The present study aimed to investigate the amount of missed nursing care in the corona ward and the reasons affecting it. According to the results of this study, it can be said that increasing the number of patients, a low number of nursing staff, long working hours of nurses, and also being in a new position causes problems for nurses such as dissatisfaction with their position, intention to leave their current position and loss of many care which has been shown to have a significant negative impact on the health of patients as well as nurses. Tolerating high levels of stress for a long time and being in an unfamiliar environment has disrupted the nursing care process and can also negatively affect nurses' attitudes toward their work 27, 28. These issues could be the reason for the lack of supportive and secondary care that we achieved in this study. Nursing staff may provide only necessary care for patients due to fear of the virus, exposure to new environments, wearing protective clothing for long hours, and simultaneous care of a large number of patients, and may pay less attention to supportive and secondary care.
The low number of nursing staff was the main reason for the missed care in the corona ward, which was found in this study, and is completely consistent with the results of a study conducted by Lam et al. (2019). They stated that the lack of human resources is one of the main factors that prevent nurses from responding appropriately in emergencies during the epidemic period 29. Therefore, the loss of care due to lack of manpower and not having enough time to do all the care is quite predictable.
A 2014 study by Bea et al. found that when nurses' shift hours should increase, the rate of nursing errors also increases 30. Another study conducted in 2020 by Zhang et al. in the corona department showed that with the increase in nurses' working hours during the corona epidemic, nurses' stress and dissatisfaction increased, which affected nurses' health and also harmed the quality of care 31. In the present study, it was also stated that in 12-hour rotating shifts, the rate of loss of necessary care is more than 10-hour shifts and less.
In corona patients with diabetes, one of the most important care is to check blood sugar by the patient's bed 32. The results of our study also show that one of the cares that have the least loss rate is checking blood sugar by the patient's bed, and this shows the nurses' attention to the importance of this issue. Reducing the time spent at the patient's bedside and reducing the time of face-to-face care in corona patients is one of the basic principles to minimize the spread of infection 32, which can be the reason for the missed secondary and supportive care.
In the present study, it is concluded that the amount of necessary and secondary care missed among male nurses is less than female nurses. A study conducted by Çelmeçe & Menekay states that the level of stress in female nurses is higher than male nurses, which can be due to more responsibilities in life and outside the workplace, which increases stress at work 33. Therefore, the loss of more care among female nurses can be the result of more stress outside of work in women. In the present study, the results showed that supportive care had the highest rate of loss, among which, the emotional support of the patient and their family had the highest rate, which is confirmed by previous studies 34, 35. Some authors also argue that due to the large volume of nurses' work, they devote the time that should be devoted to this care to other care that is more necessary and prioritized 36–38.
In this study, the least missed care was related to hand washing, which in previous studies conducted before these epidemics, this option was not one of the lowest; this could be due to the observance of protocols and more sensitivity of nurses to observe hygiene and prevent infection and transmission of this virus. In previous studies, elements such as complete recording of all necessary data, patient assessment in each shift, blood sugar checks by the patient's bed were among the less missed cares that are in line with our study 16, 24, 34, 37, 39. Some studies suggest that the rate of missed care depends on some individual characteristics of the nurse, such as education and work experience 16, 35, 38, which was also found in this study. As mentioned, the amount of missed nursing care was higher in nurses with more than 10 years of work experience than other nurses. We also noted that nurses with more work experience perform better in emergencies than nurses with less work experience.
In the category of the most important reasons for the missed care, they can be stated as follows: unpredictable situations, human resources, communication resources, responsibility, and finally material resources. This finding is supported by previous studies that consider human resources as the most important reason and material resources as the least important reason 16, 24, 39, 40. The fact that material resources were chosen as one of the least important reasons for the missed care can be due to the special circumstances of these epidemics and the efforts of hospital managers to protect staff and reduce disease transmission so that they provide all the facilities for this department.