LAUSR

AIMS The aim of this study is to reliably estimate why midwifery care is missed and to crystallise those factors that have causal links to it. BACKGROUND Studies involving the incidences and types of missed midwifery care are sparsely described. The rationales behind these deficits in care is even less well researched. METHODS A non-experimental, descriptive method using a Likert developed MISS CARE scale was used to estimate consensus estimates made by Australian midwives. Data analysis was undertaken using both Rasch analysis and Structural Equation Modelling. RESULTS Midwives' rationales behind why Australian midwifery care is missed can be quantified based on consensus estimates of participating midwives and the variances in the total scores of how important each contributing factor was in accounting for why midwifery care was missed can be explained and predicted. CONCLUSIONS Ten latent variables have significant predictor effects on why midwifery care was missed. These include insufficient human and physical care resources, increased work intensity and issues with workplace communication. These factors are further exacerbated by the midwives' teamwork satisfaction, work roster preferences and other demographic variables. The age of midwife, their highest qualification achieved and where they obtained their midwifery credentials from exerted no influence on their consensus estimates as to why midwifery care was missed. IMPLICATIONS FOR NURSING MANAGEMENT While this study confines itself to the Australian midwifery context, outcomes are informative for an international midwifery management audience. While the setting of the midwifery practice (be it private or public hospitals) is not significant in predicting why midwifery care is missed, resource allocation for care of mothers and their babies remains instrumental as a factor contributing to care omissions. Midwife demographic factors including age, type of midwifery qualification and where the credentials were obtained from exerted no influence as to why care was omitted. Midwifery recruitment should focus instead on re-dressing skills and skills mix shortages. Teamwork skills within the midwifery sector requires strengthening as problems arising from workplace communication, coupled with decreased midwifery staffing numbers and increased work intensity are strongly thought to be significant reason for missed care.