Table 6 The occurrence of and reasons for unfinished nursing care in the study using the the unfinished nursing care survey [58]

PART A – Interventions

CS

RS

Collect data on the situation of the patients’ care at the beginning of the shift, through the handover

•

••

Perform a round at the beginning of the shift to know the patients, present themselves, and deepen their situation

Document properly the interventions provided and the revision of the care plan

Help patient in need in ambulation

Help patients who need it to get into a chair

Passive mobilization/changing position in bedrest patient

Helping patients who are unable to eat independently and/or have clinical problems (e.g. dysphagia)

Helping patients who are unable to drink independently and/or have clinical problems

To stimulate the patient to maintain/improve his/her independence

Provide personal hygiene to patients who need it

••

•

Provide mouth care to patients who need it

Perform physical assessment (e.g. skin integrity, and invasive device insertion site)

Check pressure ulcers and change dressing according to protocols

•

Perform bedside glucose monitoring as prescribed

•••

•••

Monitor intake/output

••

••

Record vital signs as planned

•••

•••

Administer medications within 30 min of the time indicated in the prescription

Administer PRN medications within 15 min of the patient’s request

Monitor administered medications effects

Ensure patients’ comfort (microclimate, patient positioning)

Monitor pain as planned

•

••

Spend time with patients and their carers

Communicate with patients and carers

Inform patients and their carers regarding the nursing care they are receiving

Emotionally support patients and carers by listening to their needs/concerns

Involve patients and carers in the discharge planning

Teach patients and carers how to self-care at home

Respond promptly to patients’ calls (within 5 min)

Go to the patients at the bedside without being called

Ensure intensive surveillance, reevaluating, those patients who are unstable or who present a risk of deteriorating conditions

•

•

Prevent negative outcomes for patients at risk (e.g. falls, pressure ulcers and malnutrition)

Prevent health-care-associated infections by adopting good clinical practice (e.g. hand hygiene between patients, closed urinary drainage system)

••

••

Discuss with physicians and other staff members the problems of and interventions needed by patients

Supervise the tasks assigned to the nurse assistants

Assess the effectiveness of the care provided, for example, reviewing whether nursing care needs have been met

Fill in/update the clinical documentation/care plan in a comprehensive way

Perform clinical handover to adequately inform the next shift nursing team about patients’ conditions

•••

•••

Provide clinical teaching to nursing students

•

PART B – Reasons for Unfinished Nursing Care

Factor 1, Communication

Tension/conflicts within the nursing staff

•••

•••

Incomplete or interrupted communication among nursing staff

•

•

Tension/conflicts between nursing and medical staff

•

Incomplete or interrupted communication between nursing and medical staff

Lack of support/collaboration among team members

Factor 2, Priority setting

Inadequate nursing care model (e.g. functional task-oriented model of care)

•••

••

Inaccurate initial priority setting

•••

•••

Inadequate priority reassessment during the shift

••

•••

Factor 3, Nurse assistants supervision

Nurse assistants missed or delayed reporting the tasks left undone

••

•

Inadequate supervision of the tasks assigned to the nurse assistants

••

••

Incomplete or interrupted communication between nursing staff and nurse assistants/assistive personnel

•

••

Factor 4, Material resources

Medications prescribed not available

Equipment not available/not functioning properly when needed

Other departments did not provide the service expected (e.g. delay in diagnostic processes)

•

Factor 5, Human resources

Inadequate number of nurses

Inadequate number of nurse assistants

Factor 6, Workflow predictability

Unexpected rise in patient acuity

Heavy admission/discharge activity during the shift