Observational studyBMJ quality & safety2020
Missed nursing care in newborn units: a cross-sectional direct observational study.
Observational study in BMJ quality & safety, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 61 papers, 2 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
61 citing papers in PubMed, 2 syntheses or guidelines pooled it, 8 citations in OpenAlex.
- Missed nursing care in acute care hospital settings in low-income and middle-income countries: a systematic review.Human resources for health · 2023Pooled it
- Pooled it
- Missed Nursing Care in Paediatric Surgical Settings in Türkiye: A Nationwide Cross-Sectional Study.International journal of nursing practice · 2026Article
- Social Representations of Bedside Milk Expression Among Mothers of Preterm Newborns in Neonatal Intensive Care Units.Journal of advanced nursing · 2026Article
- Triangulating evidence, expertise, and maternal experience to design a gestational age-specific stimulation protocol for preterm infants in indian neonatal intensive care units.Journal of health, population, and nutrition · 2026Article
- "Everyone in this together": a qualitative study on mothers as partners in infection prevention in a neonatal unit in Botswana.Antimicrobial resistance and infection control · 2026Article
- Time for change in implementation research and practice.BMC medicine · 2026Article
- Categorizing missed nursing care to effectively investigate its influencing factors among pediatric nurses: a regional cross-sectional survey.BMC nursing · 2025Article
- Predictive analysis of the relationship between nurses' attitudes toward patient safety and missed nursing care.BMC nursing · 2025Article
- Experiences of mothers in the context of a staffing intervention in select newborn units in Kenyan public hospitals.International journal of nursing studies · 2025Article
- The reality of neonatal nursing work in Kenya and implications for quality and safety: Direct observation of tasks and time utilisation.International journal of nursing studies · 2025Article
- Applying a multi-layered, mixed methods approach to evaluate technology and workforce interventions in Kenyan neonatal units.Global health action · 2025Article
- Understanding the relational culture of healthcare workplaces: a framework to guide improvement interventions, derived from a realist evaluation of neonatal care in Kenya.BMC health services research · 2025Article
- Neonatal unit human resources: coverage for six cadres and trends for staff-to-baby ratios in 65 neonatal units implementing with NEST360 in Kenya, Malawi, Nigeria, and Tanzania.Human resources for health · 2025Article
- Implementation of a task-shifting and task sharing intervention: A case of ward assistants in Kenyan neonatal units.International journal of nursing studies · 2025Article
- Nurses experiences with an intervention enhancing skill-mix in Kenyan neonatal units with severe workforce deficits: A qualitative study.International journal of nursing studies · 2025Article
- Emotional dimensions of nurses' daily work in newborn units in Kenya: a qualitative study.BMC public health · 2025Article
- Delivery of care in high mortality hospital settings: a direct observational study examining 1848 h of neonatal nursing in Kenya.EClinicalMedicine · 2025Article
- Strengthening neonatal care through ward assistants: a Kenyan case study in enhancing infection prevention and control practices.Antimicrobial resistance and infection control · 2025Article
- From pilot project to toolkit: using lessons learned from a comprehensive university campus sexual violence activity in Kenya.BMC global and public health · 2025Article
1 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors at 5 institutions in 5 countries.
Funding
Abstract
backgroundImproved hospital care is needed to reduce newborn mortality in low/middle-income countries (LMIC). Nurses are essential to the delivery of safe and effective care, but nurse shortages and high patient workloads may result in missed care. We aimed to examine nursing care delivered to sick newborns and identify missed care using direct observational methods.
methodsA cross-sectional study using direct-observational methods for 216 newborns admitted in six health facilities in Nairobi, Kenya, was used to determine which tasks were completed. We report the frequency of tasks done and develop a nursing care index (NCI), an unweighted summary score of nursing tasks done for each baby, to explore how task completion is related to organisational and newborn characteristics.
resultsNursing tasks most commonly completed were handing over between shifts (97%), checking and where necessary changing diapers (96%). Tasks with lowest completion rates included nursing review of newborns (38%) and assessment of babies on phototherapy (15%). Overall the mean NCI was 60% (95% CI 58% to 62%), at least 80% of tasks were completed for only 14% of babies. Private sector facilities had a median ratio of babies to nurses of 3, with a maximum of 7 babies per nurse. In the public sector, the median ratio was 19 babies and a maximum exceeding 25 babies per nurse. In exploratory multivariable analyses, ratios of ≥12 babies per nurse were associated with a 24-point reduction in the mean NCI compared with ratios of ≤3 babies per nurse.
conclusionA significant proportion of nursing care is missed with potentially serious effects on patient safety and outcomes in this LMIC setting. Given that nurses caring for fewer babies on average performed more of the expected tasks, addressing nursing is key to ensuring delivery of essential aspects of care as part of improving quality and safety.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.