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Development and Psychometric Testing of a Tool to Measure Missed Nursing Care

Kalisch, Beatrice J. PhD, RN; Williams, Reg Arthur PhD, RN

JONA: The Journal of Nursing Administration: May 2009 - Volume 39 - Issue 5 - p 211-219
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 α 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.

Authors' Affiliations: Director, Titus Distinguished Professor of Nursing (Dr Kalisch), Nursing Business and Health Systems; and Professor (Dr Williams), Acute and Long Term Care, University of Michigan, School of Nursing, Ann Arbor.

Corresponding author: Dr Kalisch, University of Michigan School of Nursing, 400 N Ingalls St, Ann Arbor, MI 48109 (

© 2009 Lippincott Williams & Wilkins, Inc.