The Omission of Nursing Care in Emergency Departments: A Conceptual Analysis Using Walker & Avant's Methodology

ABSTRACT

Aim(s)

To analyse the dimensions of the omission of nursing care in emergency departments, including its attributes, antecedents, and consequences, using Walker & Avant's concept analysis method.

Design Concept Analysis

Methods: Walker and Avant's eight-step method defined attributes, antecedents, and consequences of the omission of nursing care in emergency departments.

Data Sources

A comprehensive literature review was conducted using CINAHL, MEDLINE, Embase, Health Management Database, and Cochrane Library, covering publications from 2001 to 2024. The search was conducted in August 2024.

Results

Key attributes were delayed, incomplete, or interrupted care, mostly due to insufficient staffing or unpredictable patient volumes. Antecedents included high workloads, inadequate skill mixes, and understaffing. Consequences were increased patient morbidity and mortality, nurse burnout, and job dissatisfaction. A research gap exists in paediatric-specific measurement tools.

Conclusion

Identifying dimensions of omitted nursing care in emergency departments informs interventions to improve patient safety and care quality. Developing paediatric-specific measurement tools is essential.

Implications for the Profession and/or Patient Care

The findings emphasise the need for improved staffing and resource allocation policies, reducing risks to patients and enhancing nurse satisfaction.

Impact

This study addressed the gap in understanding omitted nursing care specifically in emergency departments. Findings highlight systemic issues impacting patient outcomes and nurse well-being. The results will guide organisational improvements and future research globally.

Reporting Method

This study adhered to EQUATOR guidelines, following Walker and Avant's method for concept analysis.

Patient or Public Contribution

This study did not include patient or public involvement.

Impact Statement

This study underscores the critical impact of the omission of nursing care (ONC) in emergency departments (EDs) on patient safety, nurse well-being, and healthcare efficiency. ONC contributes to increased morbidity, mortality, and adverse events, highlighting the urgent need for improved staffing models and resource allocation. Training programmes should equip emergency nurses with prioritisation strategies to mitigate care omissions. Policymakers must recognise ONC as a key quality indicator, ensuring adequate workforce support. Additionally, this study identifies a gap in measuring ONC in paediatric EDs, calling for the development of tailored assessment tools and further research on intervention strategies.