Identifying missed care in pediatric nursing: A scoping review

Abstract

Problem: Missed nursing care (MNC) refers to required patient care that is omitted or delayed. Commonly missed elements include ambulation, turning, feeding, patient education, discharge planning, emotional support, hygiene, documentation, and patient surveillance. Key reasons for MNC are insufficient staffing, poor resource utilization, time constraints, lack of teamwork, ineffective delegation, habitual practices, and denial. MNC links inadequate work environments and staffing to poor clinical outcomes, especially affecting efficiency in pediatric settings.

Objective: To describe missed nursing care in pediatrics and to identify the most frequently missed categories of nursing care and summarize the reasons for this.

Eligibility criteria: Any quantitative study which reported on any combination of categories, reason and factors associated with missed nursing care within pediatric settings and which was published in English, full-text available and studies that collected variables on the structure and process of missed nursing care in pediatrics.

Sample: The following databases were searched: PubMed, Embase, CINAHL and Scopus with no time limits.

Results: Missed nursing care (MNC) is influenced by workload, work environment, and staffing levels. A higher patient-to-nurse ratios significantly increase MNC. Better work environments correlate with fewer missed care activities, but frequent interruptions and unexpected patient volume spikes remain major issues. Commonly missed activities include oral care, routine bathing, and adherence to infection protocols.

Conclusion: Addressing MNC requires strategic staffing, improved work environments, targeted interventions, and continuous education to enhance care quality. The studies collectively highlight the complexity of missed nursing care and its dependence on various factors including workload, work environment, and nurse characteristics.

Implication: Developing and validating pediatric-specific assessment tools and studying factors like workload, staff training, and work environment are crucial for addressing MNC in these settings. More research is needed to understand MNC in pediatric settings, focusing on specific challenges and needs.

Keywords: Missed nursing care; Nursing; Pediatrics.