Missed care in residential aged care in Australia: An exploratory study
Section snippets
Problem
Little is known about what care is missed and the causes of missed care in residential aged care.
What is already known
Missed care is widely reported in the acute sector related to limited access to staffing and resources; and poor communication and is associated with poorer outcomes for nurse sensitive indicators.
What this paper adds
Respondents identify missed care across all shifts in residential aged care related to staff levels, rising resident acuity and skill mix. Given recent changes in regulation and funding of aged care, missed care in residential aged care warrants further exploration.
Missed or rationed care: the research to date
Kalisch’s (2006) qualitative study of missed nursing care marked the beginning of research in the area of missed care. Using focus groups, Kalisch identified 9 key areas of regularly missed nursing care as patient ambulation, turning, delayed or missed feedings, patient teaching, discharge planning, emotional support, hygiene, intake and output, documentation, and surveillance (Kalisch, 2006). She labeled missed care as an error of omission, rather than a delayed or forgotten activity, drawing
Aim
The aim of the study was to explore perceptions of the frequency and causes of missed care in residential aged care in three Australian states: New South Wales, Victoria and South Australia. The study is part of a large survey study that invited nurses and personal care assistants (PCAs) in various health care settings to comment on missed care (Blackman, Hamilton et al., 2015).
Study design
A cross-sectional survey design was applied to the study.
Ethics approval
Ethics approval to administer the survey was sought for
Results
In total, 922 nurses and carers working in aged care across the three Australian states participated in the online survey. Two aspects of data are reported: those tasks which are reported as missed and the reasons why they are missed using both quantitative and qualitative data.
Discussion
This paper has bought together survey data from respondents working in aged care from New South Wales, Victoria and South Australia. This data reveals that all care tasks are missed at least part of the time with unplanned and rehabilitative care missed most frequently. This contrasts with findings by Zuniga et al. (2015) who identified more limited missed care. Aged care in Australia is more likely to be provided in larger, privately owned facilities than Switzerland (Baldwin et al., 2015).
Conclusion
This paper brings together responses from aged care respondents to MISSCARE surveys conducted in three states between November 2012 and July 2015. Missed care occurred on all shifts. Staffing levels, resident acuity and skill mix were identified as major reasons for missed care in both quantitative and qualitative responses, with skeleton staffing associated with difficulties in meeting unexpected care needs. Complex health care tasks such as blood glucose monitoring and maintenance of IV lines
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