Exploring the prevalence and impact of missed nursing care on nurse–patient outcomes in Western Australia: A descriptive correlational study

Author Identifier

Afia Achiaa Sarpong


Date of Award


Document Type



Edith Cowan University

Degree Name

Doctor of Philosophy


School of Nursing and Midwifery

First Supervisor

Amanda Towell-Barnard

Second Supervisor

Diana Arabiat

Third Supervisor

Lucy Gent


Introduction: The prevalence and impact of missed nursing care can have serious consequences on both nurses and patients in healthcare settings. There is limited published research exploring nurse–patient reported missed care and how this factor is related to job satisfaction of nurses and adverse events. It is, therefore, essential that the prevalence and impact of missed nursing care on both nurses and patients is well explored and understood.

Aim: The primary aim of this thesis is to provide evidence of nurse and patient perceptions of missed nursing care and the effect of missed care on nurse–patient outcomes (such as job satisfaction, intention to leave, teamwork, falls, medication errors, pressure ulcers and hospital acquired infections) in a Western Australian context. The objectives to support the primary aim of this study are fourfold: (1) To shed light on research trends and emerging areas in this field using a bibliometric analysis of scientific data on missed nursing care; (2) To describe the prevalence of missed nursing care and nurse–patient outcomes reported by earlier studies using a systematic literature review and meta-analysis; (3) To measure the prevalence, predictors and nurse-related outcomes of missed nursing care reported by nurses; and (4) To measure the prevalence, correlates and patient-related outcomes of missed nursing care reported by hospitalised patients.

Methods: This study was conducted in medical and surgical units of a tertiary teaching hospital in Western Australia. Guided by quantitative methods, a descriptive correlational study design was employed and the sample for this study consisted of nursing staff and patients in 16 medical and surgical units of the hospital. To achieve the study aims, this thesis has been separated into three phases. Firstly, a bibliometric analysis of missed nursing care research was performed in medical and nursing databases, in order to rigorously summarise published research trends in this domain. Secondly, a systematic review and meta-analysis of prevalence and outcomes of nurse–patient reported missed nursing care in acute care settings was conducted. Lastly, the final phase involved a quantitative methodological approach, in which a descriptive correlational design was used to measure the prevalence, predictors and nurse–patient related outcomes of missed care. Data were measured and described using descriptive, correlational, and logistic regression analysis.

Results: The bibliometric analysis and systematic review revealed a paucity of knowledge regarding nurse–patient-reported missed care and related outcomes following hospitalisation. The most frequently missed nursing activities reported by nurses and patients included ambulation (nurses = 87%; patients = 35%), mouth care (nurses = 78%; patients = 63%) and patient teaching about test and procedures (nurses = 79%; patients = 29%). Regression analysis reveals that missed nursing care is linked to nurse-reported job satisfaction, working overtime and patient-reported age.

Conclusion: This study provides evidence of nurse–patient-reported missed nursing care in Western Australia. Most importantly, this study has shown that, some substantial amount of nursing care is missed and that these elements of missed care negatively impact nurse and patient outcomes. This thesis provides baseline evidence and challenges the appropriateness of developing target goals to reduce and prevent missed care occurrences.



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