Factors affecting missed nursing care in hospitalized frail older adults in the medical wards: a qualitative study

Zahra Rezaei-Shahsavarloo,Robbert J J Gobbens,Foroozan Atashzadeh-Shoorideh,Abbas Ebadi

doi:10.1186/s12877-021-02524-z

Abstract

BackgroundFrail older adults who are hospitalized, are more likely to experience missed nursing care (MNC) due to high care needs, communication problems, and complexity of nursing care. We conducted a qualitative study to examine the factors affecting MNC among hospitalized frail older adults in the medical units.MethodsThis qualitative study was carried using the conventional content analysis approach in three teaching hospitals. Semi-structured interviews were conducted with 17 nurses through purposive and snowball sampling. The inclusion criteria for the nurses were: at least two years of clinical work experience on a medical ward, caring for frail older people in hospital and willingness to participate. Data were analyzed in accordance with the process described by Graneheim and Lundman. In addition, trustworthiness of the study was assessed using the criteria proposed by Lincoln and Guba.ResultsIn general, 20 interviews were conducted with nurses. A total of 1320 primary codes were extracted, which were classified into two main categories: MNC aggravating and moderating factors. Factors such as “age-unfriendly structure,” “inefficient care,” and “frailty of older adults” could increase the risk of MNC. In addition, factors such as “support capabilities” and “ethical and legal requirements” will moderate MNC.ConclusionsHospitalized frail older adults are more at risk of MNC due to high care needs, communication problems, and nursing care complexity. Nursing managers can take practical steps to improve the quality of care by addressing the aggravating and moderating factors of MNC. In addition, nurses with a humanistic perspective who understand the multidimensional problems of frail older adults and pay attention to their weakness in expressing needs, can create a better experience for them in the hospital and improve patient safety.

Highlights

Frail older adults who are hospitalized, are more likely to experience missed nursing care (MNC) due to high care needs, communication problems, and complexity of nursing care
Due to the limitations of previous studies identifying the factors contributing to MNC in hospitalized frail older adults and the importance of MNC to patient safety, the present study aimed to explore the factors affecting missed nursing care in hospitalized frail older adults on the medical wards through a qualitative approach
Older frail people receiving hospital care are more likely to be affected by MNC due to high care needs, communication problems and complexity of nursing care

Summary

Introduction

Frail older adults who are hospitalized, are more likely to experience missed nursing care (MNC) due to high care needs, communication problems, and complexity of nursing care. The population of older adults is growing as a result of health policy implementation This increase has caused serious concerns for the health care. Hospitalization imposes a high level of stress on older adults due to inappropriate ward environment [8], disorganized care, increased medication consumption [9], age discrimination [10] and missed nursing care [11]. This process aggravates their frailty, worsens the disease and leads to death [9]

Methods

Results

Discussion

Conclusion