Table 1

Behaviours and causal factors identified in studies of patient neglect
Author Method, setting, and participants SIGN quality rating Procedure neglect (failings in care that fall short of objective and observable institutional and professional standards) Caring neglect (failings in care that are below the threshold of being proceduralised, yet lead patients, family and the public to believe that staff are unconcerned about the emotional and physical wellbeing of patients) Proximal (e.g. on-the-ground) causes of neglect Distal (e.g. institutional) causes of neglect
1. Jewkes et al., 1998 [41] 103 qualitative interviews with patients and nursing staff at two South African obstetric units. Interviews focussed on treatment of patients by nursing staff 3 Not attending to patient hygiene Rudeness to patients; Not responding to patient requests or complaints of pain; Not attending to patient comfort; Talking to staff rather than patients High workloads and low staffing levels; Problems in relationship between staff and patients Normalisation of neglect; Failure of management to ensure quality of care
2. Goergen, 2001 [32] Survey of 80 staff in nine German nursing homes Measured if staff had engaged or observed patient neglect in the previous 12 months 2- Not changing patient linen or underwear (8% committed, 18% observed ); Not washing patients (11% committed, 12% observed); Not changing bedridden patient’s position (31% committed, 30% observed) Ignoring patients (35% committed, 31% observed); Delaying help for patients (19% committed, 26% observed) High workloads and low staffing levels; Patient’ ill-treatment of nursing staff; Staff stress and burnout Low staff morale
3. Erikkson & Saveman, 2002 [40] Qualitative interviews with 12 nurses who cared for patients with dementia in acute care settings 3 Not meeting patient needs; Ignoring patients; Responding to preferred patients over others High workload; Low staffing levels; Difficulties in communicating with patients; Poor teamwork Organisational change and instability; Poor technical environment
4. Georgen, 2004 [39] Qualitative interviews (e.g. patients, nursing staff, families) with 251 participants in eight nursing homes, and survey of 361 nursing care home staff across 27 institutions 2- Not changing bedridden residents position in time (29% observed); Neglecting resident’s oral hygiene (28% observed) Psychosocial neglect (29% committed, 34% observed); Intentionally ignoring resident (26% observed) Ratio of staff to patients; Staff burnout; Staff shortages, time pressure and workload Organisational politics; Culture for patients voicing concern; Low staff morale Satisfaction with management
5. Wang, 2005 [38] Cross-sectional survey of 114 caregivers in long-term care facilities in Taiwan. Respondents completed the ‘caregiver psychological abuse behaviours’ scale 2- Not responding to requests for help; Not listening to patients High workloads Low levels of staff education; Lack of appropriate training for staff
6. Swahnberg et al., 2006 [36] Survey of 661 obstetric patients in Sweden. Measured patient experiences of medical staff ‘disobeying ethical principles’ 2- Ignoring patients (79% experienced); Not acknowledging patient opinions (27% experienced); Not giving patients enough time to consider treatments (25% experienced); Excluding patients from decision-making (20% experienced) Culture for accepting ethical codes of practice
7. Khalil., 2009 [34] Qualitative survey of 373 nurses on behaviours and attitudes towards ‘good’ and ‘bad’ patients in eight South African public hospitals 2- Ignoring patients; Avoiding contact with patients; Not providing adequate care High workload and shortage of staff; Categorisation of patients as ‘bad’ or problematic Low staff morale
8. Malmedal et al., 2009 [35] Survey of 616 nursing staff in 16 Norwegian nursing homes Survey measured how often staff had engaged or observed colleagues neglecting patients once a week or less 2- Neglecting oral care (9% committed, 17% observed); Not providing appropriate nutrition (0.3% committed, 3% observed); Not washing patients (15% committed, 7% observed); Not treating an injury/wound adequately (0.3% committed, 3% observed) Ignoring a patient (5% committed, 15% observed); Delaying care assistance longer than necessary (4% committed, 15% observed) Staff burnout and stress Education and training
9. UK Parliamentary and Health Ombudsman., 2009 [44] Qualitative investigations (interviews and document analyses) into the death of six NHS patients with learning difficulties 3 Not providing appropriate nutrition or hydration; Not providing appropriate provide pain relief; Not appropriately considering patient readiness for discharge; Not appropriately planning pain management; Failures to observe, monitor, or record patient data. Not responding to concerns/complaints from families; Failure to communicate with patients and families; Lack of empathy for patients Protocol breaches; Errors in noticing deficiencies in patient care Administrative/organisational errors; Lack of organisational leadership on priorities of care; Lack of appropriate training for staff
10. Entwistle et al., 2010 [42] Qualitative study with 71 interviews and 12 focus groups investigating negative staff reactions to speaking up on patient safety 3 Not responding to concerns/complaints from families Problems in relationship between staff and patients Poor safety culture
11. Francis, 2010 [24] Qualitative and quantitative analysis of patient neglect at mid-Staffordshire NHS Foundation Trust. The report collected data through interviews with patients and staff 3 Not documenting/reporting patient injuries; Not providing appropriate nutrition or hydration; Patients left in unsanitary/unhygienic conditions; Ward and bedside areas left unclean; Not appropriately considering patient readiness for discharge; Failures to observe, monitor, or record patient data; Unnecessary delays to patient diagnosis Failures to respond to patient requests to go to the toilet; Not responding to patient’ requests; Not acknowledging concern provided by patients/families; Not providing appropriate assistance for eating and drinking; Failing to listen families; Rudeness Lack of empathy High workloads and low staffing levels; Protocol breaches; Poor ward management; Communication errors between healthcare staff Poor safety culture; Lack of training for managing complex patients; Perceived focus on task-focussed rather than patient centred-care; Lack of staff trust in management, fear for jobs, and low morale; Management ignoring staff warnings on care/workloads; Poor organisational leadership
12. Care Quality Commission, 2011 [43] Inspections of 100 acute hospitals in England in order to assess standards of dignity and nutrition for elderly patients. Methods involved observations, and interviews with staff and patients 3 Not providing appropriate nutrition or hydration; Patients left in unsanitary/unhygienic conditions; Not ensuring patients have call bells in reach Not providing appropriate assistance for eating and drinking; Failing to help patients to go to the toilet; Not responding to patient’ requests High workloads and low staffing levels; Failures in identifying poor care; Protocol breaches; Lack of appropriate training for staff Perceived focus on task-focussed rather than patient centred-care; Poor safety culture; Lack of organisational leadership on priorities of care
13. UK Parliamentary and Health Ombudsman., 2011 [45] Qualitative investigations (e.g. interviews and document analyses) into the death of ten elderly NHS patients 3 Not providing/monitoring appropriate nutrition or hydration; Not appropriately planning pain management; Ward and bedside areas left unclean; Not appropriately considering patient readiness for discharge; Not documenting/reporting patient injuries Not providing appropriate assistance for eating and drinking; Not responding to patient’ requests for help; Not aiding patients who are unable to speak; Informing patients of terminal diagnoses in public wards; Not involving families in end-of-life decision-making Protocol breaches; Communication errors between healthcare staff; Lack of appropriate training for staff; Poor English of caregivers Perceived focus on task-focussed rather than patient centred-care; Poor safety culture
14. Zhang et al., 2011 [37] Survey of 414 family members with relatives in US nursing homes. Measures focussed on observed incidences of patient neglect 2- Not turning patients in bed; Not providing appropriate nutrition or hydration; Not ensuring patient hygiene Not responding to patient’ requests for help Patient complexity; Errors in noticing deficiencies in patient care

Reader and Gillespie

Reader and Gillespie BMC Health Services Research 2013 13:156   doi:10.1186/1472-6963-13-156

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