The Longitudinal Prevalence of Unfinished Nursing Care at the US Army Burn Center

Purpose: Data from 22 studies, representing over 900,000 nurses from 20 countries, indicated that the majority of hospital nurses (55-98%) leave at least one element of nursing care unfinished. The variability of UNC over time is not known and temporal relationships between UNC and changes in the work environment have not been examined. Differences in patient care requirements, resourcing, organization, and structure pose a variety of time pressure challenges for nurses in the US Army Burn Center (USABC) that may result in previously unrecognized patterns of UNC. This study is designed to determine whether or not changes in nurse staffing and work conditions at the USABC precede changes in UNC.   

Aims: To examine variability in the prevalence and patterns of UNC in the USABC over time. Research Questions: 1) What is the monthly variation in the prevalence and patterns of UNC? 2) What is the relationship between nurse staff supply and UNC? 3) What is the relationship between working conditions and UNC?

Design: A repeated measures survey design will be used to identify prevalence and patterns of UNC in the USABC. 

Sample: All bedside nurses working at the USABC (n= ~110) will be asked to participate in this study.

Procedure: Each month for six months, a paper survey that includes demographic questions and the Perceived Implicit Rationing of Nursing Care instrument (an instrument to measure UNC) will be distributed to all USABC bedside nurses. Concurrently, 2 weeks of objective unit-level measures, such as census, patient turnover, and staffing will be collected for each nursing unit.

Analysis: Descriptive statistics and multilevel modeling will be used to examine longitudinal relationships between the presumed antecedents and UNC. These relationships will be examined across 3 levels: time, nurse, and unit.

This proposed study is relevant to military nursing clinical practice, and will meet two TSNRP priorities: 1) Nursing Competencies and Practice, by describing the longitudinal prevalence of UNC, an important quality and safety issue in the complex military nursing environment of the Burn Center, and 2) Force Health Protection, by describing the influence of UNC on patient care in a complex military nursing environment.

Final Report is available on NTRL: https://ntrl.ntis.gov/NTRL/dashboard/searchResults/titleDetail/PB2018100...