In this study, 373 nurses working in selected hospitals of Abadan University of Medical Sciences were investigated regarding the amount of missed nursing care and its relationship with the working conditions of the nursing environment.
According to the results of the analysis of this study, some demographic variables had a significant relationship with the amount of missed nursing care (Table 1), which we explain each one.
The variable of missed nursing care according to financial status has a significant difference (P = 0.0001) and the amount of missed nursing care in people with moderate to poor financial status has the first rank. This finding is consistent with Hernandez's study[18]. Considering the effect that the financial situation has on intellectual engagement and all aspects of people's lives, it is concluded that this issue can also affect the quality of performing tasks in the workplace and cause some care to be forgotten.
Considering the effect that the financial situation has on intellectual engagement and all aspects of people's lives, it is concluded that this issue can also affect the quality of performing tasks in the workplace and cause some care to be forgotten.
The amount of missed nursing care has been observed in people with night shifts (P = 0.034), which has been emphasized in other studies[19, 20]. Fatigue caused by long working hours in the night shift as well as night sleeplessness can be effective in this case. This case can be adjusted by more supervision of managers and setting policies, as well as setting up eight-hour shifts. As in some studies, this has not been observed[21, 22].
The amount of missed nursing care in people with very low interest was ranked first, then people with low interest, and finally people with medium and high interest were in the last rank(P = 0.001). Examining the relationship of this variable with the amount of missed nursing care, in other studies was not observed. Providing quality services, especially in the field of nursing, which is related to human health, requires interest and willingness to help and care for others. Especially since several factors after starting to work in the hospital, such as job burnout, can affect this interest.
In examining the level of satisfaction with the work environment and the amount of income, people with very low satisfaction rank first, then people with low satisfaction, and finally people with medium satisfaction(P = 0.0001).
Dissatisfied nurses are more susceptible to missed nursing care. This finding was consistent with many studies in different countries[2, 20, 21, 23–27]. The satisfaction of nurses' job conditions is directly related to the way they communicate with colleagues, patients, and their companions, and as a result, the quality of providing care and increasing productivity. Therefore, necessary measures are necessary to eliminate or adjust the causes of nurses' dissatisfaction.
No significant relationship was observed between the variable of gender and the amount of missed nursing care[28, 29], but in some studies, this significant relationship has been mentioned that in some cases, the amount of missed care is more reported in women and others in men[7, 30]. Since the conditions of the work environment and the nature of the job description are the same for both genders, this feature in this study did not have a significant effect on the amount of missed nursing care. However, due to the difference in the inherent characteristics of men and women, as well as the existence of contradictory studies, a more detailed investigation of this factor seems necessary.
In this study, there was no significant relationship between the variables of age, educational qualification, work experience, type of employment, and the amount of missed nursing care.
No significant relationship was observed between the workplace variable and the amount of missed nursing care[31]. This relationship has been significant in some studies. Considering that in the present study, only nurses from general departments such as internal medicine and surgery participated in the study, and other studies where this relationship was mentioned were in special departments that have a very sensitive and different nature of work.
In the review of missing nursing care items, the most negligence was in the item "re-evaluation and focused patient according to conditions", which was also observed in Kalisch's study and other studies[30, 32]. Due to factors such as the lack of nursing staff and nursing assistants, the large number of patients, the large task description, and the central task of some nurses, it is possible to see negligence in the re-examination of patients, which is a nursing intervention.
In the second rank was the item "mouth care (using mouthwash)" [18, 19, 21, 28, 32–36] and in the third rank was the item "helping the patient to the toilet in less than 5 minutes after the request" which was also observed in other studies[3, 14, 19, 28, 37, 38]. It seems that forgetting such care can be caused by the lack of nurses and assistant nurses in hospitals. According to Ausserhofer et al.[38]; Nurses often prioritize and limit care due to high work pressure to perform assigned tasks. The most important factors that can lead to negligence in these cares are: nurses not caring about care, not recording care in nursing reports, and not checking care by nurses at the time of shift delivery. According to the mentioned cases, it is necessary to pay more attention to correct the above cases.
The items with the least deficiencies are: 1) There were items "preparing meals for patients who were eating". This finding is related to the assignment of this task to the hospital nutrition unit. Regarding these items, taking care of them is only related to recording the names and type of diet of the patients. 2) "Documenting everything necessary" which can be justified considering the focus on hospital managers and the role of this type of care in lawsuits. 3) "Care of venous or central catheters and evaluation of hospital orders and policies" which is related to the invasiveness of this procedure.
In the following survey of the working environment conditions, all the scales except "doctor-nurse communication" have been evaluated in an unfavorable situation from the nurses' point of view. All scales of working environment conditions have had a significant relationship with the amount of missed nursing care(Table 2). One of these factors is "the ability of the nursing manager to lead and support nurses". This means that excellent leadership of the nurse manager, along with adequate support for nurses, will reduce the amount of missed nursing care. This issue is also consistent with previous studies[39–41]. This issue is related to the ability to lead the nurse with the missing nursing care because nursing managers are responsible for managing the working conditions of nurses, assigning tasks, and coordinating available resources. In addition, effective management increases nurses' work participation affects clinical performance, and is one of the main influencing factors concerning patient safety outcomes. In particular, nursing managers can change the overall dynamics of a unit, such as the communication pattern and the quality of nurses' work.
Other scales, such as doctor-nurse communication, which leads to the coherence and provision of safer care, the sufficiency of resources and personnel and infrastructure to improve the quality of care, which leads to less workload, as well as the existence of facilities and equipment and policies to prevent malpractice in Providing care, all of them can affect achieving the ultimate goal of the health system, providing quality and safe care and their consequences.
One of the limitations of the current study is the cross-sectional design which cannot determine the causality of the relationship between the variables under study. On the other hand, the self-report method was used to collect information, and factors such as social desirability and recall bias are among its disadvantages and may affect the accuracy of the quantity of missed nursing care. Also, the participants of this study were nurses who worked in general care departments and those who agreed to participate in the study, which could have affected the results. Therefore, the results of this study can only be generalized to this research group. Therefore, it is necessary to repeat this study with more data and stronger study designs to confirm these results.