The findings of the study showed that most of the missed care in the oncology wards were related to “participation in interdisciplinary patient care conferences” and “supervision of food preparation for the patient who can eat on his own.” These findings are in line with the findings of previous research conducted on oncology and non-oncology units [Chegin (2020) (15), Kalish et al. (2011) (14), Khajoui et al. (2019 )(13)]. Results of additional studies by Friese (2013) (16), Shih-Ping Pan et al. (2021) (17), and Vryonides et al. (2016) done in oncology wards showed that turning and positioning of patients every two hours and attendance at cross-functional/team meetings were common items for missed nursing care. “Measure vital signs based on your doctor’s instructions” (1.07), “Control the absorption of fluid and excretion” (1.10), and “Blood glucose control with glucometer” (1.12) were ranked as the least nursing missed care. These findings are consistent with the previous research findings of Kalish et al. (2011) (14), Khajooee et al. (2019) (13), and Rabin et al. (2019) (18).
From a clinical point of view, these nursing care interventions are directly related to the patient's health and care outcomes. Missed nursing care puts the patient at risk for poor patient care outcomes and decreased patient safety. Nursing care must be recorded, reported, and routinely audited by nursing wards. Khajooee (2019) noted that accurate recording of nursing care in the patient's file can aid in not forgetting such care (13). Contrary, care such as attending a conference, cooperation and supervision of the patient going to the toilet in the first 15 minutes of the request, supervision of food preparation for the patient who can eat on his own, turning and positioning of patients every two hours, attendance at cross-functional/team meetings may not be perceived as vital care، may not be recorded, or reported in nursing documentation, and also have less chance to perceived as missed care. Yet, these factors have a direct relationship with patient care outcomes. Therefore, all nursing care should be documented.
Again, according to the study results, the highest mean score of factors relating to missed care were “Unexpected increase in the number of patients or crowded wards” (3.78), "Large volume of activities related to patient admission and discharge” (3.73), and “Lack of nursing staff” (3.72). Kalisch et al. (2011) also found that an unexpected rise in patient volume and/or acuity was consistently identified as the top factor for missed care (94.9% for all respondents), with a range in frequency between 87.4–98.3% across hospitals (14). While Blackman (2015) found that a sudden increase in admission and discharge activities can be a factor in nursing missed care (19). Further, according to Hesselink et al. (2012), if the discharge and admission process is inappropriate, the quality of nursing services will be significantly affected (20). Lastly, Albelbeisi et al. (2021) reported that approximately 63.5% of their participants reported that there are not enough registered nurses on staff to provide quality patient care (9).
Along the same lines several studies in Mexico reported that labor resources were the principal factor of missed nursing care (Blackman et al. (2015) (19), Cyprus Papastavrou et al. ( 2016) (30), Italy Sist et al. (2017) (26), Kalisch et al. (2012) (26), Moreno-Monsivais et al. (2015 ) (21), Recio-Saucedo et al. (2018) (23), and Winsett et al., (2016) (22). Friese et al. (2013) identified a significant relationship between higher patient workloads and reported missed nursing care, and believed his findings support the framework of the missed care model that asserts a relationship between structure (i.e., unit-level staffing) and processes of care (missed nursing care) (16). Ball et al. ( 2019) reported care being left undone (or ‘missed’) when nurses are working on shifts with high numbers of patients per registered nurse (24).
Based on the results of this study and the literature review less staff, more patients, and increased workload for nurses in oncology units were factors relating to missed care. Dehghan-Nayeri et al. (2018) claimed many elements related towards extra workload for nurses in oncology units, including patients’ inability to explain their healthcare needs due to old age, low education levels, or being in a critical condition, as well as the inability by patients to practice self‑care (1). Umpiérrez et al. (2015) also reported that an inadequate number of staff has a direct influence on the occurrence of adverse events, since low staffing numbers, excessive workloads, and unfavorable conditions experienced by nurses restrict adequate implementation and management of healthcare (25).