TY - JOUR
T1 - MISSED NURSING CARE DURING LABOR AND BIRTH AND EXCLUSIVE BREAST MILK FEEDING DURING HOSPITALIZATION FOR CHILDBIRTH
AU - Simpson, Kathleen Rice
AU - Lyndon, Audrey
AU - Spetz, Joanne
AU - Gay, Caryl L.
AU - Landstrom, Gay L.
N1 - Funding Information:
This project was supported in part by the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) and by grant number R01HS025715 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily represent the official views of AWHONN or the Agency for Healthcare Research and Quality. Kathleen Rice Simpson is the Editor-in-Chief of MCN. Dr. Simpson did not participate in the peer review process or in the editorial decision for this article. The associate editor managed the peer review and editorial decision processes.
Publisher Copyright:
© 2020 Wolters Kluwer Health, Inc.
PY - 2020/9/1
Y1 - 2020/9/1
N2 - Purpose: The purpose of this study was to determine associations between missed nursing care and nurse staffing during labor and birth, and exclusive breast milk feeding at hospital discharge. Study Design and Methods: Labor and birth nurses in three states were surveyed about missed nursing care and their maternity units' adherence to the AWHONN (2010) nurse staffing guidelines for care during labor and birth, using the Perinatal Misscare Survey. Nursing responses were aggregated to the hospital level and estimated associations between missed nursing care, nurse staffing, and hospitals' exclusive breast milk feeding rates were measured using The Joint Commission's Perinatal Care Measure (PC-05). Results: Surveys from 512 labor nurses in 36 hospitals were included in the analysis. The mean exclusive breast milk feeding rate was 53% (range 13%-76%). Skin-to-skin care, breastfeeding within 1 hour of birth, and appropriate recovery care were on average occasionally missed (2.33 to 2.46 out of 4; 1 = rarely, 2 = occasionally, 3 = frequently, or 4 = always) and were associated with PC-05 [B(CI) -17.1(-29, -6.3), -17.9(-30.5, -6.2), and -15.4(-28.7, -2.1), respectively]. Adherence with overall staffing guidelines was associated with PC-05 [12.9(3.4, 24.3)]. Missed nursing care was an independent predictor of PC-05 [-14.6(-26.4, -2.7)] in a multilevel model adjusting for staffing guideline adherence, perceived quality, mean age of respondents, and nurse burnout. Clinical Implications: Exclusive breast milk feeding is a national quality indicator of inpatient maternity care. Nurses have substantial responsibility for direct support of infant feeding during the childbirth hospitalization. These results support exclusive breast milk feeding (PC-05) as a nurse-sensitive quality indicator.
AB - Purpose: The purpose of this study was to determine associations between missed nursing care and nurse staffing during labor and birth, and exclusive breast milk feeding at hospital discharge. Study Design and Methods: Labor and birth nurses in three states were surveyed about missed nursing care and their maternity units' adherence to the AWHONN (2010) nurse staffing guidelines for care during labor and birth, using the Perinatal Misscare Survey. Nursing responses were aggregated to the hospital level and estimated associations between missed nursing care, nurse staffing, and hospitals' exclusive breast milk feeding rates were measured using The Joint Commission's Perinatal Care Measure (PC-05). Results: Surveys from 512 labor nurses in 36 hospitals were included in the analysis. The mean exclusive breast milk feeding rate was 53% (range 13%-76%). Skin-to-skin care, breastfeeding within 1 hour of birth, and appropriate recovery care were on average occasionally missed (2.33 to 2.46 out of 4; 1 = rarely, 2 = occasionally, 3 = frequently, or 4 = always) and were associated with PC-05 [B(CI) -17.1(-29, -6.3), -17.9(-30.5, -6.2), and -15.4(-28.7, -2.1), respectively]. Adherence with overall staffing guidelines was associated with PC-05 [12.9(3.4, 24.3)]. Missed nursing care was an independent predictor of PC-05 [-14.6(-26.4, -2.7)] in a multilevel model adjusting for staffing guideline adherence, perceived quality, mean age of respondents, and nurse burnout. Clinical Implications: Exclusive breast milk feeding is a national quality indicator of inpatient maternity care. Nurses have substantial responsibility for direct support of infant feeding during the childbirth hospitalization. These results support exclusive breast milk feeding (PC-05) as a nurse-sensitive quality indicator.
KW - AWHONN
KW - Breastfeeding
KW - Healthcare rationing
KW - Hospital
KW - Maternal-child nursing
KW - Missed care
KW - Nurse staffing
KW - Nursing care standards
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U2 - 10.1097/NMC.0000000000000644
DO - 10.1097/NMC.0000000000000644
M3 - Article
C2 - 32496351
AN - SCOPUS:85094685049
SN - 0361-929X
VL - 45
SP - 280
EP - 288
JO - MCN The American Journal of Maternal/Child Nursing
JF - MCN The American Journal of Maternal/Child Nursing
IS - 5
ER -