Nurses' and older patients' perspectives on missed nursing care contextualised within the Fundamentals of Care Framework: A cross-sectional survey.

Background: The Fundamentals of Care Framework outlines the core dimensions involved in delivering essential nursing care. Resource shortages and increased care demands compromise fundamental care delivery and contribute to missed nursing care. This impacts quality and safety within healthcare settings but is disproportionately experienced by older patients, therefore both nurse and patient voices must be heard. Objectives: To individually explore both nurse-reported and patient-reported perceptions of the frequency of missed nursing care. This research also aimed to estimate the factors that contribute to missed nursing care from nurses' perspectives and to identify to what extent the MISSCARE instruments can represent the elements within the Fundamentals of Care framework. Design: A cross-sectional study using the MISSCARE instruments to elicit nurse and patient perspectives of missed nursing care. Setting: A single large university, tertiary hospital in Ireland with over 800 beds. Participants: Approximately 929 fully qualified nurses working in direct patient care and all patients aged 65 or older in 31 adult inpatient wards were invited to participate. Methods: The MISSCARE Survey and MISSCARE Survey-Patient were used to collect data between April and July 2024. Nurses indicated the frequency of and contributing factors to missed nursing care. Communication, timeliness and basic nursing care delivery were measured from the patients' perspectives. The data were analysed using SPSS and mean scores were found for each care item. The items in the MISSCARE surveys were mapped to the elements in the Fundamentals of Care Framework. Results: A total of 151 patients and 145 nurses participated. According to nurses, attending interdisciplinary care conferences, mobilisation and oral care were frequently missed. Patients reported that oral care, communication in relation to who their specific nurse was and mobilisation were frequently missed. The significant reasons for missed care included inadequate numbers of nursing staff and assistive personnel and urgent patient situations. The MISSCARE Survey-Patient demonstrated a higher percentage coverage (73.7 %) of the elements outlined within the Fundamentals of Care framework than the MISSCARE Survey (42.1 %). Conclusions: This study reiterates the need to prioritise nurse recruitment and retention strategies and highlights areas which require attention to ensure the delivery of fundamental care. The MISSCARE surveys can measure the Fundamentals of Care Framework to a certain extent however, the development of a tool to directly measure all three framework dimensions is required. The development of a succinct tool to measure nurses' and patient's perspectives on missed nursing care is also required.