomiyle ilişkili davranışları ölçen Dempster Uygulama Davranışı Ölçeği’nin Türkçe’ye uyarlanması: Geçerlik ve güvenirlik çalışması. Florence Nıghtingale Hemşirelik Dergisi, 24(2), 80-89.
-
Valles JHH, Monsiváis MGM, Guzmán MGI, Arreola LV. (2016). Nursing care missed in patients at risk of or having pressure ulcers. Revista Latino-Americana de Enfermagem, 24, e2817.
-
Van Fosson CA, Jones TL, Yoder LH. (2016). Unfinished nursing care: An important performance measure for nursing care systems. Nursing Outlook, 64(2), 124-136.
-
Van Fosson CA, Jones TL, Yoder LH. (2018). Monthly variation of unfinished nursing care at the US Army Burn Center. Burns, 44(8), 1910-1919.
-
Willis E, Henderson J, Hamilton P, Toffoli L, Blackman I, Couzner L, et al. (2015). Work intensification as missed care. Labour & Industry: A Journal of the Social and Economic Relations of Work, 25(2), 118-133. doi: 10.1080/10301763.2015.1060811
Hemşirelerin Otonomi Düzeyleri ve Karşılanmayan Hemşirelik Bakımı Arasındaki İlişkinin İncelenmesi
Year 2026,
Volume: 9 Issue: 1
,
96
-
106
,
25.04.2026
Yıldız Denat
,
Güler Karaoğlan
Abstract
Amaç: Bu araştırmada amaç, hemşirelerin otonomi düzeyleri ve karşılanmayan hemşirelik bakımı arasındaki ilişkiyi incelemektir.
Yöntem: Analitik kesitsel türdeki bu araştırmanın örneklemini Türkiye’nin batısındaki bir üniversite hastanesinin yetişkin yatan hasta klinikleri ve yoğun bakımlarında çalışan 160 hemşire oluşturdu. Araştırmada veriler “Kişisel Bilgi Formu”, “Dempster Uygulama Davranışı Ölçeği”, “Karşılanmayan Hemşirelik Bakım Gereksinimi Ölçeği” ile toplandı.
Bulgular: Hemşirelerin otonomi ile ilişkili davranışlarını ölçen Demster Uygulama Davranışı Ölçeği puanları ile karşılanmayan bakım hizmetleri puan ortalamaları arasında anlamlı bir ilişki saptanmazken (p>0,05), karşılanmayan bakım hizmetlerinin nedenleri arasında hem ölçeğin toplam puanı hem de profesyonel davranış ve karar verme alt boyut puanları arasında pozitif yönde anlamlı bir ilişki saptandı (p<0,05).
Sonuç: Hemşirelerin otonomi ile ilişkili davranışları karşılanmayan hemşirelik bakımı ile ilişkili olmayıp karşılanmayan hemşirelik bakımının nedenleri ile ilişkilidir.
Ethical Statement
Araştırmanın için Aydın Adnan Menderes Üniversitesi Hemşirelik Fakültesi Girişimsel Olmayan Araştırmalar Etik Kurulu’ndan onay (Protokol No: 2024/399), ilgili hastaneden araştırma izni alınmıştır. Araştırmacı tarafından katılımcılara araştırmanın amacı açıklanmış ve sözel onayları alınmıştır. Araştırmada kullanılan ölçekler için yazarlardan yazılı izin alınmıştır. Bu çalışma, Helsinki Deklarasyonu’na uygun olarak yürütülmüştür
Supporting Institution
Bu araştırma için herhangi bir finansal destek alınmamıştır.
Thanks
Çalışmamıza katılan tüm hemşirelere teşekkür ederiz.
References
-
Aiken LH, Sloane DM, Lake ET. (2013). Hospital nurses’ reports on hospital quality and safety: An analysis of the 2004 National Survey of Registered Nurses. International Journal of Nursing Studies, 50(3), 305-314.
-
Alghamdi R, Albloushi M, Alzahrani E, Aldawsari A, Alyousef S. (2019). Nursing education challenges from Saudi nurse educators’ and leaders’ perspectives: A qualitative descriptive study. International Journal of Nursing Education Scholarship, 16(1). doi:10.1515/ijnes-2018-0027
-
Ball JE, Bruyneel L, Aiken LH, Sermeus W, Sloane DM, Rafferty AM, et al. (2018). Post-operative mortality, missed care and nurse staffing in nine countries: A cross-sectional study. International Journal of Nursing Studies, 78, 10-15. doi: 10.1016/j.ijnurstu.2017.08.004
-
Blackman I, Henderson J, Willis E, Hamilton P, Toffoli L, Verrall C, et al. (2014). Factors influencing why nursing care is missed. Journal of Clinical Nursing, 24, 47-56. doi: 10.1111/jocn.12688
-
Bragadóttir H, Kalisch BJ. (2018). Comparison of reports of missed nursing care: Registered Nurses vs. practical nurses in hospitals. Scandinavian Journal of Caring Sciences, 32(3), 1227-1236.
-
Bruyneel A, Dello S, Sermeus W. (2025). Prevalence and risk factors for burnout, missed nursing care, and intention-to-leave the job among intensive care unit and general ward nurses: A cross-sectional study across six European countries in the COVID-19 era. Intensive and Critical Care Nursing, 77, 103430. doi: 10.1016/j.iccn.2023.103430
-
Cihangiroğlu N, Uzuntarla Y, Özata M. (2015). Otonomi ve kararlara katılımın örgütsel bağlılık üzerindeki etkisinin analizi. Bartın Üniversitesi İktisadi ve İdari Bilimler Fakültesi Dergisi, 6(12), 39-52.
-
Dutra CKDR, Salles BG, Guirardello EDB. (2019). Situations and reasons for missed nursing care in medical and surgical clinic units. Revista da Escola de Enfermagem da USP, 53, e03470.
-
Finn CP. (2001). Autonomy: An important component nurses’ job satisfaction. International Journal of Nursing Studies, 38(3), 349-354.
-
Griffiths P, Ball J, Bloor K, Briggs J, Iongh A De, Jones J, et al. (2018). Nurse staffing levels, missed vital signs and mortality in hospitals: Retrospective longitudinal observational study. Health Services and Delivery Research, 6(38). doi: 10.3310/hsdr06380
-
Gurková E, Adamkovič M, Jones T, Kurucová R, Kalánková D, Žiaková K. (2020). Factor analysis, validity of the perceived implicit rationing of nursing care instrument and prevalence and patterns of unfinished nursing care in Slovakia. Journal of Nursing Management, 28(8), 2036-2047.
-
Haftu M, Girmay A, Gebremeskel M, Aregawi G, Gebregziabher D, Robles C. (2019). Commonly missed nursing cares in the obstetrics and gynecologic wards of Tigray general hospitals; Northern Ethiopia. PLoS ONE, 14(12), 1-11. doi: 10.1371/journal.pone.0225814
-
Hedman M, Haggström E, Mamhidir AG, Pöder U. (2019). Caring in nursing homes to promote autonomy and participation. Nursing Ethics, 26(1), 280-292. doi: 10.1177/0969733017703698
-
Henderson J, Willis E, Xiao L, Blackman I. (2017). Missed care in residential aged care in Australia: An exploratory study. Collegian, 24(5), 411-416.
-
Jiang H, Li C, Gu Y, Lu H, Ye W. (2015). Status of nurse staffing and nursing care delivery in Pudong, Shanghai. Contemporary Nurse, 50(1), 104-114. doi: 10.1080/10376178.2015.1010255
-
Jones TL, 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 BJ, Landstrom GL, Hinshaw AS. (2009). Missed nursing care: A concept analysis. Journal of Advanced Nursing, 65(7), 1509-1517.
-
Kalisch BJ, Terzioglu F, Duygulu S. (2012a). The MISSCARE Survey-Turkish: Psychometric properties and findings. Nursing Economics, 30(1), 29.
-
Kalisch BJ, Tschannen D, Lee KH. (2012b). Missed nursing care, staffing and patient falls. Journal of Nursing Care Quality, 27(1), 6-12. doi: 10.1097/NCQ.0b013e318225aa23
-
Kalisch BJ, Williams RA. (2009). Development and psychometric testing of tool to measure missed nursing care. JONA, 39(5), 211-219.
-
Kalisch BJ, Xie B, Dabney BW. (2014). Patient-reported missed nursing care correlated with adverse events. American Journal of Medical Quality, 29(5), 415-422. doi: 10.1177/1062860613501715
-
Karagözoğlu Ş. (2008). Hemşirelikte bireysel ve profesyonel özerklik. Hemşirelikte Araştırma Geliştirme Dergisi, 10(3), 41-50.
-
Karagözoğlu Ş. (2009). Nursing students’ level of autonomy: A study from Turkey. Nurse Education Today, 29(2), 176-187.
-
Kaya N, Aştı T, Acaroğlu R, Kaya H, Şendir M. (2006). Hemşire öğrencilerin sosyotropik-otonomik kişilik özellikleri ve ilişkili faktörlerin incelenmesi. C.Ü. Hemşirelik Yüksekokulu Dergisi, 10(3), 1-11.
-
Mantovan F, Muzzana C, Schubert M, Ausserhofer D. (2020). “It's about how we do it, not if we do it”. Nurses’ experiences with implicit rationing of nursing care in acute care hospitals: A descriptive qualitative study. International Journal of Nursing Studies, 109, 103688.
-
Mrayyan MT. (2005). The influence of standardized languages on nurses’ autonomy. Journal of Nursing Management, 13(3), 238-241.
-
Orique SB, Patty CM, 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.
-
Palese A, Ambrosi E, Prosperi L, Guarnier A, Barelli P, Zambiasi P, et al. (2015). Missed nursing care and predicting factors in the Italian medical care setting. Internal and Emergency Medicine, 10(6), 693-702. doi: 10.1007/s11739-015-1232-6
-
Papastavrou E, Charalambous A, Vryonides S, Eleftheriou C, Merkouris A. (2016). To what extent are patients' needs met on oncology units? The phenomenon of care rationing. European Journal of Oncology Nursing, 21, 48-56.
-
Recio‐Saucedo A, Dall'Ora C, Maruotti A, Ball J, Briggs J, Meredith P, et al. (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.
-
Schubert M, Clarke SP, Glass TR, Schaffert-witvliet B, De Geest S. (2009). Identifying thresholds for relationships between impacts of rationing of nursing care and nurse- and patient-reported outcomes in Swiss hospitals: A correlational study. International Journal of Nursing Studies, 46(7), 884-893. doi: 10.1016/j.ijnurstu.2008.10.008
-
Schubert M, Sean P, Aiken LH, De Geest S. (2012). Associations between rationing of nursing care and inpatient mortality in Swiss hospitals. International Journal for Quality in Health Care, 24(3), 230-238.
-
Sönmez B, Bacaksız FE, Yıldırım A. (2016). Otonomiyle ilişkili davranışları ölçen Dempster Uygulama Davranışı Ölçeği’nin Türkçe’ye uyarlanması: Geçerlik ve güvenirlik çalışması. Florence Nıghtingale Hemşirelik Dergisi, 24(2), 80-89.
-
Valles JHH, Monsiváis MGM, Guzmán MGI, Arreola LV. (2016). Nursing care missed in patients at risk of or having pressure ulcers. Revista Latino-Americana de Enfermagem, 24, e2817.
-
Van Fosson CA, Jones TL, Yoder LH. (2016). Unfinished nursing care: An important performance measure for nursing care systems. Nursing Outlook, 64(2), 124-136.
-
Van Fosson CA, Jones TL, Yoder LH. (2018). Monthly variation of unfinished nursing care at the US Army Burn Center. Burns, 44(8), 1910-1919.
-
Willis E, Henderson J, Hamilton P, Toffoli L, Blackman I, Couzner L, et al. (2015). Work intensification as missed care. Labour & Industry: A Journal of the Social and Economic Relations of Work, 25(2), 118-133. doi: 10.1080/10301763.2015.1060811