Nurses and nursing students need to become more familiar with analysing what do when they experience the discomfort of inner conflict (dissonance) that comes with omitting a care activity while knowing that this is inconsistent with nursing values. If they reflect critically and restore their care in an optimal way they will feel better and they should therefore be highly motivated to follow this pathway. However, if care levels cannot be restored easily, the inner conflict tends to be reduced by justifications, excuses, denial, trivialisation and seeking distraction. If this becomes common practice, missed care becomes endemic. By recognising this principle it becomes possible to avoid the pitfall. Thus, all health care staff, nurses, nursing students, educators and health care organisations can increase the likelihood of restoration of care through promoting awareness of the dissonance process, daily engagement with critical reflection and the promotion and reinforcement of strong values. While the role of students and educators as critics of the health care system may be important in the process, it is probably through closer collaboration and critical reflection on practice that real changes will emerge.

Bagnasco, A., Timmins, F., de Vries, J. M., Aleo, G., Zanini, M., Catania, G., & Sasso, L. (2017). Nurse Education Today, 2017