Investigating the Relationship Between Moral Sensitivity, Moral Distress, and Patient Safety Climate With Missed Nursing Care in Clinical Nurses: A Systematic Review Publisher



Nazari A M ; Bakhtiari Dovvombaygi H ; Gholami M ; Borhani F
Source: BMC Nursing Published:2026

Abstract

Background: In recent years, missed nursing care (MNC) has been a major concern for healthcare systems. Although existing literature highlights moral sensitivity (MS), moral distress (MD), and patient safety climate (PSCL), as important factors contributing to this issue, the precise relationship between these factors and MNC remains inadequately understood. This study aimed to explore the relationship between MS, MD, and PSCL with MNC in clinical nurses. Methods: The systematic review used several international databases, including PubMed, Web of Science, Scopus, EMBASE, ProQuest as well as Google Scholar search engine. The search covered publications from January 1, 1995, to August 31, 2025; thirteen articles were included in this review. Quality was assessed using the 8-item Joanna Briggs Institute (JBI) critical appraisal tool for analytical cross-sectional studies. Results: The findings showed varying links between MS and PSCL with MNC, spanning from no significant correlation to a significant negative one. Also, the findings revealed that the eligible included studies reported different relationships between MD and MNC, varying from no significant connection to a significant positive one. Conclusion: The study identified MS, MD, and the PSCL as potentially influencing factors for clinical nurses’ MNC. Health policymakers and clinical nursing managers should focus on these specific factors to create initiatives that aim to minimize clinical nurse’ MNC and improve the quality of care provided. Clinical trial number: Not applicable. © The Author(s) 2026.