Nursing Paper on Missed Care: Quality Improvement and Safety

Nursing Paper on Missed Care: Quality Improvement and Safety

Missed care refers to nursing care that has been delayed, partially completed, or not provided at all to patients in need (Kalisch, Landstrom, & Hinshaw, 2009). Nurses are required to plan, organize, and be coordinated as they provide nursing care. They should also evaluate interventions prescribed by other medical practitioners in attempts to treat diseases among hospitalized patients. Through strategic plans, nursing care should be undertaken to deliver and evaluate any form of nurse-initiated care seeking to promote health and healing among patients. Missed care, therefore, refers to medical errors and unique types of medical underuse affecting safety. The error of omission in nursing care has been adversely affecting the quality of nursing care and patient safety (Kalisch, Landstrom, & Hinshaw, 2009).

Theoretically, missed care is a subset of error of omission which is problematic as nurses can deliver multiple prescribed care plans without striving to promote health and healing (Kalisch, Landstrom, & Hinshaw, 2009). Donabedian’s structure-process-outcome framework provides a conceptual model describing missed care as unfinished nursing care or care that has not been done (Chen, 2014). The framework therefore encourages nurses to prioritize the nursing activities. This can set stage ensuring nursing care is neither excluded nor delayed. For example, the framework can ensure adequate material resources, competent nursing staff, and effective communication and teamwork prevent missed care (Kalisch, Xie, & Dabney, 2014).

Nurses often experience challenges. For example, they are faced with restricted resources during nursing processes including those determining clinical priorities prompting them to either delay or omit certain aspects of their duties. In United States, prevalence of missed care has been high. According to Stokowski (2017), fifty-five to ninety eight percent of nurse respondents reported missing items crucial in delivery of nursing care during their shifts. This led health care investigators to conduct studies. The studies concluded that missed care mainly occurs when patients need emotional and psychological needs to be addressed. For example, mouth care and ambulation are aspects of nursing care frequently missed. The studies also revealed that in comparison to nurses, assistants report more missed care. More so, units without sufficient staffing record high rates of missed care. Thus, improving staffing and intra-nursing teamwork training interventions can reduce and prevent missed care (Stokowski, 2017).

Impact of Missed Care on Continuous Quality Improvement in health care

Due to missed care, patient care is omitted, partially delivered, delayed, or provided through low quality measures. According to Sollecito and Johnson (2012), there are various attributes to missed care. For example, decision making process to identify health care priorities can be cumbersome. Consequently, efforts to enhance nursing can either be blocked or ignored. Conversely, internal perceptions and values towards nursing care are negatively implied, undertaken, and fulfilled. Ultimately, patient satisfaction declines as nursing care efforts and practices do not provide patients with the comfort they desire and need. Thus, missed care does not improve the quality and safety in nursing care as patient care, safety, and satisfaction is delayed, omitted or partially provided (Sollecito & Johnson, 2012).

In conclusion it can be stated that currently, missed care is very common. Thus, it poses potentially dangerous health care errors. According to Kalisch, Xie, & Dabney, medical errors due to missed care have received limited attention. Thus, organizational attention, safety research, and quality improvement are vital measures in developing effective interventions against missed care. Staffing levels, teamwork, and work environments are consistent predictors of missed care. Common safety and quality threat for effective solutions attribute to missed care. Time pressure and competing demands coupled with adequate nursing staffing can prevent missed care. Evaluating organizational nurse staffing plans including average needs of nursing units and careful assessment of patient complexity can also prevent missed care (Kalisch et al., 2014).






Chen, C. H. (2014). Educational needs of inpatient oncology nurses in providing psychosocial care. Clinical journal of oncology nursing18(1), E1.

Kalisch, B. J., Landstrom, G. L., & Hinshaw, A. S. (2009). Missed nursing care: A concept analysis. Journal of Advanced Nursing, 65(7), 1509-1526.

Kalisch, B. J., Xie, B., & Dabney, B. W. (2014). Patient-reported missed nursing care correlated with adverse events. American Journal of Quality Medicine, 29(1), 415-422.

Sollecito, A W., & Johnson, K. S. (2012). Continuous quality improvement in health care. Jones & Bartlett Learning.

Stokowski, A. L. (2017). Missed care: Do patients notice? Retrieved on 15th Jan from: