Interventions to prevent or reduce rationing or missed nursing care: A scoping review

Abstract

Aims: To collate and synthesize published research on interventions developed and tested to prevent or reduce the rates of rationed or missed nursing care in healthcare institutions.

Background: Rationed and missed nursing care has been widely studied, including its predictors and associations with patient and nurse outcomes.

Design: Scoping review.

Data sources: We searched for eligible studies, published between 1980-2019, in six electronic databases.

Review methods: Researchers independently screened the abstracts of the retrieved studies using the inclusion and exclusion criteria. The decision of whether or not to include any given study was consensus-based.

Results: The search yielded 1,815 records, of which 13 were included. Three studies reported structural interventions, namely increased nurse staffing and improved nursing teamwork, both resulted in significant reductions in the rates of rationed or missed nursing care. The remaining 10 studies reported on process interventions: four concerned reminders (via technology or designated persons) and seven described interventions to change or optimize the relevant care processes. All 10 process interventions contributed to significant reductions in the rates of missed nursing care.

Conclusions: The results of the scoping review indicate that specific interventions can positively influence the performance of a selected nursing care activity, for example fall prevention. There is no evidence of a global reduction of rationed and missed nursing care through these interventions.

Impact: Clinicians, managers and researchers can use the results for adapting and implementing interventions to reduce rationed and missed nursing care.

Keywords: decision-making; interventions; nurse staffing; nursing care; prevention; quality of care; rationed and missed nursing care; scoping review; teamwork.