ReviewUnfinished nursing care, missed care, and implicitly rationed care: State of the science review
Section snippets
Introduction/background
Quality problems in healthcare have been classified into three major categories: overuse, underuse, and misuse (Chassin and Galvin, 1998). Underuse occurs when healthcare services that would have produced favorable patient outcomes are not provided. Each failure to deliver beneficial services represents a missed opportunity to improve health outcomes and is a form of medical error (Hayward et al., 2005). Evidence suggests that quality problems associated with underuse of healthcare services are
Literature search
A literature search was conducted as illustrated in Fig. 1. The search was limited to articles published in the English language and in peer reviewed journals; no date restrictions were imposed. Articles were eligible for inclusion if they contained: (1) conceptual definitions and/or concept analyses of terms related to unfinished nursing care in the hospital setting; (2) reports of original qualitative research related to the experience of unfinished nursing care in the hospital setting; (3)
Results
Three approaches to inquiry for unfinished care accounted for 89% of the published science. Each of these approaches used different operational definitions and instrumentation practices, and was traced to distinct sources of origin: the tasks undone (TU) approach originated from the IHORC formed by The University of Pennsylvania School of Nursing's Center for Health Outcomes and Policy Research (Sochalski, 2004); the implicit rationing (IR) approach originated from the Rationing of Nursing Care
Discussion
Our synthesis of conceptual frameworks suggests that unfinished care is conceived as a problem of time scarcity that precipitates the process of implicit rationing through clinical priority setting among nursing staff resulting in the outcome of care left undone. The most notable difference in the frameworks reviewed pertains to the process component of unfinished care and is most accurately portrayed as a difference of terminology rather than substance. The theoretical and qualitative evidence
Conclusions
Unfinished nursing care is a prevalent form of medical error categorized as underuse. Time scarcity among bedside nurses is the primary driver of unfinished care which is associated with multiple negative outcomes for patients, nurses, and organizations. The science of unfinished care is in its infancy and is limited by issues related to the sensitivity and specificity of available instruments as well as study designs that rely on common sources for estimates of unfinished care and outcomes of
Conflict of interest
None declared.
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