Care Left Undone Phenomenon in Italian Newborn Intensive Care Units

Introduction: Health systems around the world work to provide quality care services. A method for assessing the quality of care, which has won particular interest over the past decade, is the analysis of omitted nursing activities because the reduction of this phenomenon could help improve the quality of care itself. In newborn intensive care units (NICUs), care left undone has been studied highlighting its dimensions and characteristics; however, these studies are very few and performed mainly in the Unites States. The objective of this study is to photograph and investigate the phenomenon of care left undone in the context of pediatric nursing care provided in NICUs in Italy.

Materials and Methods: A qualitative–quantitative study was conducted: for the quantitative phase, a secondary analysis was performed, using the database of the RN4CAST@IT-Ped study with a cross-sectional observational design, by drawing the data related to NICUs. For the qualitative phase, a qualitative descriptive study was conducted, by conducting semistructured interviews in a NICU. Convenience sampling was chosen for both phases, and involved pediatric nurses and nurses, dedicated to providing direct care during the last 24 hours, coming from at least 1 of the 13 hospitals affiliated with Associazione Ospedali Pediatrici Italiani. The quantitative nurse survey was conducted between September 2017 and January 2018, through an online survey, while the semistructured interviews were conducted in January and February 2019. The quantitative data were analyzed using SPSS 22.0 software and by conducting a descriptive analysis. The qualitative data were analyzed through a verbatim transcription and the conduction of a thematic analysis.

Results: For the quantitative phase, 324 surveys were collected. Of the total sample, 90.1% were female, 47.2% held a university degree in nursing, and 31.5% held a university degree in pediatric nursing. The average age of the respondents was 38.2 years (standard deviation [SD] ± 9.52), average seniority as a nurse was 14.2 (SD ± 9.98), while average service seniority in the pediatric area was 13.12 (SD ± 10.22). The most frequent care activities left undone were “informing and educating patients or family members” (43%), and “developing or updating nursing care plans” (42%), followed by “adequately documenting nursing care” (40%) and “planning care” (39%). The least frequent care activity left undone was “oral hygiene” (28%). For the qualitative phase, seven semistructured interviews were conducted, which produced a thematic pattern consisting of seven themes, which described the experience of providing nursing care in a NICU. The thematic analysis confirmed and supported the quantitative data, showing that the most frequently omitted activities and the mostly unmet needs were those related to the relational aspects with the parents.

Conclusion: This is the first study that measures care left undone in Italian NICUs. Our results are consistent with international literature showing that nurses miss some activities more frequently. Understanding the aspects of this phenomenon, also thanks to the in-depth qualitative analysis, could be a starting point for a more in-depth analysis of the related costs. This is a current perspective consistent with health economization and spending review policies of which our country has been a protagonist in recent years, and of the respective patient outcomes, to guide health care toward the centrality of the patient and to improve the quality of care.

Keywords: newborn intensive care unit; nurses; care left undone; quality of care; patient safety

Conflict of Interest: None declared.

 

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No conflict of interest has been declared by the author(s).