{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T09:34:37Z","timestamp":1793871277275,"version":"4.6.1"},"reference-count":41,"publisher":"BMJ","issue":"1","funder":[{"DOI":"10.13039\/100004440","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["097170"],"award-info":[{"award-number":["097170"]}],"id":[{"id":"10.13039\/100004440","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Health Systems Research Initiative - Medical Research Council, UK","award":["MR\/M015386\/1"],"award-info":[{"award-number":["MR\/M015386\/1"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Qual Saf"],"accepted":{"date-parts":[[2019,5,18]]},"published-print":{"date-parts":[[2020,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Improved 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Nursing 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 \u226512 babies per nurse were associated with a 24-point reduction in the mean NCI compared with ratios of \u22643 babies per nurse.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>A 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjqs-2019-009363","type":"journal-article","created":{"date-parts":[[2019,6,6]],"date-time":"2019-06-06T17:15:32Z","timestamp":1559841332000},"page":"19-30","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":111,"title":["Missed nursing care in newborn units: a cross-sectional direct observational study"],"prefix":"10.1136","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0958-0713","authenticated-orcid":false,"given":"David","family":"Gathara","sequence":"first","affiliation":[{"name":"Public Health Research, Kenya Medical Research Institute\u2013Wellcome Trust Research Programme, Nairobi, Kenya"},{"name":"Nursing and Midwifery, Aga Khan University School of Nursing and Midwifery East Africa, Nairobi, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Serem","sequence":"additional","affiliation":[{"name":"Public Health Research, KEMRI\/Wellcome Trust Research Programme, Nairobi, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgina A V","family":"Murphy","sequence":"additional","affiliation":[{"name":"Global Health, Bill and Melinda Gates Foundation, Seattle, Washington, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfred","family":"Obengo","sequence":"additional","affiliation":[{"name":"National Nurses Association of Kenya, Nairobi, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edna","family":"Tallam","sequence":"additional","affiliation":[{"name":"Registration and Licensing, Nursing Council of Kenya, Nairobi, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Debra","family":"Jackson","sequence":"additional","affiliation":[{"name":"Nursing and Midwifery, University of Technology Sydney, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharon","family":"Brownie","sequence":"additional","affiliation":[{"name":"Nursing and Midwifery, Aga Khan University School of Nursing and Midwifery East Africa, Nairobi, Kenya"},{"name":"School of Medicine, Griffith University Faculty of Health, Gold Coast, Queensland, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mike","family":"English","sequence":"additional","affiliation":[{"name":"Public Health Research, KEMRI\/Wellcome Trust Research Programme, Nairobi, Kenya"},{"name":"Department of Paediatrics, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,6,6]]},"reference":[{"key":"2025090412522962000_29.1.19.1","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/S0140-6736(14)60496-7","article-title":"Every newborn: progress, priorities, and potential beyond survival","volume":"384","author":"Lawn","year":"2014","journal-title":"The Lancet"},{"key":"2025090412522962000_29.1.19.2","unstructured":"Requejo J , Cesar VBJ . 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