Unfinished Nursing Care Survey: A development and validation study

AIMS: To develop and validate a comprehensive tool based on those established in the field capable of reflecting the broader concept of Unfinished Nursing Care.BACKGROUND: Different tools have been established in the field of Missed Care, Rationing Care, and Tasks Left Undone. However, despite them sharing similar items and all referring to the common concept of Unfinished Nursing Care, no attempts to collapse them in a single tool capable of reflecting current nursing practice, and its increased complexity, have been attempted to date.METHODS: A development and validation study was performed in 2017. After developing the instrument starting from the MISSCARE Survey and critically reviewing the other tools available in the field, the Unfinished Nursing Care Survey (UNCS) was subjected to validation. A total of 1977 nurses from 13 acute Italian hospitals was recruited. Acceptability, construct validity (Mokken Scaling, Explorative and Confirmative Factor Analysis), internal consistency, hypothesis testing, and criterion validity were assessed according to the COnsensus-based Standards for the selection of health Measurement INstruments guideline.RESULTS: 1400 (70.8%) nurses participated. The UNCS is composed of part A (=elements of unfinished care) and part B (=reasons for unfinished care) with 21 and 18 items, respectively. The UNCS has showed high acceptability (>90%). Part A has reported a strong scalability (H = 0.52), thus suggesting a hierarchical structure among the items. The six factors in part B explained a total variance of 64.3% (internal consistency=0.806) as confirmed by the Confirmative Factor Analysis.CONCLUSIONS: The comprehensive nature of the UNCS can contribute to the establishment of a common reference measure of the phenomenon worldwide although its psychometric properties require future investigation in different cultural contexts, languages, and clinical settings.IMPLICATION FOR NURSE MANAGERS: Measuring Unfinished Nursing Care provides information on the processes implicated in the development of adverse events before these become visible; moreover, it can increase awareness on nurses' performance and inform appropriate interventions to improve it.