Factors associated with care omission and patient safety climate

Silva, Kaique Duarte Cavalcante; Carvalho, Dayse Edwiges; Lima, Juliana Carvalho de; Souza, Lucas Aragão; Silva, Ana Elisa Bauer de Camargo

doi:10.1590/1983-1447.2024.20230059.en

Kaique Duarte Cavalcante Silva

project administration

formal analysis

conceptualization

data curation

writing – original draft

writing – review & editing

investigation

methodology

resources

supervision

validation

visualization

Universidade Federal de Goiás (UFG). Faculdade de Enfermagem. Programa de Pós-Graduação em Enfermagem. Goiânia, Goiás, Brasil.

http://orcid.org/0000-0001-6829-7849

Dayse Edwiges Carvalho

writing – review & editing

investigation

Universidade Estadual de Goiás (UEG). Departamento de Enfermagem. Itumbiara, Goiás, Brasil.

http://orcid.org/0000-0001-6287-5206

Juliana Carvalho de Lima

writing – review & editing

investigation

Universidade Federal de Goiás (UFG). Faculdade de Enfermagem. Programa de Pós-Graduação em Enfermagem. Goiânia, Goiás, Brasil.

http://orcid.org/0000-0002-2195-7640

Lucas Aragão Souza

writing – review & editing

investigation

Universidade Federal de Goiás (UFG). Faculdade de Enfermagem. Programa de Pós-Graduação em Enfermagem. Goiânia, Goiás, Brasil.

http://orcid.org/0000-0002-2847-9469

Ana Elisa Bauer de Camargo Silva

project administration

conceptualization

writing – review & editing

methodology

supervision

validation

Universidade Federal de Goiás (UFG). Faculdade de Enfermagem. Programa de Pós-Graduação em Enfermagem. Goiânia, Goiás, Brasil.

http://orcid.org/0000-0003-3454-6602

Corresponding author:
Ana Elisa Bauer de Camargo Silva E-mail: anaelisa@terra.com.br

The authors declare that there is no conflict of interest.

Associate editor:

Adriana Aparecida Paz

Editor-in-chief:

João Lucas Campos de Oliveira

Variables	n (%)
Gender
Female	143 (87.2)
Male	21 (12.8)
Age (years)	43.5 (36.0 -52.0)^*
Professional category
Nurse	53 (32.3)
Nursing technician/assistant	111 (67.7)
Years of experience in position/role (years)	15.0 (8.0 -22.0)^*
Number of employment bonds
1	52 (31.7)
≥ 2	112 (68.3)
Unit
Clinical	59 (36.0)
Surgical	86 (52.4)
Pediatric	19 (11.6)
Number of patients under responsibility	6.0 (5.0 -8.0)^*
Higher educational level
High school	36 (22.0)
Higher education	42 (25.6)
Postgraduate (latosensu or strict sensu)	86 (52.4)
Weekly workload (hours)
30	60 (36.6)
36	93 (56.7)
≥ 40	11 (6.7)
Work shift
Day	90 (54.9)
Night	67 (40.8)
Rotation between day and night	7 (4.3)
Intention to leave the position
Yes	18 (11.0)
No	146 (89.0)
Frequency of feeling that the number of professionals is adequate
100% of the time	5 (3.0)
75% of the time	58 (35.4)
50% of the time or less	101 (61.6)
Job satisfaction
Verysatisfied	32 (19.5)
Satisfied	93 (56.7)
Neither satisfied nor unsatisfied	27 (16.5)
Unsatisfied	11 (6.7)
Veryunsatisfied	1 (0.6)
Satisfaction with the profession
Very satisfied	37 (22.6)
Satisfied	87 (53.0)
Neither satisfied nor unsatisfied	29 (17.7)
Unsatisfied	10 (6.1)
Very unsatisfied	1 (0.6)
Satisfaction with teamwork
Very satisfied	20 (12.2)
Satisfied	70 (42.7)
Neither satisfied nor unsatisfied	51 (31.1)
Unsatisfied	20 (12.2)
Very unsatisfied	3 (1.8)

SAQ	Mean (SD)
Overall SAQ score	63.8 (12.6)
Teamwork climate	66.7 (55.6 -80.6)^*
Safety climate	59.4 (46.9 -66.4)^*
Job satisfaction	75.0 (60.0 -90.0)^*
Perception of stress	81.3 (62.5 -100.0)^*
Perception of unit management	60.0 (50.0 -75.0)^*
Perception of hospital management	49.2 (18.6)
Working conditions	66.7 (43.8 -83.3)^*
MISSCARE - Brazil
Score MISSCARE - Brazil	2.1 (0.5)
Number of omitted care	7.0 (3.0 -12.0)^*

Omitted Nursing care	%
Walking three times a day or as prescribed	66.5
Participation in interdisciplinary team discussion on patient care	62.8
Sitting the patient out of bed	61.0
Planning and teaching the patient and/or family for hospital discharge	53.7
Changing patient’s position every two hours	51.8
Oral hygiene	43.3
Answering patient call within five minutes	40.8
Emotional support for the patient and/or family	39.0
Cleaning the patient promptly after each elimination	30.5
Requests for medication administration Y/N responded to within 15 minutes	29.3
Focused reassessment according to patient’s condition	28.7
Hand hygiene	27.4
Complete record in the patient’s medical record of all necessary data	25.6
Assessment of effectiveness of administered medications	25.6
Offering meals to patients who feed themselves	24.4
Fluid balance monitoring - input and output	24.4
Providing guidance for patients and family members regarding routines and care	24.4
Airway aspiration	21.9
Assessment of patient conditions each shift	21.3
Administering medications 30 min. before or after the prescribed time	19.5
Use of preventive measures for patients at risk of falling	17.7
Hydrate the patient, when appropriate, offering fluids orally or via tube	12.2
Care for venous access and infusion, according to the institution’s standards	9.8
Feed the patient or administer the diet through a tube, at time	7.9
Assessment of vital signs as prescribed	7.9
Bathing/patient hygiene/measures to prevent skin lesions	7.9
Care for skin lesions/wounds	7.3
Monitoring capillary blood glucose (glucometer/dextrose) as prescribed	3.0
Reasons for omission of nursing care	%
Inadequate staff size	87.8
Unexpected increase in patient volume and/or severity in the unit	84.1
Inadequate staff size for patient care or administrative tasks	81.1
Patient urgency situations (e.g. worsening of patient’s condition)	75.6
High number of admissions and discharges	75.6
High number of professionals working while ill or with health issues (hindering their ability to perform their proper duties)	72.6
The distribution of patients per professional is not balanced	65.2
The professional has more than one employment bond, which reduces their commitment/attention/concentration to provide assistance	59.1
Staff members don’t help each other	59.1
Medications not available when needed	58.5
Other team professionals not providing assistance when it was necessary (e.g. Physiotherapist not assisting with patient’sambulation)	55.5
Tension/conflict or communication problems with the medical team	50.6
Materials/equipment were not available when needed	50.0
Nurses lacking preparation to lead and supervise teamwork	50.0
The shift change from the previous shift is inadequate	46.9
Materials/equipment did not function properly when required	46.9
Tension/conflict or communication problems with other support sectors	46.3
Lack of standardization for procedures/care	46.3
The professional who did not perform is not afraid of punishment/dismissal	45.7
Negligence by nursing professionals	45.7
Lack of motivation for work	44.5
Tension/conflict or communication problems within the nursing team	43.3
The professional has no ethical stance and is not committed to the institution	42.1
Lack of in-service education on required care	42.1
High number of nurses with little professional experience	39.6
Responsible professional was unavailable or absent from the unit	39.0
The nursing assistant did not communicate that assistance was not performed	37.2
Inadequate physical facilities of the unit/department, hindering care to isolated patients or distant areas	23.8

Variables	MISSCARE-Brazil Score		Number of Omitted Care
Variables	Mean (SD)	p-value ^*	Median (P25-P75)	p-value ^*
Gender
Female	2.1 (0.5)	0.169^†	7.0 (3.0-11.0)	0.136^**
Male	2.3 (0.6)	0.169^†	10.0 (4.0-15.5)	0.136^**
Age (years)	-0.208^‡	0.008^‡	-0.190^††	0.015^††
Professional category
Nurse	2.2 (0.6)	0.204^†	8.0 (4.0-13.0)	0.173^**
Technician/assistant	2.1 (0.5)	0.204^†	6.0 (3.0-11.0)	0.173^**
Time of experience in position	-0.226^‡	0.004^‡	-0.264^††	0.001^††
Number of employment bonds
1	2.1 (0.6)	0.570^†	6.5 (2.0-11.0)	0.398^**
≥ 2	2.1 (0.5)	0.570^†	7.0 (4.0-12.0)	0.398^**
Unit
Clinical	2.2 (0.5)	0.010^{§ - §§}	7.0 (4.0-12.0)	0.019^{‡‡ - ***}
Surgical	2.1 (0.5)		7.0 (4.0-11.3)
Pediatric	1.8 (0.5)		3.0 (0.0-9.0)
Number of patients under supervision	-0.002^‡	0.975^‡	0.049^††	0.535^††
Higher educational level
High school	2.1 (0.5)	0.874^§	7.5 (5.0-12.0)	0.449^‡‡
Higher education	2.1 (0.7)		5.0 (2.0-14.0)
Post graduate	2.1 (0.5)		7.0 (3.0-11.3)
Weekly workload (hours)
30	2.0 (0.56)	0.300^§	5.5 (2.0-11.0)	0.228^‡‡
36	2.2 (0.54)		7.0 (4.0-12.5)
≥ 40	2.0 (0.42)		6.0 (3.0-10.0)
Work shift
Day	2.2 (0.5)	0.071^§	8.0 (4.0-13.0)	0.035^{‡‡ - †††}
Night	2.0 (0.5)		5.0 (2.0-11.0)
Rotation between day and night	2.3 (0.7)		11.0 (5.0-15.0)
Intention to leave the position
Yes	2.1 (0.7)	0.866^†	5.5 (3.0-12.3)	0.772^**
No	2.1 (0.5)	0.866^†	7.0 (3.0-12.0)
Adequacy of staff size
100% of the time	1.6 (0.6)	0.004^{§ - ‡‡‡}	2.0 (0.5-9,5)	0.018^{‡‡ - §§§}
75% of the time	2.0 (0.5)		5.0 (2.0-10.0)
50% of the time or less	2.2 (0.5)		8.0 (4.0-13.0)
Job satisfaction
Yes	2.1 (0.5)	<0.001^†	6.0 (3.0-11.0)	<0.001^**
No	2.7 (0.6)	<0.001^†	15.5 (8.3-19.8)	<0.001^**
Satisfaction with the profession
Yes	2.1 (0.5)	0.008^†	7.0 (3.0-11.0)	0.018^**
No	2.5 (0.7)	0.008^†	13.0 (5.0-20.0)	0.018^**
Satisfaction with teamwork
Yes	2.1 (0.5)	0.001^†	6.0 (3.0-11.0)	0.005^**
No	2.4 (0.6)	0.001^†	10.0 (6.0-18.0)	0.005^**

Variables	Overall SAQ score
Variables	Mean (SD)	p-value ^*
Gender
Female	64.4 (12.1)	0.101^†
Male	59.6 (15.7)	0.101^†
Age (years)	0.099^‡	0.206^‡
Professional category
Nurse	62.5 (14.1)	0.381^†
Technician/assistant	64.4 (11.9)	0.381^†
Time of experience in position	0.099^‡	0.209^‡
Number of employment bonds
1	65.8 (11.7)	0.166^†
≥ 2	62.9 (13.0)	0.166^†
Unit
Clinical	63.4 (13.4)	0.852^§
Surgical	64.3 (12.8
Pediatric	62.7 (9.9)
Number of patients under supervision	-0.139^‡	0.075^‡
Higher educational level
High school	64.4 (10.4)	0.939^§
Highereducation	63.7 (14.3)
Postgraduate	63.5 (12.8)
Weekly workload (hours)
30	62.7 (11.6)	0.659^§
36	64.3 (13.5)
≥ 40	65.5 (10.7)
Work shift
Day	63.6 (12.4)	0.774^§
Night	63.7 (12.7)
Rotation between day and night	67.1 (16.5)
Intention to leave the position
Yes	64.1 (13.5)	0.916^†
No	63.7 (12.6)	0.916^†
Adequacy of staff size
100% of the time	77.3 (11.1)	<0.001^{§ - **}
75% of the time	68.4 (11.2)
50% of the time or less	60.5 (12.3)
Job satisfaction
Yes	65.0 (11.9)	<0.001^†
No	48.5 (12.4)	<0.001^†
Satisfaction with the profession
Yes	64.7 (12.0)	<0.001^†
No	50.7 (14.0)	<0.001^†
Satisfaction with teamwork
Yes	65.4 (11.7)	<0.001^†
No	53.9 (13.8)	<0.001^†

[1] Corresponding author:
Ana Elisa Bauer de Camargo Silva E-mail: anaelisa@terra.com.br

Brasil

Brasil

Factors associated with care omission and patient safety climate

Factores asociados a la omisión del cuidado y al clima de seguridad del paciente

ABSTRACT

Objective:

Method:

Results:

Conclusion: