Factors Associated With Missed Nursing Care in Home Care Setting: Insights From the AIDOMUS‐IT Multicentre Study

Aims: To explore factors associated with missed nursing care (MNC) in home care in Italy. Methods: A secondary analysis of the AIDOMUS-IT national cross-sectional study was conducted investigating structural factors, including details on services offered, waiting times, nurses’ working conditions and workload, nurses’ perceptions of the work environment, climate, staffing adequateness, opportunities for career advancements, leadership, level of burnout, and work-life balance. Nurses’ and patients’ characteristics were hypothesized as “part of the MNC process,” while patients’ perception of care as an MNC outcome. The “Missed Nursing Care in the Home Care” (MNC_HC) instrument was developed and validated. Other instruments used were the “Practice Environment Scale of the Nursing Work Index,” the “NASA Task Load Index,” and the “Copenhagen Psychosocial Questionnaire version III”. Data from nursing directors, home care nurses, and patients were used in a quantile regression to explore factors linked to MNC. A univariate linear regression model assessed the relationship between MNC and patients’ evaluation of the service. Results: A total of 3949 nurses and 9780 patients participated in this study. MNC was reported by 3545 nurses (89.77%), and MNC_HC mean score of items of care missed was 5.23 (SD = 3.18) out of 9. When MNC was low, overtime work increased it, while staffing adequacy and leadership quality reduced it. When MNC was at a medium level, associated factors included longer patient waiting times, more home visits per shift, and inadequate staffing. When MNC was high, work-life conflict and burnout were strongly associated with increased MNC. High perceived workload and lack of career progression opportunities were consistently associated with MNC, regardless of its level. Conclusion: A critical appraisal of organizational and staffing features is recommended in home care. To enhance both patient outcomes and nurse satisfaction, it is advisable to implement indicators to monitor care delivery, revise nurse staffing levels, and establish advanced roles, such as specialized community nursing positions.