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Student’s Perception of Missed Care: Focus Group Results

DOI: 10.4236/ojn.2017.77064, PP. 850-874

Keywords: Missed Nursing Care, Suboptimal Care, Noncaring, Focus g Groups, Nursing, Pastoral Counseling

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Background: With the inflation of economic constraints on health care and demand to increase care quality, there is an increasing need to develop a clear understanding of what actions by health professionals are perceived as threatening quality care. Objective: To explore graduate nursing and pastoral care student’s perceptions of missed care in Norway. Research design: A qualitative study was employed with the formation of six focus groups. Data was analyzed via a thematic content of the discussions. Participants and research context: Thirty-one students attending a University College in Oslo participated. Findings: Five major themes and thirty subthemes were identified. Major themes included labor constraints, organizational contraints, professional constraints, communication constaints and emotional strain. Discussion: Findings of this study resonate with other research as well as with studies on missed nursing care. Findings also lend support to the definition of missed nursing care actions as required care that is omitted, either in part or whole, or delayed. Conclusion: The findings from this study extend understanding of what barriers health professionals perceive as inhibiting them from offering quality care. The focus groups provided a valuable flora for discussion regarding what participants perceived as missed.


[1]  Scott, T., Mannion, R., Marshall, M. and Davies, H. (2003) Does Organizational Culture Influence Health Care Performance. A Review of the Evidence. Journal of Health Sciences Research & Policy, 8, 105-117.
[2]  Bion, J.F. and Heffner, J.E. (2004) Challenges in the Care of the Acutely Ill. The Lancet, 363, 970-977.
[3]  Institute of Medicine (2004) Keeping Patients Safe. Transforming the Work Environment of Nurses. National Academy Press, Washington DC.
[4]  Reason, J.T. (1990) Human Error. Cambridge University Press, Cambridge.
[5]  McGillis Hall, L. and Doran, D. (2007) Nurses’ perceptions of hospital work environment. Journal of Nursing Management, 15, 264-273.
[6]  Massey, D., Aitken, L.M. and Chaboyer, W. (2009) What Factors Influence Suboptimal Ward Care and Critical Care Nursing. Intensive & Critical Care Nursing, 25, 169-180.
[7]  Papstravrou, E., Efstathiou, G. and Charalambous, A. (2011) Nurses’ and Patients Perceptions of Caring Behaviors: Quantitative Systematic Review of Comparative Studies. Journal of Advanced Nursing, 67, 1191-1205.
[8]  Wilman, E. and Wikblad, K. (2004) Caring and Uncaring Encounters in Nursing in an Emergency Department. Journal of Clinical Nursing, 13, 422-429.
[9]  Quirke, S, Coombs, M. and McEldowney, R. (2011) Suboptimal Care of the Acutely Unwell Ward Patient: A Concept Analysis. Journal of Advanced Nursing, 67, 1834-1845.
[10]  Wood, M. and Massey, G.L. (2007) The Good Catch Program: Increasing Potential Error Reporting. Journal of Nursing Administration, 37, 499-503.
[11]  Reason, J. (2000) Human Error: Models and Management. British Medical Journal, 320, 768-770.
[12]  Bahramnezhad, F., Cheraghi, A., Salsali, M., Asgari, P., Khoshnavay, F., Sanjari, M. and Afshar, P.F. (2014) Futile Care: Concept Analysis Based on a Hybrid Model. Global Journal of Health Sciences, 6, 301-307.
[13]  Kalisch, B.J., Landstrom, G.L. and Hinshaw, A.S. (2009) Missed Nursing Care: A Concept Analysis. Journal of Advanced Nursing, 65, 1509-1517.
[14]  Kalisch, B.J. (2006) Missed Nursing Care: A Qualitative Study. Journal of Nursing Care Quality, 21, 306-313.
[15]  Kalisch, B.J. and Lee, K.H. (2010) The Impact of Teamwork on Missed Nursing Care. Nursing Outlook, 5, 233-241.
[16]  Kalisch, B.J., Landsrom, G. and Williams, R.A. (2009) Missed Nursing Care: Errors of Omission. Nursing Outlook, 57, 3-9.
[17]  Kalisch, B.J., Lee, H. and Friese, C.R. (2011) Hospital Variation in Missed Nursing Care. American Journal of Medical Quality, 26, 291-299.
[18]  Kalfoss, M. and Owe, J. (2017) Meanings Given to Professional Care. Focus Group Results. Open Journal of Nursing, 7, 524-547.
[19]  Miller, J. (2006) Burnout and Its Impact on Good Work in Nursing. Journal of Radiology Nursing, 30, 146-149.
[20]  Attree, M. (2001) Patient’s and Relatives’ Experiences and Perspectives of Good and Not so Good Quality Care. Journal of Advanced Nursing Practice, 33, 456-466.
[21]  Prang, I.W. and Jelsness-Jørgensen, L.P. (2014) Should I Report? A Qualitative Study of Barriers to Incident Reporting Among Nurses Working in Nursing Homes. Geriatric Nursing, 35, 441-447.
[22]  Van Manen, M. (1997) Researching Lived Experience: Human Science for an Action Sensitive Pedagogy. 2nd Edition, Althouse Press, London.
[23]  Marshall, C. and Rossman, G.B. (2016) Designing Qualitative Research. 6th Edition, Sage, Los Angeles.
[24]  Peter, E. and O’Brien-Pallas, L. (2004) Analysis of the Moral Habitability of the Nursing Work Environment. Journal of Advanced Nursing, 47, 364-365.
[25]  Benner, P., Sheets, V., Uris, P., Mallock, K., Schwed, K. and Jamison, D. ( 2002) Individual, Practice, and System Causes of Errors in Nursing. Journal of Nursing Administration, 32, 509-523.
[26]  Cutler, J.R. (2002) From Ward Based Critical Care to Educational Curriculum 2: A Focused Ethnographic Case Study. Intensive Critical Care Nursing, 18, 280-291.
[27]  Clarke, S.P. and Aiken, L.H. (2003) Failure to Rescue. American Journal of Nursing, 103, 198-114.
[28]  Wolf, Z.R. and Robinson-Smith, G. (2007) Strategies Used by Clinical Nursing Specialists in “Difficult” Clinical-Patient Situations. Clinical Nurse Specialist, 21, 74-84.
[29]  English, J. and Morse, J.M. (1998) The “Difficult” Elderly Patient: Adjustment or Maladjustment. International Journal of Nursing Studies, 25, 23-39.
[30]  Nield-Andersen, L., Minarik, P.A. and Dilworth, K.M. (1999) Responding to Difficult Patients. American Journal of Nursing, 99, 26-34.
[31]  Corley, M.C. and Goren, S. (1998) The Dark Side of Nursing: Impact Stigmatizing Responses on Patients. Scholarly Inquiry for Nursing Practice, 12, 99-118.
[32]  Smith, R.C. (2006) The Difficult Patient. Up to Date.
[33]  Philips, J., Beam, S., Brinker, A., et al. (2001) Retrospective Analysis of Mortalities Associated with Medication Errors. American Journal of Health System Pharmacy, 58, 1835-1841.
[34]  Wiegmann, D.A. and Shappel, S.A. (2003) A Human Error Approach to Aviation Accident Analysis. Asage, Aldershot.
[35]  Woodhead, G., Calnan, M., Dieppe, P., et al. (2004) Dignity in Older Age: What Older People in the United Kingdom Think? Age Ageing, 33, 165-170.
[36]  Calnan, M., Woolhead, G., Dieppe, P., et al. (2005) Views on Dignity in Providing Health Care for Older People. Nursing Times, 101, 381-385.
[37]  Jacobsen, N. (2009) Dignity Violation in Health Care. Quality Health Research, 18, 1784-1792.
[38]  Thorsteinsson, L. (2002) The Quality of Nursing Care as Perceived by Individuals with Chronic Illnesses: The Magical Touch of Nursing. Journal of Clinical Nursing, 11, 32-40.
[39]  Darbyshire, P. and McKenna, L. (2013) Nursing’s Crisis of Care: What Part Does Nursing Education Own? Nursing Education Today, 33, 305-307.
[40]  National Patient Safety Agency (2007) Recognizing and Responding Appropriately to Early Signs of Deterioration in Hospitalized Patients. NPSA, London.
[41]  Endacott, R., Kidd, T., Chaboyer, W. and Edington, J. (2007) Recognition and Communication of Patient Deterioration in a Regional Hospital: A Multi-Methods Study. Australian Critical Care, 20, 100-105.
[42]  Thomas, E., Sexton, E. and Helmreich, R.L. (2003) Discrepant Attitudes about Teamwork among Critical Care Nurses and Physicians. Critical Care Medicine, 202, 746-752.
[43]  Johnson, C. (2009) Doctor-Nurse Behavior Survey.
[44]  Fang, M.F., Li, J.P., Liang, H.M., Bai, Y.J. and Song, J.H. (2014) Baccalaureate Nursing Students’ Perspectives on Learning about Caring in China: A Qualitative Descriptive Study. MMC Medical Education, 14, 42.
[45]  Traynor, M. and Buss, N. (2016) Professional Identity in Nursing: UK Student’s Explanations for Poor Standards of Care. Social Science Medicine, 166, 186-194.
[46]  Byszewski, A., Hendelman, W., McGuinty, C. and Moineau, G. (2012) Wanted: Role Models Medical Students’ Perceptions of Professionalism. BMC Medical Education, 15, 11.
[47]  Thomas, J., Jack, B.A. and Jinks, A.M. (2012) Resilience to Care: A Systematic Review and Meta-Synthesis of the Qualitative Literature Concerning the Experiences of Student Nurses in Adult Hospital Settings in the UK. Nurse Education Today, 36, 657-664.
[48]  Efstathiou, G., Papastavrou, E., Raftopoulos, V. and Merkouris, A. (2011) Compliance of Cypriot Nurses with Standard Precautions to Avoid Exposure to Pathogens. Nursing & Health Sciences, 13, 53-59.
[49]  Papastavrou, E., Efstathiou, G. and Andreou, C. (2016) Nursing Students’ Perceptions of Patient Dignity. Nursing Ethics, 23, 92-103.
[50]  Miller, J.F. (2006) Opportunities and Obstacles for Good Work in Nursing. Nursing Ethics, 13, 471-487.
[51]  Einarsen, S., Aasland, M.S. and Skogstad, A. (2007) Destructive Leadership Behavior: A Definition and Conceptual Model. The Leadership Quarterly, 18, 207-216.
[52]  Tadd, W. and Read, S. (2012) Dignity on the Wards: Improving Hospital Care for Older People. British Journal of Hospital Medicine, 73, 244-245.
[53]  Royal College of Nursing (2008) Defending Dignity: Challenges and Opportunities for Nursing. Royal College of Nursing, London.
[54]  Hendersen, A., Van Eps, M.A., Pearson, K., et al. (2012) Maintenance of Patient’s Dignity during Hospitalization: Comparison of Staff-Patient Observations and Patient Feedback through Interviews. International Journal of Nursing Practice, 15, 227-230.
[55]  Thomson, R.T., Leuttel, D., Healey, F. and Scobie, S. (2007) Safer Care for the Acutely Ill Patient: Learning from Serious Incidents. National Patient Safety Agency, London.
[56]  Nadzam, D.M. (2009) Nurses Role in Communication and Patient Safety. Journal of Nursing Care Quality, 24, 184-188.
[57]  The Joint Commission (2009) Comprehensive Accreditation Manual for Hospitals. The Joint Commission, Oakbrook Terrace.
[58]  International Board of Standards for Training, Performance and Instruction. Glossary of Terms. Needs Assessment.
[59]  Cummings, G., Hayduk, L. and Estabrooks, C. (2005) Mitigating the Impact of Hospital Restructuring on Nurses: The Responsibility of Emotionally Intelligent Leadership. Nursing Research, 54, 2-12.
[60]  Turkel, M. (2001) Struggling to Find a Balance: The Paradox Between Caring and Economics. Nursing Administration Quarterly, 26, 67-82.
[61]  Lobchuck, M. (2006) Concept Analysis of Perspective-Taking: Meeting Informal Caregivers Needs for Communication Competence and Accurate Perception. Journal of Advanced Nursing, 54, 330-341.
[62]  Wolf, Z., Miller, P. and Devine, M. (2003) Relationship between Nurse Caring and Patient Satisfaction in Patients Undergoing Invasive Cardiac Procedures. MEDSURG Nursing, 12, 391-396.
[63]  Fineman, S. (2008) The Emotional Organization: Passions and Power. Oxford Blackwell, Malden.
[64]  Huynh, T., Alderson, M. and Thompson, M. (2008) Emotional Labour Underlying Caring: An Evolutionary Concept Analysis. Journal of Advanced Nursing, 64, 195-208.
[65]  Clancy, T. (2003) Courage and Today’s Nurse Leader. Nursing Administration Quarterly, 27, 128-132.
[66]  Murray, J.S. (2007) Creating Ethical Environments in Nursing. American Nurse Today, 2, 48-49.


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