Study design and setting
Facility based cross sectional study design was conducted in eight public hospitals found in three zones of Oromia region namely Jimma, Illu Aba bora and Buno Bedelle zone, south west Ethiopia. Four primary hospitals, two general hospitals and one tertiary hospital were included. The hospitals have out-patient and inpatient services, maternal and child health services, referral and follow-up services, rehabilitative services, Intensive care and recovery services. The population being served by the hospitals is estimated to be more than 15 million annually including people from border zones and South Sudan while Jimma Medical center (tertiary hospital) has a Lion share. These hospitals have a total of 810 nurses.
Sample and sampling
The study population consisted of nursing professionals active in direct care delivery to admitted patients in selected hospitals. The sample for this study consisted of all nurses (n=422) providing direct nursing care and working in inpatient unit of eight public hospitals. Specifically, Nurses working in Medical, Surgical, Gynecology, Maternity and labor, pediatrics and ICU were included. Sample was allocated by proportional probability to size (PPS) technique for each Hospital based on number of nurses working there. Nurses with less than six-month work experience, who were absent during the data collection period, for reasons of illness or vacation, were excluded; as were those who did not want to participate.
The overall response rate was 386(91.4 %.). Simple random sampling technique was used after allocating the sample size by
Variables and measurement
Dependent variable: Nurses reported missed nursing care. Overall mean missed care score.
Independent variables: Age, Sex, Educational level, Work experience, type of hospital, Work schedules/shift, Perceived staffing adequacy, Absenteeism, on job training, Patient load, Satisfaction to being a nurse, Satisfaction to the current job, Satisfaction to the level of team work.
Data collection Tools and procedure
For perception of nurses on MNC the Modified MISSCARE (“Missed Nursing Care”) survey which is self-administered questioner designed by Kalisch and Williams was adapted and used . The questionnaire comprised of missed nursing care elements of the survey in which respondents were required to indicate, on a five-point Likert-type scale, how often each care was missed in the last working shifts. Response options are Likert-type and range from high to low: 5-always, 4-often, 3-occasionally, 2-rarely, and 1-never for all 24 listed nursing care which can result total score of minimum 24 and maximum of 120. The highest score implied highest missed nursing care. Cronbach’s alpha obtained for this section was 0.83. This section has four dimensions (basic care interventions, interventions to attend to individual needs, discharge planning and patient education, and care interventions with continuous assessment).
In addition, a cover page containing open-ended questions collecting demographic and professional data of the respondents was included such as: age, gender, education, and marital status, working hospital and unit, length of experience in nursing, extra hours worked, and absenteeism in the last 3 months. Additionally, participants were asked to report the patient load on the last shift, frequency of perceived staff adequacy (1 for 0% of the time to 5 for 100% of the time), received on job training in the last one year (Yes, No), plan to leave the current job (1-in the next six month, 2- in the next year, 3 – No plan to leave) and satisfaction toward : current job, being nurse and team work of the unit using a 5-point Likert scale (1—very Disatisfied, 5—very satisfied).
Data were collected over one-month period by20 BSc nurses after assigning ten of them to Jimma zone and ten of them for the other two zones based on the sample size allocated. Two supervisors with MSc qualification were recruited to conduct supervision. Training was provided for the data collectors and supervisor for two days by the project members. To assure the quality of data validated tool was used. Pretesting of the data collection tools was conducted at Nekemte general Hospital using 5% (21nurses) of the total sample and then the tool was improved in terms of its clarity and simplicity in collecting the data required for the study. Data collectors and supervisors were checking for completeness data every day.
Data processing and analysis
Data were entered into Epi Data version 3.1 and exported to SPSS version 20.0 for analysis. Descriptive statistics was performed for socio demographic, job related characteristics and items of missed nursing care. Regarding frequency of missed nursing care description items of nursing care reported as occasionally, frequently and always missed were considered as MNC.
Individual mean missed care scores for each respondent were calculated for each hospitals and dimensions. In addition, an overall missed care score was calculated for each of the cares – thus giving a missed care score for each individual (minimum 24 and maximum of 120). Multivariable linear regression analysis was done through backward method to identify the most significant predictors of MNC. The assumptions in multiple linear regressions (linearity, normality, and constant variance) were checked. Significant independent predictor was declared at 95% confidence interval and P-value of less than 0.05 and unstandardized β was used for interpretation.
Ethical clearance was obtained from Institutional Review board of Jimma University. A formal letter from Institute of health was submitted to all the three zone departments and hospitals in each zone. Iinformed consent was taken from respondents .