Measuring unfinished nursing care in patients with or at risk for delirium: a development and Delphi study

Background: Unfinished Nursing Care (UNC) refers to necessary patient care interventions that are delayed or omitted. Although several instruments exist to measure UNC, none are specifically designed for patients at risk of or experiencing delirium. These patients often have difficulty communicating their needs, making it harder for nurses to identify and prioritize appropriate care. Methods: A seven-round Delphi study, based on the Conducting and Reporting Delphi Studies (CREDES) framework, was conducted to develop the Unfinished Nursing Care Survey for Patients at Risk of and with Delirium (UNCSD) as an adaptation of the Unfinished Nursing Care Survey, composed of Part A and Part B. A multidisciplinary group evaluated the items using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) scale, which assigns scores from 1 to 9. The group reached consensus on the inclusion of items (70% agreement), with final consensus exceeding 90%. The Delphi process included three rounds for Part A, three for Part B, and one for the introduction section online, while one round was conducted in interactive mode to revise items and provide changes, mergers, additions, and exclusions. Results: The final UNCSD instrument consists of an introduction Section (31 items), Part A (39 essential nursing interventions, selected from an original set of 63), and Part B (23 reasons for UNC, reduced from 48). Conclusions: The UNCSD measures UNC and its reasons among patients at risk of or with delirium. Its use helps nurses identify gaps in care, improve decision-making, define care priorities, and ensure patient safety.