Background: The Missed Nursing Care (MNC) refers to nursing interventions that are not completed,
partially completed, or postponed. Despite the relevance of MNC, no assessment tools are available in
the Italian context, and no data regarding the occurrence of this phenomenon has been documented
on a large scale to date.
Objectives: The study aims were: (1) to validate the Italian version of the MISSCARE Survey tool; (2)
to measure the prevalence of missed interventions and reasons for missed care as perceived by clinical
nurses working in Italian health care settings.
Methods: After having conducted the forward and backward translation, pre-pilot and pilot phases
were developed to ensure face and content validity as well as semantic and conceptual equivalence of
the Italian version with the original version. The MISSCARE survey questionnaire was then distributed
to 1,233 clinical nurses of whom 1,003 completed the questionnaire. Overall, 979 questionnaires were
analysed. The questionnaires were completed from January to March 2012, by nurses working in medical
and surgical hospital departments in the Emilia Romagna region of Italy. Construct validity and internal
consistency of the instrument were assessed.
Results: The face and content validity were ascertained by a group of experts. The instrument
acceptability was good given that 79.4% of respondents replied to all items. Construct validity was
investigated by an Exploratory Factor Analysis. Four factors explaining 64.18% of variance emerged:
communication, lack of facilities/supplies, lack of staff, and unexpected events. Internal consistency,
evaluated with Cronbach a, was 0.94. The nursing interventions omitted with greater frequency were, in
order: ambulation (74.8%), passive mobilization (69.6%) and oral care (51.3%). The three main reasons
for missed interventions were: an unexpected increase in the number of patients (90.5%), increased
instability of the clinical condition (86.1%) and insufficient human resources (85.5%).
Conclusions: The Italian version of the MISSCARE Survey was shown to have good psychometric
properties. Therefore, it can be used to evaluate the missed nursing care phenomenon in Italy and will
allow for international comparisons.
