Conceptual and methodological challenges of studies examining the determinants and outcomes of omitted nursing care: A narrative review of the literature

Background: Over the past two decades, several studies have examined the determinants and outcomes of omitted nursing care in hospitals and other settings. These studies have raised several challenges associated with the definition and measurement of this phenomenon which must be addressed to move the field forward. However, these challenges remain scattered throughout the literature. Objectives: To synthesize the conceptual and methodological challenges of studies examining the determinants and outcomes of omitted nursing care, and to identify avenues for further research. Method: A narrative review of the literature was conducted. Relevant studies published between 2001 and 2018 were identified using four electronic databases: CINAHL, Medline, Cochrane Library and Health Management Database. Study selection, data extraction, and synthesis were carried independently by two authors following a standardized protocol, and discrepancies were resolved by consensus. Thematic analysis was used to summarize and characterize the main conceptual and methodological challenges identified. Results: Our initial search yielded 5214 citations of which 52 primary studies and 7 literature reviews met our inclusion criteria. Six conceptual and methodological challenges were identified, the: 1) use of self-reported measures; 2) use of cross-sectional designs; 3) multidimensional nature of omitted nursing care; 4) interdisciplinary and collaborative nature of health care, 5) content validity of existing instruments and, 6) multiplicity of conceptual definitions. Conclusion: We identified six challenges that characterize studies on the determinants and outcomes of omitted nursing care. For each, several solutions are proposed. To strengthen this body of evidence, patient-level longitudinal studies should be pursued. It is also required to develop and validate more objective measures of omitted nursing care. Developing such measures must involve registered nurses at the bedside, to ensure their feasibility and acceptability. (C) 2019 Elsevier Ltd. All rights reserved.