Publications by authors named "Beatrice Kalisch"

81 Publications

Identification and comparison of missed nursing care in the United States and South Korea.

J Clin Nurs 2021 Feb 15. Epub 2021 Feb 15.

Director, Innovation and Evaluation, University of Michigan School of Nursing, 400 North Ingalls Building, Ann Arbor, MI, 48109-5482.

Aims And Objectives: This study aimed to identify and compare missed nursing care types and reasons between South Korea and the United States of America.

Background: Patient safety has become a significant task of the healthcare delivery systems worldwide. The omission of nursing care constitutes a growing concern because it threatens both patient safety and nursing care quality.

Design: This study utilized a cross-sectional, descriptive, and comparative design.

Methods: Data were collected from registered nurses working in two university-affiliated tertiary hospitals and a general hospital in Korea and a Midwest United States tertiary hospital. In addition, the STROBE checklist was used in this study.

Results: While substantial, the level of missed nursing care reported by Korean nurses was lower than that of United States nurses. Only three nursing care activities, setting up meals, patient assessment, and skin/wound care, did not significantly differed between two countries. More basic nursing care types such as ambulation, feeding, mouth care were missed more than others in both countries. The reasons for missed care differed between two countries. However, both Korean and US nurses reported labor resource problems as reasons for missed care.

Conclusions: Although the types of missed nursing care differed significantly between countries, both Korean and US nurses reported labor resource problems for the top reasons for missed care. Thus, comparing missed nursing care could assist nursing administrators in developing strategies to improve care quality and patient safety.

Relevance To Clinical Practice: The level and reasons for missed nursing care are very influential factors for patient outcomes and patient safety. Appropriate skill mix and staffing are needed to decrease extent of missed care, so that enhancing patient safety and quality of nursing care.
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http://dx.doi.org/10.1111/jocn.15712DOI Listing
February 2021

Nurses' Perceptions of the Extent and Type of Missed Perioperative Nursing Care.

AORN J 2020 09;112(3):237-247

Missed nursing care is a concern on inpatient hospital units but has not been adequately explored in the perioperative setting. This cross-sectional study used results from a survey of 1,693 AORN members to investigate the amount and type of missed perioperative nursing care and evaluate associations between reported missed care and facility and nurse characteristics. The survey asked OR nurses how frequently specific care items were missed by themselves or others. Overall, nurses' perceptions of the frequency of missed care was 0.84 on a scale of 0 to 4 (0 = never, 4 = always). The survey items were categorized into five subscales: legal requirement, preparation, safety, communication, and closing routine. Nurses reported most missed care in the communication and preparation categories. The number of ORs at a facility, nurse education and job title, and perceptions of staffing adequacy were significantly associated with the perceived amount of missed perioperative nursing care.
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http://dx.doi.org/10.1002/aorn.13146DOI Listing
September 2020

The association of missed nursing care and determinants of satisfaction with current position for direct-care nurses-An international study.

J Nurs Manag 2020 Nov 25;28(8):1851-1860. Epub 2020 Aug 25.

University of Michigan School of Nursing, Ann Arbor, MI, USA.

Aim: To describe the association of missed nursing care and to identify the determinants of satisfaction with current position for direct-care nurses.

Background: Missed nursing care and job satisfaction are important issues regarding quality patient care and safety in health care, globally.

Method: This was a cross-sectional quantitative study using MISSCARE Survey data. Participants were 7,079 nursing staff providing direct patient care in hospitals in Australia, Iceland, Turkey and the USA. Multivariable nested models were used to identify the relationship between missed nursing care and nurses' satisfaction with current position.

Results: More missed nursing care was associated with less satisfaction with current position. Other determinants of job satisfaction included country, nursing experience, overtime worked, adequacy of staffing and the number of shifts missed during the previous 3 months.

Conclusion(s): Internationally, more missed nursing care is associated with less nursing job satisfaction and is influenced by work experience, overtime worked, levels of staffing and absenteeism.

Implications For Nursing Management: This study identifies that the association between missed nursing care and satisfaction with nursing position is of global concern. Other factors requiring the attention of nurse managers are staffing levels, absenteeism and work experience.
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http://dx.doi.org/10.1111/jonm.13051DOI Listing
November 2020

Parent Satisfaction With Care and Treatment Relates to Missed Nursing Care in Neonatal Intensive Care Units.

Front Pediatr 2020 18;8:74. Epub 2020 Mar 18.

Department of Health Policy and Administration, The Pennsylvania State University, University Park, PA, United States.

The satisfaction of parents of infants in neonatal intensive care is important to parent-infant bonding and parents' ability to care for their baby, including after discharge. Given the principal caregiver role of nurses in this setting, parent satisfaction is influenced by high quality nursing care. Nursing care that is required but missed, such as counseling and support, might influence parent satisfaction. How missed nursing care relates to parent satisfaction is unknown. To describe the satisfaction of parents of infants in neonatal intensive care and to determine how satisfaction relates to missed nursing care in a sample of USA nursing units. The design was cross-sectional and correlational. Thirty neonatal intensive care units that participate in the National Database of Nursing Quality Indicators were recruited. To maximize sample variation in missed care, the highest and lowest quartile hospitals on missed nursing care, measured by nurse survey, were eligible. Ten parents of infants who were to be discharged were recruited from each site to complete a survey. Parent satisfaction was measured by the EMPATHIC-38 instrument, comprising five subscales: information, care and treatment, organization, parental participation, and professional attitude, and a total satisfaction score. Multivariate regression models were estimated. Parent satisfaction was high (5.70 out of 6.00). The prevalence of missed care was 25 and 51% for low and high missed care units, respectively, and 40% for all units. On average, nurses missed 1.06 care activities; in the low and high missed care units the averages were 0.46 and 1.32. Over 10% of nurses missed activities that involved the parent, e.g., teaching, helping breastfeeding mothers, and preparing families for discharge. One standard deviation decrease in missed care activities at the unit level was associated with a 0.08-point increase in parent satisfaction with care and treatment ( = 0.01). Parents in USA neonatal intensive care units are highly satisfied. Neonatal intensive care nurses routinely miss care. Parent satisfaction with care and treatment is related to missed nursing care. Nursing care that is missed relates primarily to the care of the baby by the parents, which could have long term health and developmental consequences.
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http://dx.doi.org/10.3389/fped.2020.00074DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7093579PMC
March 2020

A revised MISSCARE survey: Results from pilot testing.

Appl Nurs Res 2019 12 20;50:151202. Epub 2019 Oct 20.

Consulting for Statistics, Computing & Analytics Research, University of Michigan, Ann Arbor, MI, United States of America. Electronic address:

Background: Missed nursing care has been recognized as a universal patient care issue that affects outcomes for patients, nurses, and healthcare institutions. The MISSCARE Survey was developed to measure and determine the reasons for missed nursing care episodes. An extensive literature review and expert nurse opinion revealed five additional reasons for missing care that the authors utilized to revise the Survey.

Methods: The revised MISSCARE Survey was pilot tested with a group of 145 nursing staff from a public, non-profit, acute care hospital in the Midwestern U.S.

Results: Analysis indicated favorable results for the revised Survey's acceptability, reliability, and construct validity.

Conclusion: Based on the initial pilot study results, the authors recommend further use and study of the revised MISSCARE Survey with other nursing populations and additional psychometric testing.
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http://dx.doi.org/10.1016/j.apnr.2019.151202DOI Listing
December 2019

The extent to which adequacy of staffing predicts nursing teamwork in hospitals.

J Clin Nurs 2019 Dec 9;28(23-24):4298-4309. Epub 2019 Jul 9.

The Social Science Research Institute, University of Iceland, Reykjavik, Iceland.

Aims And Objectives: The purpose of this study was to examine the extent to which staffing adequacy predicts nursing teamwork, controlling for demographic and background variables.

Background: Findings from former studies indicate that hospital, unit and staff characteristics may be related to nursing teamwork, such as type of hospital and unit, role, gender, age, work experience, type of shift worked, shift length, number of working hours per week, overtime and staffing adequacy. Teamwork as well as staffing is identified as significant contributors to patient and staff safety in hospitals. However, the contribution of staffing to the quality of nursing teamwork is scarcely studied.

Design: This was a quantitative descriptive cross-sectional study using the paper-and-pencil questionnaire Nursing Teamwork Survey-Icelandic.

Methods: The study was conducted in 27 inpatient units in eight hospitals in Iceland with a sample of 925 nursing staff members. Participants were 567 registered nurses, practical nurses, unit secretaries and nurse unit managers. The Strengthening the Reporting of Observational Studies in Epidemiology checklist was used for this paper.

Results: When controlling for unit type, role, experience on current unit and intent to leave, perceived adequacy of staffing alone explains up to 10% of overall teamwork. Unit type, role, years of experience on current unit and perceived staffing adequacy correlated significantly with overall teamwork.

Conclusions: The findings of this study indicate that unit and staff characteristics, including perceived adequacy of staffing, are associated with and explain the variability in nursing teamwork on inpatient hospital units. The findings of this study provide important information for clinical nurses, nurse managers, policymakers and instructors in health care.

Relevance To Clinical Practice: The findings underline the importance of adequate staffing for nursing teamwork in inpatient hospital units.
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http://dx.doi.org/10.1111/jocn.14975DOI Listing
December 2019

Association of Patient Acuity and Missed Nursing Care in U.S. Neonatal Intensive Care Units.

Med Care Res Rev 2020 10 26;77(5):451-460. Epub 2018 Oct 26.

Rutgers School of Public Health, New Brunswick, NJ, USA.

The health outcomes of infants in neonatal intensive care units (NICUs) may be jeopardized when required nursing care is missed. This correlational study of missed care in a U.S. NICU sample adds national scope and an important explanatory variable, patient acuity. Using 2016 NICU registered nurse survey responses ( = 5,861) from the National Database of Nursing Quality Indicators, we found that 36% of nurses missed one or more care activities on the past shift. Missed care prevalence varied widely across units. Nurses with higher workloads, higher acuity assignments, or in poor work environments were more likely to miss care. The most common activities missed involved patient comfort and counseling and parent education. Workloads have increased and work environments have deteriorated compared with 8 years ago. Nurses' assignments should account for patient acuity. NICU nurse staffing and work environments warrant attention to reduce missed care and promote optimal infant and family outcomes.
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http://dx.doi.org/10.1177/1077558718806743DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6739170PMC
October 2020

Determinants of nurse absenteeism and intent to leave: An international study.

J Nurs Manag 2019 Jan 13;27(1):143-153. Epub 2018 Sep 13.

University of Iceland, Faculty of Nursing and Landspitali University Hospital, Reykjavik, Iceland.

Aim: To determine factors associated with nurses' intent to leave their positions and absenteeism.

Background: There is a recognized global shortage of nurses but limited data describing and determining factors associated with nurse absenteeism and intent to leave.

Methods: This study involved a secondary analysis of the results from direct-care registered nurses' responses to the MISSCARE Survey, with data from seven countries included. Multi-level modelling was used to determine nurse characteristics and working environment factors associated with nurse absenteeism and intent to leave.

Results: The level of absenteeism and intent to leave varied significantly across countries, with registered nurses in Lebanon reporting the highest intention to leave within 12 months (43%) and registered nurses in Iceland and Australia the highest level of absenteeism (74% and 73%, respectively). Factors associated with outcomes included perceived staffing adequacy of unit, job satisfaction, and age of the nurse.

Conclusions: A significant difference between countries was identified in nurse absenteeism and intent to leave. Increased perception of unit staffing inadequacy, lower job satisfaction, less nurse experience, and younger age were significant contributors to nurse absenteeism and intent to leave.

Implications For Nursing Management: These findings suggest that regardless of country and hospital, by ensuring that units are adequately staffed and increasing job satisfaction, younger, less experienced nurses can be retained and absenteeism reduced.
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http://dx.doi.org/10.1111/jonm.12659DOI Listing
January 2019

Development and validation of the MISSCARE survey - Pediatric version.

J Adv Nurs 2018 Dec 24;74(12):2922-2934. Epub 2018 Sep 24.

Department of Health Sciences, University of Genoa, Genoa, Italy.

Aim: Develop and test the validity and reliability of MISSCARE Survey-Ped adapted from previous versions of the MISSCARE Survey, which measures omitted nursing activities and the reasons why they were left undone. Our secondary aim was to pre-test the construct validity using Exploratory Factor Analysis (EFA).

Background: Missed Nursing Care is described as "every care activity necessary for the patient that is not provided or is seriously delayed". Missed Care is correlated with negative patient outcomes, such as mortality and adverse events.

Design: A mixed-mode cross-sectional survey.

Methods: Participants included registered pediatric nurses and nurses working in pediatric wards. This study was conducted between June and September 2017 and consisted of four phases: (a) analysis of existing surveys and item construction; (b) content and face validity; (c) reliability analysis (acceptability for ease of use, Cronbach's alpha for internal consistency and test-retest to measure stability); and (d) construct validity (EFA).

Results: The MISSCARE Survey-Ped consists of two sections: Section A "Missed Nursing Care Activities" (29 items) and Section B "Reasons for Missed Nursing Care Activities" (17 items). The new survey showed good validity properties and effectively identified Missed Nursing Care activities in pediatric settings.

Conclusion: The development and validation of the MISSCARE Survey-Ped made it possible to conduct an objective and standardized study of missed nursing care activities in the field of pediatrics. This new survey offers the opportunity to collect data that enable to design and implement interventions that improve the quality and safety of pediatric nursing.
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http://dx.doi.org/10.1111/jan.13837DOI Listing
December 2018

Comparison of reports of missed nursing care: Registered Nurses vs. practical nurses in hospitals.

Scand J Caring Sci 2018 Sep 30;32(3):1227-1236. Epub 2018 Mar 30.

School of Nursing, University of Michigan, Ann Arbor, MI, USA.

Background: Missed nursing care is an error of omission defined as standard, required nursing care that is not completed or is seriously delayed. Study findings from around the world show that missed nursing care is a global concern.

Purpose: The purpose of this study was to compare reports of missed nursing care by two types of nurses - registered nurses and practical nurses - in acute care hospitals in Iceland. Former studies in the USA indicate a variance in reports of missed nursing care by staff with different roles.

Methods: This was a cross-sectional descriptive study using the MISSCARE Survey-Icelandic questionnaire for data collection. The questionnaire asks about the amount of missed nursing care on the unit for 24 nursing elements (Part A) and 17 reasons of care being missed (Part B). Participants were nursing staff from medical, surgical and intensive care units in all hospitals in Iceland.

Findings: A t-test for independent groups showed a significant difference for the overall missed nursing care score (Part A) between registered nurses (M = 2.09, SD = 0.51) and practical nurses (M = 1.82, SD = 0.59) [t(541) = 5.703, p < 0.001]. A comparison of the overall mean score for reasons of missed nursing care (Part B) between registered nurses (M = 2.32, SD = 0.38) and practical nurses (M = 2.21, SD = 0.62) indicated a significant difference in their reporting [t(299) = 2.210, p = 0.028]. In spite of the overall significant difference in ratings of the elements and reasons for missed nursing care by registered nurses and practical nurses, a pattern is evident in the ranking of the elements of nursing care being missed and reasons.

Conclusions: The findings of this study point to the need to acknowledge certain aspects of missed nursing care and the different roles within nursing. They indicate a need to improve open, sincere and structured communication and mutual respect and trust within healthcare teams in Icelandic hospitals.
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http://dx.doi.org/10.1111/scs.12570DOI Listing
September 2018

Validation of the MISSCARE-BRASIL survey - A tool to assess missed nursing care.

Rev Lat Am Enfermagem 2017 Dec 21;25:e2975. Epub 2017 Dec 21.

PhD, Full Professor, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil.

Objective: to analyze the metric validity and reliability properties of the MISSCARE-BRASIL survey.

Method: methodological research conducted by assessing construct validity and reliability via confirmatory factor analysis, known-groups validation, convergent construct validation, analysis of internal consistency and test-retest reliability. The sample consisted of 330 nursing professionals, of whom 86 participated in the retest phase.

Results: of the 330 participants, 39.7% were aides, 33% technicians, 20.9% nurses, and 6.4% nurses with administrative roles. Confirmatory factorial analysis demonstrated that the Brazilian Portuguese version of the instrument is adequately adjusted to the dimensional structure the scale authors originally proposed. The correlation between "satisfaction with position/role" and "satisfaction with teamwork" and the survey's missed care variables was moderate (Spearman's coefficient =0.35; p<0.001). The results of the Student's t-test indicated known-group validity. Professionals from closed units reported lower levels of missed care in comparison with the other units. The reliability showed a strong correlation, with the exception of "institutional management/leadership style" (intraclass correlation coefficient (ICC)=0.15; p=0.04). The internal consistency was adequate (Cronbach's alpha was greater than 0.70).

Conclusion: the MISSCARE-BRASIL was valid and reliable in the group studied. The application of the MISSCARE-BRASIL can contribute to identifying solutions for missed nursing care.
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http://dx.doi.org/10.1590/1518-8345.2354.2975DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5738959PMC
December 2017

Correlates and predictors of missed nursing care in hospitals.

J Clin Nurs 2017 Jun 20;26(11-12):1524-1534. Epub 2017 Mar 20.

The Social Science Research Institute, University of Iceland, Reykjavik, Iceland.

Aims And Objectives: To identify the contribution of hospital, unit, staff characteristics, staffing adequacy and teamwork to missed nursing care in Iceland hospitals.

Background: A recently identified quality indicator for nursing care and patient safety is missed nursing care defined as any standard, required nursing care omitted or significantly delayed, indicating an error of omission. Former studies point to contributing factors to missed nursing care regarding hospital, unit and staff characteristics, perceptions of staffing adequacy as well as nursing teamwork, displayed in the Missed Nursing Care Model.

Design: This was a quantitative cross-sectional survey study.

Methods: The samples were all registered nurses and practical nurses (n = 864) working on 27 medical, surgical and intensive care inpatient units in eight hospitals throughout Iceland. Response rate was 69·3%. Data were collected in March-April 2012 using the combined MISSCARE Survey-Icelandic and the Nursing Teamwork Survey-Icelandic. Descriptive, correlational and regression statistics were used for data analysis.

Results: Missed nursing care was significantly related to hospital and unit type, participants' age and role and their perception of adequate staffing and level of teamwork. The multiple regression testing of Model 1 indicated unit type, role, age and staffing adequacy to predict 16% of the variance in missed nursing care. Controlling for unit type, role, age and perceptions of staffing adequacy, the multiple regression testing of Model 2 showed that nursing teamwork predicted an additional 14% of the variance in missed nursing care.

Conclusions: The results shed light on the correlates and predictors of missed nursing care in hospitals. This study gives direction as to the development of strategies for decreasing missed nursing care, including ensuring appropriate staffing levels and enhanced teamwork.

Relevance To Clinical Practice: By identifying contributing factors to missed nursing care, appropriate interventions can be developed and tested.
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http://dx.doi.org/10.1111/jocn.13449DOI Listing
June 2017

The psychometric testing of the Nursing Teamwork Survey in Iceland.

Int J Nurs Pract 2016 Jun 16;22(3):267-74. Epub 2016 Feb 16.

The Social Science Research Institute, University of Iceland, Reykjavík, Iceland.

The purpose of this study was to test the psychometric properties of the Nursing Teamwork Survey-Icelandic (NTS-Icelandic), which was translated from US English to Icelandic. The Nursing Teamwork Survey, with 33 items, measures overall teamwork and five factors of teamwork: trust, team orientation, backup, shared mental models, and team leadership. The psychometric testing of the NTS-Icelandic was carried out on data from a pilot study and a national study. The sample for a pilot study included 123 nursing staff from five units, and the sample for a national study included 925 nursing staff from 27 inpatient units. The overall test-retest intraclass correlation coefficient in the pilot study was 0.693 (lower bound = 0.498, upper bound = 0.821) (p < 0.001). The Cronbach's alpha reliability for the total scale and subscales ranged from 0.737 to 0.911. A confirmatory factor analysis indicated a good fit of the data from the national study with the five-factor model for nursing teamwork. The NTS-Icelandic tested valid and reliable in this study. Study findings support further use of the Nursing Teamwork Survey internationally.
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http://dx.doi.org/10.1111/ijn.12422DOI Listing
June 2016

Impact of Healthcare Information Technology on Nursing Practice.

J Nurs Scholarsh 2015 Jul 6;47(4):287-93. Epub 2015 May 6.

Theta Psi, Research Assistant, Wayne State University College of Nursing, Detroit, MI.

Purpose: To report additional mediation findings from a descriptive cross sectional study to examine if nurses' perceptions of the impact of healthcare information technology on their practice mediates the relationship between electronic nursing care reminder use and missed nursing care.

Design: The study used a descriptive design. The sample (N = 165) was composed of registered nurses working on acute care hospital units. The sample was obtained from a large teaching hospital in Southeast Michigan in the fall of 2012. All eligible nursing units (n = 19) were included.

Methods: The MISSCARE Survey, Nursing Care Reminders Usage Survey, and the Impact of Healthcare Information Technology Scale were used to collect data to test for mediation. Mediation was tested using the method described by Baron and Kenny. Multiple regression equations were used to analyze the data to determine if mediation occurred between the variables.

Findings: Missed nursing care, the outcome variable, was regressed on the predictor variable, reminder usage, and the mediator variable impact of technology on nursing practice. The impact of healthcare information technology (IHIT) on nursing practice negatively affected missed nursing care (t = -4.12, p < .001), explaining 9.8% of variance in missed nursing care. With IHIT present, the predictor (reminder usage) was no longer significant (t = -.70, p = .48). Thus, the reduced direct association between reminder usage and missed nursing care when IHIT was in the model supported the hypothesis that IHIT was at least one of the mediators in the relationship between reminder usage and missed nursing care.

Conclusions: The perceptions of the impact of healthcare information technology mediates the relationship between nursing care reminder use and missed nursing care. The findings are beneficial to the advancement of healthcare technology in that designers of healthcare information technology systems need to keep in mind that perceptions regarding impacts of the technology will influence usage.

Clinical Relevance: Many times, information technology systems are not designed to match the workflow of nurses. Systems built with redundant or impertinent reminders may be ignored. System designers must study which reminders nurses find most useful and which reminders result in the best quality outcomes.
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http://dx.doi.org/10.1111/jnu.12138DOI Listing
July 2015

Nurse Staffing Levels and Patient-Reported Missed Nursing Care.

J Nurs Care Qual 2015 Oct-Dec;30(4):306-12

Department of Nursing, University of Michigan-Flint, Flint, MI (Dr. Dabney); and School of Nursing, University of Michigan, Ann Arbor, MI (Dr. Kalisch).

A total of 729 inpatients were surveyed using the MISSCARE Survey-Patient. Missed timeliness, patient reports of the time it took for them to receive care from nursing staff, was negatively associated with total nursing staff hours of care per patient-day (r = -0.09, P = .015), registered nurse (RN) hours per patient-day (r = -0.14, P = .0002), and RN skill mix (r = -0.13, P = .0004). RN skill mix was also a predictor of missed timeliness (P = .01).
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http://dx.doi.org/10.1097/NCQ.0000000000000123DOI Listing
May 2016

Electronic nursing care reminders: implications for nursing leaders.

J Nurs Adm 2015 May;45(5):239-42

Author Affiliations: Assistant Professor (Dr Piscotty), Research Assistant (Ms Gracey-Thomas), Professor (Dr Yarandi), Wayne State University, College of Nursing, Detroit, Michigan; Titus Distinguished Professor (Dr Kalisch), School of Nursing, University of Michigan, Ann Arbor.The authors declare no conflicts of interest.

Objective: The aim of this study is to report the results of a replication study of the relationship between self-reported nursing care reminder (NCR) use and missed nursing care.

Design: A descriptive cross-sectional correlational design was used. The sample (N = 124) was composed of medical/surgical and ICU RNs working on acute care hospital units in a large Midwestern teaching hospital.

Methods: The MISSCARE Survey, Nursing Care Reminders Usage Survey, and the Impact of Health Care Information Technology Survey were used to collect data. Adjusted hierarchical multiple regression was used to determine study outcomes.

Results: Nurses who use NCRs more frequently have decreased reports of missed nursing care. Nurses who perceive the impact of healthcare technology as positive on their practice also have decreased missed nursing care.

Conclusion: The results of this study suggest that NCRs are an effective intervention to decrease missed nursing care in acute care hospitals.
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http://dx.doi.org/10.1097/NNA.0000000000000192DOI Listing
May 2015

Hold the phone? Nurses, social media, and patient care.

Nursing 2015 May;45(5):64-7

Ronald Piscotty is an Assistant Professor at the Wayne State University College of Nursing in Detroit, Mich. Terri Voepel-Lewis is an Associate Research Scientist at the University of Michigan Department of Anesthesiology in Ann Arbor, Mich. Soohee Lee is a PhD in Nursing student at the University of Michigan School of Nursing in Ann Arbor, Mich. Ann Annis is a PhD candidate at the University of Michigan School of Nursing and a Research Health Science Specialist at the VA Ann Arbor Healthcare System, Ann Arbor, Mich. Eunjoo Lee is a Professor at the College of Nursing and Research Institute of Nursing Science at Kyungpook National University in South Korea. Beatrice Kalisch is the Shirley Titus Distinguished Professor of Nursing at the University of Michigan School of Nursing in Ann Arbor, Mich.

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http://dx.doi.org/10.1097/01.NURSE.0000459797.02711.8aDOI Listing
May 2015

Nurses' use of clinical decision support: a literature review.

Comput Inform Nurs 2014 Dec;32(12):562-8

Author Affiliations: College of Nursing, Wayne State University, Detroit, MI (Dr Piscotty); and School of Nursing, University of Michigan, Ann Arbor (Dr Kalisch).

Little is known regarding nurses' usage of clinical decision support systems. A review of the literature was conducted to understand the extant knowledge surrounding the topic of nurses' usage of clinical decision support systems. The common themes that emerged from the review of literature on clinical decision support systems usage by nurses include (1) nurse factors affecting usage, (2) patient factors affecting usage, (3) technology and design factors affecting usage, and (4) organizational factors affecting usage. Two major implications are that these systems may not be designed to support nursing practice and may not be having the intended effect on patient care and quality.
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http://dx.doi.org/10.1097/CIN.0000000000000110DOI Listing
December 2014

Lost opportunities...the challenges of "missed nursing care".

Nurs Manage 2014 Oct;45(10):40-4

Ronald Piscotty is an assistant professor of Nursing at Wayne State University in Detroit, Mich. Beatrice Kalisch is professor emerita and the Shirley Titus distinguished professor at the University of Michigan in Ann Arbor.

Learn how to define, identify, and ultimately avoid missed nursing care within your organization.
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http://dx.doi.org/10.1097/01.NUMA.0000453273.88381.57DOI Listing
October 2014

The relationship between electronic nursing care reminders and missed nursing care.

Comput Inform Nurs 2014 Oct;32(10):475-81

Author Affiliations: College of Nursing, Wayne State University, Detroit, MI (Dr Piscotty), and School of Nursing, University of Michigan, Ann Arbor, MI (Dr Kalisch).

The purpose of the study was to explore relationships between nurses' perceptions of the impact of health information technology on their clinical practice in the acute care setting, their use of electronic nursing care reminders, and episodes of missed nursing care. The study aims were accomplished with a descriptive design using adjusted correlations. A convenience sample (N = 165) of medical and/or surgical, intensive care, and intermediate care RNs working on acute care hospital units participated in the study. Nurses from 19 eligible nursing units were invited to participate. Adjusted relationships using hierarchical multiple regression analyses indicated significant negative relationships between missed nursing care and nursing care reminders and perceptions of health information technology. The adjusted correlations support the hypotheses that there is a relationship between nursing care reminder usage and missed nursing care and a relationship between health information technology and missed nursing care. The relationships are negative, indicating that nurses who rate higher levels of reminder usage and health information technology have decreased reports of missed nursing care. The study found a significant relationship between nursing care reminders usage and decreased amounts of missed nursing care. The findings can be used in a variety of improvement endeavors, such as encouraging nurses to utilize nursing care reminders, aid information system designers when designing nursing care reminders, and assist healthcare organizations in assessing the impact of technology on nursing practice.
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http://dx.doi.org/10.1097/CIN.0000000000000092DOI Listing
October 2014

Translation and psychometric testing of the Icelandic version of the MISSCARE Survey.

Scand J Caring Sci 2015 Sep 20;29(3):563-72. Epub 2014 May 20.

The Social Scinence Research Institute, University of Iceland, Reykjavík, Iceland.

Background: Missed nursing care, required standard care that is not provided, is a relatively new concept in nursing, and prior to this study, it had not been discussed in Iceland.

Aim: To successfully translate the MISSCARE Survey from US English to Icelandic.

Method: The translation and psychometric testing of the MISSCARE Survey-Icelandic was completed in six steps: (1) forward translation, (2) revision of the translation, (3) back-translation, (4) revision of the back-translation, (5) pilot-testing, (6) data collection and psychometric testing. Back-translation included work of linguists, clinicians and scholars in the original and target country. Psychometric testing was completed on data from a pilot-test and a national study. The target population was nursing staff providing patient care in medical, surgical and intensive care units in hospitals in Iceland. Pilot study data were collected in November-December 2011, and data for the national study were collected in March-April 2012. The MISSCARE Survey asks about missed nursing care activities (part A), and reasons for missed nursing care (part B), besides demographic and background questions.

Results: Response rate for the pilot study was 57% (67/118), and for the national study, it was 69% (599/864) with good acceptability. Overall test-retest Pearson's correlation coefficient for part A was 0.782 (p < 0.001) and 0.530 (p < 0.05) for part B. Cronbach's alpha reliability coefficient for the overall part B and subscales ranged from 0.795-0.894. Confirmatory factor analysis for part B indicated a good model fit to the three factors: Communication, Material resources and Labour resources.

Conclusion: The MISSCARE Survey was successfully translated from US English to Icelandic, using a stringent back-translation method. The Icelandic version tested reliable and valid. This study supports global use of the MISSCARE Survey.
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http://dx.doi.org/10.1111/scs.12150DOI Listing
September 2015

Staffing and job satisfaction: nurses and nursing assistants.

J Nurs Manag 2014 May 2;22(4):465-71. Epub 2012 Nov 2.

Innovation and Evaluation, School of Nursing, University of Michigan, Ann Arbor, MI, USA.

Aim: The aim of this study was to examine the relationship between staffing and job satisfaction of registered nurses (RNs) and nursing assistants (NAs).

Background: Although a number of previous studies have demonstrated the link between the numbers of patients cared for on the last shift and/or perceptions of staffing adequacy, we could find only one study that utilized a measure of actual staffing (opposed to perceptions of staffing adequacy) and correlated it with job satisfaction of registered nurses.

Methods: This cross-sectional study included 3523 RNs and 1012 NAs in 131 patient care units. Staff were surveyed to determine job satisfaction and demographic variables. In addition, actual staffing data were collected from each of the study units.

Results: Hours per patient day was a significant positive predictor for registered nurse job satisfaction after controlling for covariates. For NAs, a lower skill mix was marginally significant with higher job satisfaction. In addition, the more work experience the NAs reported, the lower their job satisfaction.

Conclusion: Adequate staffing levels are essential for RN job satisfaction whereas NA job satisfaction depends on the number of assistive personnel in the mix of nursing staff.

Implications For Nursing Management: Two implications are (1) providing adequate staffing is critical to maintain RN job satisfaction and (2) the NA job needs to be re-engineered to make it a more attractive and satisfying career.
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http://dx.doi.org/10.1111/jonm.12012DOI Listing
May 2014

Errors of Omission: Missed Nursing Care.

West J Nurs Res 2014 08 29;36(7):875-90. Epub 2014 Apr 29.

University of Michigan, Ann Arbor, USA.

A series of studies on missed nursing care (i.e., required standard nursing care that is not completed) is summarized. Missed nursing care is substantial and similar levels are found across hospitals. Reasons for missed nursing care are staffing resources, material resources, and communication and these are also similar across hospitals. The higher the staffing levels, the fewer occurrences of missed nursing care. Magnet status and higher levels of teamwork are associated with less missed nursing care, and more missed care leads to a lower level of staff satisfaction. Missed nursing care has been found to be a mediator between staffing levels and patient falls. Patient identified missed nursing care predicts adverse events (i.e., falls, pressure ulcers, new infections etc.).
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http://dx.doi.org/10.1177/0193945914531859DOI Listing
August 2014

An intervention to improve nursing teamwork using virtual simulation.

West J Nurs Res 2015 Feb 23;37(2):164-79. Epub 2014 Apr 23.

University of Michigan, Ann Arbor, USA.

The purpose of this study was to test the use of virtual simulation to improve teamwork among nursing staff. Using a quasi-experimental design, nursing staff (n = 43) from one patient care unit participated in a 1-hr session, which focused on common nursing teamwork problems. The overall mean teamwork scores improved from pre- (M = 3.25, SD = 0.58) to post-intervention (M = 3.49, SD = 0.67, p < .012). The intervention also had large (0.60 ≤ d ≤ 0.97) and significant effects on the measures of three teamwork subscales (i.e., trust, team orientation, and backup).
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http://dx.doi.org/10.1177/0193945914531458DOI Listing
February 2015

IOM scholars focus on empowering nurses, shaping policy.

Authors:
Beatrice Kalisch

Am Nurse 2013 Nov-Dec;45(6):11

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March 2014

Train-the-trainer intervention to increase nursing teamwork and decrease missed nursing care in acute care patient units.

Nurs Res 2013 Nov-Dec;62(6):405-13

Beatrice J. Kalisch, PhD, RN, FAAN, is Titus Distinguished Professor and Director, Innovation and Evaluation, University of Michigan, Ann Arbor. Boqin Xie, MS, RN, is PhD Student; and David L. Ronis, PhD, is Research Scientist, School of Nursing, University of Michigan, Ann Arbor.

Background: Teamwork is essential for patient safety and results in less missed nursing care.

Objectives: The aim of this study was to test the impact of a train-the-trainer intervention on the level of satisfaction with nursing teamwork and the amount of missed nursing care.

Methods: This study used a quasiexperimental design with repeated measures taken at pretest, posttest, and 2 months after completion of the intervention. The sample for this study was the nursing staff on three medical-surgical units in three separate acute care hospitals (one unit in each hospital). Three nurses from each unit underwent a training program and then taught the skills and knowledge they acquired to the staff members on their units in three-hour-long sessions. The training involved staff role-playing scenarios based on teamwork problems that occur regularly on inpatient units in acute care hospitals followed by debriefing, which focused on teamwork behaviors (e.g., leadership, team orientation, backup, performance monitoring) and missed nursing care. Four measures were used to test the efficacy of this intervention: The Nursing Teamwork Survey, the MISSCARE Survey, and questions about the knowledge of and satisfaction with teamwork. Return rates for the surveys ranged from 73% to 84%. Follow-up tests individually comparing pretest, posttest, and delayed posttest were conducted within the mixed model and used the Bonferroni correction for multiple comparisons.

Results: Teamwork increased (F = 6.91, df = 259.01, p = .001) and missed care decreased (F = 3.59, df = 251.29, p = .03) over time. Nursing staff also reported a higher level of satisfaction with teamwork and an increase of teamwork knowledge after the intervention.

Discussion: The intervention tested in this study shows promise of being an effective and efficient approach to increase nursing teamwork and decrease missed nursing care.
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http://dx.doi.org/10.1097/NNR.0b013e3182a7a15dDOI Listing
January 2014

Outcomes of inpatient mobilization: a literature review.

J Clin Nurs 2014 Jun 13;23(11-12):1486-501. Epub 2013 Sep 13.

School of Nursing, University of Michigan, Ann Arbor, MI, USA.

Aims And Objectives: To review current research evidence on the outcomes of mobilising hospitalised adults.

Background: Although immobility is known to cause functional decline or complications, inpatient ambulation emerged as the most often missed element of nursing care. This study is designed to review research studies that give evidence as to the consequences of mobilising or not mobilising hospitalised adult patients.

Design: A literature review of published peer-reviewed empirical research was undertaken.

Methods: The electronic databases of MEDLINE (Ovid), CINAHL, and PubMed were accessed to search for relevant empirical articles, supplemented by a search of reference lists contained in retrieved articles and citation tracking.

Results: Thirty-six studies were identified for inclusion in the review. Four areas (study design, sample size, measurement and statistical analysis) were evaluated for methodological quality, and most studies showed strong quality. A synthesis of the findings generated four themes of the effects of inpatient mobilisation: (1) physical outcomes included pain, deep vein thrombosis, fatigue, etc.; (2) psychological outcomes included anxiety, depressive mood, distress, comfort and satisfaction; (3) social outcomes included quality of life and independence; and (4) organisational outcomes included length of stay, mortality and cost.

Conclusion: Mobilising hospitalised adults brings benefits for not only physical functioning, but also their emotional and social well-being. Moreover, ambulation yields important organisational benefits. These benefits of mobilisation on four areas required viewing the patient in a holistic manner. Even though each study approached different types of patients, illnesses and procedures, this review showed that most inpatients would benefit from mobilisation and would experience optimal functions.

Relevance To Clinical Practice: The importance of mobilisation for positive patient outcomes highlights the need to develop methods to ensure that this nursing action is completed on a systematic basis.
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http://dx.doi.org/10.1111/jocn.12315DOI Listing
June 2014

Patient-reported missed nursing care correlated with adverse events.

Am J Med Qual 2014 Sep-Oct;29(5):415-22. Epub 2013 Sep 4.

University of Michigan, Ann Arbor, MI.

The aim of this study was to determine the extent and type of missed nursing care as reported by patients and the association with patient-reported adverse outcomes. A total of 729 inpatients on 20 units in 2 acute care hospitals were surveyed. The MISSCARE Survey-Patient was used to collect patient reports of missed care. Patients reported more missed nursing care in the domain of basic care (2.29 ± 1.06) than in communication (1.69 ± 0.71) and in time to respond (1.52 ± 0.64). The 5 most frequently reported elements of missed nursing care were the following: (a) mouth care (50.3%), (b) ambulation (41.3%), (c) getting out of bed into a chair (38.8%), (d) providing information about tests/procedures (27%), and (e) bathing (26.4%). Patients who reported skin breakdown/pressure ulcers, medication errors, new infections, IVs running dry, IVs infiltrating, and other problems during the current hospitalization reported significantly more overall missed nursing care.
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http://dx.doi.org/10.1177/1062860613501715DOI Listing
August 2016

Cultural adaptation and internal consistency analysis of the MISSCARE Survey for use in Brazil.

Rev Lat Am Enfermagem 2013 Mar-Apr;21(2):610-7

Prefeitura Municipal de Marília, Marília, SP, Brazil.

Objective: The aims of this methodological research were to culturally adapt the MISSCARE Survey instrument to Brazil and analyze the internal consistency of the adapted version.

Method: The instrument consists of 41 items, presented in two parts. Part A contains 24 items listing elements of missed nursing care. Part B is comprised of 17 items, related to the reasons for not delivering care. The research received ethics committee approval and was undertaken in two phases. The first was the cultural adaptation process, in which a committee of five experts verified the face and content validity, in compliance with the steps recommended in the literature. The second was aimed at analyzing the internal consistency of the instrument, involving 60 nursing team professionals at a public teaching hospital.

Results: According to the experts, the instrument demonstrated face and content validity. Cronbach's alpha coefficients for parts A and B surpassed 0.70 and were considered appropriate.

Conclusion: The adapted version of the MISSCARE Survey demonstrated satisfactory face validity and internal consistency for the study sample.
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http://dx.doi.org/10.1590/s0104-11692013000200019DOI Listing
May 2014

Missed nursing care, level of staffing, and job satisfaction: Lebanon versus the United States.

J Nurs Adm 2013 May;43(5):274-9

School of Nursing, University of Michigan, Ann Arbor 48109, USA.

Missed nursing care refers to omission of standard required nursing care of patients in acute care hospitals. The objective of this study was to compare the amounts and reasons of missed nursing care, the level of nurse staffing, and job satisfaction between the United States and Lebanon. Several studies in the United States have shown that a significant amount of care is being missed. This study is designed to determine if Lebanon is experiencing a similar phenomenon and what reasons are given for missing nursing care. Findings support that a substantial amount of nursing care is missed in Lebanon, although less than that in the United States (t = 11.53, P < .001), that nurses in Lebanon were less satisfied with being a nurse than are nurses in the United States, and there was no difference in the identification of staffing resources as a reason for missed care in the 2 countries.
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http://dx.doi.org/10.1097/NNA.0b013e31828eebaaDOI Listing
May 2013