Nurs Crit Care. 2025 Nov;30(6):e70178. doi: 10.1111/nicc.70178.
ABSTRACT
BACKGROUND: Patients in the intensive care unit (ICU) require complex care with rapidly changing conditions, and missed nursing care (MNC) can lead to severe consequences. Investigating the current status and influencing factors of MNC in the ICU is essential to enhance patient safety, optimise care quality and improve nurse job satisfaction, providing evidence-based strategies for ICU nursing management.
AIMS: The aims of this study were to investigate the current status of MNC in ICU and to analyse its causes, providing insights to reduce missed care and improve the quality of nursing for critically ill patients.
STUDY DESIGN: This is a cross-sectional study, using convenience sampling, 191 ICU nurses from five tertiary hospitals in Sichuan Province were selected as participants from 1 June 2024 to 30 June 2024. Data were collected through a general information questionnaire and the Missed Nursing Care in Intensive Care Units Scale.
RESULTS: A total of 191 questionnaires were sent out in this survey, and finally, 185 were included for data analysis. The score for MNC in ICU was 72.14 ± 15.61 points. All nurses reported experiencing at least one instance of missed care during their shifts. The most frequently missed care items were as follows: assisting and guiding patients in early rehabilitation, analgesia and sedation management and psychosocial assessment of critically ill patients. Statistical analysis revealed that MNC in ICU was significantly influenced by nurses’ gender, education level, professional title, ICU type and patient load (p < 0.05). The score for reasons behind MNC was 63.24 ± 18.53 points. The primary contributing factors were as follows: heavy nurse workload, excessive patient transfers, high frequency of patient condition changes and emergency events. ICU type (Internal Medicine ICU/comprehensive ICU), patients load (≥ 4 patients/nurse) and characteristics (master’s degree and above, intermediate nurse) emerged as modifiable risk factors for MNC.
CONCLUSION: Missed nursing care occurs frequently in ICU and is influenced by multiple factors. These findings suggest that nursing administrators should ensure adequate nurse staffing levels and enhance training programmes on MNC awareness, and improve nurses’ understanding of this phenomenon. These measures would effectively reduce missed care occurrences and subsequently improve ICU nursing quality.
RELEVANCE TO CLINICAL PRACTICE: This study identifies missed nursing care (MNC) in intensive care units (ICUs), particularly in rehabilitation, pain management and psychosocial support.
KEY FINDINGS: Staffing/workload (≥ 4 patients/nurse) and unit type (medical/general ICUs) significantly increase MNC. Non-urgent but critical care (e.g., psychological support) is often deprioritised.
SOLUTIONS: Implement safe staffing ratios, train nurses on MNC consequences and optimise workflows (e.g., standardised handoffs).
PMID:41054904 | DOI:10.1111/nicc.70178
