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

Nurses are the first point of contact in hospitalsandplay 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 hospitalacquired infections.

This study aimed to investigate missed nursing care and its causes and related factors in the north of Iran.

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.

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).

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.