Missed nursing care in acute care hospital settings in low-income and middle-income countries: a systematic review

Imam, Abdulazeez; Obiesie, Sopuruchukwu; Gathara, David; Aluvaala, Jalemba; Maina, Michuki; English, Mike

doi:10.1186/s12960-023-00807-7

Human Resources for Health

Table 1 Summary of instruments used to measure missed nursing care in LMIC settings

From: Missed nursing care in acute care hospital settings in low-income and middle-income countries: a systematic review

Instrument (Original reference for tool)	Level of measurement of missed nursing care	Brief tool description	Adaptations	Number of questions	Scale/score category	Studies in the review employing specific tool (references in footnote)
Basel Extent of Rationing of Nursing Care—Revised (BERNCA-R) [38]	Nurse self-report	Scale consists of 32 nursing activities, nurses report on the degree to which they were unable to carry these out in their preceding week of duty Activities are broadly divided into 5 domains of care: – Activity of Daily livings, e.g., Bathing, bed linen change – Caring-support – Rehabilitation-instruction-Education – Monitoring-Safety – Documentation	Revised from the BERNCA which was adapted from the International Hospital Outcome Study	32	5-point Likert scale that measures the frequency with which care was missed: 0 = not required (i.e., rationing of nursing activity was not required in the last week) 1 = never 2 = rarely 3 = sometimes 4 = often	a, b
MISSCARE [39]	Nurse self-report	Two parts (A and B). Part A is designed to measure missed nursing care and consists of a list of nursing activities; nurses are asked to report if they missed these on their previous shifts Part B is designed to measure perceived nurse reasons for missed nursing care around 3 domains—Labour, material, and communication/teamwork	Not applicable	Part A—24 questions Part B—17 questions	5-point Likert scale to measure the frequency of missed nursing care: 1 Never missed (i.e., nurse activity being measured is never missed) 2 Rarely 3 Occasionally 4 frequently 5 Always missed	c, d, e, f, g, h, i, j, k, l, m, n, o
MISSCARE-Brasil [25]	Nurse self-report	Same as MISSCARE tool	Addition of a few questions to reflect the Brazilian context	Part A—28 questions Part B-28 questions	Same as MISSCARE tool	p, q, r, s, t, u
MISSCARE-Chinese [26]	Nurse self-report	Same as MISSCARE tool	Some original MISSCARE questions modified with a few additional questions to reflect the Chinese context	Part A—29 questions Part B—22 questions	Same as MISSCARE tool	v
MISSCARE (modified by maternal health experts) [40]	Nurse self-report	A modification of the MISSCARE tool my maternal health experts Contains questions covering timely cervical examinations and labour support to fit nursing activities in an Obstetrics and Gynaecology unit	Adapted specifically to assess missed care in Obstetrics and Gynaecology	26 questions	Same as MISSCARE tool	w
MISSCARE-PU [41]	Nurse self-report	Abridged version of MISSCARE tools with some modified questions and additional questions to cover aspects of pressure ulcers management	Adapted specifically to assess missed care in nurses’ management of pressure ulcers	13 questions	Same as MISSCARE tool	x
Missed Nursing Care Scale (MNCS)	Nurse self-report	Questionnaire covers 12 essential nursing tasks which were left undone on the most recent nursing shift	Not applicable	12 questions	4-point Likert scale measuring the degree to which nursing activities were left undone: 0 never 1 rarely 2 occasionally 3 frequently	y, z
Nursing Care Index (NCI) [27]	Direct observation of patients	Structured tool used by a bedside observer to collect data around care delivered to a newborn. Covers domains, such as routine newborn care, vital sign monitoring and medications	Not applicable	Not applicable	Observed care are summed up and expressed as a proportion of explicitly defined expected care to derive a patient-level aggregate score of care	aa
RN4Cast Questionnaire [9]	Nurse self-report	Questionnaire covering a list of 13 necessary nursing activities to which nurses are asked to identify which were left undone in their most recent shifts because of time constraints. Activities measured include those related to clinical care, patient care planning and communication	Adapted from the from International Hospital Outcome Study	13 questions	Binary—care is missed or not missed, and results are reported as percentage of specific care that is missed	ab
Unnamed tool [42]	Nurse self-report	Questionnaire covers a list of 15 nursing activities including clinical, planning patient education and counselling	Not applicable	15 questions	Binary—care is missed or not missed, and results are reported as percentage of specific care that is missed	ac

a Assaye et al. [23], b Zhu et al. [37], c Arslan et al. [43], d Nahasaram et al. [57], e Al-Faouri et al. [24], f Hammad et al. [49], g Chegini et al. [46], h Bacaksiz et al. [44], i Saqer et al. [22], j Hernández-Cruz et al. [50], k Kalisch et al. [51], l Moreno-Monsiváis et al. [56], m Ghezeljeh et al. [48], n Taskiran et al. [61], o Grajales et al. [62], p Moura et al. [55], q Lima et al. [54], r Dutra et al. [47], s Silva et al. [60], t Pereira Lima Silva et al. [59], u Siqueira et al. [25], v Du et al. [26], w Haftu et al. [40], x Valles et al. [41], y Labrague et al. [52], z Labrague et al. [53] aa Gathara et al. [27], ab Nantsupawat et al. [58], ac John et al. [42]

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ISSN: 1478-4491

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