The measurement of outcomes and their relationship with nursing practice have been essential elements for the continued monitoring of patient safety and quality of care, thus enabling to improve and optimize care (Doran, 2003). However, one of the main issues of modern healthcare systems reported and discussed globally is the lack of resources that are not always enough to ensure the provision of safe and high-quality care (WHO, 2013; RCN, 2017).
One of the consequences of this lack of resources, which has drawn great attention from international scientific literature, is Missed Nursing Care (Kalisch, Landstrom & Hinshaw, 2009). However, missed nursing care has not been fully investigated from the patient’s point of view (Kalisch, McLaughlin & Dabney, 2012; Kalisch, Xie & Dabney, 2012; Dabney & Kalisch, 2015), despite patients are the end users of health care, with the consequence of not identifying all the dimensions of nursing care that are not appropriately provided or omitted.
Aims
The aim of this study is to review and synthesize adult inpatients met and unmet needs related to nursing care, from their point of view. A thematic analysis was conducted to identify the patients’ fundamental met or unmet needs.
Design
A scoping approach was adopted, guided by the methodological framework proposed by Arksey and O’Malley (Arksey, and O’Malley, 2005), which includes five steps to identify, select, and revise the literature: 1) identifying the research question; 2) identifying relevant studies; 3) study selection; 4) charting the data; 5) collating, summarising and reporting the results.
Search methods
The search strategy included the keywords based on Population, Exposure and Outcomes (PEO) matrix. Then, in September 2018, three databases were searched: MEDLINE/ PubMed, CINAHL, and SCOPUS. Inclusion criteria were: primary studies, published in peer reviewed journals, written in English or Italian, related to routine care provided in adult surgery or general medicine inpatient settings. The exclusion criteria were: articles related to nursing education or nursing students, papers not referring to nursing care, studies that did not considering the patients’ point of views, and studies published before 2009 because this was the year when the RN4CAST studies started (Bruyneel et al., 2009; Sermeus et al., 2011), and the Missed Nursing Care concept analysis was formulated (Kalisch, Landstrom & Hinshaw, 2009).
Search outcomes
The initial database search identified 1541 abstracts. After removing the duplicates, another 1256 abstracts were removed due to exclusion criteria. The remaining articles were screened for full-text eligibility (n=172). Another 128 articles were removed following the full-text review, as they did not meet the inclusion criteria. At the end, a total of 44 papers were included for data extraction and analysis.
At least two authors independently reviewed all the papers, during the steps mentioned above. At the end of each step, the screening results were compared among the research members, and a final agreement was reached.
Quality appraisal
During data extraction, the papers underwent a quality appraisal. For the qualitative articles, we used the CASP checklist for Qualitative Studies (CASP, 2018), and for the quantitative articles we used Kelley reporting of Survey research (Kelley et al., 2003).
Data abstraction & synthesis
Arksey and O'Malley refer to this stage as an "analytical descriptive method" that includes information about the synthesis process in a relevant format (Arksey and O’Malley, 2005). The team of reviewers jointly developed a data collection table to determine which variables to extract to answer the research question and then conduct a descriptive analysis. The information included in the table was: references and countries, study design and aim, participants/setting and data collection, met/unmet needs and general findings. Subsequently a thematic analysis was performed, with an initial coding and development of candidate themes conducted by two authors. Then, this initial analysis was compared with the other authors, who then met to agree the final thematic analysis of the findings.
Results
Of the 44 papers included in the review, 16 were qualitative studies and 28 were quantitative studies. Of the 44 papers, the majority (18) were conducted in European countries, followed by the Middle East (8), and the United States and Canada (8).
The following five themes emerged: ‘communication’, ‘self-management, autonomy, and education’, ‘private sphere’, ‘essential physical care’, and ‘emotional and psychological care’. These enable to gain a comprehensive vision of the entire nursing process, highlighting those elements that patients consider essential, and which health professionals may not see.
Conclusions
The results of this review highlight the importance of taking into account the perspective of patients throughout the healthcare process, because patients are the principal end users of the services that health organizations provide. The themes related to the private sphere and to emotional and psychological care, show how patients feel the need for nurses to pay more attention to their cultural backgrounds, and to consider the person as a whole, demanding for nursing care to be holistic and respectful of patients’ dignity.