Missed care affected by electronic or manual recording methods in Neonatal Intensive Care Nurses

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On the other hand, time-consuming actions such as record can effect the type and quality of care. Although no study was found on the effect of manual and electronic record of nurses on missed care, the present study was conducted to compare the effect of manual or electronic recording methods on the missed care in neonatal intensive care nurses. Methods : A descriptive comparative multicenter study was conducted from September 2022 to February 2023 by census of 151 nurses in the neonatal intensive care units. Tubbs-cooley missed care questionnaire was used for data collecting. Data was analyzed by SPSS software version 26. Results: There was no significant difference in the mean difference between the electronic and manual records (30 intensive care) in the majority of cares item(p<0.05). Only in three cares, "observing the correct principles of drug administration (8 rights)", "reviewing high-risk drugs according to the protocol" and "adjusting oxygen based on the saturation level according to the protocol or order", a statistically significant difference was observed between electronic and manual record. The mean scores for electronic records were lower than manual records and close to one score (complete care). Conclusion: In neonatal intensive care unit, because of high sensitivity of caring, nurses should complete the types and details of cares and methods of records have no significant effect on missed care. It seems that electronic record provides more opportunity for ideal care and may play a role in decreasing missed care. Missed Care Nursing Records Intensive Care Units Neonatal Background Neonates admitted to NICU are embryos which develop in an environment outside the mother's womb and may be exposed to undesirable consequences. The brain of the neonates grows faster than any other time during this period [ 1 ]. These neonates need continuous and complicated nursing care due to their anatomical, physiological and immunological conditions [ 2 ]. Problems with each type of care can have devastating effects on the growth and development of the neonates even in the long term [ 3 ]. For example, poor care for neonates venous lines increases the risk of infection and the hospitalization period, or lack of precise oxygen saturation of the neonates can increase the risk of retinopathy [ 4 , 5 ]. Recent research shows that even the slightest negligence in taking care of premature neonates increases the mortality rate and complications of diseases in them[ 6 ] and increasing missed care leads to dramatically decrease in the quality of care services [ 7 – 9 ], which is of paramount importance in the care of vulnerable neonates. According to studies conducted in the occurrence of missed care, human power factors including lack of nurses, mismanagement, work difficulty, shift changes, inappropriate job distribution, lack of experience of some nurses, lack of interpersonal communication, poor teamwork and high nurses working load have a significant impact [ 10 , 11 ]. Also, lack of time management skills is cited as other important reasons for missed care [ 12 ]. The more specialized and sensitive the ward where nurses work, the more accurate the nursing report should be recorded at shorter intervals [ 13 ]. Nursing records in NICU should also be performed in very detailed and very accurate detail [ 14 ]. Nurses increase the level of monitoring of the neonates as the clinical condition worsens, and at these times they often identify and record subtle changes, following these detailed records, more accurate and appropriate actions are taken. [ 15 ]. In other words, nursing record, due to the critical condition and nature of neonates in intensive care unit, in order to consistency and continuity in neonate care, effective relationship between the staff is necessary to prevent missing of care [ 16 ]. With the advances in technology, patient information records have changed, and hospital information systems have been generated in electronic form. In parallel with these changes, electronic forms of nursing records have also been developed, and nursing records are conducted manually or electronically, or a combination of both methods [ 17 , 18 ]. In electronic record, the power and decision speeds are increased and due to the readability of reports and the use of standard words, errors caused by the misconception of reports are reduced. Also, access to information is easier and information exchange and shift delivery are done faster [ 17 , 19 ]. In studies, the primary consequence of electronic record is to reduce the time of record and increase the continuity of care period [ 19 – 21 ]. According to the results of a systematic study, 92% of nurses were satisfied with the increased quality of care after using electronic systems in recording [ 22 ]. Despite these advantages, implementing electronic record comes with some challenges [ 23 ]. Electronic recording requires typing skills and can cause typing errors in data recording, or if the system fails, the recording will not be done. Accordingly, electronic systems have not been able to have their proper place in health care centers as they should. It has also been mentioned in the relevant literature that although electronic recording can increase care time and improve interdepartmental exchanges, it can also increase nursing workload [ 24 ]. But in manual recording, nurses can record their reports even at the patient's bedside. Given that different results have been reported regarding the advantages and disadvantages of electronic and manual recording, it is difficult to judge the priority of the recording method. In the neonatal intensive care unit, due to the large number of care and treatment measures and the need to provide services with great detail, nurses spend a lot of time performing and recording these activities. Therefore, the results of comparing missed care in two types of manual and electronic recording can be effective in improving the quality of care for hospitalized neonates. The present study was conducted with the aim of comparing missed care in manual and electronic recording methods among neonatal intensive care nurses in Tabriz. Methods Study Design and Settings A descriptive comparative multicenter study was conducted from September 2022 to February 2023 in neonatal intensive care units of all educational hospitals affiliated to Tabriz University of Medical Sciences. The neonatal intensive care units in these three educational hospitals are highly similar in terms of patient diversity and care conditions, but in terms of the record types, nurses' record is done electronically in Al-Zahra Hospital and manually in Taleghani and Mardani Azar Hospitals. Given the purpose of the study, this difference was used to investigate nurses' missed care. Participants Participants were nurses in the neonatal intensive care units. The inclusion criteria included at least 6 months of caring experience in neonatal intensive care unit and possess a bachelor's degree in nursing or higher. Unwillingness to participate in the study and not completing more than 10% of the questionnaire questions were considered as exclusion criteria. Sample Size and Sampling To determine the sample size, the mean estimation formula and ratio were used for descriptive studies. The sample size was calculated using the data of Kalisch et al. (2009) for missed care variable with 95% confidence and 0.1% acceptable error. With the highest sample size, 151 samples were calculated. Considering the number of nurses working in the NICU (160) and the calculated sample size (151), sampling was carried out in the form of a census. Nurses who met the inclusion criteria were asked to complete the questionnaires in a self-report format at any location they preferred and submit them to the researcher within 72 hours. Data Measurement The data collection tool was a two-part questionnaire, the first part of which was a form of personal, and occupational characteristics of NICU nurses, such as age, gender, working hours per week, work experience in NICU, and the method of nursing record, either manually or electronically. The second part was the missed care questionnaire, was developed by Kalisch and Williams in 2006 and validated in 2009. In 2014, it was modified by Tubbs-Cooley to the usable version in NICU. The questionnaire consists of 33 items, each of these items is scored on a four-point Likert scale from zero to three (0- It was not part of the duty, 1- I have done completely, 2- I have done incompletely, 3- completely missed).The higher score in each of the items represents the higher possibility of having to missed care. The validity and reliability of missed care questionnaire in Iran have been investigated and confirmed in different studies [2, 8, 25]. In the present study, the validity of the missed care questionnaire was measured by the content validity method and by using a panel of experts and determining CVI and CVR indicators. The value of CVI and CVR for each item was obtained on average above 0.85. In order to calculate the reliability of missed care questionnaires, Cronbach's alpha coefficient was calculated with the participation of 20 participants. The values of Cronbach's alpha coefficients for the missed care questionnaire were 0.83. Statistical Methods missed care variables as well as demographic data of nurses were reported using descriptive statistics including number, percentage, mean and standard deviation. After verifying the data normalization skewness and kurtosis, an independent t-test was used to determine the mean difference between the variable of missed care in two types of manual and electronic records, with a statistical significance level of p<0.05. Data analysis was performed in SPSS software version 26. Ethical Consideration The current study was approved by the Ethics Committee of Tabriz University of Medical Sciences (ethics code: IR.TBZMED.REC.1401.437). All participants completed a written informed consent form and were told them that they can leave the study freely in any part of the study. All study stages were conducted following the Declaration of Helsinki. Results The mean age of nurses was 35.56 ± 7.43 years. The demographic characteristics of nurses are provided in Table No. 1. Table 1- Descriptions of demographic characteristics of nurses of Tabriz University of Medical Sciences, 2023 Quantitative variables Average standard deviation Age 56/35 43/7 Working hours per week 01/44 22/7 Work history in NICU (years) 19/8 25/6 Number of beds in NICU 36/24 21/2 Typical Number of neonates per Shifts 30/4 40/1 Qualitative variables Frequency Percent Qualitative variables Frequency Percent Marital status Married 123 5/81 Nursing Record Format Manual 73 3/48 Single 28 5/18 Electronic 78 7/51 Workplace hospital Alzahra 77 51 Education Undergraduate 135 4/89 Mardani Azar 57 7/37 Master of Science 15 9/9 Taleqani 17 3/11 PhD 1 7/0 Based on the results of the independent t-test, in the separate analysis of the average difference of each care in two types of electronic and manual record, no statistically significant difference was found between the most of the cares (30 cares) (p<0.05). Only in three cares, "observing the correct principles of drug administration (8 rights)", "reviewing high-risk drugs according to the protocol" with a significant level (p <0.02) and "adjusting oxygen based on the saturation level according to the protocol or order" With a significant level (p=0.05), a statistically significant difference was observed between electronic and manual record. The average score of these cares in the electronic record was lower than the manual record and was close to the score of one (caring completely). (Table No. 2). Table 2. Mean Comparison of Missed Care in Neonatal Intensive Care Units in Manual and Electronic Recording Manual Record (73n= ) Electronic Recording (78n= ) test index (t) Significant level (p) Job description Range of grades of each dialect (0 to3) Row Average standard deviation Average standard deviation 01/1 20/0 00/1 0 57/0 56/0 Full attendance on shift delivery time 1 21/1 33/0 07/1 26/0 94/0 34/0 Transfer all the critical information of the newborns during shift switching to other staff 2 35/1 56/0 21/1 44/0 66/1 98/0 Providing psychological support to parents-families 3 35/1 53/0 34/1 20/1 06/0 94/0 Involving parents in childcare 4 35/1 51/0 26/1 55/0 00/1 31/0 Parents learn about home care 5 05/1 22/0 03/1 19/0 47/0 63/0 Check vital protocol class signs 6 20/1 52/0 05/1 50/0 83/1 06/0 Oral care for neonates under ventilator 7 04/1 19/0 03/1 19/0 06/0 94/0 Recommended oral nutrition at every convenient opportunity 8 15/1 36/0 03/1 19/0 36/2 02/0 Observing the proper principles of drug administration at a time 9 09/1 34/0 07/1 26/0 38/0 70/0 Carry out drug orders on time 10 16/1 47/0 02/1 22/0 27/2 02/0 Review of High-Risk Drugs According to Protocol 11 35/1 56/0 26/1 50/0 00/1 31/0 The effect of drugs in 30-60 minutes after injection or according to the protocol 12 06/1 30/0 01/1 11/0 47/1 14/0 Prescribing PRN drugs as ordered 13 02/1 16/0 06/1 24/0 08/1- 28/0 Care of the skin and wounds according to the routine or when required 14 02/1 23/0 00/1 16/0 84/0 40/0 Protect the central lines and check them according to the protocol 15 01/1 26/0 00/1 00/0 44/0 65/0 Environmental Venous Line Care and Investigation According to Protocol 16 13/1 34/0 08/1 40/0 77/0 44/0 Comprehensive Physical Analysis of Newborns according to the Protocol 17 05/1 32/0 07/1 41/0 35/0- 72/0 Measuring and recording hourly liquid absorption and disposal according to the protocol 18 13/1 34/0 05/1 22/0 79/1 07/0 Observing infection control precautions according to the protocol 19 01/1 26/0 03/1 19/0 66/0- 50/0 Respond to alarms on time 20 16/1 37/0 14/1 35/0 39/0 69/0 Check the pain according to the protocol 21 15/1 43/0 05/1 22/0 76/1 08/0 Pain management with medication or support care available 22 02/1 16/0 00/1 00/0 42/1 15/0 Obtaining laboratory samples as ordered 23 08/1 32/0 03/1 19/0 00/1 31/0 Observing hand hygiene according to protocol 24 13/1 38/0 03/1 29/0 75/1 08/0 Health Control of Warmer Sites or Incubators Per Shift or by protocol 25 26/1 55/0 14/1 38/0 52/1 12/0 Giving the baby a position at least every 2 hours 26 12/1 40/0 06/1 24/0 07/1 28/0 Providing Evolutionary Care (In-Nest Care-Skin Care to Skin and ...) 27 08/1 39/0 01/1 11/0 43/1 15/0 Infant's Reconsideration Following Health Changes 28 09/1 34/0 01/1 11/0 98/1 05/0 Adjustment of oxygen based on the degree of saturation according to the protocol or doctor's order 29 04/1 26/0 00/1 00/0 34/1 18/0 Identification and Report of Critical Tests According to Neonatal Status 30 05/1 28/0 00/1 00/0 65/1 10/0 Identification and report of critical vital signs in terms of the baby's condition 31 08/1 36/0 06/1 24/0 36/0 71/0 Detailed chart of all care that is being taken 32 06/1 38/0 02/1 15/0 88/0 37/0 Detailed chart of all treatments performed 33 Discussion The present study aimed to compare missed care in manual and electronic recording methods among neonatal intensive care nurses in Tabriz. In comparing the average care scores in the two methods of records, no statistically significant difference was found between the most of the care. Accordingly, it seems that in the neonatal intensive care unit, due to the high sensitivity of care measures, nurses are required to complete care details and the type of nursing records does not have much effect on missed care. According to the study results, a statistically significant difference was observed between electronic and manual recording in three care areas: "observing the correct principles of drug administration ", "reviewing high-risk drugs according to the protocol" and "adjusting oxygen based on the saturation level according to the protocol or order". The mean score for electronic records was close to a score of one, indicating complete care. The need for careful attention to these three cares in neonatal intensive care units raises the possibility that electronic nursing record provides nurses with more opportunities for ideal nursing care and accurate checking of actions. Despite the lack of a significant relationship, the average score for most care items in electronic records was lower than in manual records. This difference indicates that in electronic record, the care provided is somewhat more complete than manual record. However, it should be noted that low familiarity with the electronic record method of nurses and nurse practitioners who perform the monitoring and management of the nurses' reports and on the other hand, continuous and accurate control of nurses' reports and records in manual recording can have an impact on the results of this study. The results of the Laith Adnan Abudalbouh study showed that electronic record offers several advantages, including increased patient care, increased efficiency, improved care coordination, and decreased medical errors. Also, using this recording method also fosters effective communication between healthcare providers [ 26 ]. In general, it can be said that electronic record improves the quality of care. The results of our study also showed that although electronic record had no significant effect on quality of care, but had an effect on reduced risk of care errors. Results of study indicated that nurses with manual record system spent more time in writing the nursing activities and in the electronic record system, there was more control and management than manual record system. On the other hand, the accuracy and quality of nursing reports in both types of records were reported in the same level [ 17 ]. Jafari Gulistan et al. also noted in the review study that in the electronic recording method, the power and speed of decision-making increases, continuity of care is easier, recording occurs more accurately and errors are reduced, standard words are used and time is saved [ 19 ]. In a systematic review on the effects of electronic nursing record on improving or enhancing the quality of care and patient safety, it was concluded that electronic nursing record saves time and reduces the amount of documentation errors [ 20 ]. Although, the results of the present study did not reveal the effect of the record method on all aspects of missed care, but due to the importance of electronic record and data management ability in electronic record, it is possible to maintain the data in high volumes and large time. So, we have to make the most of this possibility for management and decision-making. However, it should be kept in mind that electronic record requires facilities and equipment such as a large and extensive computer network, holding introductory courses on computer use, and familiarity with the software required for nurses.[ 19 ]. Limitations and suggestions In the present study, the missed care questionnaire was completed as a self-report, which raises the possibility of bias in the presentation of information that an attempt was made to somewhat mitigate this position by emphasizing the confidentiality of information and the anonymity of the questionnaires. On the other hand, because of forgetting, some information may have been missed by the nurses, by providing a 72-hour opportunity to complete the questionnaires, an attempt was made to reduce the impact of this limitation to some extent and provide nurses with the opportunity to complete the questionnaires correctly, although it may not have a significant impact on managing this limitation. The samples examined in this study were nurses, and the quality of care was not assessed from the perspective of neonatal parents and the quality of recording by officials were not examined. Therefore, it is suggested that future studies also examine the perspectives of the neonatal parents and officials to obtain more comprehensive results and greater generalizability. Conclusion Overall, it can be concluded from the study findings that although electronic recording had a significant impact on missed care in only a few cases, considering the positive care effects of this recording method, in order to provide safe and quality care in the neonatal intensive care unit, it seems that electronic recording provides more opportunities for ideal care, and by creating appropriate infrastructure and strengthening the capabilities of nurses in electronic recording, we can witness more positive effects from this potential. Declarations Ethics approval and consent to participate The current study was approved by the Ethics Committee of Tabriz University of Medical Sciences (ethics code: IR.TBZMED.REC.1401.437) Informed consent was obtained from every eligible nurses. All study stages were conducted following the Declaration of Helsinki. Consent for publication Not applicable. Competing interests The authors declare no competing interests Author Contribution Study concept and design:A,B, DAcquisition of data:B, DAnalysis and interpretation of data:A,B, CDrafting of the manuscript:A, DCritical revision of the manuscript for important intellectual content:A, B,C,DStatistical analysis:A,B,C, DAdministrative, technical, and material support:DStudy supervision:B, C, A Acknowledgment The authors would like to acknowledge the financial support of Tabriz University of Medical Sciences. Also, we are grateful to participants for sharing their experiences in the study. 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Abudalbouh, L.A., Electronic nursing documentation interventions to promote or improve patient safety and/or quality care in an acute setting: Rapid review. International journal of health sciences, 2023. 7 (3): p. 154-164. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5807796","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":407643167,"identity":"cd2835de-a6f2-4e4f-aa48-16cb77aa22d3","order_by":0,"name":"Ebrahim Aliafsarimamaghani","email":"","orcid":"","institution":"Maragheh University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Ebrahim","middleName":"","lastName":"Aliafsarimamaghani","suffix":""},{"id":407643168,"identity":"6f52e32c-0bfe-47a5-b841-e06bacf28450","order_by":1,"name":"Mahni RahkarFarshi","email":"","orcid":"","institution":"Tabriz University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Mahni","middleName":"","lastName":"RahkarFarshi","suffix":""},{"id":407643169,"identity":"d30359e0-bc78-4ee7-a0ce-2267eb102afb","order_by":2,"name":"Mohammad Arshadi","email":"","orcid":"","institution":"Tabriz University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Mohammad","middleName":"","lastName":"Arshadi","suffix":""},{"id":407643170,"identity":"e9b72a22-a065-4307-9568-4dab3df6388d","order_by":3,"name":"Laila Hajtaghi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6UlEQVRIiWNgGAWjYBACPgbGxgMMPyTk+NmbDwD5EjIEtbAxMDYcYOyxMZbsOZYA0sJDhBYGhgMMbGmJG2bkGIAEiNDCfrjhwA+ew4kbeM58fnWjxoKHgf3w0Q14tfAkNhzssThsvJ29d5t1zjGgw3jS0m7gd1hiwwEensOyO3vObjPOYQNqkeAxw6+F/2HDwT9shxk33Mh5ZpzzjxgtEokNh3nY0hSBWpgf57YRpeVhw2FZSCCbMef2SfCwEfILP3/6w4dvIFH5+HPOtzog4/AxvFpQbQSTxCoHAeYPpKgeBaNgFIyCkQMAgwhMvnQPnNsAAAAASUVORK5CYII=","orcid":"","institution":"Maragheh University of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Laila","middleName":"","lastName":"Hajtaghi","suffix":""}],"badges":[],"createdAt":"2025-01-11 07:08:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5807796/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5807796/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":87792634,"identity":"fd736ae3-309a-4bc0-9fce-a8773ec37f7d","added_by":"auto","created_at":"2025-07-29 06:08:55","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":697187,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5807796/v1/3f11dae1-cf5e-4aae-8217-3329e28134d5.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Missed care affected by electronic or manual recording methods in Neonatal Intensive Care Nurses","fulltext":[{"header":"Background","content":"\u003cp\u003eNeonates admitted to NICU are embryos which develop in an environment outside the mother's womb and may be exposed to undesirable consequences. The brain of the neonates grows faster than any other time during this period [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. These neonates need continuous and complicated nursing care due to their anatomical, physiological and immunological conditions [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Problems with each type of care can have devastating effects on the growth and development of the neonates even in the long term [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. For example, poor care for neonates venous lines increases the risk of infection and the hospitalization period, or lack of precise oxygen saturation of the neonates can increase the risk of retinopathy [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Recent research shows that even the slightest negligence in taking care of premature neonates increases the mortality rate and complications of diseases in them[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] and increasing missed care leads to dramatically decrease in the quality of care services [\u003cspan additionalcitationids=\"CR8\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], which is of paramount importance in the care of vulnerable neonates. According to studies conducted in the occurrence of missed care, human power factors including lack of nurses, mismanagement, work difficulty, shift changes, inappropriate job distribution, lack of experience of some nurses, lack of interpersonal communication, poor teamwork and high nurses working load have a significant impact [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Also, lack of time management skills is cited as other important reasons for missed care [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe more specialized and sensitive the ward where nurses work, the more accurate the nursing report should be recorded at shorter intervals [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Nursing records in NICU should also be performed in very detailed and very accurate detail [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Nurses increase the level of monitoring of the neonates as the clinical condition worsens, and at these times they often identify and record subtle changes, following these detailed records, more accurate and appropriate actions are taken. [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. In other words, nursing record, due to the critical condition and nature of neonates in intensive care unit, in order to consistency and continuity in neonate care, effective relationship between the staff is necessary to prevent missing of care [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWith the advances in technology, patient information records have changed, and hospital information systems have been generated in electronic form. In parallel with these changes, electronic forms of nursing records have also been developed, and nursing records are conducted manually or electronically, or a combination of both methods [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. In electronic record, the power and decision speeds are increased and due to the readability of reports and the use of standard words, errors caused by the misconception of reports are reduced. Also, access to information is easier and information exchange and shift delivery are done faster [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. In studies, the primary consequence of electronic record is to reduce the time of record and increase the continuity of care period [\u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. According to the results of a systematic study, 92% of nurses were satisfied with the increased quality of care after using electronic systems in recording [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Despite these advantages, implementing electronic record comes with some challenges [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Electronic recording requires typing skills and can cause typing errors in data recording, or if the system fails, the recording will not be done. Accordingly, electronic systems have not been able to have their proper place in health care centers as they should. It has also been mentioned in the relevant literature that although electronic recording can increase care time and improve interdepartmental exchanges, it can also increase nursing workload [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. But in manual recording, nurses can record their reports even at the patient's bedside.\u003c/p\u003e \u003cp\u003eGiven that different results have been reported regarding the advantages and disadvantages of electronic and manual recording, it is difficult to judge the priority of the recording method. In the neonatal intensive care unit, due to the large number of care and treatment measures and the need to provide services with great detail, nurses spend a lot of time performing and recording these activities. Therefore, the results of comparing missed care in two types of manual and electronic recording can be effective in improving the quality of care for hospitalized neonates. The present study was conducted with the aim of comparing missed care in manual and electronic recording methods among neonatal intensive care nurses in Tabriz.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy Design and Settings\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA descriptive comparative multicenter study was conducted from September 2022 to February 2023 in neonatal intensive care units of all educational hospitals affiliated to Tabriz University of Medical Sciences. The neonatal intensive care units in these three educational hospitals are highly similar in terms of patient diversity and care conditions, but in terms of the record types, nurses\u0026apos; record is done electronically in Al-Zahra Hospital and manually in Taleghani and Mardani Azar Hospitals. Given the purpose of the study, this difference was used to investigate nurses\u0026apos; missed care.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParticipants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants were nurses in the neonatal intensive care units. The inclusion criteria included at least 6 months of caring experience in neonatal intensive care unit and possess a bachelor\u0026apos;s degree in nursing or higher. Unwillingness to participate in the study and not completing more than 10% of the questionnaire questions were considered as exclusion criteria.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSample Size and Sampling\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo determine the sample size, the mean estimation formula and ratio were used for descriptive studies. The sample size was calculated using the data of Kalisch et al. (2009) for missed care variable with 95% confidence and 0.1% acceptable error. With the highest sample size, 151 samples were calculated. Considering the number of nurses working in the NICU (160) and the calculated sample size (151), sampling was carried out in the form of a census. Nurses who met the inclusion criteria were asked to complete the questionnaires in a self-report format at any location they preferred and submit them to the researcher within 72 hours.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Measurement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data collection tool was a two-part questionnaire, the first part of which was a form of personal, and occupational characteristics of NICU nurses, such as age, gender, working hours per week, work experience in NICU, and the method of nursing record, either manually or electronically.\u003c/p\u003e\n\u003cp\u003eThe second part was the missed care questionnaire, was developed by Kalisch and Williams in 2006 and validated in 2009. In 2014, it was modified by Tubbs-Cooley to the usable version in NICU. The questionnaire consists of 33 items, each of these items is scored on a four-point Likert scale from zero to three (0- It was not part of the duty, 1- I have done completely, 2- I have done incompletely, 3- completely missed).The higher score in each of the items represents the higher possibility of having to missed care. The validity and reliability of missed care questionnaire in Iran have been investigated and confirmed in different studies [2, 8, 25].\u003c/p\u003e\n\u003cp\u003eIn the present study, the validity of the missed care questionnaire was measured by the content validity method and by using a panel of experts and determining CVI and CVR indicators. The value of CVI and CVR for each item was obtained on average above 0.85. In order to calculate the reliability of missed care questionnaires, Cronbach\u0026apos;s alpha coefficient was calculated with the participation of 20 participants. The values of Cronbach\u0026apos;s alpha coefficients for the missed care questionnaire were 0.83.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Methods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003emissed care variables as well as demographic data of nurses were reported using descriptive statistics including number, percentage, mean and standard deviation. After verifying the data normalization skewness and kurtosis, an independent t-test was used to determine the mean difference between the variable of missed care in two types of manual and electronic records, with a statistical significance level of p\u0026lt;0.05. Data analysis was performed in SPSS software version 26.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Consideration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe current study was approved by the Ethics Committee of Tabriz University of Medical Sciences (ethics code: IR.TBZMED.REC.1401.437). All participants completed a written informed consent form and were told them that they can leave the study freely in any part of the study. All study stages were conducted following the Declaration of Helsinki.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe mean age of nurses was 35.56 \u0026plusmn; 7.43 years. The demographic characteristics of nurses are provided in Table No. 1.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"8\" valign=\"top\" style=\"width: 618px;\"\u003e\n \u003cp\u003eTable 1- Descriptions of demographic characteristics of nurses of Tabriz University of Medical Sciences, 2023\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003eQuantitative variables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003eAverage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003estandard deviation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" style=\"width: 383px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e56/35\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e43/7\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" style=\"width: 383px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003eWorking hours per week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e01/44\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e22/7\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" style=\"width: 383px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003eWork history in NICU (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e19/8\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e25/6\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" style=\"width: 383px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003eNumber of beds in NICU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e36/24\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e21/2\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" style=\"width: 383px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 86px;\"\u003e\n \u003cp\u003eTypical Number of neonates per Shifts\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e30/4\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e40/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"5\" style=\"width: 383px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 155px;\"\u003e\n \u003cp\u003eQualitative variables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003ePercent\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 183px;\"\u003e\n \u003cp\u003eQualitative variables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 79px;\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 61px;\"\u003e\n \u003cp\u003ePercent\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 86px;\"\u003e\n \u003cp\u003eMarital status\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e123\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e5/81\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 77px;\"\u003e\n \u003cp\u003eNursing Record Format\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003eManual\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e73\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e3/48\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e28\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e5/18\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003eElectronic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e78\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e7/51\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 86px;\"\u003e\n \u003cp\u003eWorkplace hospital\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003e\u0026nbsp;Alzahra\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e77\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e51\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 77px;\"\u003e\n \u003cp\u003eEducation\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003eUndergraduate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e135\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e4/89\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003eMardani Azar\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e57\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e7/37\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003e\u0026nbsp;Master of Science\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e15\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e9/9\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 68px;\"\u003e\n \u003cp\u003eTaleqani\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e17\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e3/11\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 106px;\"\u003e\n \u003cp\u003ePhD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 61px;\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e7/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eBased on the results of the independent t-test, in the separate analysis of the average difference of each care in two types of electronic and manual record, no statistically significant difference was found between the most of the cares (30 cares) (p\u0026lt;0.05).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOnly in three cares, \u0026quot;observing the correct principles of drug administration (8 rights)\u0026quot;, \u0026quot;reviewing high-risk drugs according to the protocol\u0026quot;\u0026nbsp;with a significant level (p \u0026lt;0.02) and \u0026quot;adjusting oxygen based on the saturation level according to the protocol or order\u0026quot;\u0026nbsp;With a significant level (p=0.05), a statistically significant difference was observed between electronic and manual record.\u003c/p\u003e\n\u003cp\u003eThe average score of these cares in the electronic record was lower than the manual record and was close to the score of one (caring completely). (Table No. 2).\u003c/p\u003e\n\u003cdiv align=\"right\"\u003e\n \u003ctable dir=\"rtl\" border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"116%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"8\" style=\"width: 100px;\"\u003e\n \u003cp dir=\"LTR\"\u003eTable 2. Mean Comparison of Missed Care in Neonatal Intensive Care Units in Manual and Electronic Recording\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 17px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003eManual Record\u003c/span\u003e\u003c/p\u003e\n \u003cp dir=\"RTL\"\u003e(73n= )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 17px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003eElectronic Recording\u003c/span\u003e\u003c/p\u003e\n \u003cp dir=\"RTL\"\u003e(78n= )\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 6px;\"\u003e\n \u003cp dir=\"RTL\"\u003e\u003cspan dir=\"LTR\"\u003etest index\u003c/span\u003e\u003c/p\u003e\n \u003cp dir=\"RTL\"\u003e(t)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp dir=\"LTR\"\u003eSignificant level (p)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 43px;\"\u003e\n \u003cp dir=\"LTR\"\u003eJob description\u003c/p\u003e\n \u003cp dir=\"LTR\"\u003eRange of grades of each dialect (0 to3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 5px;\"\u003e\n \u003cp dir=\"LTR\"\u003eRow\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003eAverage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003estandard deviation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003eAverage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003estandard deviation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e01/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e20/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e00/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e57/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e56/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp dir=\"LTR\"\u003eFull attendance on shift delivery time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e21/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e33/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e07/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e26/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e94/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e34/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp dir=\"LTR\"\u003eTransfer all the critical information of the newborns during shift switching to other staff\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e2\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e35/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e56/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e21/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e44/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e66/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e98/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp dir=\"LTR\"\u003eProviding psychological support to parents-families\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e3\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e35/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e53/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e34/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e20/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e06/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e94/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp dir=\"LTR\"\u003eInvolving parents in childcare\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e4\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e35/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e51/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e26/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e55/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e00/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e31/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp dir=\"LTR\"\u003eParents learn about home care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e5\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e05/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e22/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e03/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e19/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e47/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e63/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp dir=\"LTR\"\u003eCheck vital protocol class signs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e6\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e20/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e52/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e05/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e50/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e83/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e06/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp dir=\"LTR\"\u003eOral care for neonates under ventilator\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e7\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e04/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e19/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e03/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e19/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e06/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e94/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp dir=\"LTR\"\u003eRecommended oral nutrition at every convenient opportunity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e8\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e15/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e36/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e03/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e19/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e36/2\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e02/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp dir=\"LTR\"\u003eObserving the proper principles of drug administration at a time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e9\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e09/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e34/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e07/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e26/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e38/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e70/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp dir=\"LTR\"\u003eCarry out drug orders on time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e10\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e16/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e47/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e02/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e22/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e27/2\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e02/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp dir=\"LTR\"\u003eReview of High-Risk Drugs According to Protocol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e11\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e35/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e56/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e26/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e50/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e00/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e31/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp dir=\"LTR\"\u003eThe effect of drugs in 30-60 minutes after injection or according to the protocol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e12\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e06/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e30/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e01/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e11/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e47/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e14/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp dir=\"LTR\"\u003ePrescribing PRN drugs as ordered\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e13\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e02/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e16/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e06/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e24/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e08/1-\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e28/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp dir=\"LTR\"\u003eCare of the skin and wounds according to the routine or when required\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e14\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e02/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e23/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e00/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e16/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e84/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e40/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp dir=\"LTR\"\u003eProtect the central lines and check them according to the protocol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e15\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e01/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e26/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e00/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e00/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e44/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e65/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp dir=\"LTR\"\u003eEnvironmental Venous Line Care and Investigation According to Protocol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e16\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e13/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e34/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e08/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e40/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e77/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e44/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp dir=\"LTR\"\u003eComprehensive Physical Analysis of Newborns according to the Protocol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e17\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e05/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e32/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e07/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e41/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e35/0-\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e72/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp dir=\"LTR\"\u003eMeasuring and recording hourly liquid absorption and disposal according to the protocol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e18\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e13/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e34/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e05/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e22/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e79/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e07/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp dir=\"LTR\"\u003eObserving infection control precautions according to the protocol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e19\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e01/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e26/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e03/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e19/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e66/0-\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e50/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp dir=\"LTR\"\u003eRespond to alarms on time\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e20\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e16/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e37/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e14/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e35/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e39/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e69/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp dir=\"LTR\"\u003eCheck the pain according to the protocol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e21\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e15/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e43/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e05/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e22/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e76/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e08/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp dir=\"LTR\"\u003ePain management with medication or support care available\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e22\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e02/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e16/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e00/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e00/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e42/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e15/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp dir=\"LTR\"\u003eObtaining laboratory samples as ordered\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e23\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e08/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e32/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e03/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e19/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e00/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e31/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp dir=\"LTR\"\u003eObserving hand hygiene according to protocol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e24\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e13/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e38/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e03/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e29/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e75/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e08/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp dir=\"LTR\"\u003eHealth Control of Warmer Sites or Incubators Per Shift or by protocol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e25\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e26/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e55/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e14/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e38/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e52/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e12/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp dir=\"LTR\"\u003eGiving the baby a position at least every 2 hours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e26\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e12/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e40/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e06/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e24/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e07/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e28/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp dir=\"LTR\"\u003eProviding Evolutionary Care (In-Nest Care-Skin Care to Skin and ...)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e27\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e08/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e39/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e01/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e11/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e43/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e15/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp dir=\"LTR\"\u003eInfant\u0026apos;s Reconsideration Following Health Changes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e28\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e09/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e34/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e01/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e11/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e98/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e05/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp dir=\"LTR\"\u003eAdjustment of oxygen based on the degree of saturation according to the protocol or doctor\u0026apos;s order\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e29\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e04/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e26/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e00/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e00/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e34/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e18/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp dir=\"LTR\"\u003eIdentification and Report of Critical Tests According to Neonatal Status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e30\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e05/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e28/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e00/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e00/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e65/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e10/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp dir=\"LTR\"\u003eIdentification and report of critical vital signs in terms of the baby\u0026apos;s condition\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e31\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e08/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e36/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e06/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e24/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e36/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e71/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp dir=\"LTR\"\u003eDetailed chart of all care that is being taken\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e32\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e06/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e38/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e02/1\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e15/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 6px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e88/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 10px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e37/0\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 43px;\"\u003e\n \u003cp dir=\"LTR\"\u003eDetailed chart of all treatments performed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp dir=\"LTR\"\u003e\u003cspan dir=\"RTL\"\u003e33\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe present study aimed to compare missed care in manual and electronic recording methods among neonatal intensive care nurses in Tabriz. In comparing the average care scores in the two methods of records, no statistically significant difference was found between the most of the care. Accordingly, it seems that in the neonatal intensive care unit, due to the high sensitivity of care measures, nurses are required to complete care details and the type of nursing records does not have much effect on missed care.\u003c/p\u003e \u003cp\u003eAccording to the study results, a statistically significant difference was observed between electronic and manual recording in three care areas: \"observing the correct principles of drug administration \", \"reviewing high-risk drugs according to the protocol\" and \"adjusting oxygen based on the saturation level according to the protocol or order\". The mean score for electronic records was close to a score of one, indicating complete care. The need for careful attention to these three cares in neonatal intensive care units raises the possibility that electronic nursing record provides nurses with more opportunities for ideal nursing care and accurate checking of actions. Despite the lack of a significant relationship, the average score for most care items in electronic records was lower than in manual records. This difference indicates that in electronic record, the care provided is somewhat more complete than manual record. However, it should be noted that low familiarity with the electronic record method of nurses and nurse practitioners who perform the monitoring and management of the nurses' reports and on the other hand, continuous and accurate control of nurses' reports and records in manual recording can have an impact on the results of this study.\u003c/p\u003e \u003cp\u003eThe results of the Laith Adnan Abudalbouh study showed that electronic record offers several advantages, including increased patient care, increased efficiency, improved care coordination, and decreased medical errors. Also, using this recording method also fosters effective communication between healthcare providers [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. In general, it can be said that electronic record improves the quality of care. The results of our study also showed that although electronic record had no significant effect on quality of care, but had an effect on reduced risk of care errors.\u003c/p\u003e \u003cp\u003eResults of study indicated that nurses with manual record system spent more time in writing the nursing activities and in the electronic record system, there was more control and management than manual record system. On the other hand, the accuracy and quality of nursing reports in both types of records were reported in the same level [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Jafari Gulistan et al. also noted in the review study that in the electronic recording method, the power and speed of decision-making increases, continuity of care is easier, recording occurs more accurately and errors are reduced, standard words are used and time is saved [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. In a systematic review on the effects of electronic nursing record on improving or enhancing the quality of care and patient safety, it was concluded that electronic nursing record saves time and reduces the amount of documentation errors [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Although, the results of the present study did not reveal the effect of the record method on all aspects of missed care, but due to the importance of electronic record and data management ability in electronic record, it is possible to maintain the data in high volumes and large time. So, we have to make the most of this possibility for management and decision-making. However, it should be kept in mind that electronic record requires facilities and equipment such as a large and extensive computer network, holding introductory courses on computer use, and familiarity with the software required for nurses.[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eLimitations and suggestions\u003c/h2\u003e \u003cp\u003eIn the present study, the missed care questionnaire was completed as a self-report, which raises the possibility of bias in the presentation of information that an attempt was made to somewhat mitigate this position by emphasizing the confidentiality of information and the anonymity of the questionnaires. On the other hand, because of forgetting, some information may have been missed by the nurses, by providing a 72-hour opportunity to complete the questionnaires, an attempt was made to reduce the impact of this limitation to some extent and provide nurses with the opportunity to complete the questionnaires correctly, although it may not have a significant impact on managing this limitation. The samples examined in this study were nurses, and the quality of care was not assessed from the perspective of neonatal parents and the quality of recording by officials were not examined. Therefore, it is suggested that future studies also examine the perspectives of the neonatal parents and officials to obtain more comprehensive results and greater generalizability.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eOverall, it can be concluded from the study findings that although electronic recording had a significant impact on missed care in only a few cases, considering the positive care effects of this recording method, in order to provide safe and quality care in the neonatal intensive care unit, it seems that electronic recording provides more opportunities for ideal care, and by creating appropriate infrastructure and strengthening the capabilities of nurses in electronic recording, we can witness more positive effects from this potential.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e\n\u003cp\u003eThe current study was approved by the Ethics Committee of Tabriz University of Medical Sciences (ethics code: IR.TBZMED.REC.1401.437) Informed consent was obtained from every eligible nurses. All study stages were conducted following the Declaration of Helsinki.\u003c/p\u003e\n\u003ch2\u003eConsent for publication\u003c/h2\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003ch2\u003eCompeting interests\u003c/h2\u003e\n\u003cp\u003eThe authors declare no competing interests\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eStudy concept and design:A,B, DAcquisition of data:B, DAnalysis and interpretation of data:A,B, CDrafting of the manuscript:A, DCritical revision of the manuscript for important intellectual content:A, B,C,DStatistical analysis:A,B,C, DAdministrative, technical, and material support:DStudy supervision:B, C, A\u003c/p\u003e\n\u003ch2\u003eAcknowledgment\u003c/h2\u003e\n\u003cp\u003eThe authors would like to acknowledge the financial support of Tabriz University of Medical Sciences. Also, we are grateful to participants for sharing their experiences in the study.\u003c/p\u003e\n\u003ch2\u003eData availability\u003c/h2\u003e\n\u003cp\u003eAll the data used and analyzed in this study are available at the request of the corresponding author.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eLiebowitz, M., K.P. Kramer, and E.E. Rogers, \u003cem\u003eAll Care is Brain Care: Neuro-Focused Quality Improvement in the Neonatal Intensive Care Unit.\u003c/em\u003e Clin Perinatol, 2023. \u003cstrong\u003e50\u003c/strong\u003e(2): p. 399-420.\u003c/li\u003e\n\u003cli\u003eEmamyN, \u003cem\u003eMissed care and its referral from the perspective of nurses in neonatal intensive care units of Tabriz University of Medical Sciences and its relationship with job satisfaction.\u003c/em\u003e (MS Thesses): p. Nursing field,Tabriz: Tabriz University of Medical Sciences,2016.\u003c/li\u003e\n\u003cli\u003eKim, S. and S.-M. Chae, \u003cem\u003eMissed nursing care and its influencing factors among neonatal intensive care unit nurses in South Korea: a descriptive study.\u003c/em\u003e Child Health Nursing Research, 2022. \u003cstrong\u003e28\u003c/strong\u003e(2): p. 142.\u003c/li\u003e\n\u003cli\u003eTubbs-Cooley, H.L., et al., \u003cem\u003eAssociation of Nurse Workload With Missed Nursing Care in the Neonatal Intensive Care Unit.\u003c/em\u003e JAMA Pediatr, 2019. \u003cstrong\u003e173\u003c/strong\u003e(1): p. 44-51.\u003c/li\u003e\n\u003cli\u003eHaghshenas Mojaveri, M. and S. Rasoulinejad, \u003cem\u003eThe Relationship between Maternal and Neonatal Diseases and Retinopathy of Prematurity and Its Progression.\u003c/em\u003e Journal of Babol University of Medical Sciences, 2021. \u003cstrong\u003e23\u003c/strong\u003e(1): p. 323-330.\u003c/li\u003e\n\u003cli\u003eVerklan MT, W.M., Forest S, editors,\u003cem\u003e Core curriculum for neonatal intensive care nursing e-book. Elsevier Health Sciences; \u003c/em\u003e. 2020 Mar 22.\u003c/li\u003e\n\u003cli\u003eVatankhah, I., M. Rezaei, and E. Baljani, \u003cem\u003eThe correlation of missed nursing care and perceived supervisory support in nurses.\u003c/em\u003e Iran Journal of Nursing, 2020. \u003cstrong\u003e33\u003c/strong\u003e(126): p. 103-116[persian].\u003c/li\u003e\n\u003cli\u003eEbadi, J., et al., \u003cem\u003e[Missed nursing care and its related factors in ardabil and khalkhal educational and medical centers in 2020.\u003c/em\u003e Journal of Health and Care, 2021. \u003cstrong\u003e23\u003c/strong\u003e(1): p. 78-87[persian].\u003c/li\u003e\n\u003cli\u003ePapathanasiou, I., et al., \u003cem\u003eMissed Nursing Care; Prioritizing the Patient\u0026rsquo;s Needs: An Umbrella Review.\u003c/em\u003e Healthcare, 2024. \u003cstrong\u003e12\u003c/strong\u003e(2): p. 224.\u003c/li\u003e\n\u003cli\u003eNajafi, F., A. Nikbakht Nasrabadi, and L. Mardanian Dehkordi, \u003cem\u003eExploring the lived experience of missed nursing care in postgraduate nursing students in iran.\u003c/em\u003e International Journal Of Community Based Nursing and Midwifery, 2021. \u003cstrong\u003e9\u003c/strong\u003e(1): p. 44-54[persian].\u003c/li\u003e\n\u003cli\u003eEdfeldt, K., et al., \u003cem\u003eMissed nursing care in surgical care\u0026ndash; a hazard to patient safety: a quantitative study within the inCHARGE programme.\u003c/em\u003e BMC Nursing, 2024. \u003cstrong\u003e23\u003c/strong\u003e(1): p. 233.\u003c/li\u003e\n\u003cli\u003eWillis, E., et al., \u003cem\u003eAn integrative review of missed nursing care and the general practice nurse.\u003c/em\u003e Australian Journal of Primary Health, 2024. \u003cstrong\u003e30\u003c/strong\u003e(1).\u003c/li\u003e\n\u003cli\u003eMbuthia, N., et al., \u003cem\u003eGeneral ward nurses detection and response to clinical deterioration in three hospitals at the Kenyan coast: a convergent parallel mixed methods study.\u003c/em\u003e BMC Nursing, 2024. \u003cstrong\u003e23\u003c/strong\u003e(1): p. 143.\u003c/li\u003e\n\u003cli\u003eSassaki, R.L., D.F. Cucolo, and M.G. Perroca, \u003cem\u003eInterruptions and nursing workload during medication administration process.\u003c/em\u003e Rev Bras Enferm, 2019. \u003cstrong\u003e72\u003c/strong\u003e(4): p. 1001-1006.\u003c/li\u003e\n\u003cli\u003eLee, R.Y., et al., \u003cem\u003eVariability in Nursing Documentation Patterns across Patients\u0026apos; Hospital Stays.\u003c/em\u003e AMIA Annu Symp Proc, 2023. \u003cstrong\u003e2023\u003c/strong\u003e: p. 1037-1046.\u003c/li\u003e\n\u003cli\u003eFarzi, S., S. Farzi, and A. Moladoost, \u003cem\u003eQuality of nursing records and its relationship with some demographic characteristics of nurses working in intensive care units.\u003c/em\u003e Iranian Journal of Nursing Research, 2016. \u003cstrong\u003e11\u003c/strong\u003e(2): p. 24-31[persian].\u003c/li\u003e\n\u003cli\u003eRahkar Farshi, M., M. Jebreili, and B. Abdinia, \u003cem\u003eComparison of manual and electronic methods of nursing record: a nurse\u0026apos;s perspective.\u003c/em\u003e International Journal of Pediatrics, 2015. \u003cstrong\u003e3\u003c/strong\u003e(1.1): p. 367-373.\u003c/li\u003e\n\u003cli\u003eAkinyemi, O.R., M.N. Sibiya, and O. Oladimeji, \u003cem\u003eCommunication model enhancement using electronic health record standard for tertiary hospital.\u003c/em\u003e 2022, 2022. \u003cstrong\u003e24\u003c/strong\u003e(1).\u003c/li\u003e\n\u003cli\u003eJafari golestan N, d.F., \u003cem\u003e[Electonic records replace paper records in nursing documentation]. .\u003c/em\u003e journal of army nursing faculty 2011. \u003cstrong\u003e;11(1):20-4(persian)\u003c/strong\u003e.\u003c/li\u003e\n\u003cli\u003eMcCarthy, B., et al., \u003cem\u003eElectronic nursing documentation interventions to promote or improve patient safety and quality care: A systematic review.\u003c/em\u003e Journal Nurse Manag, 2019. \u003cstrong\u003e27\u003c/strong\u003e(3): p. 491-501.\u003c/li\u003e\n\u003cli\u003eAsmirajanti, M., A.Y.S. Hamid, and R.T.S. Hariyati, \u003cem\u003eNursing care activities based on documentation.\u003c/em\u003e BMC Nurs, 2019. \u003cstrong\u003e18\u003c/strong\u003e(Suppl 1): p. 32.\u003c/li\u003e\n\u003cli\u003eShafiee, M., et al., \u003cem\u003eDevelopment and evaluation of an electronic nursing documentation system.\u003c/em\u003e BMC Nursing, 2022. \u003cstrong\u003e21\u003c/strong\u003e(1): p. 15.\u003c/li\u003e\n\u003cli\u003eKim, M.K., et al., \u003cem\u003eChallenges in and Opportunities for Electronic Health Record-Based Data Analysis and Interpretation.\u003c/em\u003e Gut Liver, 2024. \u003cstrong\u003e18\u003c/strong\u003e(2): p. 201-208.\u003c/li\u003e\n\u003cli\u003eBakhoum, N., et al., \u003cem\u003eA time and motion analysis of nursing workload and electronic health record use in the emergency department.\u003c/em\u003e Journal of Emergency Nursing, 2021. \u003cstrong\u003e47\u003c/strong\u003e(5): p. 733-741.\u003c/li\u003e\n\u003cli\u003eKhajooeeRa, \u003cem\u003eMissed nursing care and its related factors from the points of view of nurses affiliated to Kerman University of Medical Sciences.\u003c/em\u003e 2017(MS Thesses[persian]).\u003c/li\u003e\n\u003cli\u003eAbudalbouh, L.A., \u003cem\u003eElectronic nursing documentation interventions to promote or improve patient safety and/or quality care in an acute setting: Rapid review.\u003c/em\u003e International journal of health sciences, 2023. \u003cstrong\u003e7\u003c/strong\u003e(3): p. 154-164.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Missed Care, Nursing Records, Intensive Care Units, Neonatal","lastPublishedDoi":"10.21203/rs.3.rs-5807796/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5807796/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eMissed care causes irreversible complications for infants in neonatal intensive care units. On the other hand, time-consuming actions such as record can effect the type and quality of care. Although no study was found on the effect of manual and electronic record of nurses on missed care, the present study was conducted to compare the effect of manual or electronic recording methods on the missed care in neonatal intensive care nurses.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: A descriptive comparative multicenter study was conducted from September 2022 to February 2023 by census of 151 nurses in the neonatal intensive care units. Tubbs-cooley missed care questionnaire was used for data collecting. Data was analyzed by SPSS software version 26.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThere was no significant difference in the mean difference between the electronic and manual records (30 intensive care) in the majority of cares item(p\u0026lt;0.05). Only in three cares, \"observing the correct principles of drug administration (8 rights)\", \"reviewing high-risk drugs according to the protocol\" and \"adjusting oxygen based on the saturation level according to the protocol or order\", a statistically significant difference was observed between electronic and manual record. The mean scores for electronic records were lower than manual records and close to one score (complete care).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion: \u003c/strong\u003eIn neonatal intensive care unit, because of high sensitivity of caring, nurses should complete the types and details of cares and methods of records have no significant effect on missed care. It seems that electronic record provides more opportunity for ideal care and may play a role in decreasing missed care.\u003c/p\u003e","manuscriptTitle":"Missed care affected by electronic or manual recording methods in Neonatal Intensive Care Nurses","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-01-29 05:09:36","doi":"10.21203/rs.3.rs-5807796/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1ec440b4-4af8-41c9-8a9a-8eeda51ea618","owner":[],"postedDate":"January 29th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-07-29T06:08:31+00:00","versionOfRecord":[],"versionCreatedAt":"2025-01-29 05:09:36","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5807796","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5807796","identity":"rs-5807796","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}