Communication-focused interventions to reduce missed nursing care: A systematic review

Missed nursing care (MNC) is associated with adverse patient outcomes, and communication problems may contribute to care omissions. Evidence on interventions that explicitly target communication to reduce MNC remains unclear.

To synthesize interventional evidence on communication-focused strategies intended to reduce MNC or specific nursing care omissions.

We conducted a PRISMA-guided systematic review of six databases and gray-literature sources. Randomized, quasi-experimental, and pre-experimental studies involving nursing staff in health institutions were eligible when communication was an explicit intervention component. Risk of bias and certainty of evidence were assessed using design-appropriate tools and GRADE. Owing to heterogeneity, findings were synthesized narratively.

Six U.S. studies met the inclusion criteria: four quasi-experimental, one pre-experimental, and one randomized intervention study. Interventions included structured handovers and care-plan communication, teamwork training, electronic communication systems, and cue-based strategies. Three studies directly measured MNC using MISSCARE; others assessed communication processes or downstream clinical outcomes. Selected care omissions or communication processes improved in some studies, but findings were inconsistent. Moderate-to-high risk of bias, imprecision, heterogeneous outcomes, and inconsistent reporting precluded meta-analysis and limited certainty.

Communication-focused interventions may improve selected aspects of care completion or communication, but current evidence does not establish a consistent or generalizable effect on MNC. Stronger studies using standardized MNC outcomes are needed, particularly outside the United States.

This review identifies a small and heterogeneous body of intervention evidence in which communication is explicitly targeted to reduce MNC or care omissions. Direct measures of MNC should be distinguished from communication processes, patient experience, and downstream clinical outcomes. Evidence from LMICs remains absent.