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The future of care: Where do we stand and how can we meet the challenges of the future?

Wednesday, 18 January, 2023 - 13:18

Prof Mag Dr Hanna Mayer and Ana Valente dos Santos Cartaxo, MSc, both from the Division of Nursing Science with a focus on Person-Centred Care Research, together with Prof Dr Inge Eberl from the Catholic University of Eichstätt-Ingolstadt, provide a data basis on the current situation of nursing care in Austria in the MISSCARE Austria study. On this basis, interventions for successful care provision in the future can be better planned.

The aim was to survey the extent of "missed nursing care" in conservative and surgical general wards of Austrian hospitals. "Missed nursing care" refers to the omission or delayed performance of necessary nursing activities.
The Revised MISSCARE-Austria questionnaire was used to collect online data from approximately 1000 caregivers interviewed
  • on hospital and ward characteristics such as hospital size, type (private, public, non-profit) and location (urban, rural), 
  • on sociodemographic and occupational characteristics of participants such as age, education, and work experience,
  • on the frequency of care activities that are not performed or are performed late and related determining factors, and
  • on the work situation (e.g. number of patients cared for/service) and job satisfaction (e.g. how often is a change of profession considered)
surveyed. The survey period was May and June 2021, and the sample can be considered representative of Austria. 
Rationalization of nursing activities: missed nursing care
Necessary nursing activities were omitted or delayed to varying degrees. Nursing interventions for emotional support are particularly affected by this: in more than 2/3 of the cases, these are not performed or are performed with delay. Frequently mentioned reasons for not or delayed nursing interventions are the completion of several activities simultaneously, frequent interruptions, the increase of patients in need of care, and staff shortage.
Counteracting missed nursing care is not only in the interest of patients to avoid complications, but also underlines the need to minimize staff absenteeism by promoting the health of nursing professionals and counteracting early retirement.
Missed nursing care promotes job dissatisfaction
Nearly ¾ of caregivers surveyed said they were considering leaving the profession. A lower age, working overtime, general satisfaction with the nursing profession, and the degree of "missed nursing care" are relevant influencing factors. Job dissatisfaction increased as the frequency of missed or delayed necessary nursing care increased.
Adequacy of staffing
Staff shortages and the need to perform several activities simultaneously cause, among other things, delays in necessary nursing activities.  To assess what is necessary to improve the quality of care in general wards of Austrian hospitals and to create satisfactory working conditions with manageable workloads, the researchers surveyed the patients to be cared for by a nurse per service within the framework of MISSCARE Austria. With 18.4 patients per nurse and service, Austria has a high number within European countries compared to data from previous studies. Accordingly, 2/3 of the interviewed nursing staff state that in the last 3 months, the staffing of the caregivers was rarely or never adequate. 
Analysis of the actual state for adaption of future interventions
Omission or delayed performance of necessary nursing activities has a clear, statistically significant association with adequate staffing, as evidenced by data from the MISSCARE Austria study. As a positive aspect, the descriptive cross-sectional study highlights potentially modifiable influencing factors around Missed nursing care and describes a tool for measuring the quality of care in specific settings in Austria. Further efforts are needed in practice and research to achieve "qualitatively adequate nursing staff deployment".  The theoretical discussion is the basis for further detailed discussion of high-quality health and nursing care goals. Thanks to open-access funding from Karl Landsteiner University, the study description and results are freely available in the journal HeilberufeScience published by Springer Verlag.
Original publications
  • Einführende Überlegungen: Missed Nursing Care aus der internationalen und österreichischen Perspektive. doi: 10.1007/s16024-022-00391-1
  • Häufigkeit von Missed Nursing Care und assoziierten Einflussfaktoren auf Allgemeinstationen in österreichischen Krankenhäusern. doi: 10.1007/s16024-022-00387-x
  • Patient-to-Nurse Ratio, Angemessenheit der Pflegepersonalbesetzung und deren Einfluss auf Missed Nursing Care – eine quantitative Datenexploration auf Allgemeinstationen in österreichischen Krankenhäusern. doi: 10.1007/s16024-022-00389-9
  • Missed Nursing Care auf Allgemeinstationen in österreichischen Krankenhäusern: Einfluss auf die Arbeitszufriedenheit und auf die Absicht, den Beruf zu verlassen. doi: 10.1007/s16024-022-00390-2
  • Zusammenfassende Implikationen und weiterführende Überlegungen. doi: 10.1007/s16024-022-00391-1


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