The State of Missed Nursing Care in a Telemetry Nursing Unit: A Descriptive Case Study

The State of Missed Nursing Care in a Telemetry Nursing Unit: A Descriptive Case Study

Author: 
Ann Marie Svolos
Program of study: 
Ph.D./NUR
Abstract: 
Missed nursing care in the acute hospital setting is care left undone. Omitted, missing and even rationed care, are not new concepts in nursing practice. However, in 2006 Dr. Beatrice Kalisch formally identified the type of care that is regularly missed in acute general hospital units and the reasons missed nursing care occurs. Missed nursing care is a problem for nursing and healthcare because it may lead to negative patient and staff outcomes which may result in harm. The purpose of the research was to understand missed nursing care from a telemetry nurse’s perspective to learn how it continues to occur. A descriptive, case study design allowed for a comprehensive review of the phenomenon within a specific patient care setting where health information, communication, and care technologies are used by nurses to deliver patient care. Four themes emerged from the data: (a) environmental conditions may contribute to missed nursing care; (b) the effects of changing nursing workflows on nurses’ time have not been identified; (c) nursing staff performance may be a contributing and a mitigating factor for missed nursing care; and (d) use of technology resources may mitigate missed nursing care. Recommendations regarding missed nursing care include educating front line staff about the phenomenon, assessing the type and frequency of events in individual practice settings, examining nursing workflows and workload, and assessing the dual role that teamwork has as a contributing and mediating factor for missed nursing care.
Dedication: 
This dissertation is dedicated to my nursing colleagues and to my children. First, to my nursing colleagues who fight the good fight each day. Your tireless work and efforts in a rapidly changing environment with dwindling resources inspired me to conduct this research. It is my hope that it is but a starting point for a conversation about how to best use technology to improve the practice of nursing and the delivery of patient care. Second, to my three girls Christina, Julianna, and Amanda who have known no other world than one with a mother as a working student. I cannot thank them enough for their love, patience, and understanding as I pursued each degree and for their complete acceptance when I gave them the news that I was returning to school for a PhD. My greatest reward has been to witness the dedication and commitment they have to their own education. I hope that my example has, in some small way, inspired them to be lifelong learners.
Acknowledgements: 
First, and foremost, I acknowledge nursing leaders of the past and present. During the doctoral journey I was often in awe of the amazing work that has been and is being done to further nursing science. In the early days of this journey when I was doubtful of my ability to conduct research, it was the example of those who came before me and of those conducting research now that motivated me to push forward. I have always been proud of my profession, but learning how to become a nurse researcher has given me a deeper respect and understanding of the nursing academic and scientific communities. Second, I would like to acknowledge two nursing mentors without whom this dissertation would not have been possible. First to Mayra Sloves, my first nursing instructor and the woman responsible for helping me recognize that I was being called to be a nurse. Her example was my first introduction to the concept of nursing excellence and I will be forever grateful that I had the honor of calling her teacher and then later Mom. Second, is Caroline Gaffney-Esparza, a true nurse leader who has been an informal mentor to me throughout my career. As a nurse leader, she provided me with an example of how to advocate for nurses and patients without apology or compromise. As my supervisor, she allowed me to work a flexible schedule so that I would be able to juggle career, family, and the doctoral journey. As a mentor, she has consistently modeled professionalism and excellence in career and in life. I am indebted to her for the role she has played in my professional growth and development and for helping me achieve some semblance of balance as I traversed this sometimes-crazy journey. Third, I would like to thank my doctoral committee chair, Dr. Cydney Mullen for the time she invested in me and her commitment to my success. She has been a guiding light and a positive force that has helped me stay on the path and remain focused. Without her encouragement and her expertise, I know I would not have successfully completed my dissertation. To my committee members Dr. Donna Taliaferro and Dr. Mirella Brooks, I cannot thank you enough for your feedback, guidance, and support throughout the dissertation process. Your expertise was instrumental in helping me produce my best work. Lastly, I would like to acknowledge my family and friends. I will refrain from naming each of you to avoid missing even one of you. Know, however, that you each helped me reach my goals in ways big and small. Your patience, understanding and love sustained me on this long journey and made it possible for me to achieve something I barely dared to dream I could have. I am forever grateful and blessed to have you in my life.