Presenteeism, self-directed learning, and missed nursing care in the operating theatre: a cross-sectional study

The operating theatre is a high-risk, high-pressure environment where patient safety and surgical results may be at risk due to missed nursing care (MNC). To date, there has been no multi-centre survey exploring MNC among operating theatre nurses in China. Even though presenteeism and self-directed learning ability have been connected to the quality of care in other settings, less is known about how they relate to perioperative MNC, especially in China.

To explore the current status and types of operating theatre nurses' MNC and to determine the correlation between presenteeism, self-directed learning ability and perioperative missed nursing care.

A multicentre cross-sectional study was conducted among operating theatre nurses from July to September 2025 in public hospitals in Jiangsu Province, China. Data were collected using the self-developed demographic questionnaire, the MISSCARE Survey-Operating Room Scale, the Presenteeism Behaviour Questionnaire, and the Self-Directed Learning Ability Scale. Questionnaires were distributed and collected via the "Questionnaire Star" online platform. Data were analysed using SPSS version 27.0 for descriptive and inferential statistics. Binary logistic regression was used to identify factors associated with MNC.

A total of 391 validated questionnaires were analysed (response rate: 94.22%). The incidence of MNC among operating theatre nurses was found to be 34.53%. Postoperative routine tasks demonstrated the highest omission rates, whereas safety-related activities had the lowest. The most frequently reported missed tasks were "checking whether the patient is wearing graduated compression stockings during surgery" and "allowing 3 minutes for antiseptic skin preparation solutions to dry". Human resource allocation (inadequate staffing and fatigue), material resource limitations, and poor teamwork emerged as primary contributors to missed care. Presenteeism was positively associated with the frequency of MNC, while self-directed learning ability showed a significant negative association-representing a previously underexplored relationship among perioperative nurses.

According to the results of this study, missed nursing care is moderately prevalent among operating theatre nurses, which is correlated with organisational resources, presenteeism, and individual self-directed learning ability. To reduce missed nursing care, nursing managers may consider prioritising resolving staffing and material constraints, as well as addressing presenteeism. Enhancing self‑directed learning capabilities can be pursued as a long‑term professional development strategy alongside supportive cultural initiatives.

Not applicable.