Unfinished Nursing Care and Its Reasons in Neonatal Intensive Care

ABSTRACT Background: Unfinished Nursing Care (UNC) in Neonatal Intensive Care Units (NICUs) is a critical determinant of infant outcomes. The Neonatal Extent of Work Rationing Instrument (NEWRI) measures the frequency of UNC but not the underlying reasons. Integrating the NEWRI with the UNC Survey (UNCS) to capture these reasons may help prevent or mitigate UNC. Purpose: To develop and validate a comprehensive tool for investigating UNC and related reasons in NICUs. Methods: A developmental and validation study was conducted in 2024 following the COnsensus-based Standards for the selection of health Measurement INstruments guideline. Part A of the NEWRI and Part B of the UNCS were integrated to develop the Italian version of the NEWRI with Reasons (NEWRI_IR). Nurses from 8 Italian NICUs (N = 342) were invited to participate. Descriptive and inferential analyses, Mokken Scale Analysis, and Confirmatory Factor Analyses were conducted. Results: A total of 198 nurses (57.9%) participated. The NEWRI_IR comprises 2 sections: Part A (25 items, care interventions) and Part B (15 items, reasons). Part A demonstrates strong scalability (H = 0.743), indicating a hierarchical structure among items. Part B revealed a 5-factor structure: “Human resources and workflow predictability,” “Communication issues,” “Material resources,” “Priority setting,” and “Human resources issues.” The most frequent UNC involved parental education and support, whereas inadequate nurse staffing and frequent interruptions were main reasons. Implication for Practice and Research: The NEWRI_IR is a psychometrically validated instrument for assessing the frequency and reasons for UNC in NICUs, supporting monitoring of care quality and guiding organizational interventions.