Original Article

Najafi F, Nikbakht Nasrabadi AR, Mardanian Dehkordi L

Exploring the Lived Experience of Missed

Nursing Care in Postgraduate Nursing Students
in Iran

Fatemeh Najafi1, PhD candidate; Alireza Nikbakht Nasrabadi1, PhD; Leila Mardanian
Dehkordi1,2, PhD candidate
1
Department of Medical Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical
Sciences, Tehran, Iran;
2
Department of Adults Health Nursing, School of Nursing and Midwifery, Isfahan University of Medical
Sciences, Isfahan, Iran

Corresponding Author:
Alireza Nikbakht Nasrabadi, PhD; Department of Medical Surgical Nursing, School of Nursing and
Midwifery, Tehran University of Medical Sciences, Dr. Mirkhani Street, Tohid Sq., P.O. Box: 14197-33171,
Tehran, Iran
Tel: +98 21 66933600; Fax: +98 21 66904252; Email: [email protected]

Received: 4 July 2020 Revised: 20 September 2020 Accepted: 20 November 2020

Abstract
Background: Missed care is a global phenomenon, which can include many clinical conditions that
threaten the patients’ safety in all countries and cultures, and also indicates the quality of nursing care.
The nursing students’ awareness and understanding of missed nursing care is of great importance. The
current study aims to explore the lived experience of postgraduate nursing students in missed care.
Methods: The current qualitative study was performed based on the interpretive phenomenological
approach in Tehran, Iran, in February to December 2019. A total of 10 master’s degree nursing students
were selected through purposive sampling. A total of 10 semi-structured individual interviews were
used to collect the data. The trail version of MAXQDA-10 software was used for coding. All interviews
were recorded and codified, and the main themes were extracted from them using Dicklemann et al.’s
(1989) analytical method.
Results: Two main themes, five sub-themes, and 31 meaning units were obtained. The main themes
included: “unfulfilled care” and “living in limbo”.
Conclusion: Missed care, as unfulfilled care, is accompanied with living in limbo for nursing students,
and this condition is influenced by organizational and personal factors. It seems that managers can
prevent missed nursing care by supervising nursing care, reducing the nurses’ workload, creating a
sense of commitment to work, and enforcing ethical issues among nurses.

Keywords: Experiences, Missed care, Nursing students, Phenomenology

Please cite this article as: Najafi F, Nikbakht Nasrabadi AR, Mardanian Dehkordi L. Exploring the Lived
Experience of Missed Nursing Care in Postgraduate Nursing Students in Iran. IJCBNM. 2021;9(1):44-54. doi:
10.30476/ijcbnm.2020.85865.1344.

44 ijcbnm.sums.ac.ir
 Missed nursing care in postgraduate nursing students

Introduction nursing care.6, 7 Reasons for missed care are

often related to nurses, inefficiency in doing
Nurses work in complex environments where tasks, “it’s not my job” syndrome, habit,
technology and practice are constantly changing; prolonged involvement with the patient, and
hence, they need more competencies to provide denial that are traditionally associated with
quality care to their clients.1, 2 Patient care appropriate nursing care, but it is usually
depends on the treatment and involves nurturing, ignored or left incomplete and nurses fail
professional activities, processes, and crucial to follow up their duties and use denial as
decision-making. In other words, patient care a mechanism to deal with missed care.6 The
is the spiritual, physical, and mental provision lack of time management skills; failure to
of nursing services to clients and their families.3 assign the nurses to different wards based on
Clients expect all care and treatment services their scientific, physical and mental abilities;
to be delivered on time without any delay and and the lack of familiarity with the equipment
with adequate skills, accuracy, and continuity.4 are mentioned as other reasons for missed
They want to be cared for by knowledgeable, nursing care.12
trustworthy, and communicative people with Missed care is consistently associated
mutual understanding.5 with negative consequences for the nurse,
Missed nursing care refers to any aspect patient, and organization.14 Studies have
of missed or postponed care, and is described reported many negative outcomes related
as an unintentional error.6-8 The health care to missed nursing care such as decreased
professionals, especially nurses, play an job satisfaction, absenteeism and quitting
important role in providing safe care to job.15 Some of the complications of missed
patients. Nursing practice environment is care for the patient include falls, medication
recognized as an important predictor of the errors, nosocomial infections, pressure sores,
quality of care and its consequences for the gastrointestinal bleeding, increased pain and
patient.9 Missed nursing care reflects the discomfort, and readmissions.8, 16-18 Patient
quality of nursing care,7, 8 and one of the transfer to (ICU), cardiac arrest, and death
most important components of the quality are other catastrophic consequences of missed
of care is patient safety.10 Patient safety is care.18, 19 A study referred to prioritization,
affected by errors of commission (such as teamwork, intentional and thoughtful action,
wrong side marking in eye surgery) and and reflection on how these activities are
errors of omission (such as not ambulating carried out as the strategies of overcoming the
the patient).11 The errors of commission were barriers to appropriate nursing care.8 Despite
evaluated in many studies, while errors of the long history of missed care, it has recently
omission have not received much attention.11-13 been a concern for the nursing profession;
Missed nursing care is a global phenomenon also, despite the prevalence of missed care
and refers to many clinical conditions that and its importance, few studies have been
threaten the patient’s safety in all countries conducted in Iran on this issue,12 so little is
and cultures.7, 8 known about its nature and associated factors.
The prevalence of missed care among Missed nursing care continues, and
Intensive Care Units (ICU) nursing staff this demonstrates the need to address this
is reported 55%-98% worldwide.14 Nine phenomenon. Since missed nursing care has
areas of mobility, repositioning patients, always been reported alongside medical errors,
delayed or missed feeding, patient education, it is important to have a clear understanding
discharge planning, emotional support, of what health professionals call a threat to
commitment to good hygiene, intake and the quality of care. Adequate awareness and
output documentation, and supervision have understanding of the dimensions and issues
been reported as common areas of missed relevant to this problem is one of the essentials

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Najafi F, Nikbakht Nasrabadi AR, Mardanian Dehkordi L

for any decision making, planning, and taking experience of postgraduate nursing students
measures by all health decision makers and about missed nursing care in February to
policymakers. Previous studies on missed care December 2019. The study setting was one of
in Iran have been conducted among nurses in the Iranian universities. Data were collected and
clinical setting,12, 20 but among postgraduate analyzed simultaneously, after completing the
nursing students with clinical and educational research plan and receiving confirmation and
experiences, no study has been done to discover approval by Research Committees of the School
the meanings of missed nursing care. Since of Nursing and Midwifery. The participants
postgraduate nursing students will have more were selected from master’s degree nursing
managerial roles and are more likely to continue students with acceptable clinical practice
their education in the future, selecting this experiences. These students had passed their
group as the target of this study will have more internship program and were employed as
potential effects for improvement of health care clinical nurses in teaching hospitals. Invitation
in future. Therefore, a deeper understanding letters containing a description of the study
of the unknown aspects of this issue can objectives were presented to the students, and
facilitate the planning of a comprehensive those who were willing to participate were
nursing care program and improvement of asked to sign informed consent and plan a
quality of nursing care. Full understanding of specific time for the interviews. Participants
postgraduate nursing students’ experiences is were selected using purposive sampling. A total
not possible without qualitative research. The of 10 students including six females and four
researchers in the present study aimed to use males were selected and individual, in-depth,
interpretive phenomenology because its goal face to face semi-structured interviews were
is to better understand the nursing students’ then held with them. In order to reach the
experience of missed nursing care. The purpose maximum variation, we considered different
of phenomenological research is to describe conditions in terms of age, gender, specialty,
specific phenomena as lived experience. and work experience in different clinical wards.
Phenomenology is the lived experience of Inclusion criteria were students with at least 1
human beings from the world of their everyday year of clinical practice experience and study in
lives. In fact, it is the experience of a person that postgraduate level. Exclusion criteria included
tells him what is real and true in his life. These unwillingness to continue with the study and
lived experiences give meaning to a person’s withdrawing from the study.
perception of a particular phenomenon, which The number of sessions and the length of each
is influenced by all internal and external interview varied based on each participant’s
factors.21 Interpretive phenomenology focuses condition and depended on factors such as
on the experience of human beings and their the time and willingness of individuals. The
interpretations of those experiences.22, 23 The mean time of interviews varied from 30 to 40
current phenomenological study aimed to minutes and each participant was interviewed
explore the lived experience of postgraduate once. Before starting the interviews, an initial
nursing students regarding missed nursing care interview guide was provided and helped the
and to understand this complex phenomenon researcher to ask further questions in the field.
and its various dimensions in order to find a In the interviews, first a basic and follow-up
way to develop strategies for managing and question such as “What comes to your mind
reducing it. when I say missed care?, What is missed care
like?”, “How do you feel when missed care
Methods occurs?”, and “Can you give an example”, were
asked followed by the in-depth exploratory
The present interpretive phenomenology study questions such as: “Can you explain more or
was conducted to explore and analyze the When you say ... what do you mean and how

46 ijcbnm.sums.ac.ir
 Missed nursing care in postgraduate nursing students

...?, Have you had any similar experiences?, was performed to relate the themes in the best
and What do you mean by saying…?” At the manner. In order to achieve rigor of the study,
end, the participants were asked to comment if we considered and used the criteria proposed
there was anything left to say. Interviews were by Lincoln and Guba in 1985, which include
digitally recorded with the permission of the credibility, dependability, confirmability and
participants and then transcribed verbatim and transferability.24 Therefore, by selecting the
converted into Microsoft word. The MAXQDA- appropriate context, resources, and eligible
10 software was used to better manage the participants; close prolonged and continuous
data. Interviews continued until we reached interaction with the participants; adopting
the depth, richness, abstraction, and relevance. a team approach using collective team
Data analysis and collection were performed discussion; doing analytical comparisons and
simultaneously; for instance, data analysis reciprocal referral to raw data, the validity of
was started with the first interview. Finally, the study was ensured.
by obtaining eligible participants, the data Ethical consideration was observed
were collected and analyzed simultaneously through explaining the aims and methods
and saturated within 10 months. The data used in the research for the participants,
were analyzed using the Dicklemann et al.’s obtaining informed written consent from
(1989) approach, a seven-step process based the research participants, assuring the
on the Heidegger phenomenology, with a participants about the confidentiality of their
team approach. This step-by-step process was information, explaining the purpose of using
carried out as follows: Each interview was first the audio recording, reminding the voluntary
transcribed verbatim and reviewed one or more participation in research, and the possibility of
times to get a general understanding of the withdrawal at any stage of research. This study
context. For each transcript, a commentary was approved by the local research ethics
was written by the author to understand and committee of Tehran University of Medical
extract the hidden meanings through coding. Sciences (IR.TUMS.VCR.REC.1397.727).
Team members exchanged their ideas on
extracting the topics and themes, and as the Results
interviews continued, previous topics became
clearer and evolved, and sometimes new ones Study participants included six women and four
emerged. This was done through discussion men, with a mean age of 30.6 years, ranging
with team members. By finding new topics, from 23 to 39 years. Four of the participants
patterns and interpretations were formed and were married and the rest were single. Also
explicit and implicit meanings were extracted seven of them were in the second semester
from the interview texts. These meanings and three in the fourth semester of the master’s
were not simply the participants’ statements, degree program. Eight participants were
but also included the interview space and the studying medical-surgical nursing and two were
way the participants answered the questions. studying geriatric nursing. All participants were
In order to clarify, categorize, and eliminate working; of whom six had work experience
the contradictions in the interpretation, of less than 10 years and four over 10 years.
we repeatedly returned to the texts. The Five participants worked in the (ICU), two in
purpose of data analysis was to extract the the emergency department, and three in the
concepts and then the themes. The themes Cardiac Care Units (CCU). The participants’
were a set of general characteristics that demographic information is listed in Table 1.
represent the central meaning of the concepts,
similarities, and differences. At each stage, as 1. Unfulfilled Care
the work progressed, by the combination of This theme represents the majority of the
interpretive abstracts, the combined analysis nursing students’ experience of missed care

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Najafi F, Nikbakht Nasrabadi AR, Mardanian Dehkordi L

Table 1: Demographic characteristics of the participants

Participant Age Sex Academic field Semester work experience Unit
1 23 Male Medical-Surgical Second 1 year and two months CCUa
2 33 Female Medical-Surgical Fourth 11 years Emergency
3 27 Male Geriatric Second 5 years ICU b
4 24 Male Medical-Surgical Second 2 years Emergency
5 37 Female Medical-Surgical Second 12 years ICU
6 39 Female Medical-Surgical Second 14 years ICU
7 34 Female Medical-Surgical Second 11 years ICU
8 25 Male Geriatric Second 2 years CCU
9 33 Female Medical-Surgical Fourth 6 years CCU
10 31 Female Medical-Surgical Fourth 7 years ICU
Two main themes emerged in the data analysis process: “Unfulfilled care” and “Living in limbo”. a: Coronary
Care Unit; b: Intensive Care Unit

Table 2: Table of the meaning units, sub-themes and main themes

Meaning units Subtheme Theme
Delay in care Deterioration of opportunity Unfulfilled care
An irreparable situation
A Necessity Missed
Missing circle in providing care
Unsuccessful care
Painful outcome Induction of death
Equivalent to death
Pushing to death
Irreparable outcome
Negative wave
Ineffective care Worthless conception of care
Inevitable event
Normalization
Unnecessary care
Impatience in providing care
Trampling on the patient’s right Ethical conflict Living in limbo
Discredit
Discrimination in care
Being questioned
Immoral care
Feeling worthless and inadequate
Deception and denial
Ignoring error
Lack of adequate information and proper training
Feeling of Regret The turbulence of existence
Mental struggle
Emotional struggle
Stressful feeling
Impact on the nurse’s mind
Concealment of truth
Disappointment

as a missed opportunity that may even lead to induction of death, and worthless conception
death and catastrophic consequences for the of care, which are explained as follows by the
patient. It was also considered as a routine care participants’ quotes. The information about
by the participants. Unfulfilled care had three the main themes, sub-themes and meaning
sub-themes of deterioration of opportunity, units is given in Table 2.

48 ijcbnm.sums.ac.ir
 Missed nursing care in postgraduate nursing students

1.a. Deterioration of opportunity: the consequences can be very severe.”

This sub-theme includes five common (Participant 6)
meanings, including: delay in care, an 1.c. Worthless conception of care:
irreparable situation, a necessity missed, This sub-theme includes five common
missing circle in providing care and concepts: ineffective care, inevitable
unsuccessful care. Regarding the meaning event, normalization, unnecessary care
of missed care, the participants stated that the and impatience in providing care. Some
patients needed some care, but due to working participants found some cares unnecessary and
conditions, it was ignored and a valuable useless for patients based on their diagnosis
care was missed, and also that care was not and opinions or workplace conditions such
completed and cannot be compensated. as heavy workload or nurses’ fatigue. At
Some of the participants’ statements that their discretion, they prioritized the care that
reflect the deterioration of opportunity are as had led to the missing of some important
follows: care. Some also argued that documenting is
“You find a patient who had received superior to nursing care itself. “I didn’t change
cares that were not delivered on time, so he the dressing that I should have done because
missed something valuable. For example, you I was tired or late, or I felt that it shouldn’t
had something so valuable, but you lost it” be changed because I thought the wound was
(Participant 10). clean and good ... For example, something
“The patient needed some care, but we like dressing change (e.g. PRN) probably does
were unable to actually provide him with not hurt the patient. If I’m tired or busy, the
that, because of working conditions, a missed patients are ill, or for whatever reason I can’t
circle in our care, which means no attention do it, well, I don’t ..” (Participant 1.)
is paid to that...” (Participant 3) Perceiving some care, which were
1.b. Induction of death: worthless and repetitive such as patient
This sub-theme includes five common education, was also extracted from some
concepts: painful outcome, equivalent participants’ statements:
to death, pushing to death, irreparable “Sometimes, I felt that the words and
outcome, and negative wave. The participants trainings were even repeated for the patient
perceived missed care as an early induction and he has heard them before. As a nurse,
of a critically ill patient’s death, worsening I thought that this training doesn’t help
of the patient’s condition, pushing him or her my patient, it was just something routine,
into a bad condition, prolonged treatment, something that he should know, and the
and a catastrophe, which will cause many care that you consider to be trivial may be
complications for the patient, nurses and missed...” (Participant 2)
organization. The statements of many of the
participants about missed care indicated that 2. Living in Limbo
this phenomenon is associated with negative This theme reflects the ethical conflicts
feeling, leads to death, and even is equivalent and challenges that may arise in relation to
to death, as follows: the patient, and the confusions and emotions
“It is like after death you get the cure; this experienced by nursing students during
is the best example I can give. Because what missed care as expressed in the interviews
should be done was not done ...” (Participant 1) with various explanations.
“The treatment is longer, so it has more 2.a. Ethical conflict:
complications for the patient. Some of the This sub-theme includes nine common
care that is missed has consequences. They concepts: trampling on the patient’s right,
are caused by the same care that is missed discredit, discrimination in care, being
and some care that are not delivered, and questioned, immoral care, feeling worthless

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Najafi F, Nikbakht Nasrabadi AR, Mardanian Dehkordi L

and inadequate, deception and denial, conscience-stricken or an internal discomfort

ignoring error, lack of adequate information, about which you might not be able to talk to
and proper training. Some nurses do not others, but it is inside you; it bothers you and
report missed care to their coworkers for fear maybe remains in your mind for 2-3 days until
of being reprimanded during their shift. They you forget ... Such things may affect feeling
may also think that no one may notice it, but and job confidence of nurses...” (Participant 2)
it can lead to loss of patient rights and patient “It doesn’t feel good and I’m tormented
harm. The statements of some participants by my conscience. I’m upset, so I don’t fix it.
about the missed care are as follows: I say nothing should be missed until the last
“Now delivering a service to the patient minute ...” (Participant 6)
mistakenly, but not mentioning in to him, or
documentation error, whatever intentionally, Discussion
mistakenly, or due to fatigue, is very
bad because it will postpone everything In the current study, several meanings of missed
unintentionally...” (Participant 9) care were extracted from the statements of
“I think being afraid of reprimand, for postgraduate nursing students. Two main
example, telling a nurse why you didn’t do themes and five subthemes resulted from data
that, causes the nurse not to report the missed analysis. The main themes included unfulfilled
care ...” (Participant 7) care and living in limbo.
Some participants also experienced the In a similar qualitative content analysis
lack of adequate information and proper study in Iranian nurses, similar findings
training in creating ethical conflicts and such as lack of motivation of the staff to
missed care: do interventions that they think were not
“When I don’t have adequate information, necessary for the patient as well as ineffective
it will definitely hurt a patient; different things care and a waste of time were reported as
may happen...” (Participant 7) components of missed nursing care. Some
2.b. The turbulence of existence: participants in both studies have stated that
This sub-theme includes seven common sometimes missed nursing care is unavoidable
concepts: feeling of regret, mental struggle, due to systemic and managerial problems.12
emotional struggle, stressful feeling, impact In line with a similar study conducted
on the nurse’s mind, concealment of truth in Norway, emotional stress that emerged
and disappointment. All nursing students as a subtheme in this study explained the
also talked about the impact of missed care nature of missed nursing care. Other findings
on nurses. They were so upset while talking reported factors such as work constraints,
about it and their sadness was evident on their organizational constraints, professional
faces. When they experience missed care, they constraints in relation to missed nursing care
experience feelings of regret, remorse, and similar to the present study.6
constant and endless mental distress, which Unfulfilled care reflects deterioration of
accompany them even long after the shift is opportunity, induction of death, and worthless
over. Some of them have even considered conception of care that the participants in this
leaving their jobs out of frustration. Inefficient study experienced.
system and insufficient supervision were the The participants in this study described
factors that caused frustration and negative missed nursing care as an irreparable situation
feelings due to the lost care in nurses. like a missing circle in the care process. In
A participant said: one similar study, missed nursing care was
“Your patient is hospitalized and you defined as the omission or delay in any part of
are at home, while your timing was lost; nursing care required by the patient, which is
there would be a feeling inside you that is consistent with some characteristics of missed

50 ijcbnm.sums.ac.ir
 Missed nursing care in postgraduate nursing students

nursing care in this study.25 According to had lost the art of patient care to paperwork
another study, the basis of missed nursing care and they were discouraged from neglecting
is the nurse’s involvement between the routine care and paying more attention to paperwork
methods and real empathy for the patient’s tasks. In the same study, according to the
recovery,26 which is similar to the meaning participants, nurses cannot fully care for
of the missing circle in the care process in the each patient due to a heavy workload, so the
present study. probability of missing nursing care is more and
As in the present study, induction of inevitable.26 In another study, perfunctory was
death was interpreted as a painful outcome, identified as the most important underlying
equivalent to death, an irreparable outcome, cause of missed nursing care. Many nurses
and negative wave of nursing students’ do not have a caring attitude and often want
experiences of missed care. Various studies to act like doctors and forget that the role of
have also mentioned the catastrophic nurse is caring for patient. Indeed, they do
consequences of missed care. In fact, the not consider the patient and think that care
consequences of missed care include a threat is unnecessary for the patient.20 This finding
to patient’s safety.12 The results of a study is in line with the results of our study where
that evaluated why and how nursing care is some participants pointed out that some care
missed indicated that a large proportion of were unnecessary and not important.31
hospitalized patients are at risk of missed care Another theme of this study, living in
or nursing errors.27 According to the findings limbo, also included ethical conflict and
of another study, missed care is associated the turbulence of existence that participants
with negative patient outcomes such as experienced as missed care. Ethical conflict
falls, medication errors, hospital infections, represented the practice of reprimand,
increased hospital costs, and death.28 However, trampling on the patient’s right, discrediting,
compared to other studies, the issue of death, discriminating in care, being questioned,
non-existence and irreparability has been providing unethical care, feelings of
more prominent, which may be due to the worthlessness and inadequacy, deception, and
cultural considerations. denial that nursing students had experienced.
As the findings of the present study Missing care is an ethical debate that
indicated, missed care is sometimes caused challenges the nurses’ professional and
by the notion that something normal, ethical values. Ethical distress is one of
unnecessary care and impatience in care is the factors that leads to lack of care and
missed; the point that was also referred to in mismatch between the patients’ needs and
the literature on missed nursing care. Review available resources.8 Nurses who experience
of the literature in this field shows that missed ethical distress change their circumstances
care is a global problem that is concealed by by resigning, reducing working hours, or
different experiences and different natures.14, 29, moving to other wards. Increased medical
30
In this regard, the results of a study showed errors, exacerbated patients’ condition and
that nursing staff was used to making no suffering of their families, and reduced trust
attempt to do some aspects of care. According and satisfaction in health care systems are
to the participants in this study, when some the other consequences of missed care.8, 32
aspect of care such as patient reposition is Regarding the nursing students’ denial of
missed, it is easier to set it aside for tomorrow missed care, in a similar study it was found
and the following days. If tasks are ignored that many nurses did not ask the specialist
for a long time, expectations to complete a nurses and physiotherapists for the care they
care disappear.25 had to deliver, but rather assumed that it
In one study, the participants noted that had been done, because they did not want
they sought patient satisfaction, but they to know that care was missed.25 Although

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Najafi F, Nikbakht Nasrabadi AR, Mardanian Dehkordi L

the reality is that missed care in the clinical the findings of the present study.6
setting cannot and should not be denied, when This study had some strengths and
nurses keep silent about it, the opportunity to limitations. This research is one of the first
take corrective action is missed by the staff in studies conducted on this phenomenon
next shift. This increases the probability of the among graduate nursing students in Iran. The
recurrence of the same missed care and the students had a rich experience of missed care
risk of negative outcome for patients.14 and eagerly shared their experiences. One of
In the present study, some participants the limitations of this study was that it did not
mentioned the role of lack of adequate include all the experiences of students living
information and proper training in the in other cities.
occurrence of missed care. Missed nursing
care is related to complex factors such as Conclusion
organizational structure, time, healthcare
staff, and professional, material, educational Missed care is experienced as unfulfilled care
and personal characteristics of the nurses.6 and living in limbo for postgraduate nursing
Indeed, delays in care, poor evaluation, and students, which is influenced by organizational
inadequate patient management depend on the and personal factors. The message of this
healthcare staff and educational factors.33 The study to policymakers, health care providers,
use of unqualified personnel leads to missed managers, and scholars is that missed nursing
care, which is manifested by delays or failure care needs to be given greater priority in today’s
to provide services.20 The complexity of health care system. Missed care and unfulfilled
workload may also put the nurses in a position care is a situation that, if not managed, could
to make difficult choices about prioritizing put the future of nursing profession at serious
care,34 which is consistent with the findings risk. It seems that managers can prevent missed
of the present study. nursing care by applying more supervision on
The turbulence of existence represented nursing care, obtaining feedback on nurses’
feeling of regret, mental and emotional performance, reducing the nurses’ workload,
struggle, stress and disappointment perceived creating a culture of teamwork, creating a sense
by nursing students. Many studies indicated of commitment to work, and enforcing ethical
that nurses often had concerns about issues among the nurses.
missed patient’s care, emotional pressure,
and impaired teamwork, the points that Acknowledgments
were also observed in the present study.6
Nurses described their experiences as moral This article is the result of a research project
distress, role disorder, emotional exhaustion, approved by the research department of
discomfort, concern, dissatisfaction, and Tehran University of Medical Sciences with
role of stress in the face of failure to provide the code No. of 40056. We sincerely thank all
complete care for their patients.35, 36 Missed the postgraduate nursing students of Tehran
care is one of the key factors in the nurses’ University of Medical Sciences and all those
satisfaction with working in clinical setting.34 who collaborated with us in this project.
In a study that evaluated the impact of
missed nursing care on nursing staff’s job Conflict of Interest: None declared.
satisfaction, the results showed that nursing
staff who perceived missed nursing care less References
were more satisfied with their job.37 Another
study listed the consequences of missed care, 1 Masters K. Role Development in
which included disappointment, helplessness, Professional Nursing Practice. Burlington
stress, vulnerability, and loneliness, similar to (US): Jones & Bartlett Publishers; 2014.

52 ijcbnm.sums.ac.ir
 Missed nursing care in postgraduate nursing students

2 Pepito JA, Locsin R. Can nurses remain a threat to patient and nurses’ health.
relevant in a technologically advanced Medical Journal of the Islamic Republic
future? International Journal of Nursing of Iran. 2015;29:276.
Sciences. 2019;6:106-10. 13 Kalisch BJ, Lee KH. Missed nursing care:
3 Taylor CR, Lillis C, LeMone P, et al. Study Magnet versus non-Magnet hospitals.
guide for fundamentals of nursing: The art Nursing Outlook. 2012;60:e32-9.
and science of nursing care. Philadelphia: 14 Jones TL, Hamilton P, Murry N.
Lippincott Williams & Wilkins; 2010. Unfinished nursing care, missed care,
4 Liu Y, Wang G. Inpatient satisfaction and implicitly rationed care: State of the
with nursing care and factors influencing science review. International Journal of
satisfaction in a teaching hospital in Nursing Studies. 2015;52:1121-37.
China. Journal of Nursing Care Quality. 15 Ausserhofer D, Zander B, Busse R, et
2007;22:266-71. al. Prevalence, patterns and predictors
5 Peyrovi H, Bahadori A, Ashghali-Farahani of nursing care left undone in European
M, Haghani H. Comparison of in-patients’ hospitals: results from the multicountry
satisfaction with different domains of cross-sectional RN4CAST study. BMJ
nursing care. Quarterly Journal of Nursing Quality & Safety. 2014;23:126-35.
Management. 2013;2:59-66. [In Persian] 16 Hessels AJ, Flynn L, Cimiotti JP, et
6 Kalfoss M. Student’s perception of missed al. The impact of the nursing practice
care: focus group results. Open Journal of environment on missed nursing care.
Nursing. 2017;7:850-74. Clinical Nursing Studies. 2015;3:60-5.
7 Bragadóttir H, Kalisch BJ, Tryggvadóttir 17 Simpson KR, Lyndon A. Consequences
GB. Correlates and predictors of missed of delayed, unfinished, or missed nursing
nursing care in hospitals. Journal of care during labor and birth. The Journal
Clinical Nursing. 2017;26:1524-34. of Perinatal & Neonatal Nursing.
8 Gustafsson N, Leino-Kilpi H, Prga I, 2017;31:32-40.
et al. Missed Care from the Patient’s 18 Wieczorek‐Wojcik B, Gaworska‐
Perspective-A Scoping Review. Krzemińska A, Owczarek AJ, Kilańska
Patient Preference and Adherence. D. In‐hospital mortality as the side
2020;14:383-400. effect of missed care. Journal of Nursing
9 Dutra CKDR, Salles BG, Guirardello Management. 2020. doi: 10.1111/
EdB. Situations and reasons for missed jonm.12965 [online]
nursing care in medical and surgical clinic 19 Quirke S, Coombs M, McEldowney R.
units. Revista da Escola de Enfermagem Suboptimal care of the acutely unwell
da USP. 2019;53:e03470. ward patient: a concept analysis. Journal
10 Yaghobifar M, Takbiri A, Haghgoshaee E, of Advanced Nursing. 2011;67:1834-45.
Tabaraee Y. The survey of patient safety 20 Dehghan-Nayeri N, Shali M, Navabi N,
culture and recognizing its weaknesses Ghaffari F. Perspectives of oncology unit
and strengths in Sabzevar hospitals: 2011. nurse managers on missed nursing care:
Journal of Sabzevar University of Medical A Qualitative study. Asia-Pacific Journal
Sciences. 2013;20:154-64. [In Persian] of Oncology Nursing. 2018;5:327-36.
11 Dabney BW, Kalisch BJ. Nurse staffing 21 VanScoy A, Evenstad SB. Interpretative
levels and patient-reported missed nursing phenomenological analysis for LIS
care. Journal of Nursing Care Quality. research. Journal of Documentation.
2015;30:306-12. 2015;71:338-57.
12 Dehghan-Nayeri N, Ghaffari F, Shali M. 22 Speziale HS, Streubert HJ, Carpenter
Exploring Iranian nurses’ experiences of DR. Qualitative research in nursing:
missed nursing care: a qualitative study: Advancing the humanistic imperative. 5th

IJCBNM January 2021; Vol 9, No 1 53

Najafi F, Nikbakht Nasrabadi AR, Mardanian Dehkordi L

ed. Philadelphia: Lippincott Williams & Zagheri Tafreshi M. The concept of

Wilkins; 2011. nursing care quality from the perspective
23 Evans W, O’Connor T. “I have collected of stakeholders: a phenomenological
qualitative data; now what do I do?” study. Journal of Qualitative Research
approaches to analysing qualitative data. in Health Sciences. 2012;1:214-28. [In
Research and Review Insights. 2017;1(3). Persian]
24 Lincoln YS, Guba EG. Naturalistic 32 Nobahar M. Professional errors and
inquiry. US: Sage Publications; 1985. patient safety in intensive cardiac care
25 Kalisch BJ. Missed nursing care: a unit. Journal of Holistic Nursing and
qualitative study. Journal of Nursing Care Midwifery. 2015;25:63-73. [In Persian]
Quality. 2006;21:306-13. 33 Hernández-Cruz R, Moreno-Monsiváis
26 Harvey C, Thompson S, Pearson M, et MG, Cheverría-Rivera S, Díaz-Oviedo
al. Missed nursing care as an ‘art form’: A. Factors influencing the missed
the contradictions of nurses as carers. nursing care in patients from a private
Nursing Inquiry. 2017;24(3). hospital. Revista Latino-Americana de
27 Kalisch BJ, Landstrom G, Williams RA. Enfermagem. 2017;25:e2877.
Missed nursing care: errors of omission. 34 Winsett RP, Rottet K, Schmitt A, et al.
Nursing Outlook. 2009;57:3-9. Medical surgical nurses describe missed
28 Kalisch BJ, Landstrom GL, Hinshaw nursing care tasks-Evaluating our work
AS. Missed nursing care: a concept environment. Applied Nursing Research.
analysis. Journal of Advanced Nursing. 2016;32:128-33.
2009;65:1509-17. 35 Papastavrou E, Andreou P, Vryonides S.
29 Suhonen R, Scott PA. Missed care: A need The hidden ethical element of nursing care
for careful ethical discussion. Nursing rationing. Nursing Ethics. 2014;21:583-93.
Ethics. 2018;25:549-51. 36 Winters R, Neville S. Registered nurse
30 Zeleníková R, Gurková E, Jarošová perspectives on delayed or missed nursing
D. Missed nursing care measured by cares in a New Zealand Hospital. Nursing
MISSCARE survey–the first pilot study Praxis in New Zealand. 2012;28:19-28.
in the Czech Republic and Slovakia. 37 Kalisch B, Tschannen D, Lee H.
Central European Journal of Nursing and Does missed nursing care predict job
Midwifery. 2019;10:958-66. satisfaction? Journal of Healthcare
31 Atashzadeh Shoorideh F, Pazargadi M, Management. 2011;56:117-34.

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