Anat Drach‐Zahavy

Objective: To develop and validate the Unfinished Community Nursing Care Reasons Survey (UCNC_RS) transnationally and compare Unfinished Nursing Care (UNC) reasons across countries. Design: This development and validation study was conducted in Israel and Italy, following the COnsensus‐based Standards for the selection of health Measurement Instruments guidelines. Sample and measurement: Tool identification, adaptation, and development were followed by content and language validation; structural validation was then performed with 309 community nurses (156 in Israel and 153 in Italy) who agreed to participate. Exploratory Factor Analysis (EFA), Mokken analysis, and descriptive statistics were conducted. Results: The UCNC_RS consists of 23 items. Israeli EFA identified three factors, while the Italian EFA identified two, with items loading on more than one factor in both countries. Mokken analysis indicated a good model fit. Reasons for UNC differed between countries, both in their order of importance and in their averages, indicating different patterns of perceived elements affecting UNC occurrence. Conclusion: Overall, the UCNC_RS may be used in daily practice to survey and proactively address factors that may increase the occurrence of UNC. Reasons for UNC are organized hierarchically, suggesting that actions should target different system levels to reduce its occurrence. In Israel, priority policies are needed at the macro‐, exo‐, and nurse‐system levels, while in Italy, policies are needed at the macro‐, meso‐, and micro‐levels. Moreover, the reasons for UNC differ across countries, both in their order of importance and in their scores, with only some common elements, indicating different patterns of perceived reasons.

Background: Evidence on effective interventions to reduce missed care is limited. While various strategies exist, proactive huddle intervention remains underexplored. Objectives: This study aimed to develop, implement, and evaluate proactive huddles as an effective process to reduce missed care in nursing wards. A secondary objective was to investigate the moderating effect of personal nurse accountability on the relationship between proactive huddles and missed care. Methodology: A randomized controlled study was conducted in a medium-sized hospital, involving 180 nurses across six internal and four surgical wards. Methods: Participants were randomly assigned to a 3-month intervention (n = 85) and control (n = 95) groups between March 2022 and May 2023. The intervention consisted of daily huddles, incorporating four key elements: status of tasks, potential delays, tasks that might not be completed, and assistance needed. The MISSCARE Survey (measured on three different occasions) and the 3D Accountability Questionnaire were assessed at baseline and immediately after the 3-month intervention. Results: A total of 602 huddles, each lasting about 5 minutes, were included. Gaps were identified in 69% of huddles, with 57% resolved. The intervention group showed reduced missed nursing care compared to the control, with effectiveness moderated by personal accountability—benefiting nurses with lower accountability more. Conclusions: Huddles require minimal resource investment to reduce missed nursing care, especially for nurses with lower personal accountability. Making huddles a standard practice can improve nursing care quality. Practice Implications: Nursing managers are encouraged to support consistently implementing huddles in hospital settings.

Background: According to organizational mindfulness (OM) theory, teams must constantly anticipate and recover from unforeseen events by avoiding oversimplified explanations, being attuned to operational details, maintaining commitment to resilience, engaging in preoccupation with failure, and prioritizing expertise in problem solving. Despite its merits, the assimilation of OM theory into health care systems remains challenging, as fundamental practices and procedures within these systems often conflict with the core principles of OM, leading to an implementation gap. Purpose: We begin by emphasizing why health care professionals, particularly nurses, are not yet ready for and even resistant to OM. Although OM is intensely patient focused and enables nurses to practice in alignment with the ideals of nursing, they may be reluctant to embrace it due to the burden it places on them without adequate resources. Methodology: We argue that readiness for change (RFC) theory offers valuable insights into addressing this challenge by identifying and mitigating barriers to change. We combine research on OM with the RFC model to conceptualize how to systematically integrate OM into health care settings. Findings: Conceptually integrating RFC and OM frameworks can aid in narrowing the OM theory–implementation gap. To advance the field further, OM scholars should focus on better operationalizing OM principles, designing interventions to implement OM, and assessing their effectiveness with longitudinal designs and identify contextual boundary conditions for OM effective implementation. Moreover, we describe how leaders can support OM and RFC while managing resource constraints and supporting overwhelmed health care workers. Practice Implications: We distill our analysis into the 6-Step Road Map, suggesting evidence-based strategies for health care policymakers, administrators, and managers aiming to implement OM.

This study aimed to develop and validate the Situational Nursing Awareness Probe—Missed Nursing Care Edition (SNAP‐MNC) questionnaire, a novel tool designed to assess nurses' situational awareness in the context of missed nursing care. Data were collected from March to October 2022, following a rigorous five‐phase questionnaire development process. The five‐item questionnaire was developed through literature review and expert evaluation, establishing face and content validity. It was tested with 190 nurses across three shifts. Construct validity was assessed via confirmatory factor analysis, reliability via Cronbach's alpha, and criterion validity by correlating with the MISSCARE survey. The final five‐item questionnaire demonstrated suitability for assessing personal situational awareness. The findings established content, construct, criterion validity, and good internal reliability. Confirmatory factor analysis displayed suitable loadings and an excellent fit to a one‐dimensional model. Nurses received, on average, low situational awareness scores. The SNAP‐MNC effectively assesses nurses' situational awareness, focusing on missed nursing care. This tool evaluates the identification of relevant clinical factors, understanding their implications, and projecting strategies to address challenges, offering actionable insights for improving nursing care quality and outcomes.

Aims: To compare nurses' and patients' reports of missed nursing care, explore patients' perspectives and utilise these insights to elucidate discrepancies or congruence between perceptions.Design: A descriptive mixed‐methods design combining quantitative (questionnaires) and qualitative (semi‐structured interviews) methods.Methods: In the quantitative phase, 143 nurses and 643 patients completed the MISSCARE and MISSCARE‐Patient surveys. Correlations between their total missed care scores were examined. In the qualitative phase, 68 patients participated in semi‐structured interviews analysed using thematic analysis.Results: The correlation between nurses' and patients' perceptions of missed nursing care was nonsignificant. Qualitative findings revealed three themes: (1) patients' need to preserve individuality; (2) most patients attributed missed care to systemic factors, while some attributed it to nurses' attitudes and (3) emotional responses varied from empathetic understanding, inadvertently enabling more missed care, to frustration and assertiveness to ensure receiving necessary care.Conclusions: This study reveals a significant discrepancy between nurses' and patients' perceptions of missed care. Patient perspectives offer insights into this misalignment, highlighting differences in care priorities and role understanding.Implications for the Profession and/or Patient Care: Enhancing nurse–patient communication and patient empowerment are crucial. Healthcare institutions should integrate patient feedback into quality initiatives, create supportive work environments and foster a patient‐centred care culture. Effectively marketing nurses' expertise and implementing strategies to manage patient assertiveness are essential.Impact: This study addresses the discrepancy in perceptions of missed nursing care between nurses and patients. It reveals how patients' care priorities and attributions influence their experience of missed care. Findings will impact healthcare policymakers, nursing educators and hospital administrators, informing strategies to improve care quality, patient satisfaction and nurse work environments across healthcare settings.Reporting Method: The study has adhered to STROBE guidelines for the quantitative component and SRQR guidelines for the qualitative component.Patient or Public Contribution: No patient or public contribution.

Aims: To examine a novel moderated‐mediation model, investigating whether personal accountability moderates the link between nurse workload and missed nursing care and whether missed nursing care mediates the association between workload and moral distress.Design: Nested diary study.Methods: Data spanning from February 2019 to February 2023 were collected from 137 nurses working in various inpatient wards in two medium‐sized hospitals. Nurses reported care given to specific patients on three to five occasions across different shifts, establishing nurse‐patient dyads. Validated measures of missed nursing care, personal accountability, moral distress and workload were analyzed using mixed linear models to test the nested moderated‐mediation model.Results: Under high workload conditions, nurses with higher personal accountability reported lower frequencies of missed nursing care compared to those with lower personal accountability. In contrast, under low workload conditions, personal accountability did not significantly influence missed nursing care occurrences. Furthermore, the interaction between workload and personal accountability indirectly affected nurses' moral distress through missed nursing care. Specifically, higher personal accountability combined with lower missed nursing care contributed to reduced levels of moral distress among nurses.Conclusion: The study highlights accountability's dual role—safeguarding against care omissions and influencing nurses' moral distress amid rising workload pressures.Implication for the Profession and/or Patient Care: Cultivating a culture of accountability within healthcare settings can serve as a protective factor against the negative effects of workload on patient care quality and nurse psychological distress, highlighting the need for organizational interventions to promote accountability among nursing staff.Impact: By recognizing accountability's pivotal role, organizations can implement targeted interventions fostering accountability among nurses, including training programs focused on enhancing responsibility/ownership in care delivery and creating supportive environments prioritizing accountability to achieve positive patient outcomes.Reporting Method: The study has adhered to STROBE guidelines.Patient or Public Contribution: No patient or public contribution.

Introduction. Falls among hospitalized patients continue to pose a serious threat to patient safety worldwide. Effective fall-prevention education is considered vital for fall prevention. Nurses’ resilience and proactivity may improve the fall-prevention education nurses provide to patients, but how to motivate nurses’ proactivity remains unsolved. This study aimed to examine whether (1) nurse’s resilience and social capital are jointly associated with nurse proactivity and (2) adherence to procedures further moderates the relationships between nurse proactivity and the fall prevention education provided to patients by the nurse. Methods. A nested (∼3 patients per nurse) cross-sectional observational design has been employed in this study. 101 bedside registered nurses were recruited from fourteen internal and surgical wards at a medium-size hospital. For each nurse, ∼3 of their newly admitted patients were recruited (total of 271 patients). Nurses completed validated questionnaires on personal resilience, social capital, following procedures, and sociodemographic data. Fall-prevention education was assessed via a short-structured interview with patients. Hypotheses were analyzed using the Hayes PROCESS macro. Results. Social capital, nurse resilience, and their interaction were associated with proactive behavior. Proactive behavior, adherence to procedures, and their interaction (β = −0.57, ) were associated with patient education for fall prevention given by nurses. The moderated-mediation model was significant under medium and high levels of social capital and low levels of adherence to procedures. Conclusion. The study highlights the importance of nurse proactivity in educating patients about fall prevention, especially when adherence to procedures in the ward is perceived as low. Furthermore, nurses’ proactivity can be promoted by nurturing both their resilience and their social capital. Nursing managers should nurture proactivity at the work environment of the 21-century, by fostering resilience and enculturing social capital. Concomitantly, employees should be educated at ways to promote personal resilience and engage in wise proactivity.

AimThe aim of this study was to test a moderated-mediation model, explaining how and under which circumstances a process- or an outcome-accountability focus affects performance.DesignRandomized controlled design, using screen-based simulations.MethodsData were collected during 2021. Two screen-based simulations of medication administration (for low- and high-complexity tasks) were used. Each participant was randomly assigned to one of the six experimental conditions. Nurses completed validated questionnaires on strain levels and their perceptions of the simulated task complexity and accountability focus. Performance was assessed via validated checklists assessing nurses' performance of the simulation.ResultsTask complexity significantly moderated the relationship between accountability-focus conditions and strain. For the process-accountability-focus condition, strain levels were lower during high-complexity tasks compared with low-complexity tasks, while for the outcome-accountability-focus condition, strain levels were lower during low-complexity tasks compared with high-complexity tasks. The highest strain levels were observed under the no accountability-focus condition. Additionally, this interaction had an impact on performance, with nurses' strain playing a mediating role.ConclusionsAny accountability focus reduces strain levels and enhances performance compared with having no accountability focus. The choice of accountability focus should be based on task-complexity considerations.Implications for the Profession and Patient CareManagers can effectively reduce nurses' strain and improve performance by prioritizing outcome accountability focus for simpler tasks and process accountability focus for complex tasks.ImpactThe study addressed previous ambiguous findings regarding the type of accountability focus that better motivates nurses' performance. By considering accountability focus, nurse managers can balance nurses' strain levels with improved performance.Reporting MethodWe have adhered to the relevant EQUATOR guidelines: CONSORT.Patient or Public ContributionThere is no patient or public contribution, as the study only concerns the providers of the service, that is the nurses themselves.