[Decision Making process and missed nursing care: findings from a scoping review].
Luisa Sist, Alvisa Palese
Abstract
. Decision Making process and missed nursing care: findings from a scoping review. INTRODUCTION: Several aspects of the Missed Care (MNC) model have been studied (conceptual aspects, causes, process, measurement instruments, outcomes) however, the decision-making processes influencing the MNC have not yet been settled into an accessible guide. OBJECTIVE: To describe (a) the terms most used in the literature to define the decision-making processes influencing the MNC, (b) the conceptual models, as well as (c) the available tools. METHOD: A scoping review was carried out in March-August 2020 by consulting the following databases: Cochrane Library, Pubmed, Scopus, CINAHL Complete, PsycINFO. Of the 385 retrieved studies, 92 abstracts were evaluated and 36 studies included. RESULTS: Four terms are used to address the process of nursing intervention delivered on time, postponed or missed: (a) Priority setting; (b) Prioritisation of clinical care; (c) Implicit rationing; and (d) Time scarcity. While the lack of time expresses the common denominator, a substantial difference emerges between priority setting and rationing: the first establishes a preferential sequence of activities with the result of delaying those less significant; the second leads to unfinished nursing care. Decision models to date have not considered the processes influencing MNC; therefore, the available measurement instruments are also of little use. CONCLUSIONS: The decision-making processes underlying MNC have not yet been well understood, and described using different terms. Reliable instruments to measure them are still lacking.