Missed nursing care surfaced as a routine strain in northern Ghana’s critical care units
In a tertiary hospital in northern Ghana, missed nursing care was not an abstract quality metric. It appeared in day-to-day omissions that directly touch bedside recovery: helping patients ambulate, setting up meals for those able to self-feed, providing mouth care, bathing, skincare, and joining interdisciplinary care conferences.
The study surveyed 217 registered nurses working in critical care units and used the 24-item MISSCARE Survey to measure how often essential tasks were left undone during routine practice. The mean missed nursing care score was 41.78 ± 12.52, a level that signals repeated pressure on nursing time, staffing bandwidth, and workflow. In a high-acuity environment, even small omissions accumulate quickly. A missed turn, a delayed mouth care session, or a skipped conference can influence discomfort, infection risk, mobility, and coordination of treatment plans.
Which care tasks were most often left incomplete
The most frequently missed activity was participation in interdisciplinary care conferences, reported by 75.6% of nurses. Patient ambulation followed at 70.0%, then meal setup for patients able to self-feed at 64.5%. Mouth care was missed by 62.2% of nurses, and bathing or skincare by 61.8%.
These omissions point to a familiar pattern in critical care: tasks that preserve function, dignity, and communication often lose out when staff must prioritize immediate physiologic instability. Airway management, hemodynamic monitoring, urgent medication administration, and crisis response are non-negotiable. Less dramatic tasks may be deferred, yet they are not optional from a patient-safety standpoint. Reduced mobilization can prolong weakness. Poor oral care can increase discomfort and may contribute to preventable complications. Skipped meal assistance can undermine nutrition and recovery in patients who are otherwise able to eat with minimal help.
One finding stands out sharply: interdisciplinary care conferences were the most commonly missed activity. In critical care, those meetings are where treatment priorities are aligned across disciplines, and their absence can fragment decision-making.
Unit assignment shaped missed care scores
The association between clinical setting and missed nursing care was not uniform. Compared with nurses working in the Medical High Dependency Unit, nurses in the Accident and Emergency Unit had higher missed nursing care scores, with a β of 0.16 (95% CI: 0.01–0.33; p = 0.049). Nurses in the Obstetrics/Gynaecology Emergency Unit had an even higher score, with a β of 0.61 (95% CI: 0.23–0.99; p = 0.002).
Those differences are consistent with the operational reality of emergency-facing units. Patient turnover is faster, acuity can shift in minutes, and competing priorities often compress the time available for basic supportive care. In that setting, missed nursing care may not reflect indifference or poor knowledge. It may instead reflect a system under sustained pressure, where immediate stabilization repeatedly displaces lower-visibility nursing work.
Leadership support and professional agency lowered missed care
Two organizational and professional factors were linked to lower missed nursing care scores. Nurses who reported supportive leadership in addressing patient safety concerns had lower scores, with a β of −0.17 (95% CI: −0.33 to −0.01; p = 0.041). Nurses who felt they could make a meaningful impact on patient safety also had lower scores, with a β of −0.30 (95% CI: −0.53 to −0.06; p = 0.015).
The pattern is clinically intuitive. Supportive leadership can reduce friction in escalation, staffing coordination, and problem-solving when workloads spike. It can also make it easier for nurses to speak up when essential care is slipping. Perceived professional impact matters for a different reason: when nurses believe their actions can change patient outcomes, routine supportive care is more likely to be treated as part of safety-critical work rather than as expendable bedside “extras.”
Organizational culture does not create missed care in isolation, but it can either absorb pressure or magnify it. When leaders respond to safety concerns with visible support, frontline staff may have more room to preserve essential tasks that are otherwise the first to disappear.
What the findings mean for critical care practice
The study draws attention to a specific kind of care gap: not advanced technology failure, but the erosion of nursing fundamentals under pressure. In critical care, the consequences can be subtle at first and then cumulative. Reduced ambulation can slow rehabilitation. Incomplete oral hygiene can worsen comfort and complicate respiratory care. Delayed feeding assistance can affect energy balance. Missed conference participation can weaken team coordination.
Because this was a hospital-based cross-sectional survey in a single tertiary center, the associations cannot be treated as causal. The findings also cannot be generalized automatically beyond this setting. Still, the data provide a practical signal for hospital administrators and nurse leaders: missed nursing care is distributed unevenly across units, and it appears to track with both workload intensity and organizational support.
No specific grant supported the work, and the investigators obtained ethical approval before collecting informed consent from all participants. The design remains limited to one point in time, which means the next question is not whether missed care exists, but how often similar patterns appear across other hospitals, staffing models, and critical care environments in Ghana and beyond.