Unfinished Nursing Care for the patient at risk and with Delirium

Background Patients with delirium are defined in the literature as frailty patients who are more vulnerable to unfinished care due to their inability to communicate their needs. Unfinished nursing care (UNC) is used as an umbrella term, in the literature and is defined as 'a problem of time scarcity that leads nurses to implicitly ration care through the clinical prioritisation process. From this knowledge gap, a research project was built with the following objectives: a) To describe the state of the art about concepts used in the literature to describe the cognitive process underlying UNC; the conceptual models and the measurement tools available; b) To explore how nurses prioritise interventions in practice and the reasons for such choices within acute and post-acute settings for patients at risk of functional and/or cognitive decline at risk of delirium. c) To adapt the Unfinished Nursing Care Survey (UNCS) tool for the assessment of delayed or missed care among patients at risk or with delirium and to evaluate its psychometric properties in a sample of nurses. Materials and methods To meet objective a) a Scoping Review was conducted, b) a Q-Methodology study was conducted, (involving a systematic literature review and the Nominal Group Technique to produce the Q methodology materials). Finally, to meet objective c) a validation study was performed Results Prioritisation is an important activity for nurses, who have to decide which unfinished nursing tasks to prioritise. In study b) 56 nurses working in medical, geriatric and post-acute care facilities were involved. The results describe the preventive and management interventions that received the highest/lowest priority, the patterns that emerged among the nurses, and the reasons. Conclusions This project highlighted the importance of focusing on the way nurses prioritise, motivate and measure unfinished care to promote safe and quality care.