Patient perceptions of missed nursing care.

Background: A series of studies involving nursing staff perception have shown that a significant amount of standard nursing care is being "missed"-that is, aspects of required patient care are omitted or significantly delayed. A study was conducted to (1) determine the elements of nursing care that patients are able to report on and (2) to gain insight into the extent and type of missed nursing care experienced by a group of patients.

Methods: In-depth, semistructured, face-to-face interviews, guided by open-ended and interactive questions, were conducted with 38 inpatients on seven different patient care units in an acute care hospital.

Findings: For Question 1, elements were categorized as fully reportable (for example, mouth care, bathing, and pain medication), partially reportable (hand washing, vital signs, and patient education), or not reportable (nursing assessment, skin assessment, intravenous site care). For Question 2, patients identified mouth care, ambulation, discharge planning, patient education, listening to them, and being kept informed as frequently missing. Patients sometimes missed response to call lights and alarms, meal assistance, pain medication and follow-up, other medication administration, and repositioning. Nursing care identified as rarely missed were bathing, vital signs, and hand washing.

Conclusions: There is a large area of care for which patients can give an account if they are cognizant of their surroundings and mentally able to do so. For certain aspects of care, patients' perceptions of missed care were similar to those of nursing staff. There is a need to link specific aspects of nursing care to patient outcomes to assist in determining how essential specific elements of nursing care are and the cost-benefit balance of completing them or not.