A mixed-methods systematic review of factors affecting missed nursing care in intensive care

To systematically review and synthesize evidence on the factors influencing missed nursing care in intensive care unit, using the conservation of resources as the analytical framework.

A convergent integrated mixed-methods systematic review was conducted according to the Joanna Briggs Institute guidelines. Nine databases (PubMed, EMBASE, CINAHL, Web of Science, Cochrane Library, CNKI, VIP, CBM, Wanfang) were searched from inception to October 2024. The Mixed Methods Appraisal Tool was used to assess methodological quality, and quantitative findings were transformed and thematically integrated with qualitative evidence.

Thirteen studies were included. Findings were synthesised within the conservation of resources theory framework, with influencing factors mapped to the four corresponding core resource domains: personal (e.g., clinical title, experience), energy (e.g., staffing, workload), social (e.g., teamwork, communication), and material (e.g., equipment, medications). High patient acuity was consistently identified as a primary external demand straining these resources.

Missed nursing care in the ICU is conceptualised as an outcome of an imbalance between clinical demands and nurses' resource reserves. The conservation of resources theory provides a coherent explanatory framework, indicating that interventions must address multifactorial resource deficits to mitigate missed care.

Clinical management strategies should focus on optimizing staffing models to protect energy resources, enhancing teamwork and communication to strengthen social resources, and ensuring the reliable availability of material resources. Building supportive work environments and training in priority-setting are also recommended to reduce the incidence of missed nursing care.