Author Affiliations: Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia (Drs Clark and Lake and Ms Mason); Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania (Drs Clark and Lake and Ms Mason); Demography Department, University of Pennsylvania School of Arts and Sciences, Philadelphia (Dr Peele); and Pennsylvania Hospital, University of Pennsylvania Health System, Philadelphia (Dr Clark.
J Perinat Neonatal Nurs. 2024;38(2):158-166. doi: 10.1097/JPN.0000000000000824. Epub 2024 May 13.
To examine the effect of nurse staffing in varying work environments on missed breastfeeding teaching and support in inpatient maternity units in the United States.
Breast milk is the optimal food for newborns. Teaching and supporting women in breastfeeding are primarily a nurse's responsibility. Better maternity nurse staffing (fewer patients per nurse) is associated with less missed breastfeeding teaching and support and increased rates of breastfeeding. We examined the extent to which the nursing work environment, staffing, and nurse education were associated with missed breastfeeding care and how the work environment and staffing interacted to impact missed breastfeeding care.
In this cross-sectional study using the 2015 National Database of Nursing Quality Indicator survey, maternity nurses in hospitals in 48 states and the District of Columbia responded about their workplace and breastfeeding care. Clustered logistic regression models with interactions were used to estimate the effects of the nursing work environment and staffing on missed breastfeeding care.
There were 19 486 registered nurses in 444 hospitals. Nearly 3 in 10 (28.2%) nurses reported missing breastfeeding care. In adjusted models, an additional patient per nurse was associated with a 39% increased odds of missed breastfeeding care. Furthermore, 1 standard deviation decrease in the work environment was associated with a 65% increased odds of missed breastfeeding care. In an interaction model, staffing only had a significant impact on missed breastfeeding care in poor work environments.
We found that the work environment is more fundamental than staffing for ensuring that not only breastfeeding care is not missed but also breastfeeding care is sensitive to nurse staffing. Improvements to the work environment support the provision of breastfeeding care.
Both nurse staffing and the work environment are important for improving breastfeeding rates, but the work environment is foundational.
在美国住院产妇单位中，考察不同工作环境下护士配置对母乳喂养教学和支持的影响。
母乳是新生儿的最佳食物。教授和支持妇女进行母乳喂养主要是护士的责任。更好的产妇护士配置（每名护士的患者人数较少）与较少的母乳喂养教学和支持以及更高的母乳喂养率有关。我们考察了护理工作环境、人员配置和护士教育与母乳喂养护理缺失之间的关联程度，以及工作环境和人员配置如何相互作用以影响母乳喂养护理缺失。
在这项使用 2015 年全国护理质量指标数据库调查的横断面研究中，来自 48 个州和哥伦比亚特区的医院的产科护士对其工作场所和母乳喂养护理情况进行了回应。使用具有交互作用的聚类逻辑回归模型来估计护理工作环境和人员配置对母乳喂养护理缺失的影响。
共有 444 家医院的 19486 名注册护士参与了研究。近 3 成（28.2%）护士报告称存在母乳喂养护理缺失的情况。在调整后的模型中，每增加一名患者，母乳喂养护理缺失的几率就会增加 39%。此外，工作环境每降低 1 个标准差，母乳喂养护理缺失的几率就会增加 65%。在交互模型中，只有在工作环境较差的情况下，人员配置才会对母乳喂养护理缺失产生显著影响。
我们发现，工作环境对于确保不仅母乳喂养护理不被忽视，而且对护士人员配置敏感至关重要，比人员配置更重要。改善工作环境有助于提供母乳喂养护理。
护士人员配置和工作环境对于提高母乳喂养率都很重要，但工作环境是基础。
