Qom University of Medical Sciences Journal

Introduction
With the rapid growth of the aged population, problems and emergency care and treatment also increase. The emergency department is one of the most important wards for providing services to older adults. With the increasing occurrence of emergency situations in older adults, responding to their care needs is one of the health priorities. In these situations, some care may be missed or forgotten. The time limitation and multiple duties of a nurse make them prioritize care and decide which care to eliminate or prioritize, and as a result, some care is missed. Studies in Iran on the missed nursing care (MNC) for older adults in the emergency departments are limited. Considering the importance of elderly care and preventing the complications of MNC, there is a need for more extensive research. Therefore, this study aims to determine the MNC for older adults hospitalized in the emergency departments of hospitals in Qom, Iran.
Methods
This is a descriptive cross-sectional study. The study population consists of all nurses working in the emergency departments of hospitals affiliated to Qom University of Medical Sciences in 2022. Using a quota sampling and convenience sampling method, 300 nurses were selected. The entry criteria were a bachelor’s degree or higher, at least 3 months of work experience in the emergency department, and consent to participate in the study. Demographic and work-related characteristics, including age, gender, marital status, educational level, and work experience, were recorded. Then, the MNC questionnaire designed by Kalisch (2009) was completed. It has 24 items rated on the four-point Likert scale: 1 (rarely missed), 2 (sometimes missed), 3 (often missed) and 4 (always missed). The total score ranges from 24 to 96, with a higher score indicating a higher possibility of missed care. Data were analyzed in SPSS software version 16. Descriptive statistics, including frequency and mean, were used to describe the variables.
Results
Most of the nurses (42%) were in the age range of 20-30 years old, female (58%), married (55%), with a work experience between 3 months and 10 years (64%). The mean score of MNC was 30.35±11.98 (out of 96), indicating that the level of MNC was lower than the average. The highest percentages of missed care were related to the items “feeding patient when the food is still warm” (84.3%), “vital signs assessed as ordered” (55.77%), “attending interdisciplinary care conferences” (53%), and “full documentation of all necessary data” (51.3%). Also, the item with the least missed care was “skin care” (3.7%).
Conclusion
The MNC for older adults hospitalized in the emergency departments of hospitals in Qom is below average. To provide optimal care and reduce MNC for older adults in the emergency departments of hospitals, it is necessary to upgrade interdisciplinary training programs for nursing staff, recognize the characteristics of older adults, and know how to provide them with specialized care. Also, it is recommended to use experienced nursing staff in these departments.
Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Ethics Committee of Vice Chancellor of Research, Qom University of Medical Sciences, Qom, Iran (Code: IR.MUQ.RES.1401.077).
Funding
This study was funded by the Vice Chancellor of Research of Qom University of Medical Sciences, Qom, Iran.
Authors contributions
The authors contributed equally to preparing the paper.
Conflicts of interest
The authors declared no conflict.
Acknowledgments
The authors  are grateful to the honorable Vice Chancellor of Research and research experts of Qom University of Medical Sciences, Qom, Iran.