An Exploration of Nurses' Perceptions of Unfinished Nursing Care

Monday, 30 October 2017

Mary Lee Potter, MBA, BSN
Wound Care, Methodist Hospital, San Antonio, TX, USA

Unfinished nursing care exists within today’s acute care setting and impacts both patients and nurses. “Unfinished care is conceptualized as a three-pronged phenomenon consisting of a problem (resource/time scarcity), a process (clinical decision making to prioritized and ration care), and an outcome (care left undone)” (Jones, Hamilton, & Murry, 2015, p. 1122). The concept of unfinished care and related concepts has been documented in the literature for almost two decades. Researchers have examined the concept of unfinished care or the omission of care within the acute-care setting and what impacts this has on patients, staff, and organizational outcomes. The purpose of this pilot study is to explore the perceptions of acute-care registered nurses regarding their experience with unfinished nursing care. Using an ethnographic approach, four nurses working in an acute care hospital setting were interviewed during November and December 2016. Interviews were recorded and transcribed. The researcher aims to explore the pilot study findings concerning nurses’ perceptions of unfinished nursing care and their potential relationship to the components within the conceptual framework: Implicit Rationing of Care in which the individual nurse characteristics, the unit dynamics, and system culture all interact together and potentially contribute to the approach the nurse uses in the overall care of the patient. Coding and analysis of the interviews are therefore being guided by this conceptual framework. The author’s preliminary findings suggest rationing of care continues to be pertinent in today’s acute care setting with elements of the four interviews falling within each component of the framework. With these early findings, the author categorizes most of the nurses’ thoughts and comments into the nurse work environment and philosophy of care sections. The following powerful comment depicts the profound struggles facing nurses in the acute care setting: “I think the biggest thing in regards to finishing tasks is mostly gonna be – at least for me and for my unit the biggest barrier that I have is just based on patient ratios. If you have one of those days that you are maxed out on patients and it’s a very high acuity load, there’s sometimes you just don’t have enough help or you don’t have enough staff on the floor in general and you’re overwhelmed and everyone’s overwhelmed”. Final results of this pilot study will be available in Spring 2017.