Missed nursing care and associated factors among nurses working in critical care units in northern Ghana

Abstract

In high-pressure clinical environments, essential nursing tasks may be unintentionally omitted, a phenomenon known as missed nursing care. Despite its implications for patient safety and care quality, empirical evidence on missed nursing care in Ghana remains limited. This study aimed to determine missed nursing care and identify factors associated with its occurrence among nurses working in critical care units at a tertiary hospital in northern Ghana. A hospital-based cross-sectional survey was conducted among 217 registered nurses in one tertiary hospital in northern Ghana, selected using proportionate stratified and simple random sampling. Data were collected using the 24-item version of the Missed Nursing Care Questionnaire (MISSCARE Survey), which assesses the frequency of missed nursing care activities using a 4-point response scale (1 = “I miss rarely” to 4 = “I miss always”). The total composite score ranged from 25 to 86, with higher scores indicating more frequently missed nursing care. Participants reported missed nursing care activities in their unit during routine nursing practice. For robust regression, the average missed nursing care score was used as the continuous outcome. Robust regression using an MM-type estimator was used to examine factors associated with missed nursing care. The mean total missed nursing care score was 41.78 ± 12.52. The most frequently missed nursing care activities were participation in interdisciplinary care conferences (75.6%), patient ambulation (70.0%), meal setup for patients able to self-feed (64.5%), mouth care (62.2%), and bathing/skincare (61.8%). In the multivariable robust regression analysis, compared with nurses working in the Medical High Dependency Unit (HDU), those working in the Accident and Emergency (A/E) Unit had higher missed nursing care scores (β = 0.16, 95% CI: 0.01–0.33, p = 0.049), as did those working in the Obstetrics/Gynaecology Emergency Unit (β = 0.61, 95% CI: 0.23–0.99, p = 0.002). Conversely, nurses who reported supportive leadership in addressing patient safety concerns had lower missed nursing care scores (β = −0.17, 95% CI: −0.33 to − 0.01, p = 0.041). Nurses who perceived that they could make a meaningful impact on patient safety also reported lower missed nursing care scores (β = −0.30, 95% CI: −0.53 to − 0.06, p = 0.015). Missed nursing care varied across clinical units and was associated with organizational and professional factors, particularly leadership support and nurses’ perceived ability to make a meaningful impact on patient safety. Strengthening supportive leadership and improving organizational conditions may help reduce missed nursing care. However, given the cross-sectional design and single-hospital setting, the observed associations should not be interpreted as causal, and the findings may have limited generalizability beyond the study setting.

The authors' abstract, as published at the source. Scientific Reports, 2026 · DOI ↗