Missed Nursing Care and Its Causes and Effects on Moral Distress in Neonatal Intensive Care Nurses

Abstract

Background: Deficiencies emerge in the care provided by nurses because of the complex treatment plans, shortage of labour resources and communication problems in neonatal intensive care units (NICUs). Knowing how to provide quality patient care but being unable to maintain it because of individual or institutional issues can lead to moral distress among nurses. Aim: This study aimed to examine missed nursing care in NICUs and its relationship with the moral distress experienced by nurses. Study Design: This was a cross-sectional study. This study included a sample of 153 NICU nurses. The data were collected online between January and May 2024 using a descriptive information form, the Missed Care Survey-Paediatric Form, and the Moral Distress Scale-Revised for Paediatric Nurses. Results: The mean age of the participants was 31.22 years, and on average, they cared for 3.42 ± 0.96 patients per day. The medical condition of the child under care (t = 2.954, p <.001), duration of working in the NICU (F = 15.901, p <.001), inadequate number of nurses (F = 3.626, p =.029) and job satisfaction (F = 3.359, p =.037) were listed as variables affecting the reasons for missed nursing care. Communication (β =.275, p =.018) and labour resources (β =.216, p =.021), subdimensions of the Missed Care survey used in the study, were predictive factors that positively affected moral distress. Conclusions: The factors associated with missed care should be explored as strategies to reduce moral distress. Managers should focus on integrating effective communication techniques into nursing care and increasing the labour resources to reduce missed nursing care, thus improving the moral distress levels of NICU nurses. Relevance to Clinical Practice: Understanding the factors associated with missed care and developing related strategies can complement the efforts of NICU managers, educators and nurses in reducing moral distress. © 2025 The Author(s). Nursing in Critical Care published by John Wiley & Sons Ltd on behalf of British Association of Critical Care Nurses.