RESEARCH ARTICLE

Commonly missed nursing cares in the

obstetrics and gynecologic wards of Tigray
general hospitals; Northern Ethiopia
Mebrahtom Haftu ID*1, Alem Girmay1, Martha Gebremeskel2, Gebrekiros Aregawi1,
Dawit Gebregziabher1, Carmen Robles3
1 School of Nursing, College of Health Science, Aksum University, Aksum, Tigray, Ethiopia, 2 School of
Nursing, College of Health Science, Mekelle University, Mekelle, Tigray, Ethiopia, 3 Midwifery Department,
College of Health Science, Mekelle University, Mekelle, Tigray, Ethiopia

* [email protected]

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a1111111111 Abstract
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Background
Missed nursing care is considered an error of omission and is defined as any aspect of
required patient care that is omitted (either in part or whole) or significantly delayed. Nursing
care missed in the perinatal setting can cause negative outcomes and repercussions for the
OPEN ACCESS
quality and safety of care. This has been reported in multiple settings and countries and is
Citation: Haftu M, Girmay A, Gebremeskel M,
tied to negative maternal outcomes. Preventing missed nursing care requires in-depth
Aregawi G, Gebregziabher D, Robles C (2019)
Commonly missed nursing cares in the obstetrics research considering the clinical setting.
and gynecologic wards of Tigray general hospitals;
Northern Ethiopia. PLoS ONE 14(12): e0225814.
https://doi.org/10.1371/journal.pone.0225814
Objective
The main aim of the study was to assess commonly missed nursing care elements, reasons,
Editor: Bernadette Watson, Hong Kong Polytechnic
University, HONG KONG and factors for the omission in the obstetric and gynecologic units of general hospitals in
Tigray 2017/18.
Received: June 27, 2018

Accepted: November 13, 2019

Methods and materials
Published: December 23, 2019
A cross-sectional study was conducted in eight randomly selected general hospitals in
Copyright: © 2019 Haftu et al. This is an open
Tigray, Ethiopia. A total of 422 nurses and midwives were selected through simple random
access article distributed under the terms of the
Creative Commons Attribution License, which sampling using the staff list as a sampling frame. To identify the commonly missed nursing
permits unrestricted use, distribution, and care and related factors, the MISSCARE survey tool was used. Descriptive, bivariate, and
reproduction in any medium, provided the original multivariate logistic regression analysis was performed to assess potential risk factors of
author and source are credited.
nursing cares omission.
Data Availability Statement: All relevant data are
within the paper and its Supporting Information
files. Result
Funding: The authors received no specific funding The study results showed that 299 (74.6%) participants commonly missed at least one nurs-
for this work. ing care in the perinatal setting. Labor resources 386(96.3%), teamwork 365(91%), material
Competing interests: The authors have declared resources 361 (90%) and communication 342 (85.3%) were the reasons identified for com-
that no competing interests exist. monly missing care. In the multivariate analyses, sex (p-value <0.001), educational level (p-

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 Commonly missed nursing cares

value 0.034), working shift (p-value <0.001) and having an intention to leave the institution
(p-value <0.001) showed a significant association with commonly missing care.

Conclusion
The proportion of commonly missed nursing care was high. After adjusting for demographic
variables, labor resources, material resources, and communication were reasons for com-
monly missed nursing care. Increasing male professional proportion, investing in nurses/
midwives training, and harmonizing nursing service administration through appropriate
working shift arrangement and timely assessment of professionals’ stability and satisfaction
could minimize frequent omission of nursing care.

Introduction
Conceptually, missed nursing care is considered an error of omission and is defined as any
aspect of required patient care that is omitted (either in part or whole) or significantly delayed
[1]. Over the last two decades, many studies have been published supporting the hypothesis
that the quality and quantity of nursing care contribute directly and indirectly to outcomes
such as morbidity and mortality, failure to rescue, hospital length of stay (LOS), hospital read-
mission, and patient satisfaction in hospitalized patients [2–4].Missed nursing care was only
recently recognized as a widespread concern within the nursing and midwifery disciplines.
Ensuring quality nursing care and patient safety is a major challenge facing nurses and mid-
wifery leaders today and it is not commonly recognized that required nursing care is often left
undone [2, 5, 6]. However, evidence suggests that 9 out of 10 nurses miss some essential care
activities each shift [1]. Estimates of the prevalence of missed care are high (55–98%), depend-
ing on the instrument used, among nursing and midwifery staff in acute care hospitals of mul-
tiple settings and countries [3, 5]. According to the literature, this problem is high even in the
developed world. In Sweden, 74% of hospital nurses miss nursing care [7]. In the United States
of America (USA) important nursing care omission ranges from 10% to27% in all settings [8].
Studies conducted on nursing care omission mainly cover the emergency, critical care unit,
medical, and surgical units. The most frequent omission was documented in nursing care ele-
ments like ambulation, mouth care, medication timing, and patient turning [4, 7, 9]. Labor
resources are the main reason for commonly missed nursing care. Hospital system factors
such as working shift [7, 10], wages and the career structure of institutions also affect the pro-
fessional’s performance as it determines stability, i.e reduce the likelyhood of an intention to
leave [8, 11, 12]. Beyond this, nursing care omission is determined by professional’s character-
istics like gender stereotype [13–16], level of education [17], experience, knowledge, and
attitude.
Ethiopian nurses and midwives are exposed to many work-related challenges that may
influence the quality of nursing care. Challenges include staff shortages, working immediately
after graduation with no experience, working overtime or having two or three different jobs.
In addition poor collaboration with other healthcare professionals is higher compared to other
African countries [12, 18].
Ethiopian hospital’s overall implementation of nursing/midwifery care standard practice is
still just 48.2%. In the perinatal setting, the implementation is less than 20%. Poor implementa-
tion of the nursing care plan and absence of clear job distribution are problems in perinatal
settings[19, 20]. Though midwives are mainly responsible for care given in labor and delivery

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 Commonly missed nursing cares

units, and nurses oversee care given in gynecology wards, dysfunctional job distribution is has
caused conflicting roles among nurses/midwives. According to one systematic review and
meta-analyses, the estimated pooled level of patient satisfaction with nursing care in Ethiopia
is 55% [21].
In the developing world, literature that documents nursing care omission is scant. In the
perinatal setting, though it is not widely assessed, it would have a positive effect on the health-
seeking behavior of pregnant mothers and their utilization of antenatal and postnatal care [2,
6]. The high maternal mortality ratio in Ethiopia and other developing countries reflects these
problems[2, 22, 23]. So identifying care missed and factors related to these omissions in devel-
oping countries like Ethiopia will contribute to the improvement of nursing care service in the
perinatal setting.

Materials and methods

An Institution-based cross-sectional study was conducted between October and December
2017 among general hospitals of Tigray northern Ethiopia. There were 16 general hospitals in
the study area, and during the study period, there were 3067 nurses and 792 midwives assigned
in the hospitals. All nurses and midwives who work in the obstetrics and gynecology unit of
Tigray general hospital served as source populations.

Sample size determination and sampling

The sample size was calculated using a single population proportion formula by considering
the proportion of missed nursing care in the perinatal setting of general hospitals as 50% with
a 5% margin of error and a 95% confidence level.
2 2
ðZa =2 Þ Pð1 PÞ ð1:96Þ 0:5ð1 0:5Þ
n¼ ¼ ¼ 384
d2 0:052
Considering a 10% contingency for non-response, the survey was conducted on 422 profes-
sionals. However, only 401 (95%) participants completed questionnaires. Participants were
selected from eight randomly selected general hospitals out of the sixteen general hospitals in
Tigray and the actual participants were randomly selected through computer-generated num-
bers using the staff list as the sampling frame.

Data collection procedures

Data was collected using the MISSCARE survey tool which was adopted from Kalisch BJ [9]. It
is an instrument that measures missed nursing care elements and the reasons for the nursing
care omission. The questionnaires consisted of 53 questions divided into three parts. Part one
contains socio-demographic questions. Part two contains 26 questions that assess the fre-
quency of nursing care element omission. The response range consisted of a Likert scale with
the following answers: 0 does not apply, 1 never, 2 rarely, 3 sometimes, 4 frequently and 5
always missed. Part three assessed reasons for the omission of nursing care. Eighteen questions
were asked in four categories: labor resources (6 questions), material resources (3 questions),
teamwork (5 questions), and communications (4 questions). The response range consists of
1–4; one if no reason, two minor reasons, three for a moderate reason, and four significant rea-
sons. The tool was developed through an analysis of interview data, a review of literature and
interviews with key informants, and then tested on two occasions to determine and construct
validity and reliability of the instrument [1]. A modification was made by maternal health
experts to assess the relevance of nursing care elements to the perinatal units.

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 Commonly missed nursing cares

Study variables
Commonly missed nursing care was the dependent variable. In this study, commonly missed
care is defined as any aspect of required patient care that is often or always omitted (either in
part or in whole) or significantly delayed (if the care was conducted after it becomes no longer
necessary). Socio-demographic characteristics of professionals, staff outcomes (satisfaction,
turnover, intent to leave), unit characteristics e.g. type of nurse and midwives staffing, and
teamwork (communication within and other discipline) were the independent variables.

Data analysis procedures

The collected data were double entered into a computer using Epi-info version 7 and exported
into SPSS version-22 for analysis. For our analyses, response alternatives on missed nursing
care were transformed into a dichotomous scale, in which the alternatives 1, 2 and 3 were con-
sidered as care provided, and alternatives 4 and 5 were considered as care commonly missed
[9, 24]. Descriptive statistics summarized factors relating to care lost using frequencies, per-
centages as well as mean and SD. Bivariate logistic regression was used to determine the associ-
ation between independent and dependent variables and those variables with a p-value < 0.2

Table 1. Socio demographic and personal characteristics of participants (N = 401).

Variable Frequency N Percent (%)
Sex
Male 146 36.4
Female 255 63.6
Educational status
Diploma 30 7.5
Degree 342 85.3
Masters 29 7.2
Profession
Nurse 167 42.6
Midwives 234 58.4
Job experience
Less than one year 7 1.7
One up to five years 246 61.3
More than five years 148 36.9
Absent for >2 days within 3 months
Yes 96 23.9
No 305 76.1
Shift mostly worked
Day 332 82.8
Night 69 17.2
Institution Graduated from
Private institution 126 31.4
Governmental 275 68.6
Satisfied with the payment
Yes 79 19.7
No 322 80.3
Intent to leave institution
Yes 287 71.6
No 114 28.4
https://doi.org/10.1371/journal.pone.0225814.t001

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 Commonly missed nursing cares

were included in a multivariate logistic regression in order to control the possible confounders.
Before inclusion of predictors to the final logistic regression model, the multi-collinearity effect
was checked using VIF/Tolerance test. The Hosmer-Lemeshow goodness-of-fit statistic was
used to check if the data fit the logistic model. Adjusted Odds ratio with 95% confidence inter-
val for those variables with p-value < 0.05 was calculated to show the level of association and
statistical significance.

Ethical considerations
Ethical clearance was received from Aksum University Collage of Health Science Health
Research Ethics Review Committee (IRB: 041/2017) and full written informed consent was
obtained from participants. Privacy and strict confidentiality were maintained during the data
collection process. No personal details were recorded or produced on any documentation
related to the study.

Results
The response rate was 95%. The analysis was performed on the 401 completed questionnaires.
Most participants were females. The mean age of respondents was 29 ± 5.06 years, with ages

Table 2. Results on frequency of nursing care elements omission (n = 401).

Nursing Care activity

Elements Commonly missed Performed
N (%) N (%)
Physical examination (head-to-toe) 148(36.9) 253(63.1)
Ongoing and timely monitoring of patient status 137(34.2) 264(65.8)
Intake and output measure 133(33.2) 268(66.8)
Response to rapidly changing condition or deterioration 123(30.7) 278(69.3)
Reassuring the mother 122(30.4) 279(69.9)
Documentation 120(29.9) 281(70.1)
Timely Nurse/Midwives to patient communication 118(29.4) 283(70.6)
Complete review of history 117(29.2) 284(70.8)
General comfort care based on patient need 115(28.7) 286(71.3)
Repositioning when patients needed 112(27.9) 289(72.1)
Timely cervical examinations 111(27.7) 290(72.3)
Labor support 109(27.2) 292(72.8)
Continuous history taking (clerking) 108(26.9) 293(73.1)
Medications given immediately postpartum 106(26.4) 295(73.6)
Answering questions raised by patient 104(25.9) 294(74.1)
Initial assessments (physical, social, emotional, psychological) 100(24.9) 301(75.1)
Handoffs at every shift 97(24.2) 304(75.8)
Bedside presence “Being with” the woman 96(23.9) 305(76.1)
Developing a plan of care 94(23.4) 307(76.6)
Medication administration for labor 93(23.2) 308(76.8)
Monitoring FHR 89(22.2) 312(77.8)
Pain management 82(20.4) 319(79.6)
Teaching about procedures, tests diagnostic studies 80(20) 321(80)
Discussing about patients expectation 77(19.2) 324(80.2)
Reassuring the family 73(18.2) 328(81.8)
Review of lab results obtained during labor and birth 70(17.5) 331(82.5)

https://doi.org/10.1371/journal.pone.0225814.t002

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 Commonly missed nursing cares

ranging from 23 to 45 years. Most of the participants were BSc degree holders. Results also
showed that over two-fifth had from one up to five years of experience, and four out of five
participants mostly worked a day shift. Only one-fifth of the professionals were satisfied with
the payment they were receiving, and the majority had an intention to leave the institution
(Table 1).

Commonly missed nursing cares

Distribution of responses on how frequently each element of care was commonly missed by
the professionals showed that 299 (74.6%) reported that they commonly missed at least one
nursing care. Several nursing care activities were reported as frequently or often missed;
among them, complete head to toe physical examination was the most frequently missed ele-
ment reported by 148 (36.9%) of the participants, followed by ongoing and timely monitoring
of patient status 137 (34.2%), continuous intake and output measurement 133 (33.2%), giving
an immediate response to patients rapidly changing condition or deterioration 123 (30.7%)
and giving a reassurance to the mother 122 (30.4%) On the other hand, the least frequently
reported commonly missed nursing care activities were; reviewing laboratory results, giving
reassurance to the family, discussing about the mothers expectation, giving an explanation
mothers about the test and diagnosis, which were reported by 70 (17.5%), 73 (18.2%), 77
(19.2%) and 80 (20%) of the participants respectively (Table 2).

Reasons for commonly missing a nursing care

The current study shows that labor resources was the primary reason for commonly omitting
or delaying a nursing care 386 (96.3%), followed by teamwork 365 (91%), material resources
361 (90%), and communication 342(85.3%). In the labor resources subscale, the most com-
monly reported items were lack of experience or previous exposure (88.1%) and unexpected
rise in patient volume (86.8%). Among the material resources, shortage of supplies and equip-
ment’s when needed (89.5%), and from the teamwork resources category, lack of backup sup-
port from team members when needed (84.5%) was the prominently reported reasons
(Table 3).

Factors associated with commonly missed nursing cares

Logistic regression analysis was done to identify the commonly missed nursing care elements
and variables that can independently affect nurses’ and midwives’ behavior so as to commonly
miss care in the perinatal setting. All variables with a p-value < 0.2 in the bivariate analyses
were used in multivariate logistic regression in further analyses to control for confounders.
Participant’s sex, educational level, working shift, and having an intention to leave the institu-
tion were factors that showed a significant association in this multivariate analysis.
In the multivariate analysis, four variables had significant effects. Male professionals had
lower odds to miss care commonly compared to female professionals. (AOR: 0.20, 95% CI:
(0.10, 0.38)). The second variable was educational level. Those who had a bachelor’s degree
were sixteen times higher (p-value, 0.034) and those who had diploma were five times higher
(p-value, < 0.001) to miss nursing care commonly than those who had a master’s degree. The
third variable that showed an association was working shift. Professionals that mostly work in
the night shift were about six times more likely to commonly miss nursing care as compared
to those who work in the day shift. The fourth variable was having an intention to leave the
institution, which increased the odds of missing nursing care commonly by 2.33 times com-
pared to being stable (Table 4).

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 Commonly missed nursing cares

Table 3. Results on reason for commonly missing a nursing care in the perinatal setting (N = 401).
Reason category Reason sub-scale Reasoning scale
Not a reason Minor reason Moderate reason Significant reason
Inadequate number of staff 91(22.7) 76(19) 153(38.2) 81(20.2)
Urgency of patient situations/ patient’s condition worsening 52(13) 153(38.2) 115(28.7) 81(20.2)
Labor Resources Unexpected rise in patient volume 53(13.2) 149(37.2) 94(23.4) 105(26.2)
Inadequate number of assistive personnel 74(18.5) 110(27.4) 139(34.7) 78(19.5)
Heavy admission and discharge activity 103(25.7) 84(20.9) 131(32.7) 83(20.7)
Lack of experience or previous exposure 48 (11.9) 128(31.9) 110(27.4) 115(28.7)
Material Medications were not available when needed 55(13.7) 150(37.4) 81(20.2) 115(28.7)
Resources Supplies/equipment not available when needed 42(10.5) 97(24.2) 136(33.9) 126(31.4)
Supplies/equipment not functioning properly when needed 49(12.2) 95(23.7) 15237.9 105(26.2)
Team work Unbalanced patient assignments 86(21.4) 128(31.9) 117(29.2) 70(17.5)
Inadequate hand-off from previous shift or sending unit 71(17.7) 178(44.4) 113(28.2) 39(9.7)
Other departments/unites did not provide the care needed 71(17.7) 155(38.7) 108(26.9) 67(16.7)
Lack of back up support from team member 66(16.5) 149(37.2) 138(34.4) 48(12)
Caregiver go off unit or unavailable 98(24.4) 137(34.2) 119(29.7) 47(11.7)
Communication Tension or communication breakdowns with other departments 53(13.2) 143(35.7) 148(36.9) 57(14.2)
Tension or communication breakdowns within the team 120(29.9) 88(21.9 107(26.7) 86(21.4)
Tension or communication breakdowns with the medical staff 89(22.2) 114(28.4) 114(28.4) 84(20.9)
Nursing/Midwifery assistant did not communicate if that care was not 74(18.5) 104(25.9) 103(25.7) 120(29.9)
done
https://doi.org/10.1371/journal.pone.0225814.t003

Discussion
In any setting, missing essential aspects of nursing care is common especially when the envi-
ronment is busy. Regardless of the workload, a tremendous element of nursing care is left
undone in different settings and for different reasons [1, 23]. In this study 74.6% of the partici-
pants commonly miss at least one important nursing care in the Obstetrics and Gynecology
ward per shift. These findings are comparable to a study from Sweden which resulted in 74%
[7] and the first quantitative studies conducted using the MISSCARE Surveys 70% [1, 4]. How-
ever, the magnitude of nursing care omission was higher compared to the study conducted in
New Jersey USA (10–27%)[8]. This difference might be due to the study setting and sample
size difference. Moreover, the increased magnitude of nursing care omission could be related
to the fact that nurses/midwives do not prioritize these interventions, give low emphasis to the
importance of the nursing care element, or they consider these tasks manageable by other col-
leagues or relatives of the patient [25].
The five most frequently missed elements in the perinatal setting are: complete head-to-toe
physical examination; ongoing and timely monitoring of patient status; continuous intake and
output measurements; immediate response to a patient’s rapidly changing condition or deteri-
oration; and providing reassurance to the mother. These findings revealed that the maternal
condition was neglected and the caregiver’s attention might be with the newborn; this is evi-
denced by the increased maternal mortality ratio in Ethiopia and other developing countries
[22].
Nursing care activities such as reviewing laboratory results, providing reassurance to family,
discussing the mother’s expectations, giving explanations, and teaching mothers about tests
and diagnoses were considered to be the least frequently reported elements. This result is clear
especially in the clinical perspective because cares are audited and cross-checked by unit heads

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 Commonly missed nursing cares

Table 4. Bivariate and multivariate binary logistic results on factors that affect nursing care omission commonly.
Variable Commonly Miss Care COR(95%CI) AOR(95% CI) P- Value
Yes NO
N (%) N (%)
Sex
Male 98(32.8) 48(47.1) 0.55(0.35,0.87) 0.20(0.10,0.38) <0.001
Female 201(67.2) 54(52.9) 1 1
Educational status
Diploma 16(5.4) 14(13.7) 3.6(1.18,10.9) 5.06(1.13,22.7) 0.034
Degree 276(92.3) 66(64.7) 13.1(5.4,32.0) 16.7(5.35,52.2) <0.001
Masters 7(2.3) 22(21.6) 1 1
Job experience
< one year 22(7.4) 16(15.7) 0.54(0.25,1.13) 0.86(0.30,2.43) 0.77
1–5 years 178(59.5) 47(46.1) 1.49(0.91,2.43) 1.86(0.89,3.86) 0.09
5 years & more 99(33.1) 39(38.2) 1 1
Two or > Absent within 3 months
No 222(74.2) 83(81.4) 0.66(0.38,1.16) 0.45(0.21,1.94) 0.34
Yes 77(25.8) 19(18.6) 1 1
Shift type that you mostly worked
Night 256(85.6) 76(74.5) 2.04(1.17,3.53) 6.05(2.56,14.3) <0.001
Day 43(14.4) 26(25.5) 1 1
Institution Graduated from
Private 104(34.8) 22(21.6) 1.94(1.14,3.29) 3.0(0.43,6.33) 0.54
Governmental 195(65.2) 80(78.4) 1 1
Marital status
Single 159(53.2) 46(45.1) 1.38(0.88,2.17) 1.38(0.67,2.82) 0.37
Married 140(46.8) 56(54.9) 1 1
Experienced professional are Leaving
Yes 252(84.3) 98(96.1) 0.21(0.07,0.62) 0.13(0.04,1.41) 0.110
No 47(15.7) 4(3.9) 1 1
Satisfied with the payment
No 238(79.6) 84(82.4) 0.83(0.46,1.49) 0.96(0.43,2.12) 0.92
Yes 61(20.4) 18(17.6) 1 1
Intent to leave institution
Yes 231(77.3) 56(54.9) 2.79(1.73,4.48) 4.6(2.33,9.09) <0.001
No 68(22.7) 46(45.1) 1 1
https://doi.org/10.1371/journal.pone.0225814.t004

and other professionals such as physicians. This could be the reason for the less frequent omis-
sion [8].
In the reason’s assessment for commonly missing nursing care: Labor resource is the most
quoted reason. Within the labor resource subscale, unexpected rise in a patient volume cited
as the top cause for missed cares[1, 3, 26]. Study results reveal labor resources as one of the fac-
tors, with increased patient volume being the next; but inadequate work experience and expo-
sure was the prominent reason. This shows that the staff lacks competency regarding standard
nursing care implementation in the clinical setting. This problem might be related to profes-
sional dissatisfaction, unsatisfactory rotation schedule and low emphasis given for professional
development in the study area[12].
Findings from this study reveal significant correlates of nursing care omission. Among
those professionals, gender is one. Nursing and midwifery remain a female-dominated

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 Commonly missed nursing cares

profession around the world and gender stereotyping is still a major issue in developing coun-
tries. Few studies report the situation of novice male nurses even in their first year of service
[13, 16]. Supporting this evidence in this study, male professionals were less likely to com-
monly miss care compared to female professionals (AOR: 0.20, 95% CI: (0.10, 0.38). The most
cited reason was the male concern about their career options and promotion. Most male
nurses/midwives are unhappy if they deliver less advanced care. Thus, immediately after
deployment to the professional practice, male nurses/midwives typically concentrate on deliv-
ering a good standard of service and earning a promotion [13, 16, 27]. This possibly helps
them overlook essential cares less frequently than their female counterparts [13, 16].
Regarding educational level, in this study diploma, and bachelor professionals as compared
to the master’s degree holders reported higher rates of missed care. This result is in line with
the previous study findings, revealing that lower-level nurses/midwives on duty increase the
likelihood of many aspects of care being delayed or left undone [17]. This could be because of
the fact that level of education determines the exposure, experience, knowledge, and attitude
of these professionals. But in this study individual that holds a bachelor’s miss an element of
care more commonly than the diploma degree holders; This could be because of the existing
problem in the job description, which leaves bachelor holders inexperienced and less
supervised.
Another factor that showed an association was the working shift. Professionals that work
mostly during the night shift were six times more likely to miss nursing care as compared to
those who worked during the day shift. This result is in line with earlier literature [7, 10]. The
science that describes the effect of diurnal variation is the most commonly cited reason for
poor performance in the night shift. Working at night can frequently induce sleep disorder
because of short circadian rhythms of cortisol secretions which could influence mental and
physical health; leading them to miss important care.
Stability in the working environment is another factor. Those who had intentions to leave
their institution were 2.33 times more likely to miss nursing care than those who do not. This
result is also supported by the literature [11]. Those who intended to leave their institution are
possibly investing their time in searching for a vacancy or doing overtime work. This might
deteriorate their concern about their care performance and their absenteeism which might
then lead them to miss nursing care.
The study findings of this study are pertinent to the field as it will allow nursing and mid-
wifery managers to make decisions that will strengthen nursing care. Still, besides its signifi-
cance, the study had drawbacks. We conducted the study through self-administered
questionnaires; therefore, the study was assessed by self-report. Because of this, under-report-
ing of the nursing omission might affect the result. Study participants were nurses and mid-
wives hence lacking patients’ opinions that would provide greater clarity in the phenomenon
of missed care. As the study was cross-sectional, the result does not show the impact of missed
perinatal care on the mother and infant.

Conclusion
Most of the nurses and midwives working in the Obstetrics and Gynecology wards were com-
monly missing nursing care elements. The magnitude of nursing care omission was high in
the study data. Labor resources were one of the reasons for missing nursing care. Regional
Health Bureau and Hospital Administration, which requires strengthening the support and
supervision on implementing the nursing care plan to minimize the omission. Professionals of
the female gender, of a lower educational status, working in night shift, and having an inten-
tion to leave the institution were also independent predictors. Consequently, increasing the

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 Commonly missed nursing cares

proportion of male professionals, investing in nurses’ and midwives’ education, and harmoniz-
ing nursing service administration could reduce the frequency of omissions in nursing care.
Nurse and Midwife managers also need to assess professionals’ stability and satisfaction to
enhance nurses’ and midwives’ working capacities. To assess the impact of the commonly
missed nursing care elements, researchers need to focus on a further longitudinal follow up
study.

Supporting information
S1 Dataset.
(SAV)
S1 Fig.
(TIFF)

Acknowledgments
Our deepest gratitude goes to the School of Nursing, College of Health Sciences, Aksum Uni-
versity for giving as such an opportunity to conduct this research. We would like to thank the
Tigray regional health bureau, participant hospitals, data collectors, and study participants for
their cooperation and assistance. Our Special thanks go to, colleagues and friends for their
unlimited contribution and support for the success of this paper.

Author Contributions
Conceptualization: Mebrahtom Haftu, Alem Girmay, Martha Gebremeskel, Gebrekiros Are-
gawi, Carmen Robles.
Data curation: Mebrahtom Haftu, Alem Girmay.
Formal analysis: Mebrahtom Haftu.
Investigation: Mebrahtom Haftu, Dawit Gebregziabher.
Methodology: Mebrahtom Haftu, Alem Girmay, Dawit Gebregziabher, Carmen Robles.
Project administration: Mebrahtom Haftu.
Resources: Mebrahtom Haftu, Gebrekiros Aregawi, Dawit Gebregziabher.
Software: Alem Girmay.
Supervision: Gebrekiros Aregawi.
Validation: Martha Gebremeskel, Gebrekiros Aregawi, Dawit Gebregziabher.
Visualization: Martha Gebremeskel.
Writing – original draft: Mebrahtom Haftu, Martha Gebremeskel.
Writing – review & editing: Mebrahtom Haftu, Carmen Robles.

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