Pediatrik ve Yenidoğan Birimlerde Karşılanmamış Hemşirelik Bakımı: Kapsamlı Bir Literatür Derleme

Yıl 2024, Cilt: 9 Sayı: 2, 281 - 290, 02.06.2024

Sinem Özmen Havva Arslan Yürümezoğlu

https://doi.org/10.61399/ikcusbfd.1378047

Öz

Amaç: Hemşire yetersizliği ve çalışma ortamından kaynaklanan nedenlerle karşılanmamış hemşirelik bakımı bir hasta güvenliği sorunudur. Bu derleme, pediatri kliniklerinde karşılanmamış hemşirelik bakımını inceleyen araştırmaların sonuçlarını gözden geçirmek amacıyla yapılmıştır.

Gereç ve Yöntem: Bu kapsamlı derleme, Joanna Briggs Enstitütü’sünün derleme protokolü dikkate alınarak yürütülmüştür. Aralık 2022-Ağustos 2023 tarihleri arasında Pubmed, EBSCO, OVID, SCOPUS ve ULAKBİM veri tabanları kullanılarak belirlenen anahtar sözcükleri ile tarama yapılmıştır. Elemelerden sonra kalan 22 çalışma JBI’nın kesitsel çalışmalar ve sistematik derlemeler için hazırlanmış kontrol listeleri kullanılarak değerlendirilmiştir. Bu kontrol listelerinde yer alan sorular “Evet, Hayır, Belirtilmemiş/ Açık Değil, Uygun Değil” olmak üzere dört seçenek ile yanıtlanmaktadır. “Evet” yanıtı “1”, “hayır, belirtilmemiş/açık değil, uygun değil” yanıtları ise “0” olarak puanlanmaktadır. Puanın yüksek olması incelenen araştırmanın metodolojik olarak iyi kalitede olduğunu göstermektedir.

Bulgular: Pediatri kliniklerinde karşılanmamış hemşirelik bakımının; iş yükü, hasta yoğunluğu, çalışma ortamı ve hemşire özellikleri ile ilişkili olduğu değerlendirilmiştir. Yapılan çalışmalarda, karşılanmamış hemşirelik bakımının hasta ve hemşire sonuçları üzerinde olumsuz etkisi olduğu gösterilmiştir.

Sonuç: Bu derlemede incelenen çalışma sonuçları, hemşirelerin çoğunlukla çalışma ortamına bağlı faktörlere bağlı olarak bakımı karşılayamadıklarını göstermektedir. Karşılanmamış bakım oranlarını azaltmak için hemşirelere yeterli kaynak sağlanması ve bakım gereksinimlerine ilişkin gerçekçi beklentiler belirlenmesi önemlidir. Bu nedenle, yönetici hemşirelerin karşılanmamış bakım sorununun hazırlayıcı faktörleri ve karşılanmamış bakım sonuçlarını yönetim kararlarında kullanmaları önerilmektedir.

Anahtar Kelimeler

Karşılanmamış hemşirelik bakımı, pediatri, yenidoğan, hemşire, hasta.

Unmet Nursing Care in Pediatric and Newborn Units: A Scoping Review

Öz

Objective: Unmet nursing care, which occurs due to nursing shortages and negative working environment, is seen as a patient safety issue. This study was conducted to review the results of studies examining unmet nursing care in pediatric units.

Material and Method: This scoping review was conducted following the Joanna Briggs Institute (JBI) review protocol. Between December 2022 and August 2023, pre-determined keywords were searched using Pubmed, EBSCO, OVID, SCOPUS and ULAKBIM databases. 22 eligible studies that remained after exclusion were evaluated using JBI's critical appraisal checklists, which are designed for cross-sectional studies and systematic reviews. The questions in both checklists are answered with four options as "Yes, No, Unclear or Not/Applicable". "Yes" answers are scored as "1" and "no, unclear or not applicable" answers are scored as "0". A high score indicates the methodological quality of the research examined.

Results: The results of the studies examined in the review showed that unmet nursing care in pediatric units was associated with workload, patient intensity, working environment and nurse characteristics. Studies have shown that unmet nursing care has a negative effect on patient and nurse outcomes.

Conclusion: The results of the good-quality studies included in this review show that nurses do not meet the nursing care due to many factors. In order to reduce unmet nursing care rates, it is important to provide adequate resources to nurses and to set realistic expectations regarding care needs. Therefore, it is recommended that nurse managers should on the antecedent factors and use these results, which are related to the predisposing factors and the consequences of missed nursing care in their management decisions.

Anahtar Kelimeler

Unmet nursing care, pediatrics, newborn, nurse, patient

Kaynakça

• Kalisch BJ. Missed nursing care: A qualitative study. Journal of Nursing Care Quality. 2006; Oct-Dec; 21(4): 306-313. DOI: 10.1097/00001786- 200610000-00006.
• Lake ET, Germack HD, Viscardi MK. Missed nursing care is linked to patient satisfaction: A cross-sectional study of US hospitals. BMJ Quality & Safety. 2016 Jul; 25(7): 535-543. DOI: https://doi.org/10.1136/ bmjqs-2015-003961.
• Nelson ST, Flynn L. Relationship between missed care and urinary tract infections in nursing homes. Geriatric Nursing. 2015 Mar-Apr; 36(2): 126-130. DOI: https://doi.org/10.1016/j.gerinurse.2014.12.009.
• Schubert M, Clarke SP, Aiken LH, De Geest S. Associations between rationing of nursing care and inpatient mortality in Swiss hospitals. International Journal for Quality in Health Care. 2012 Jun; 24(3): 230- 238. DOI: https://doi.org/10.1093/intqhc/mzs009.
• Tschannen D., Kalisch BJ., Lee KH. Missed nursing care: the impact on intention to leave and turnover. The Canadian Journal of Nursing Research. 2010 Dec; 42(4): 22-39.
• Dutra CKDR, Guirardello EDB. Nurse work environment and its impact on reasons for missed care, safety climate, and job satisfaction: A cross-sectional study. Journal of Advanced Nursing. 2021 May; 77 (5): 2398– 2406. DOI: https://doi.org/10.1111/ jan.14764.
• Tubbs‐Cooley HL, Pickler RH, Younger JB, Mark BA. A descriptive study of nurse‐ reported missed care in neonatal intensive care units. J Adv Nurs. 2014 Apr; 71(4):813-824. DOI: 10.1111/jan.12578.
• Lake ET, de Cordova PB, Barton S, Singh S, Agosto PD, Ely B, et al. Missed nursing care in Pediatrics. Hospital Pediatrics. 2017a Jul; 7(7): 378-384. DOI: 10.1542/hpeds.2016-0141.
• Rochefort CM, Clarke SP. Nurses’ work environments, care rationing, job outcomes, and quality of care on neonatal units. J Adv Nurs. 2010 Oct; 66(10): 2213-2224. DOI: 10.1111/j.1365-2648.2010.05376.x.
• Mackie BR, Marshall A., Mitchell M. Acute care nurse's views on family partecipation and collaboration in fundamental care. Journal of Clinical Nursing. 2018 Jun; 27(11-12): 2346-2359. DOI: 10.1111/jocn.14185.
• Jones CW, Lynn MR. Blogs written by families during their child's hospitalization: A thematic narrative analysis. Journal of Pediatric Nursing. 2018 Jul- Aug; 41: 110-116. DOI: https://doi.org/10.1016/j. pedn. 2018.03.011.
• Peters MDJ, Marnie C, Tricco AC, Pollock D, Munn Z, Alexander L, et al. Updated methodological guidance for the conduct of scoping reviews. JBI Evidence Synthesis, 2020 Oct; 18(10):2119-2126. DOI: 10.11124/JBIES-20-00167.
• Aslan M., Karaaslan A, Yıldız A, Doğan F, Evirgen H. Workload of nurses and care left undone: Do we really care enough? International Journal of Caring Sciences. 2016 May- Aug; 9(2): 596.
• Gathara D, Serem G, Murphy GAV, Obengo A, Tallam E, Jackson D, et al. Missed nursing care in newborn units: A cross-sectional direct observational study. BMJ Quality & Safety. 2019 Jan; 29(1): 19-30. DOI: https://doi.org/10.1136/bmjqs- 2019-009363.
• Lake ET, Staiger D, Edwards EM, Smith JG, Rogowski JA. Nursing care disparities in neonatal ıntensive care units. Health Services Research. 2017b Aug; 53(Suppl 1): 3007-3026. DOI:10.1111/1475-6773.12762.
• Bagnasco A, Dasso N, Rossi S, Timmins F, Aleo G, Catania G, et al. A qualitative descriptive inquiry of the influences on nurses’ missed care decision-making processes in acute hospital paediatric care. J Nurs Manag. 2019 Dec; 28(8):1929-1939. DOI: https://doi. org/10.1111/ jonm.12935.
• Lake ET, Smith JG, Staiger OD, Hatfield AL, Cramer E, Kalisch BJ et al. Parent satisfaction with care and treatment relates to missed nursing care in neonatal ıntensive care units. Frontiers in Pediatrics. 2020 Mar; 18(8): 74. DOI: 10.3389/fped.2020.00074.
• Kim S, Chae Sun-Mi. Missed nursing care and its influencing factors among neonatal intensive care unit nurses in South Korea: A descriptive study. Child Health Nurs Res. 2022 Apr; 28(2):142-153. DOI: https://doi. org/10.4094/chnr.2022.28.2.142.
• Lake ET, Staiger DO, Cramer E, Hatfield LA, Smith JG, Kalisch BJ, et al. Association of patient acuity and missed nursing care in U.S. neonatal intensive care units. Med Care Res Rev. 2018 Oct; 77(5):451-460. DOI 10.1177/1077558718806743.
• Rozensztrauch A, Smigiel R, Uchmanowicz I. Missed care phenomenon on neonatal intensive care unit (NICU). Journal of Neonatal Nursing. 2021 Oct; 27(5): 341-346. DOI: https://doi. org/10.1016/j.jnn.2021.02.001.
• Çalıkuşu Incekar MÖ, İspir B, Sönmez B, Selalmaz M, Erdost ŞK. Turkish validation of the MİSSCARE survey-pediatric version. Journal of Pediatric Nursing. 2020 Jul- Aug; 53:e156-e163. DOI: https://doi. org/10.1016/j.pedn.2020.03.012.
• Tubbs-Cooley HL, Mara CA, Carle AC, Mark BA, Pickler RH. Association of nurse workload with missed nursing care in the neonatal ıntensive care unit. JAMA Pediatrics. 2019 Jan; 173(1): 44-51. DOI: https://doi. org/10.1001/jamapediatrics.2018.3619.
• Lake ET, Germack HD, Viscardi MK. Missed nursing care is linked to patient satisfaction: A cross-sectional study of US hospitals. BMJ Quality & Safety. 2016 Jul; 25(7): 535–543. DOI: https://doi.org/10.1136/ bmjqs-2015-003961.
• Tubbs-Cooley HL, Pickler RH, Mara CA, Othman M, Kovacs A, Mark BA. Hospital magnet designation and missed nursing care in neonatal intensive care units. Journal of Pediatric Nursing. 2016 May-Jun; 34: 5–9. DOI: https://doi.org/10.1016/j.pedn.2016.12. 004.
• Bartoníčková D, Gurková E, Kalánková D, Mazalová L, Bečvářová R. Missed nursing care and its association with the work environment of nurses working in pediatrics. Journal of nursing and social sciences related to health and illness. 2021; 24(1): 3. DOI: 10.32725/kont.2021.053.
• Elmaoğlu E., Özdemir S. Pediatri hemşireleri tarafından karşılanamayan bakım ve nedenleri. Dokuz Eylül Üniversitesi Hemşirelik Fakültesi Elektronik Dergisi. 2022; 15(2): 175-185 DOI: 10.46483/ deuhfed.971502.
• Lake ET, Staiger D, Smith JG., Rogowski JA. The Association of missed nursing care with very low birthweight ınfant outcomes. Medical Care Research and Review. 2022 Jan; 77(5): 451-460. DOI: https://doi. org/10.1177/10775587221150950.
• Rochefort CM, Rathwell BA, Clarke SP. Rationing of nursing care interventions and its association with nurse- reported outcomes in the neonatal intensive care unit: A cross-sectional survey. BMC Nursing. 2016 Aug; 15(1): 46. DOI: 10.1186/s12912-016-0169-z.
• Smith JG, Rogowski JA, Lake ET. Missed care relates to nurse job enjoyment and intention to leave in neonatal intensive care. J Nurs Manag. 2019 Nov; 28(8): 1940-1947. DOI: https://doi.org/10.1111/ jonm.12943.
• Bagnasco A, Rossi S, Dasso N, Catania G. Zanini M, Aleo G, et al. Exploring care left undone in pediatric nursing. Journal of Patient Safety. 2022 May; 18(6): e903-e911. DOI: 10.1097/PTS.0000000000001044.
• Jankowska-Polańska B, Czyrniańska B, Sarzyńska K, Świątoniowska- Lonc N, Chabowski M. Impact of fatigue on nursing care rationing in paediatric haematology and oncology departments – a cross-sectional study. BMC Nursing. 2021 Aug; 10; 20 (1): 139 DOI: https://doi. org/10.1186/s12912-021-00663-7.
• Purdy IB, Craig JW, Zeanah P. NICU discharge planning and beyond: Recommendations for parent psychosocial support. Journal of Perinatology. 2015 Dec; 5(Suppl. 1): 24-28. DOI: https://doi.org/10.1038/ jp.2015.146.
• Malepe TC, Havenga Y., Mabusela PD. Barriers to family-centred care of hospitalised children at a hospital in Gauteng. Health SA Gesondheid. 2022 Oct; 8(27):1786. DOI: 10.4102/hsag.v27i0.1786.
• Utomo MT, Sampurna MTA, Melisa M, Permana BPD, Albright IA, Etika1 R, et al. Nurse workload, missed nursing care, and the contributing factors in the neonatal ıntensive care unit in a limited resource setting: A case from Indonesia, 2022 Apr, 11:468 DOI: https://doi.org/10.12688/ f1000research.109105.1.
• Chiappinotto S, Papastavrou E, Efstathiu G, Andreou P, Stemmer R, Ströhm C, et al. Antecedents of unfinished nursing care: a systematic review of the literature. BMC Nursing. 2022 Jun; 21(1):137. DOI: 10.1186/ s12912-022-00890-6.
• O’Brien K, Robson K, Bracht M, Cruz M, Lui K, Alvaro R, et al. Effectiveness of family integrated care in neonatal intensive care units on infant and parent outcomes: A multicenter, multinational, cluster-randomised con- trolled trial. The Lancet Child & Adolescent Health. 2018 Apr; 2(4): 245-254. DOI: 10.1016/S2352-4642(18)30039-7.
• Ogboenyiya AA, Tubbs-Cooley HL, Miller E, Johnson K, Bakas T. Missed nursing care in pediatric and neonatal care settings: An integrative review. MCN: The American Journal of Maternal/Child Nursing. 2020 Sep-Oct; 45(5): 254-264. DOI: 10.1097/NMC.0000000000000642.
• Bekker M, Coetzee SK, Klopper HC, Ellis SM. Non- nursing tasks, nursing tasks left undone and job satisfaction among professional nurses in South African hospitals. Journal of Nursing Management. 2015 Nov; 23(8): 1115-1125. DOI: https://doi.org/10.1111/jonm.12261.
• Kalisch BJ, Tschannen D, Lee H, Friese CR. Hospital variation in missed nursing care. Am J Med Qual. 2011 Jul; 26(4):291–299. DOI: https://doi. org/10.1177/1062 860610395929.
• Blackman I, Lye CY, Darmawan GN, Henderson J, Giles T, Willis E, et al. Modeling missed care: İmplications for evidence- based practice. Worldviews Evid Based Nurs. 2018 Jun;15 (3):178-188. DOI: https://doi. org/10.1111/wvn.12285.
• Tschannen D, Kalisch BJ, Lee KH. Missed nursing care: The impact on intention to leave and turnover. The Canadian Journal of Nursing Research. 2010 Dec; 42(4): 22-39.
• Karlsson AC, Gunningberg L. Bäckström J, Pöder U. Registered nurses' perspectives of work satisfaction, patient safety and intention to stay - A double-edged sword. Journal of Nursing Management. 2019 Oct; 27(7): 1359-1365. DOI: https://doi.org/10.1111/jonm.12816.
• Brooker KJ., Vikan M., Thyli, BA qualitative exploratory study of Norwegian or nurses' patient positioning priorities. AORN Journal. 2020 Feb; 111(2): 211-220. DOI: https://doi.org/10.1002/aorn.12930.
• Coker E., Ploeg J., Kaasalainen S., Carter N. Nurses' oral hygiene care practices with hospitalised older adults in postacute settings. International Journal of Older People Nursing, 2017 Mar; 12(1): e12124. DOI: https://doi.org/10.1111/opn.12124.
• Doshi M., Mann J., Quentin L., Morton-Holtham L., Eaton KA. Mouth care training and practice: A survey of nursing staff working in National Health Service hospitals in England. Journal of Research in Nursing. 2021 Sep; 26(6): 574-590. DOI: https://doi.org/10.1177/ 17449871211016524.
• Van Noort HHJ, Witteman BJM, den Hertog-Voortman R, Everaars B, Vermeulen H, Huisman-de Waal GA. A context analysis on how oral care is delivered in hospitalised patients: A mixed-methods study. Journal of Clinical Nursing. 2020 Jun; 29(11-12): 1991-2003. DOI: https://doi. org/10.1111/jocn.15130.
• Griffiths P, Recio-Saucedo A, Dall Ora C, Briggs J, Maruotti A, Meredith P, et al. The association between nurse staffing and omissions in nursing care: A systematic review. Journal of Advanced Nursing. 2018 Jul; 74(7):1474-1487. DOI 10.1111/jan.13564.
• Mandal L, Seethalakshmi A, Rajendrababu A. Rationing of nursing care, A deviation from holistic nursing: a systematic review. Nurs Philos. 2018 Jan; 21(1):e12257. DOI: https://doi.org/10.1111/nup.12257.
• Schubert M, Glass TR, Clarke SP, Schaffert-Witvliet B, De Geest S. Validation of the Basel extent of rationing of nursing care instrument. Nurs Res. 2007 Nov- Dec; 56(6):416-424. DOI: https://doi.org/10.1097/01. NNR.0000299853.52429.62.
• Suhonen R., Scott PA. Missed care: A need for careful ethical discussion. Nursing Ethics. 2018 Aug; 25 (5): 549-551. DOI: 10.1177/0969733018790837.