Abstract
Unfinished, rationed, missed, or otherwise undone nursing care is a phenomenon observed across health‐care settings worldwide. Irrespective of differing terminology, it has repeatedly been linked to adverse outcomes for both patients and nursing staff. With growing numbers of publications on the topic, scholars have acknowledged persistent barriers to meaningful comparison across studies, settings, and health‐care systems. The aim of this study was thus to develop a guideline to strengthen transparent reporting in research on unfinished nursing care. An international four‐person steering group led a consensus process including a two‐round online Delphi survey and a workshop with 38 international experts. The study was embedded in the RANCARE COST Action: Rationing Missed Nursing Care: An international and multidimensional Problem. Participation was voluntary. The resulting 40‐item RANCARE guideline provides recommendations for transparent and comprehensive reporting on unfinished nursing care regarding conceptualization, measurement, contextual information, and data analyses. By increasing the transparency and comprehensiveness in reporting of studies on unfinished nursing care, the RANCARE guideline supports efficient use of the research results, for example, allowing researchers and nurses to take purposeful actions, with the goal of improving the safety and quality of health‐care services.
Highlights
Unfinished nursing care is “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” (Jones et al, 2015)
Based on a review of the literature on unfinished nursing care and a review of existing methodological guidelines, we developed a list of n = 61 items, capturing methodological or conceptual barriers in research on unfinished nursing care, which were introduced for feedback on their relevance (“How do you rate the relevance of this item for inclusion in the reseArch on uNfinished nursing CARE (RANCARE) guideline?”) and clarity (“How do you rate the clarity of wording of this item?”) in the Delphi survey
The components of the final RANCARE guideline consist of 40 items that address key elements influencing the reporting of quantitative research on unfinished nursing care
Summary
Unfinished nursing care is “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” (Jones et al, 2015). While the research community widely acknowledges the common underlying phenomenon of unfinished nursing care, differences in its key elements are still reflected in publications: quantitative studies on the topic face a variety of methodological and conceptual challenges (Vincelette et al, 2019) that are reflected in measurement and analyses as well as the transparency and comprehensiveness of their reporting. High levels of variability are seen between studies investigating different conceptualizations (e.g., missed care vs implicit rationing) and within studies using a single concept and corresponding instrument (e.g., different cutoffs in the scoring of multi‐item surveys; different terminology used for the same instrument and sample; differing task list within the same approach [tasks undone scales TU‐5 and TU‐13]; differing temporal frame for the reference period [previous 7 working days vs previous 30 days vs previous 7 shifts worked]; differing aggregation, on individual, unit‐level, or institution level). The lack of transparency and comprehensiveness on these elements complicates interpretation and meaningful comparison of study findings enormously
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