External influencing factors on missed care in Austrian hospitals: Testing the theoretical antecedents of missed care using structural equation modelling

Problem: Missed Nursing Care (MNC) is an error of omission which occurs when a necessary nursing intervention is not initiated, is not completed, or when it is delayed. The MNC model explains this problem and describes four antecedents that can lead to MNC: (1) demand for patient care, (2) available human resources, (3) material resources, and (4) and relationship and communication factors.Aims: This study aims to test the relationship between the theoretical antecedents of MNC and their impact on MNC.Design: A quantitative cross-sectional study.Methods: The Austrian version of the revised MISSCARE Survey was completed by nurses working in general hospital units between May and July 2021. Recruitment followed a respondent-driven sample via Austrian nursing education institutions and social media. One thousand six nurses fulfilled inclusion criteria. The structure of the theoretical constructs of the MNC model was tested using a confirmatory factor analysis approach. The relationships between the four antecedents and MNC were explored using structural equation modelling with 427 complete cases.Results: The results support the structural validity of the revised MISSCARE Austria concerning the defined theoretical constructs, although discriminant validity and measurement error should be further investigated. The antecedent resource allocation: labor had a statistically significant impact on MNC: The lack of adequate nursing staff played the most important role to explain missed care in our model.Conclusion: In our study in Austria, MNC was mostly influenced by a lack of appropriate labor resources. Further studies exploring mediation effects and non-linear relationships may contribute to better understanding of reasons for MNC.Patient or Public Contribution: No patient or public contribution.

Automated summary

This study aims to test the relationship between the theoretical antecedents of Missed Nursing Care (MNC) and their impact on MNC. The results support the structural validity of the revised MISSCARE Austria, although further investigation is needed for discriminant validity and measurement error. In Austria, MNC is mostly influenced by a lack of appropriate labor resources.