How Do Nurses Decide on Missed Nursing Care? A Grounded Theory Study of Grassroots Arrangement of Nursing Care.

Aims: To explore the complete decision-making process and action logic of nurses making autonomous decisions that result in missed nursing care.

Background: The complex characteristics of patients in Intensive Care Units place higher demands on the allocation of nursing resources, as well as on the professional skills, resilience and ethics of nursing staff. Preventing missed nursing care is particularly crucial in Intensive Care Units.

Design: A theory construction qualitative study using grounded theory.

Methods: Semistructured face-to-face interviews were conducted with 20 nurses, including three head nurses and 17 bedside nurses. Head nurses provided insights into counselling and management practices.

Results: The theoretical model of nurses' decision-making processes comprise four strategies: setting priorities, seeking help, delaying nursing care and omitting nursing care. The latter two constitute missed nursing care. Inadequate staffing, task urgency and negative emotions can lead to omitting nursing care.

Conclusions: This study proposes an original concept: grassroots arrangement of nursing care (GANC). Grassroots arrangement of nursing care includes the autonomous and adaptive decision-making process used by bedside nurses to optimise workflow in busy environments. It includes specific strategies and quality implications, enabling a nuanced balance between limited nursing resources, increasing patient needs and maintaining the best possible quality of care.

Relevance To Clinical Practice: Nursing managers should consider the dual aspects of grassroots arrangement of nursing care, support nurses' grassroots autonomy and streamline decision-making processes.

Reporting Method: This study follows the Consolidated Criteria for Reporting Qualitative Studies (COREQ).

Patient Or Public Contribution: No patient or public contribution.