Nursing Article Critique

This article critically analyzes the research findings of Bragadottir, Kalisch & Tryggyadottr (2017) in terms of the significance of the research, research methods and designs used by the authors, findings, and their relevance to contemporary nursing practice.

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NURSING ARTICLE CRITIQUE 1
Contents
Introduction...........................................................................................................................................2
The research problem...........................................................................................................................2
SIGNIFICANCE........................................................................................................................................3
The research designs.............................................................................................................................3
The research methods...........................................................................................................................4
Findings.................................................................................................................................................4
IMPORTANCE TO NURSING POLICY.......................................................................................................5
Critical Analysis......................................................................................................................................5
Conclusion.............................................................................................................................................7
References.............................................................................................................................................7

NURSING ARTICLE CRITIQUE 2
Introduction
One of the major causes of death in hospital is errors in hospital care (Makary& Daniel,
2016). Missed nursing care is the main reason that arises to these errors in hospital.Missed
nursing care (MNC) is a quality measure of nursing care and safety of patient. To reduce the
potential serious errors, there are various patient safety initiatives. Current research
studiesfocus on the fact that errors of omission like missed nursing care is equally important
as errors of commission when it comes to patient safety.Researchers have observed that there
are few care operations that directly proceed to patients without passing through the
nurses(Jones, Hamilton & Murry, 2015). Missed care is a form of health care underuse which
is more severe than health care overuse or combined misuse (Kalisch &Xie, 2014). The
present essay critically analyses the research findings of Bragadottir, Kalisch &Tryggyadottr
(2017) in terms of significance of the research, research method and designs used by the
authors, findings and their relevance to contemporary nursing practise.
The research problem
Irrespective of country and setting, the most common MNC is observed to be the basic care
which includes ambulating and reporting patients, timely nourishing of patients, conversation
of reassurance with patient and his/her family, training of patient, timely conduct of
medicine, documentation and addressing interdisciplinary rounds. However, in the current
study the authorsidentified two major research problems that are the role of hospital
departments, staff traits, staff efficacy and collaborative work can all contribute to MNC and
to what level the prediction of MNC is effected by units, staff trait and collaborative work
(Bragadottir, Kalisch &Tryggyadottr, 2017).

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SIGNIFICANCE
Unfinished or Missed nursing care is a serious issue in critical care hospitals globally.
Prioritisation approaches of nurses leads to unsafety of patients in terms of educational,
emotional, and psychological necessities. Majorrestraints of the science consist of the risk of
generalprocess/cause bias, insufficient clarityconcerning the application of mixed samples
and subsidiary analysis, irregularity in the documentationofmissed care frequency, and a
shortage of arbitration studies(Kalisch, Xie& Dabney, 2014; Lake, Germack&Viscardi,
2016).
The research designs
The primarygoals of the current study were to recognise how and to what extend hospital,
department, staff trait and collaborative work are linked with MNC. To study all of that, the
authors carried out their study on the basis of the conceptual framework which was derived
from Kalisch and Lee (2010) (Bragadottir, Kalisch &Tryggyadottr, 2017). The hospital trait
studied was to identify it as a teaching hospital. Unit traits were distinguished as medical unit,
surgical unit, ICU or combinatorial units. Staffs were characterised on the basis of gender,
age, title of job, number of weekly working hours, experience, overtime, days of leave, staff
efficiency and number of patients attended. The current study is based on 5 basic constituents
of teamwork and 3 aiding correlating method. The 5 major components include leadership in
team, monitoring of correlative performances, backup behaviour, adaptability and orientation
of team. The correlating mechanisms include sharing of mental representation, secured loop
transmission and correlative trust. All these together enhances teamwork especially during
stressful situations.

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The research methods
The methods carried out in the current study is quantitative cross-sectional survey study. In a
cross-sectional survey study data are collected for making inferences for an interested
population for a particular period of time. This type of survey is considered as documentation
of the populations on the basis of data collected. Cross-sectional surveys are sometimes
periodically repeated. In a repeated survey study, the respondents of a survey at a certain
period of time are not sampled in the next time. In the current study, they performed cross
sectional survey study in all units of medicine, surgery and ICUs in Iceland. The sample
comprised of n=864 nursing staffs that provides direct care to the patients. This study
included registered nurses and practical nurses. A consolidated questionnaire of MISSCARE
survey-Icelandic and NTS-Icelandic was used for data collection. Both the surveys were then
verified for authenticity, adequacy and validity. The questionnaire included multiple choice
questions including one question where they had to give descriptive answer regarding the
number of patients attended by them in the previous shift.
Findings
It was observed that majority of the nurses were female aging from 35 years or above, having
experience for more than 5years. They work on rotating shifts and mostly have working
hours for more than 30h. Majority of them have worked for overtime in the past 3 months.
Almost half the number of nurses has taken leave for 2days or more in the past 3 months. On
an average, the responding nurses attended 6.39 patients in the last shift. Majority of them
have taken care of 8 or less patients.This trend of limitation of caring of patients have been
observed not only in Iceland but also in other parts of the world. This is a global issue.

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Almost every hospital irrespective of country have been observed to be going through this
problem (Qureshi, Purdy, Mohani& Neumann, 2019; Ball et al, 2014; Knopp-Sihota,
Niehaus, Squires, Norton &Estabrooks, 2015).
IMPORTANCE TO NURSING POLICYAND PRACTISE
In context of nursing policy implications, the policy makers must have the understanding of
the problem from dual perspective i.e. the nursing professional’s perspective and hospital
administration perspective.Policies must address the minimum number of nursing
professionals to be maintained as per patient load. Inclusion of such issue-based practice
knowledge in nursing curriculum can be a potential solution.
From the aspect of nursing practice, involving nursing staff’s in the process of decision
making and implantation of organisation guidelines can be more beneficial than forcing rules
andguidelines in better recognition of problems and finding solution. Identification of
factorsattributing to MNC,adequatesolutionsmay be derived by nursing care staffs and
clinicians. Efficient interferencetargeted at crucial nursing actions and reinforcing
teamworkamong departments can be beneficial.
Critical Analysis
The findings of this study provides an indication that hospital, individual units, every staff
and the nursing teamwork together contribute to missed nursing care. So, a collaborating
effort taken by all the staff together not only the nursing staff, the hospital authorities,
individual units and employees in there can work together to eliminate chances of missed
care.Winsett et al (2016) reported unit cohesiveness, improvement in nursing work
environment and preventing interruptions can reduced missed care (Winsett et al., 2016). In
the present study results observed shows that majority of the nurses were female and above

NURSING ARTICLE CRITIQUE 6
age of 35years. Recruiting additional male and young staff can increase the efficacy of the
care system and reduce MNC. This is recommended because Diab and Ebrahim (2019) study
showed missed nursing care is associated with female nurses as compared to male nurse.
Majority of the nurses were observed to work overtime but simultaneously it was observed
that the number of patients cared by every nurse is less. So, by increasing nursing staff and
proper allocation of working hours to every nurse can reduce overtime and instead the time
overused can be utilised for treating more patients. But research by Dabney and Kalisch
(2015) found negative correlationship between missed care and staffing levels as well as RN
care hours for each patient. It implicates, there might be other factors that affects the care
process resulting in missed timelines. Before addressing issues with patients directly the
hospital authorities should approach them via the nurses. All the staff should work as a team
so that a smooth process can be carried out and even a particular nursing staff fails to care a
patient, there should be alternative staff taking care of the same patient. The team work effect
on mitigating missed nursing care issues have been reported by Chapman, Rahman Courtney
& Chalmers (2016) carrying out a primary study in four Australian hospitals. There should be
proper team work among all the hospital staffs. Unit type, age, duty and staff efficacy
anticipated 16% of the divergence in MNC and collaborative work anticipated an extra 14%
to the divergence of missed nursing care.
As mentioned above, MNC is a global issue. This study concentrates on the circumstances in
Ireland, but similar issues are observed throughout the world. Universal hospital staff policies
and proper application of the policies should be prioritised. Proper caring and appropriate
conversation with the patient and their family should be mandatory criteria for the staff.
Every hospital staff should be assigned with respective roles in the hospital but should also be
encouraged to work as team. The hospital management should make guidelines and proper
training in the hospital where they will be mandated and encouraged for collaborative

NURSING ARTICLE CRITIQUE 7
performance. Caring for more patients should be made compulsory but simultaneously, it
should also be accounted that the quality of the care should not be hampered in the process.
Both the quality and quantity of the patient care can be increased by team work and help from
every staff at the hospital.
Conclusion
According to the finding of the current study the error of omission by the nurses is perhaps
considered as more serious issue and critical in the well being of the patient. The results focus
on the correlations and predictions of missed nursing care at hospitals. This study provides
direction on the aspect of developing strategies to reduce missed nursing care which includes
assurance of proper staff levels and increased teamwork. The findings obtained from the
current study suggests the importance of focusing on individual units in hospital and how
inadequate staffing and low collaborative work can affect nursing care. The frequency of
Missed Nursing care is extreme amidst nursing staff in critical care hospitals globally.
Therefore, not just one but several factors including the staff characteristics, the contribution
of the hospital and the teamwork significantly influences MNC compared to single factor.

NURSING ARTICLE CRITIQUE 8
References
Ball, J. E., Murrells, T., Rafferty, A. M., Morrow, E., & Griffiths, P. (2014). ‘Care left
undone’during nursing shifts: associations with workload and perceived quality of
care. BMJ Qual Saf, 23(2), 116-125.
Bragadóttir, H., Kalisch, B. J., &Tryggvadóttir, G. B. (2017). Correlates and predictors of
missed nursing care in hospitals. Journal of clinical nursing, 26(11-12), 1524-1534.
Chapman, R., Rahman, A., Courtney, M., & Chalmers, C. (2017). Impact of teamwork on missed care
in four Australian hospitals. Journal of clinical nursing, 26(1-2), 170-181.
Dabney, B. W., & Kalisch, B. J. (2015). Nurse staffing levels and patient-reported missed nursing
care. Journal of nursing care quality, 30(4), 306-312.
Diab, G. M. A. E. H., & Ebrahim, R. M. R. (2019). Factors Leading to Missed Nursing Care among
Nurses at Selected Hospitals. American Journal of Nursing, 7(2), 136-147.
Jones, T. L., Hamilton, P., & Murry, N. (2015). Unfinished nursing care, missed care, and
implicitly rationed care: State of the science review. International journal of nursing
studies, 52(6), 1121-1137.
Kalisch, B. J., & Lee, K. H. (2010). The impact of teamwork on missed nursing care. Nursing
outlook, 58(5), 233-241.
Kalisch, B. J., &Xie, B. (2014). Errors of omission: Missed nursing care. Western Journal of
Nursing Research, 36(7), 875-890.

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Knopp‐Sihota, J. A., Niehaus, L., Squires, J. E., Norton, P. G., &Estabrooks, C. A. (2015).
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