Elsevier

Collegian

Volume 24, Issue 5, October 2017, Pages 411-416
Collegian

Missed care in residential aged care in Australia: An exploratory study

https://doi.org/10.1016/j.colegn.2016.09.001Get rights and content

Abstract

Background

The phenomena of missed nursing care is usually measured through quantitative surveys that detail the specific tasks that are rationed or delayed, and the reasons why this is so. These studies report high levels of agreement within and across countries between the two major measures employed; the Kalisch’s MISSCARE tool and the RN4Cast Basel Extent of Rationing of Nursing Care (BERNCA) instrument. Most of these studies have been conducted in acute care settings and demonstrate the impact of lack of human and other resources upon decisions to omit care. Less in known about missed care in residential aged care

Aim

To explore the frequency and causes of missed care in residential aged care in three Australian states: New South Wales, Victoria and South Australia.

Methods

Quantitative and qualitative data from 922 respondents working in residential aged care to the MISSCARE survey were bought together to identify the tasks missed in aged care and reasons for this.

Findings

Respondents report the omission of unplanned care (toileting and answering bells) and rehabilitative care. The primary reasons for missed care are staffing shortages and difficulties in meeting residents’ complex health care needs due to demands arising from increased resident acuity and fewer skilled nurses to meet this demand.

Conclusion

Resident care is missed in residential aged care with staffing numbers identified as a key cause.

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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