Associations of Interprofessional Adaptive Coordination and Intercultural Communication Competence with Missed Nursing Care in Remote Hospitals in South Papua, Indonesia

Background: Missed nursing care remains an important patient safety concern in geographically isolated and culturally diverse healthcare settings. Evidence remains limited on how cognitive safety capabilities, interprofessional coordination, and intercultural communication are associated with missed nursing care in remote multicultural settings. Methods: A cross-sectional survey was conducted among 312 nurses from four hospitals in Merauke Regency, South Papua, Indonesia. Data were analyzed using Partial Least Squares Structural Equation Modeling (PLS-SEM). Results: Risk pattern recognition, safety sensemaking, and learning from events orientation were positively associated with nurse moral resilience. Risk pattern recognition, safety sensemaking, and nurse moral resilience were also positively associated with interprofessional adaptive coordination, whereas learning from events orientation was not statistically associated with it. Interprofessional adaptive coordination was negatively associated with perceived missed nursing care, while nurse moral resilience showed no significant direct association. Nurse moral resilience also showed a significant indirect association with missed nursing care through interprofessional adaptive coordination. Intercultural communication competence moderated the association between interprofessional adaptive coordination and perceived missed nursing care, with a more negative association at higher levels of intercultural communication competence. Conclusions: The findings position interprofessional adaptive coordination as a distinctive relational component of the pattern surrounding perceived missed nursing care, with intercultural communication competence representing a pathway-specific contextual condition. The study provides an explanatory perspective on missed nursing care in a remote, culturally diverse healthcare setting.