Critical Appraisal of Missed Nursing Care and its Contributing Factors

This critical appraisal examines the research conducted by Bragadóttir, Kalisch, and Tryggvadóttir (2017) on missed nursing care and its contributing factors. The study highlights the importance of addressing this issue to improve patient safety and nursing practice. The research design and methodology are analyzed, and the findings suggest that unit and staff characteristics, as well as teamwork, significantly contribute to missed nursing care. The paper concludes with recommendations for training, recruitment, and policy changes to reduce missed nursing care and enhance patient outcomes.

Running head: CRITICAL APPRAISAL
Name of the student
Name of the university
Author note:

1CRITICAL APPRAISAL
Introduction:
With the global burden of chronic disease, the high quality of health care services is required to
meet the criteria of patients. Therefore, to evaluate the quality of care, Bragadóttir, Kalisch, and
Tryggvadóttir (2017), undertaken research in order to identify the contribution of hospital, unit,
staff efficacy and adequate team work to the missed nursing care Iceland hospital. The rationale
behind undertaking this research that accumulated literature identified that one of the quality
indicators of the nursing care and patient safety is missed nursing care (Winsett et al., 2015). As
discussed by Lake Germack and Viscardi (2016), missed nursing care (MNC) is the benchmark
of nursing care which reflects the omission of the required nursing care or delaying in nursing
care. There are several contributing factors of MNC highlighted in the clinical setting that
questioned the safety of the patient and give rise to ethical issues. Therefore, the research
undertaken by Bragadóttir, Kalisch, and Tryggvadóttir (2017) would provide in-depth knowledge
of the missed nursing care and associated factors contributing to it to reduce the possible
medications. The journal contents detailed information of quantitative cross-sectional survey
study including data collection, analysis, result, discussion and relevancy to the nursing practice.
This paper will provide critical analysis of each section of the journal such as research problem
and significance, methodology and result with discussion. Lastly, the paper will provide a
conclusion as a summative overview of the critical analysis in the following paragraphs.
Research problem and significance:
Despite the presence of the clinical guideline, safety standards, and quality care protocol,
nurses failed to provide quality care to the patient (Lake et al., 2016). Mountain of research
highlighted that missed nursing care (MNC ) is one of the quality indicator of nursing care since

2CRITICAL APPRAISAL
MNC contributed to high medication error which questions the patient safety and therefore, it
becomes a global concern. No comparable former study was conducted in Iceland about MNC
because of the lack of adequate knowledge of contributing factors of MNC and prevention
method MNC for improved outcome. As discussed by Cho et al. (2015), MNC basically
observed in basic care provisions such as mouth care, feeding patient on time, turning patient on
time, assisting a post-operative patient on time with daily activities, patient education,
medication administration on time and documentation. The significance of the problem is that
because of inadequate knowledge of the nurses, health professionals, lack of interpersonal skills,
critical thinking they failed to provide accurate care (Jones et al., 2016). Consequently, MNC
leads to repetitive hospital admission, slow recovery from the illness, resistance to the treatment
and low patient outcome and satisfaction. MNC also disrupts the mental wellbeing of the patients
and their family members since they exposed to the high level of psychological distress.
Therefore, Bragadóttir, Kalisch, and Tryggvadóttir (2017) conducted the quantitative cross-
sectional survey with the aim of identifying the contribution of the hospital units, staff
characteristics, teamwork, staff adequacy to the missed nursing care in the Iceland hospital. It
would help to reduce clinical error and increase patient outcome and satisfaction.
Research design and method:
Bragadóttir, Kalisch, and Tryggvadóttir (2017) conducted quantitative cross-sectional
survey considering all of registered nursing and practices nurses (total 864) as well as a nurse
manager and other staffs working on 27 medical, surgical and intensive care unit in eight
hospitals of Iceland in between March to April 2012. As discussed by Antwi and Hamz (2015),
quantitative study assists to identify the underlying factors behind the issue and provide detailed
insight into issues from the response of the respondents which contributed to the successful

3CRITICAL APPRAISAL
research. Hence, it is appropriate for the research. The researchers collected the data through the
survey, informed letter to gain an understanding of the contributing factors to the missed nursing
care. As discussed by Goertzen (2017), the survey is the most suitable method of data collections
since it helped researchers to measure the numerical relationships between variables, in this case,
MNC and it’s contributing factors. Moreover, it is a cheap method represents a large number of
samples and high statistical significance (Goertzen, 2017). Hence, it is an appropriate method for
the study. The researchers used M SPSS version 22 to analyze the data and only participants
who spent maximum time on the unit were included in the analysis. As discussed by Lock and
Seele (2015), SPSS is the most suitable method of data analysis because it provides the
opportunity to customize the collected data and data entry is much easier compared to other
software resulted in the accurate data analysis. Hence, it is an accurate method of analysis for
conducting research.
Findings:
The result of the study undertaken by Bragadóttir, Kalisch, and Tryggvadóttir (2017),
reported that unit and staff h characteristics along with the team working significantly
contributed to the missed care nursing. The result suggested that the age of nurses, type of the
unit and perception of staff adequacy contributed to 16% of MNC. The missed nursing care
highlighted in the medical and surgical unit of ICU. MNC also highlighted when the inadequate
staff was observed in the hospital and registered nurses along with younger nurses are more
prone to missed nursing care. The age is a crucial player in this case since with the rapid aging
the registered nurses gathered more experiences which contributed to their high patient safety
competency. However, the research also suggested that students nurses are more patient-centered
resulted in minimum MNC compared to an old and experienced registered nurse who is a more

4CRITICAL APPRAISAL
professional center. The longer work shifts and absentees also associated with the missed
nursing care which is especially observed in the surgical unit and intensive care unit.
The research is relevant to the nursing practice because this research will help nurses to
involve themselves in the training process which focuses on the core values of nurses, code of
conduct and interpersonal skills (Jones et al., 2016).. The information gathered from the research
highlighted would assists to reform their beliefs regarding person-centered care, prioritizing
patients based on the urgency of the health conditions and gained knowledge of the current so
that they can evaluate their skills of time management, interpersonal skills (Winsett et al., 2015).
The research would assists nurses to work in the partnership with the patient, family members,
and coworkers to promote the collaborative practice. The research also assists employers to
recruit competent and adequate nurses in order to reduce MNC (Jones et al., 2016). The
research is relevant to the nursing policy “Care Coordination” which promotes the incorporation
of the family members in the care for improving the patient care quality and satisfaction
(Nursingworld.org., 2019).
Conclusion:
Thus it can be concluded that MNC contributed to high medication error which questions
the patient safety and becomes a global concern. The MNC observed mouth care, feeding
patient on time, turning patient on time, assisting a post-operative patient on time with daily
activities, patient education, medication administration on time and documentation. This paper
provided a critical analysis of a journal where researchers conducted a quantitative cross-
sectional survey with appropriate research design and method. The result highlighted that MNC
is high in ICU and surgical unit because of the inadequacy of staffs, perception of nurse and lack
of teamwork.

5CRITICAL APPRAISAL

6CRITICAL APPRAISAL
References:
Antwi, S. K., & Hamza, K. (2015). Qualitative and quantitative research paradigms in business
research: A philosophical reflection. European Journal of Business and
Management, 7(3), 217-225.
Cho, S. H., Kim, Y. S., Yeon, K. N., You, S. J., & Lee, I. D. (2015). Effects of increasing nurse
staffing on missed nursing care. International nursing review, 62(2), 267-274.
Goertzen, M. J. (2017). . Introduction to Quantitative Research and Data. Library Technology
Reports, 53(4), 12-18.
Jones, T. L., Gemeinhardt, G., Thompson, J. A., & Hamilton, P. (2016). Measuring unfinished
nursing care: What to consider when choosing and scoring surveys. Journal of nursing
care quality, 31(1), 90-97.
Lake, E. T., Germack, H. D., & Viscardi, M. K. (2016). Missed nursing care is linked to patient
satisfaction: a cross-sectional study of US hospitals. BMJ Qual Saf, 25(7), 535-543.
Lake, E. T., Staiger, D. O., Cramer, E., Hatfield, L. A., Smith, J. G., Kalisch, B. J., & Rogowski,
J. A. (2018). Association of Patient Acuity and Missed Nursing Care in US Neonatal
Intensive Care Units. Medical Care Research and Review, 1077558718806743.

7CRITICAL APPRAISAL
Lock, I., & Seele, P. (2015). Quantitative content analysis as a method for business ethics
research. Business Ethics: A European Review, 24, S24-S40.
Nursingworld.org. (2019). Care Coordination and the Essential Role of Nurses | American
Nurses Association (ANA). Retrieved from https://www.nursingworld.org/practice-
policy/health-policy/care-coordination/.
Winsett, R. P., Rottet, K., Schmitt, A., Wathen, E., Wilson, D., & Group, M. N. C. C. (2016).
Medical surgical nurses describe missed nursing care tasks—Evaluating our work
environment. Applied Nursing Research, 32, 128-133.