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

Abstract 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 ( β = .34, p = .002) and professional self‐efficacy ( β = .18, p = .011), while negatively affecting missed nursing care ( β = −.34, p = .003). Care quality positively and negatively influenced professional self‐efficacy ( β = .40, p = .003) and missed nursing care ( β = −.13, p = .003), respectively. Professional self‐efficacy indirectly impacted missed nursing care ( β = −.32, p = .003). Care quality ( β = −.10, p = .003) and professional self‐efficacy ( β = .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.