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Missed Care in Nursing


MissedCare in Nursing

Missednursing care describes a concept that refers to any feature ofrequired patient care, which is omitted wholly or partially, ordelayed. Missed care in nursing entails an error of omission. Twochief types of errors have been identified by the patient safetymovement as being acts of omission or acts of commission. Althoughacts of commission have been given considerable attention, acts ofomission have not been addressed (Duffy,2009). The issue of missed care became first identified by Kalisch ina study involving missed nursing care. Although missed nursing caretakes place, it has not been identified as a critical nursing issueto study and understand. The research entailing the concept of themissed nursing care will be presented in this paper. The chiefpurpose of studying the concept is to have a better understanding ofthe concept and providing knowledge on the concept, which can beutilized for future studies concerning the concept.

ReasonsWhy the Concept is of Interest to Nursing

Thenotion of missed care is of interest to nursing since it is capableof helping managers be in a position of identifying various issuesthat lead to the missed nursing care. It is through understanding andidentifying these issues that managers in a health setting can becapable of mitigating the outcomes of missed nursing care. Besides,the concept is of interest in nursing since it can help in makingnurses understand what they can do in avoiding missed nursing care.On the other hand, the concept is of interest in nursing sincethrough studying and understanding the concept, nurses are capable ofidentifying reasons for missed nursing care, which they can avoid.Furthermore, the concept is of interest to nursing since it can helpin increasing nursing efficiencies.

Attributesof Missed Care

Fromthe study done by Kalisch, different attributes that contribute tomissed care were identified these include antecedents in the careenvironment, which inhibit or facilitate the nursing practice,aspects of the nursing process, care provided as planned, delayed, oromitted, patient outcomes, and internal perceptions and decisionsteps (Kalisch et al, 2010). These attributes are as described in thefollowing paragraphs


Antecedentsof missed nursing care usually exist in the context of the caresetting are usually external to the nurses and develop a need forthem in deciding the care to be provided. One of the antecedentsincludes labor resources available in providing patient care. Laborresources are usually critical since they address the type and numberof nurse and assistant caregivers available in regard to the demandsfor nursing care. The other antecedent entails material resourcesthat assist in providing care. These material resources influence thecapacity of nurses in providing care. On the other hand, teamwork andcommunication entail the third antecedent. Ineffective communicationhas the possibility of leading to missed care since a nurse may notbe capable of providing certain care due to lack of communication(Molinari&amp Bushy, 2012). Besides, in case a team member fails to informothers concerning a certain care situation, there is a possibility ofhaving missed care. Therefore, teamwork and communication arecritical in providing care.


Nursingcare aspects usually depend on the nursing process. The nursingprocess usually entails different phases that include assessment,planning, diagnosis, evaluation and implementation. There are variousnursing actions, which are appropriate to a certain patient for everynursing phase. This implies that in case a nurse does not follow thecorrect nursing process, there is a possibility of having missedcare.

InternalProcesses of Nurses

Thechoice of completing, delaying or omitting items of patient care canbe influenced by different factors that are internal to a nurse,which entails team norms, decision making process, habits, andinternal values and beliefs. Each team has norms regarding acceptablebehavior. Team norms are usually implicit and fresh members learnthese conducts relatively quickly. In case nurses perceive that othernurses do not conform to the customs of the group, they are alsolikely not to conform to the group norms. For example, in case freshnurses note that most old nurses do not ambulate patients, then thefresh nurses are likely to conform to the norm (Molinari&amp Bushy, 2012). This is likely to lead to missed care. Besides,when nurses are determining the aspects of care within the nursingprocess, they base their assessments on the condition and needs ofpatients. Nurses can include an item of care in the planning processof the day depending on the conditions of patients. However, someplanned aspects of care may not be prioritized leading to delay oromission of some elements of care. On the other hand, habits affectthe ultimate decision by nurses in delaying or omitting care (Kalischet al, 2009).When care is missed and no apparent detrimental impact on patient ornobody notices, it becomes easy to omit or delay the element of careduring the next period of care provision. One the habit is initiated,it may become exceedingly difficult for the nurses to leave thehabit, and will only become corrected or addressed once omission isnoticed or patients discover the missing element of care. Inaddition, attitudes, values and believes held by nurses concerningtheir responsibilities usually shape the behavior of nurses inproviding care. These attitudes, values and believes may make nursesdecide the care to be provided, while they omit others. Therefore,attitudes, values and believes of nurses concerning theirresponsibilities may lead to missed care.


Mostarticles that have information concerning the missed nursing carehave a presentation of the same definition of the term missed nursingcare. From the analysis of different articles that present thisconcept, missed nursing care has been defined as any part ofnecessary patient care, which is omitted or delayed omission may bewholly or partially. The following articles discuss this concept

Missednursing Care: A Qualitative Study

Thisarticle presents a study that was involved in determining nursingcare that is frequently missed on medical-surgical units. Besides,reasons for missed care are presented in this article. In its study,the article involved 9 elements of frequently missed nursing carethese entail turning, ambulation, missed or delayed feedings,discharge planning, hygiene, patient teaching, emotional support,surveillance, and intake and output documentation. The article has anopinion that ensuring quality patient safety and nursing careconstitutes a main challenge that faces nurses and nursing leaders.The article also presents different reasons leading to missed carethese include exceedingly few staff, timely intervention, poorutilization of existing staff, habit, denial, and ineffectivedelegation (Kalischet al, 2009).

Dostaffing levels predict missed nursing care? InternationalJournal for quality in Health Care

Thisarticle tries to find whether nurse staffing can predict missed care.The article argues that, increased staffing levels have beenassociated with a reduction in various patient outcomes such asmortality rates, pressure ulcers, infection rates. Such outcomesusually lead to increased costs and extended stays in hospitals.Besides, the article is of the opinion that although there is a linkamid patient outcomes and staffing levels, few studies have centeredon nursing care process, which leads to better outcomes during thetime when staffing is richer. In addition, the article concludes thatmissed nursing care can only explain partly the association amidpatient outcomes and staffing levels (Kalischet al, 2011).

TheImpact of Teamwork on Missed Nursing Care

Accordingto this article, teamwork is a critical aspect in assuring patientssafety and quality care. Teamwork problems lead to poor quality innursing care. The article also provides that patient andorganizational unit properties, along with the nursing teamwork levelcan be used in predicting missed nursing care. The article concludesthat the nursing teamwork level on impatient acute care hospitalpatient units has an impact on the nursing care process (Kalisch&amp Lee, 2010).

Theoretical&amp Operational Definition

Thetheoretical definition of the concept is the nursing care that apatient misses. The nursing care entails giving the patient certaincare elements, which are necessary for proper and efficient treatmentof the patient. Therefore, in case a patient misses an element of thenursing care, then the patient is said to miss care. On the otherhand, the theoretical definition of missed nursing care is any partof necessary patient care, which is omitted or delayed omission heremay be wholly or partially.

Relationof the Concept to Nursing and Its Use in the Future

Thenotion of missed care can be applied in all healthcare settings.Healthcare leaders can apply the concept in an attempt to find outvarious issues such as its effects to the patient outcomes, or itsrelation to staffing ratios. Thus, the manager can use it inunderstanding its relation with other elements of the healthcare.Besides, nurses can use this concept in identifying the frequentareas that are likely to lead to missed nursing care. It is throughunderstanding these areas that nurses can be capable of mitigatingcases and instances of missed nursing care. On the other hand, thenotion of missed care can be utilized by healthcare researchers intrying to understand a patient outcome associated with the concept.In addition, nursing students can apply the concept during theirpractice in order to avoid promoting missed nursing care, when theyenter the nursing care practice.

Inthe future, the concept can be utilized by researchers in trying tounderstand what is already known concerning the concept, in order toresearch more on what is not understood regarding the concept. As aresearcher, I will be in a position to gain knowledge on the previousresearch done concerning the concept, which will aid in focusing inother unaddressed areas. Besides, in the future, I will use theconcept in guiding nursing students in identifying the reasons forthe missed nursing care and what to do in order to avoid the missednursing care. In addition, as a manager, I will use the concept inthe future in trying to understand the areas that are frequentlyassociated with missed nursing care so as to ensure efficient nursingcare.

Valueof Concept Analysis

Conceptanalysis has added value to the nursing knowledge that I already havesince it has helped in gaining special knowledge that I did notpossess. If it were not for the concept analysis, I could not be in aposition to understand most areas of nursing since a concept may bejust mentioned without going deep into its analysis. The conceptanalysis gives a better understanding of the concepts used in thenursing practice, which is critical in providing nursing care. As amatter of fact, concept analysis aids in knowing everythingconcerning a given concept. This is vital in ensuring that nursingstudents obtain the much needed knowledge for nursing practice.


Missednursing care is any part of necessary patient care, which is omittedor delayed. In this case, omission can be wholly or partially. Thisconcept is critical as it helps in ensuring efficient and safe careis accessible to patients (Duffy&amp Duffy,2013). By fully understanding this concept, nursing students can bein a position to avoid the frequent areas that lead to missed nursingcare this is vital in ensuring that patients access and receiveefficient care. Different attributes have been noted to contribute tomissed care these include antecedents in the care environment, whichinhibit or facilitate the nursing practice, aspects of the nursingprocess, care provided as planned, delayed, or omitted, patientoutcomes, and internal perceptions and decision steps. Theseattributes need to be observed in a healthcare setting in order toensure efficient nursing care.


Duffy,J. R. (2009).&nbspQualitycaring in nursing: Applying theory to clinical practice, education,and leadership.New York: Springer Pub.

Duffy,J. R., &amp Duffy, J. R. (2013).&nbspQualitycaring in nursing and health systems: Implications for clinicians,educators, and leaders.New York, NY: Springer Pub.

KalischB.J.,Landstrom G.L. &amp Hinshaw A.S.(2009) Missednursing care: a concept analysis.Journal of Advanced Nursing 65(7), 1509–1517.

KalischBJ, Landstrom G, Williams RA (2009). Missednursing care: Errors of omission.Nurs Outlook.

KalischBJ, Lee H, Salas E (2010). Thedevelopment and testing of the nursing teamwork survey.

Kalisch,BJ &amp Lee, HK. (2010). TheImpact of Teamwork on Missed Nursing Care.Nurs Outlook.

Kalisch,BJ, Tschannen, D. &amp Lee, HK. (2011). Dostaffing levels predict missed nursing care? InternationalJournal for quality in Health Care Vol. 23 (3), pp302-308.

Molinari,D., &amp Bushy, A. (2012).&nbspTherural nurse: Transition to practice.New York, NY: Springer Publishing Company.