Missed Nursing Care During the COVID-19 Pandemic in Educational and Medical Centers in Northern Iran: A Cross-sectional Study

Abstract

Background: Nurses are the first point of contact in hospitals and play a significant role in providing high-quality care. Missed nursing care has been shown to be associated with poorer patient outcomes, increased mortality, medication errors, falls, and hospital-acquired infections. Objectives: This study aimed to investigate missed nursing care and its causes and related factors in the north of Iran. Methods: This cross-sectional study was conducted during the COVID-19 pandemic in Rasht, Iran, from January to March 2021. A total of 326 nurses from non-emergency wards of 7 medical centers were enrolled using a simple random sampling method. The data on demographic characteristics, occupational stress (using the expanded nursing stress scale [ENSS]), and missed nursing care and its causes (using the MISSCARE questionnaire) were collected. Data were analyzed by descriptive statistics and multiple logistic regression analyses. Results: Sixty-nine percent of nurses reported that at least 1 aspect of nursing care was missed occasionally, often, or frequently. Also, the median number of missed care items reported on each shift was 4 out of 25. Attending interdisciplinary care conferences (46%), interventions for basic care (45%), and psychological supports for patients (42%) were the most omitted items. The most stated reason was human resources (53%). Also, the occurrence of occasionally, often, or frequently missed care was significantly related to a higher level of nursing occupational stress (adjusted odds ratio [OR], 2.12; 95% CI, 1.28 - 3.52; P < 0.001) and rotating shift work compared to day shift work (adjusted OR, 4.54; 95% CI, 2.38-9.10; P = 0.003). Conclusions: Nursing missed care is relatively prevalent in the north of Iran. Human resources, work shift schedules, and occupational stress play an important role in missed nursing care during the COVID-19 pandemic. It is necessary for policymakers and nursing managers to use strategies to optimize manpower and equipment, develop a standard work shift, and reduce stress in the workplace to improve the quality of patient care.