Nurs Res. 2022;71(6):432-440. doi: 10.1097/NNR.0000000000000620. Epub 2022 Sep 3.
Nursing care is essential to overall quality of healthcare experienced by patients and families-especially during childbearing. However, evidence regarding quality of nursing care during labor and birth is lacking, and established nurse-sensitive outcome indicators have limited applicability to maternity care. Nurse-sensitive outcomes need to be established for maternity care, and prior research suggests that the initiation of human milk feeding during childbirth hospitalization is a potentially nurse-sensitive outcome.
The aim of this study was to determine the relationship between nurse-reported staffing, missed nursing care during labor and birth, and exclusive breast milk feeding during childbirth hospitalization as a nurse-sensitive outcome.
2018 Joint Commission PC-05 Exclusive Breast Milk Feeding rates were linked to survey data from labor nurses who worked in a selected sample of hospitals with both PC-05 data and valid 2018 American Hospital Association Annual Survey data. Nurse-reported staffing was measured as the perceived compliance with Association of Women's Health, Obstetric and Neonatal Nurses staffing guidelines by the labor and delivery unit. Data from the nurse survey were aggregated to the hospital level. Bivariate linear regression was used to determine associations between nurse and hospital characteristics and exclusive breast milk feeding rates. Generalized structural equation modeling was used to model relationships between nurse-reported staffing, nurse-reported missed care, and exclusive breast milk feeding at the hospital level.
The sample included 184 hospitals in 29 states and 2,691 labor nurses who worked day, night, or evening shifts. Bivariate analyses demonstrated a positive association between nurse-reported staffing and exclusive breast milk feeding and a negative association between missed nursing care and exclusive breast milk feeding. In structural equation models controlling for covariates, missed skin-to-skin mother-baby care and missed breastfeeding within 1 hour of birth mediated the relationship between nurse-reported staffing and exclusive breast milk feeding rates.
This study provides evidence that hospitals' nurse-reported compliance with Association of Women's Health, Obstetric and Neonatal Nurses staffing guidelines predicts hospital-exclusive breast milk feeding rates and that the rates are a nurse-sensitive outcome.
护理是患者和家庭整体医疗质量的重要组成部分，尤其是在分娩期间。然而，关于分娩期间护理质量的证据不足，并且已确立的护士敏感的结局指标对产妇护理的适用性有限。需要为产妇护理建立护士敏感的结局指标，先前的研究表明，分娩住院期间开始母乳喂养是一个潜在的护士敏感的结局。
本研究旨在确定护士报告的人员配备、分娩期间的护理缺失与分娩住院期间的纯母乳喂养之间的关系，作为护士敏感的结局。
2018 年联合委员会 PC-05 纯母乳喂养率与在选定的样本医院工作的分娩护士的调查数据相关联，这些医院既有 PC-05 数据又有有效的 2018 年美国医院协会年度调查数据。护士报告的人员配备被衡量为分娩和分娩单位遵守妇女健康、产科和新生儿护士协会人员配备指南的感知程度。护士调查数据被汇总到医院层面。使用双变量线性回归来确定护士和医院特征与纯母乳喂养率之间的关联。使用广义结构方程模型来模拟医院层面上护士报告的人员配备、护士报告的护理缺失和纯母乳喂养之间的关系。
该样本包括来自 29 个州的 184 家医院和 2691 名在白天、夜间或晚上轮班工作的分娩护士。双变量分析表明，护士报告的人员配备与纯母乳喂养呈正相关，护理缺失与纯母乳喂养呈负相关。在控制协变量的结构方程模型中，护士报告的皮肤接触母婴护理缺失和出生后 1 小时内母乳喂养缺失介导了护士报告的人员配备与纯母乳喂养率之间的关系。
本研究提供了证据表明，医院护士报告的遵守妇女健康、产科和新生儿护士协会人员配备指南预测了医院纯母乳喂养率，并且该率是一个护士敏感的结局。
