Le decisioni infermieristiche e le missed nursing care: risultati di una scoping review [Decision Making process and missed nursing care: findings from a scoping review]

Decision Making process and missed nursing care: findings from a scoping review. Introduction. Several aspects of the Missed Care (MNC) model have been studied (conceptual aspects, causes, process, measurement instruments, outcomes) however, the decision-making processes influencing the MNC have not yet been settled into an accessible guide. Objective. To describe (a) the terms most used in the literature to define the decision-making processes influencing the MNC, (b) the conceptual models, as well as (c) the available tools. Method. A scoping review was carried out in March-August 2020 by consulting the following databases: Cochrane Library, Pubmed, Scopus, CINAHL Complete, PsycINFO. Of the 385 retrieved studies, 92 abstracts were evaluated and 36 studies included. Results. Four terms are used to address the process of nursing intervention delivered on time, postponed or missed: (a) Priority setting; (b) Prioritisation of clinical care; (c) Implicit rationing; and (d) Time scarcity. While the lack of time expresses the common denominator, a substantial difference emerges between priority setting and rationing: the first establishes a preferential sequence of activities with the result of delaying those less significant; the second leads to unfinished nursing care. Decision models to date have not considered the processes influencing MNC; therefore, the available measurement instruments are also of little use. Conclusions. The decisionmaking processes underlying MNC have not yet been well understood, and described using different terms. Reliable instruments to measure them are still lacking.