Development and psychometric testing of a tool to measure missed nursing care

J Nurs Adm. 2009 May;39(5):211-9. doi: 10.1097/NNA.0b013e3181a23cf5.


Background: In a qualitative study, medical-surgical and intensive care staff nurses reported that they did not complete a significant amount of nursing care on regular basis. Thus, it was determined that a quantitative tool was needed to measure the amount and type of missed nursing care and the reasons for missing care.

Objective: The authors report the results of a psychometric evaluation of this tool (The Missed Nursing Care Survey [MISSCARE Survey]) to measure missed nursing care (part A) and the reasons for missed nursing care (part B).

Study methods: Two studies were conducted--study 1 (n = 459) and study 2 (n = 639). A sample of staff nurses was drawn from 35 medical-surgical, rehabilitation, and intensive care patient units in 4 acute care hospitals.

Results: Acceptability was high, with 85% of the respondents answering all items on the survey. Factor analysis with Varimax rotation resulted in a 3-factor solution for part 2 (communication, labor resources, and material resources). Cronbach alpha values ranged from 0.64 to 0.86. Confirmatory factor analysis demonstrated a good fit of the data. Using a contrasting group approach, a comparison of nurse's perceptions of missed care on intensive care units versus rehabilitation units resulted, as hypothesized, in a significantly lower amount of missed care on intensive care units. Pearson correlation coefficient on a test-retest of the same subjects yielded a value of 0.87 on part A and 0.86 on part B.

Conclusion: Although further validation of the MISSCARE Survey is needed, current evidence demonstrates that the tool meets stringent psychometric standards.

Publication types

  • Validation Study

MeSH terms

  • Data Collection / methods*
  • Factor Analysis, Statistical
  • Focus Groups
  • Humans
  • Medical Errors / nursing
  • Medical Errors / statistics & numerical data*
  • Midwestern United States
  • Nursing Administration Research / methods*
  • Nursing Care / statistics & numerical data*
  • Nursing Evaluation Research / methods*
  • Nursing Methodology Research
  • Nursing Staff, Hospital / organization & administration*
  • Nursing Staff, Hospital / psychology
  • Personnel Staffing and Scheduling / organization & administration
  • Psychometrics
  • Qualitative Research
  • Quality of Health Care / statistics & numerical data
  • Time and Motion Studies
  • Workload / statistics & numerical data