[MISSCARE Survey - Italian Version: findings from an Italian validation study]

Background: The Missed Nursing Care (MNC) refers to nursing interventions that are not completed, partially completed, or postponed. Despite the relevance of MNC, no assessment tools are available in the Italian context, and no data regarding the occurrence of this phenomenon has been documented on a large scale to date. Objectives: The study aims were: (1) to validate the Italian version of the MISSCARE Survey tool; (2) to measure the prevalence of missed interventions and reasons for missed care as perceived by clinical nurses working in Italian health care settings. Methods: After having conducted the forward and backward translation, pre-pilot and pilot phases were developed to ensure face and content validity as well as semantic and conceptual equivalence of the Italian version with the original version. The MISSCARE survey questionnaire was then distributed to 1,233 clinical nurses of whom 1,003 completed the questionnaire. Overall, 979 questionnaires were analysed. The questionnaires were completed from January to March 2012, by nurses working in medical and surgical hospital departments in the Emilia Romagna region of Italy. Construct validity and internal consistency of the instrument were assessed. Results: The face and content validity were ascertained by a group of experts. The instrument acceptability was good given that 79.4% of respondents replied to all items. Construct validity was investigated by an Exploratory Factor Analysis. Four factors explaining 64.18% of variance emerged: communication, lack of facilities/supplies, lack of staff, and unexpected events. Internal consistency, evaluated with Cronbach a, was 0.94. The nursing interventions omitted with greater frequency were, in order: ambulation (74.8%), passive mobilization (69.6%) and oral care (51.3%). The three main reasons for missed interventions were: an unexpected increase in the number of patients (90.5%), increased instability of the clinical condition (86.1%) and insufficient human resources (85.5%). Conclusions: The Italian version of the MISSCARE Survey was shown to have good psychometric properties. Therefore, it can be used to evaluate the missed nursing care phenomenon in Italy and will allow for international comparisons.