Intensive and critical care nurses patient safety, care quality, professional self-efficacy, and missed nursing care: Structural equation model analysis

Background: Globally, nurses' patient safety, care quality, and missed nursing care are well documented. However, there is a paucity of studies on the mediating roles of care quality and professional self-efficacy, particularly among intensive and critical care unit (ICCU) nurses in developing countries like the Philippines. Aim: To test a model of the interrelationships of patient safety, care quality, professional self-efficacy, and missed nursing care among ICCU nurses. Methods: A cross-sectional, correlational design study was used. ICCU nurses (n = 335) were recruited via consecutive sampling from August to December 2023 and completed four validated self-report scales. Spearman Rho, structural equation modeling, mediation, and path analyses were utilized for data analysis. Results: The emerging model demonstrated acceptable fit parameters. Patient safety positively influenced care quality (beta = .34, p = .002) and professional self-efficacy (beta = .18, p = .011), while negatively affecting missed nursing care (beta = -.34, p = .003). Care quality positively and negatively influenced professional self-efficacy (beta = .40, p = .003) and missed nursing care (beta = -.13, p = .003), respectively. Professional self-efficacy indirectly impacted missed nursing care (beta = -.32, p = .003). Care quality (beta = -.10, p = .003) and professional self-efficacy (beta = .13, p = .003) showed mediating effects between patient safety and missed nursing care. Linking Evidence to Action: ICCU nurses' care quality and professional self-efficacy are essential mediating factors that can bolster patient safety practices, hence reducing missed nursing care. Therefore, healthcare organizations, nurse managers, and policymakers should cultivate care quality and self-efficacy by creating support programs and providing a positive practice environment. Nurses and nurse supervisors could directly observe missed nursing care in the ICCU to understand its underreported causes.