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To identify and synthesise qualitative evidence on nurses' perceptions of reasons for missed nursing care in hospitals.
Systematic review of qualitative evidence.
An extensive search of all relevant databases was conducted. Study selection, quality assessment, data extraction and meta-aggregation were performed independently by two reviewers according to the JBI guidelines for systematic reviews of qualitative evidence. Confidence in the findings was assessed using the ConQual approach.
The electronic databases CINAHL, PubMed, Embase, PsychInfo, and Scopus were searched in January 2024 and repeated in May 2025.
Thirty-one studies from hospital settings worldwide were included following critical appraisal, with overall quality rated moderate to high. The studies contributed 168 findings, which were organised into 10 categories and three synthesised findings: Organisational and system-level factors influencing missed nursing care, Teamwork and cultural factors influencing missed nursing care, and Individual nurse- and patient-related factors influencing missed nursing care.
Reasons for missed nursing care represent an interplay of systemic, organisational, and individual factors within complex resource-constrained contexts.
Healthcare organisations are recommended to implement system-level interventions, rather than relying solely on behaviour-focused solutions. Healthcare leaders should ensure flexible staffing, strong managerial support, and adequate resources to enable fundamental care. Building collaborative, interprofessional cultures that value relational and fundamental care as well as technical tasks is essential, together with education and mentorship that support nurses' decision-making, resilience, and clinical competence.
Hospital leaders, policymakers, and nurse managers can use the recommendations to reduce missed nursing care and promote a safe person-centred practice. Implementing systemic changes will improve nurses' working conditions and capacity to deliver comprehensive care, ultimately enhancing patient satisfaction and outcomes.
The ‘enhancing transparency in reporting the synthesis of qualitative research statement’.
No patient or public involvement.
The review is registered in the International Prospective Register of Systematic Reviews. PROSPERO CRD42023438198 (https://www.crd.york.ac.uk/PROSPERO/search)
To describe the development and refinement of the Flinders Fundamentals of Care Assessment Tool for Clinical Practice through stakeholder feedback. The tool, based on the Fundamentals of Care Framework, supports healthcare leaders and clinicians in assessing fundamental care in a practical and user-friendly manner that embraces rather than minimises the inherent complexity of this care delivery as it occurs in practice.
Multi-method study informed by participatory action principles.
Data collection involved an anonymous online survey and cognitive interviews with key stakeholders internationally to gauge perspectives on the clarity, usability, and acceptability of the tool. Data were collected between October–December 2023. Quantitative, categorical data were analysed using descriptive statistics. Qualitative data were analysed via content analysis.
Participants described the Tool as Comprehensive, Practical, and Useful. Participants liked the visual representation of results in the form of bar and radar diagrams, which aided in interpreting the outcomes. The main suggestions for improvement were: (1) Simplifying items relating to the ‘Context of Care’ dimension of the Fundamentals of Care Framework; (2) Reducing similarity between some items; (3) Separating or simplifying items with multiple components; and (4) Clarifying terminology.
Based on stakeholder feedback, the Flinders Fundamentals of Care Assessment Tool for Clinical Practice is now digitised and includes a comprehensive instruction manual and definitions for each element of the Fundamentals of Care Framework assessed within the tool. The tool supports healthcare leaders and clinicians to assess fundamental care delivery at multiple levels—individual, team, unit/ward, organisational—identifying areas of strength and improvement to inform decision-making, planning, and quality improvement. The tool offers a way of assessing fundamental care holistically as a multi-dimensional construct rather than as a series of disaggregated tasks, better reflecting and capturing the complex reality of fundamental care delivery.
The Flinders Fundamentals of Care Assessment Tool for Clinical Practice supports real-time feedback (i.e., immediate visualisation of results), facilitating its integration in clinical practice to support enhanced fundamental care delivery.
Seeking stakeholder feedback has enhanced the relevance, acceptability, and feasibility of the Flinders Fundamentals of Care Assessment Tool for Clinical Practice, facilitating its use as a decision-making and planning tool to support improved fundamental care delivery across clinical settings.
This study is reported using the CROSS and SRQR guidelines.
No Patient or Public Contribution.
To explore nursing students' experience of how the COVID-19 pandemic influenced the learning environment in clinical setting and how they responded to the change.
Qualitative descriptive interview study.
Eleven third-year baccalaureate nursing students from a University College in Northern Denmark participated in individual semi-structured interviews conducted in the spring 2021. Data analysis was guided by Braun and Clarke's thematic analysis.
Two themes were generated: ‘A compromised learning environment’ and ‘Adjusting to circumstances and making things work’.
Students perceived that their learning became secondary and was influenced negatively. Some students' focus shifted from an attention to learning opportunities to managing daily patient care and became hesitant to pose questions that were relevant to their learning. Students faced a dilemma between helping with daily tasks and prioritising their learning needs. Some students adjusted to the circumstances by taking the lead. Others reacted more passively and prioritised helping nurses in managing the daily workload.
The study highlights that changes in the work environment impact students. Institutions must ensure that students feel a sense of belonging and prioritise time with clinical supervisors for questions and reflection, avoiding situations where practical tasks take priority over learning. Since students manage changes differently, they require tailored support.
The study addressed changes in the clinical learning environment caused by the COVID-19 pandemic. The changes within the environment influenced the students learning negatively. The findings are of relevance to lecturers, supervisors, and academic decision-makers within nursing education and may guide the planning of clinical placements to better accommodate individual learning needs.
The study adheres to the COREQ guidelines.
This study did not include patient or public involvement in its design, conduct, or reporting.
FreshRSS 