Missed Care in Community Nursing in Ireland

Background: Reform in community nursing in Ireland has remained static despite demographic change, policy change and structural change within health services. Community nursing services are consequently under strain and this... [ view full abstract ]

Background: Reform in community nursing in Ireland has remained static despite demographic change, policy change and structural change within health services. Community nursing services are consequently under strain and this impacts on service capacity.

Aim and objectives of the study: The aim of the study was to identify what care is being missed in the Irish community nursing sector and the factors relating to such missed care.

Research Design: Methods of data collection: a) a bespoke community based missed care survey (n=283); b) four semi-structured interviews with key stakeholders; c) and a focus group (health economic focus).
Sample: a) & c) Community registered general nurses and public health nurses
b) Strategic stakeholders in community nursing in Ireland.
Analysis: a) Statistical Package for the Social Sciences (SPSS).
b) & c) Thematic Content Analysis
Ethical approval: Obtained from University College Dublin.

Findings: All 64 domain questions demonstrated some level of missed care. Missed care was observed at over the 50% threshold for health promotion, care management, disadvantaged groups, older people, administration, family support, the provision of other services and home nursing care, eduction and within primary healthcare teams. For public health nurses, missed care was also observed within child health and child protection. The data from the interviews and the focus groups supported the findings within the survey. The data from the interviews and the focus groups supported the findings within the survey. Reasons for missed care included: inadequate staffing levels, unanticipated rise in client volume and/acuity/complexity and a lack of administrative support.

Conclusions and Implications: The findings are significant in the context of both the job desciptions and health policies in Ireland The experiences of the community nurses demonstrate that they are prioritising clincal work and legislation obligations. In applying case scenarios based on cost benefit analysis of addressing health promotion areas in a comprehensive way, clear potential economic saving can be made. Consequentally, urgent reform is required in terms of ensuring comprehensive care is delivered by a community nursing healthforce that can adequately contribute to contemporary health demands at primary, secondary and tertiary care levels for individuals, families and communities.