Introduction Patient safety is a concern in the hospital setting. Missed nursing care due to high nurse patient ratios, or staffing issues leads to patient falls. Patient falls tend to be a big issue and expensive matter for hospitals nationwide. This paper will focus on a qualitative research article regarding missed nursing care, staffing, and patient falls. Included will be a summary of the research, methods and research used in the study, significance of the research findings, ethical considerations, and a conclusion.

Summary of Research Problem Falls pose problems for many patients, such as death, fractures, functional need, and afraid of reoccurrence. Although, hospitals have set forth evidence based guideline strategies for de creasing the number of falls. Consistency and implementation of the strategies are limited. Data was gathered from 188 medical surgical units in 48 separate hospitals nationwide. Data revealed there was not consistent use of interventions to address specific risks. The findings go hand in hand with nursing care being regularly missed.

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Nursing care often gets missed due to staffing issues. Missing any nursing care or not fully completing tasks leads to patient falls (Kalisch, Tschannen & Lee, 2012). Methods and Research Used in the Study A qualitative approach was used in the design of this research. The research project was conducted in smaller scale hospitals of 60 beds to larger scaled hospitals with 913 beds. The total number of units was 124, this was broken down to as little as 2 units in the smaller hospitals to as many as 22 units in the bigger hospitals.

Unit inclusion criteria were, an average patient length of stay of 2 days or more and, a patient population greater than 18 years. Exclusion criteria were short stay units and pediatric, women’s health, perioperative, and psychiatric units. All patient care units in the hospitals that met the inclusion criteria agreed to participate in the study (Kalisch, Tschannen ; Lee, 2012). 3432 nurses were included in this study. In addition to nurses 980 nursing assistants were participants of this study. The surveys return rate was 57. 3%, some units was as high as 99. 6% and as low as 34.4%. (Kalisch, Tschannen ; Lee, 2012).

Missed nursing care data was collected from the MISSCARE survey. This survey focuses on identifying the rate of missed care. (Kalisch, Tschannen ; Lee, 2012). The article states that the National Database of Nursing Quality Indicator standards was used as a guideline to describe Hour Per Patient Day (HPPD). The number of working hours by all nursing staff was to calculate these HPPD values (Kalisch, Tschannen ; Lee, 2012). Any witnessed or unwitnessed event that leads to a patient found on a floor is used as a definition for patient falls.

A ratio of falls per 1000 patient days was used as the calculation of fall rates for this research. (Kalisch, Tschannen ; Lee, 2012). Significance of Research Findings Statistical analysis showed that there is a high correlation between patient falls and the factors of nurse staffing that were addressed in this study. This shows that nurse staffing is significant in preventing patient falls and safety concerns in the hospital. The findings in data collected reinforce previous findings that greater staffing leads to fewer patient falls in the hospital.

There were several correlations between the data collected and patient falls. The correlation and data collected also support that the types of missed care can be predicted at different staffing levels(Kalisch, Tschannen ; Lee, 2012). Ethical Considerations After institutional review board approval from each of the contributing hospitals, study data was collected from November 2008 to August 2009. During the research process patient privacy remained protected. No ethical issues were listed to being an issue.


The findings from this research study emphasizes the significance of guaranteeing that required care is accomplished daily, to decrease the number of patient falls. Although, staffing may affect the rates of patient falls, the level of influence is lowered when care is finished entirely. Additional work must be done to help nurses in completing essential tasks such as ambulating patients, assisting patients with toileting, patient assessments, and answering call lights, which may mean more staff members. Techniques for helping staff members complete all portions of nursing care include lists, reminders, and engagement of the patient.

Until it is completely understood that the process of nursing care and its relationships to patient outcomes are related, we will not be able to develop positive strategies to stop unfavorable proceedings such as falls. Staffing and nurse to patient ratios should be considered to help aid in nursing care completion. (Kalisch, Tschannen ; Lee, 2012) References: Kalisch, B. J. , Tschannen, D. , ; Lee, K. H. (2012). Missed nursing care, staffing, and patient falls. Journal of Nursing Care Quality:, 27(1), 6-12. doi: 10. 1097/NCQ. 0b013e318225aa23.