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Table 1. Sample Characteristics
Characteristic
Gender
Female
Male
Age
<25
25-34
35-44
45-54
5-64
Practice Setting
Medical-surgical Acute Care
Medical-surgical Critical Care
Missing
Primary Shift
Day Shift (7 am to 7 pm)
Night Shift (7pm to 7am)
Missing
Employment Status
Full time
N(%)
66 (89)
8 (11)
12 (16)
23 (31)
14 (19)
15 (20)
10 (14)
36 (49)
35 (47)
3 (4)
43 (58)
30 (41)
1 (1)
74 (100)
% Never
% Rare
Mean Category
Documenting
Full documentation of all necessary data (M)
Document all of the nursing care you provided in sufficient detail
(P)
Document the initiation or revision of a patient’s plan of care (P)
Document all of your assessment and monitoring activities (P)
Evaluating
Adequately evaluate the plan of care (using critical thinking) to
determine the appropriateness and/or effectiveness of interventions
and make revision as needed (P)
Monitoring/Surveillance
Monitor a patient’s physiological status as had been prescribed by
physician/unit standards or as you felt was necessary (e.g. vital
signs, lab values) (P)
Monitoring intake & output (M)
Vital signs assessed as ordered (M)
Patient assessments performed each shift (M)
Monitor a patient’s affect and behavior as prescribed by
physician/unit standards or as you felt necessary (e.g. compliance,
eating habits, social interaction, mood) (P)
Monitor a patient’s physical safety as had been prescribed by a
physician/unit standards or as you felt necessary (P)
Focused reassessments according to patient condition (M)
Follow-up on patient status changes, unanswered requests for
interventions (including assessments or referrals), or unclear orders
(P)
Review multidisciplinary patient documentation to inform yourself
about a patient (P)
Supervise Care
Unable to provide adequate supervision of or follow up on delegated
activities (P)
Hygiene
Carry out routine hygiene for patients (e.g. bathing, oral care, dental
care) or ensure completion of this task through delegation (P)
Mouth care (M)
% Not Needed
Item (Instrument)
% Missing
Table 2. Item-Level Analyses for the PIRNCA and MISSCARE Surveys
1
1
0
0
26
32
36
38
R
R
4
5
1
0
41
51
40
29
<R
<R
0
0
27
46
R
3
1
66
28
<R
1
0
1
3
0
0
0
8
23
39
75
52
36
46
21
36
R
<R
<R
<R
1
1
61
35
<R
0
3
0
1
51
47
38
44
<R
<R
5
0
44
29
<R
1
0
37
41
<R
0
0
23
45
R
1
0
15
36
R
Patient bathing/skin care(M)
Carry out routine skin care for patients or ensure completion of this
task through delegation (P)
Change, in an adequate time period, patients’ bed linen soiled with
blood or body fluids or ensure completion of this task through
delegation (P)
Nutrition
Assist patients unable to eat or drink independently with the intake
of food or fluids or ensure completion of this task through
delegation (P)
Feeding patient when the food is still warm (M)
Setting up meals for patients who feed themselves (M)
Administer enteral or parenteral nutrition as prescribed and in
accordance with safer practices (P)
Physical Comfort
Implement measures to promote physical comfort (e.g. timely
administration of pain medication, temperature adjustment,
massage/backrub) or ensure completion of these tasks through
delegation (P)
Mobility
Ambulate 3 time per day or as ordered (M)
Assist a patient with needed ambulation or ensure completion of this
task through delegation (P)
Turn patient every 2 hours (M)
Mobilize or change position of a patient with limited mobility or
ensure completion of this task through delegation (P)
Elimination
Assist with toileting needs within 5 minutes of request (M)
Provide timely assistance with bowel or bladder elimination (e.g.
bedpan, bedside commode, walk to bathroom) or ensure completion
of this task through delegation (P)
Treatment, Tests, & Procedures
Administer medications (including intravenous therapy) as
prescribed and in accordance with safe medication practices (P)
Medications administered within 30 minutes before or after
scheduled time (M)
PRN medication requests acted on within 15 minutes (M)
Assess effectiveness of medications (M)
IV central lines site care and assessments according to hospital
policy (M)
Change intravenous access sites, tubing. And/or dressings within the
timeframe prescribed by physician/unit standard or as you felt was
needed (P)
Bedside glucose monitoring as ordered (M)
Skin/Wound care (M)
0
0
0
1
23
33
42
45
R
<R
0
0
42
47
<R
1
5
39
51
<R
1
3
1
16
12
19
13
33
71
39
40
29
R
R
<R
1
0
38
47
<R
0
0
12
7
6
32
25
44
R
R
3
3
1
1
10
30
37
52
R
<R
1
1
0
1
22
40
48
51
R
<R
3
0
68
21
<R
1
0
22
38
R
1
1
1
0
0
0
36
33
47
43
44
38
<R
R
<R
0
0
45
41
<R
0
0
1
1
50
27
44
51
<R
R
Provide wound care (including changing dressings) as prescribed by 0
8
physician/unit standards or as you felt was necessary (P)
Prepare patients for treatments, tests, or procedures (P)
1
0
Adhere to recommended guidelines for safe patient handling (e.g.
5
7
use of lift assist equipment and/or additional staff (P)
Patient/Family Teaching
Patient teaching about procedures, tests, and other diagnostic studies 4
0
(M)
Provide the amount of teaching you felt was indicated for the patient 4
0
or his/her family (P)
Psychological/Emotional Support
Emotional support to patient and/or family (M)
0
0
Offer the level of emotional or psychological support to a patient (or 1
0
family) that you felt was necessary (P)
Infection Control
Hand washing (M)
0
0
Adequately adhere to infection control guidelines (e.g. hand
4
0
hygiene, aseptic technique, isolation) (P)
Timeliness of Care
Response to call light is initiated within 5 minutes (M)
0
0
Keep a patient or family member waiting longer than 5 minutes
3
0
when a request was initiated (e.g. by the call light)
Coordination & Discharge Planning
Teach patients about plans for their care after discharge and when to 0 4
call after discharge (M)
Have important conversation with a patient or family member about 5 3
discharge needs or instructions or the conversation was delayed (P)
Attend interdisciplinary conference (M)
1 10
Have important conversation with another member of a patient’s
3 1
multidisciplinary team regarding his/her care, or the conversation
was delayed (P)
Have important conversation with an external agency about the care 1 26
of a patient or the conversation was delayed (P)
M=Item on MISSCARE; P=Item on PIRNCA; R=rarely; <R= Less than rarely
49
43
<R
53
46
33
34
<R
<R
16
41
R
24
44
R
23
29
45
45
R
R
54
63
38
30
<R
<R
37
36
42
47
R
<R
38
44
<R
40
40
<R
20
32
30
44
R
<R
41
46
<R
Table 3. Comparison of Unfinished Care Estimates by Instrument
Aggregate Estimates of Unfinished Care
PIRNCA
MISSCARE
Original
Adapted
Category, Mean Score (SD)
< Rarely, 2.62 (.51) Not assessed
Rarely, 2.00 (.63)
97
77
97
% RNs  1 Positive Response
Mean Positive Responses, (SD)
17 (9.06)
7 (6.35)
16 (6.39)
Mean % Positive Responses, (SD) .57 (.31)
.29 (.26)
.69 (.28)
Instrument Agreement Based on Mean Score Categories
MISSCARE Survey
PIRNCA
Total
< Rarely
Rarely
< Rarely
40
0
40
Rarely
13
16
29
Occasionally/Sometimes
1
4
5
Kappa = .510 (p<.000)
Instrument Agreement Based on Sum of Positive Responses
Instruments
Mean
Mean Absolute 95% LoA
Difference (SD Difference (SD)
PIRNCA and MISSCARE Original
10.08 (6.26)
10.36 (6.07)
-2.19 to 22.35
PIRNCA and MISSCARE Adapted
1.49 (7.28)
6.04 (4.27)
-12.8 to 15.48
Instrument Agreement Based on Percent of Positive Responses
Instruments
Mean
Mean Absolute 95% LoA
Difference (SD Difference (SD)
PIRNCA and MISSCARE Original
.29 (.23)
.31 (.21)
-.16 to .74
PIRNCA and MISSCARE Adapted
-.11 (.26)
.21 (.19)
-.62 to .40
SD=standard deviation; LoA= Level of Agreement
Estimate