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September/October 2020 - Volume 45 - Issue 5
pp: 253-316,E17-E20


Implications of Missed Care, Nurse Staffing, and the Nursing Work Environment on Patient Outcomes in Maternity, Neonatal, and Pediatric Inpatient Settings

Simpson, Kathleen Rice

MCN, The American Journal of Maternal/Child Nursing. 45(5):253, September/October 2020.

In this special topics series on maternity, neonatal, and pediatric nurse staffing and the nursing work environment, we present four studies that cover challenges of practicing in stressful clinical settings including inadequate nurse staffing and unsafe environments, relative to potential implications for patients and nurses. Missed, delayed, and incomplete nursing care is now being studied in these specialty settings with a focus on links to patient outcomes. Two of the studies specifically included hospitals' adherence to the Association of Women's Health, Obstetric, and Neonatal Nurses nurse staffing guidelines as a factor in their findings and clinical implications.

Hot Topics in Maternity Nursing

Structural Competence

Wisner, Kirsten

MCN, The American Journal of Maternal/Child Nursing. 45(5):308, September/October 2020.

Perinatal nurses can tailor care and supportive strategies by maintaining cultural competence, practicing cultural humility, and probing for structural barriers and risk factors inherent in each patient's unique situation. Our maternity nursing expert, Dr. Wisner, explains how to integrate these concepts in clinical practice.

Hot Topics in Pediatric Nursing

Lessons Learned from the COVID-19 Pandemic for Pediatric Workplaces

Beal, Judy A.

MCN, The American Journal of Maternal/Child Nursing. 45(5):309, September/October 2020.

The COVID-19 pandemic has shown the best of the best in nursing. Nurses are using scientific evidence to guide care, leading teams of clinicians into uncharted territory, and supporting patients, families and co-workers at unprecedented levels. Our pediatric nursing expert, Dr. Beal, highlights lessons to be learned that can strengthen the quality of pediatric work environments.


Protecting Milk Supply During the COVID-19 Pandemic

Spatz, Diane L.

MCN, The American Journal of Maternal/Child Nursing. 45(5):310, September/October 2020.

During the pandemic, supporting needs of childbearing families and the role of human milk as a lifesaving medical intervention should not be forgotten. International organizations such as the United Nations Children's Fund and the World Health Organization have recommended early, exclusive breastfeeding and skin-to-skin contact during COVID-19 including women who are positive for the virus. Our breastfeeding expert, Dr. Spatz, offers details of these recommendations.

Global Health and Nursing

Self-Help-Plus: Making a Difference for Vulnerable Women

Callister, Lynn Clark

MCN, The American Journal of Maternal/Child Nursing. 45(5):311, September/October 2020.

There are women globally whose life experiences have been different than many of our own: women who have experienced or witnessed horrible traumatic events; women who struggle with overwhelming poverty, lack of inadequate housing and food insecurity; women who live in places where chronic endemic violence and armed conflict exists; women living in places where there are extensive humanitarian needs; and women who are displaced, forgotten and alone. Our global health and nursing expert, Dr. Callister, discusses one of the low-intensity psychological interventions for women in need developed by the World Health Organization.

Toward Evidence-Based Practice

Perinatal Patient Safety Column

Measuring Nurses' Contribution to Care and Outcomes is a Patient Safety Issue

Simpson, Kathleen Rice

MCN, The American Journal of Maternal/Child Nursing. 45(5):316, September/October 2020.

Ability to accurately and reliably measure nursing care and link with patient outcomes is a safety issue. The type and dose of nursing care that is required for optimal outcomes must be established as part of the body of evidence to support safe nurse staffing. More work is needed to identify nurse-sensitive measures in maternity, neonatal, and pediatric nursing settings.

Association of Clinical Nursing Work Environment with Quality and Safety in Maternity Care in the United States

Clark, Rebecca R. S.; Lake, Eileen T.

MCN, The American Journal of Maternal/Child Nursing. 45(5):265-270, September/October 2020.

This study included 1,165 nurses from 166 maternity units in four states. One-third of nurses gave their units an overall safety grade of “excellent,” but this decreased to less than one-sixth of nurses in units with poor work environments. Overall, 65% of nurses reported that their mistakes were held against them. A good work environment, compared to a poor work environment, was significantly associated with fewer nurses grading safety as poor.

Missed Nursing Care During Labor and Birth and Exclusive Breast Milk Feeding During Hospitalization for Childbirth

Simpson, Kathleen Rice; Lyndon, Audrey; Spetz, Joanne; More

MCN, The American Journal of Maternal/Child Nursing. 45(5):280-288, September/October 2020.

When maternity nurses are caring for women in the context of inadequate nurse staffing, important aspects of nursing care may be missed, delayed, or incomplete. The concept of missed nursing care is increasingly being applied to maternity, neonatal and pediatric nursing settings after many years of focus on medical-surgical units in acute care hospitals. In this study missed nursing care and inadequate nurse staffing were found to be associated with exclusive breast milk feeding during the childbirth hospitalization.

Impact of the Quality of Postpartum Sleep and its Health Determinants on Human Milk Volume

Carrega, Joanna; Lee, Shih-Yu; Clark, Patricia; More

MCN, The American Journal of Maternal/Child Nursing. 45(5):289-295, September/October 2020.

In this study of new mothers, the relationship between sleep quality and breast milk volume was explored. Most women reported substantial sleep disturbance during the first month postpartum. Poor sleep quality was a significant predictor for lower milk volume.

Intraoperative Mother and Baby Skin-to-Skin Contact during Cesarean Birth: Systematic Review

Frederick, Anitra; Fry, Tena; Clowtis, Licia

MCN, The American Journal of Maternal/Child Nursing. 45(5):296-305, September/October 2020.

Placing the newborn skin-to-skin on the mother's chest after birth while cesarean surgery is completed was found to be beneficial in this systematic review. Safety of mother and baby during skin-to-skin contact are promoted when nurse staffing in the operating room and post anesthesia care unit are consistent with published professional guidelines so the mother-baby couplet can be continually assessed.

CE Connection

Missed Nursing Care in Pediatric and Neonatal Care Settings: An Integrative Review

Ogboenyiya, Anisa A.; Tubbs-Cooley, Heather L.; Miller, Elaine; More

MCN, The American Journal of Maternal/Child Nursing. 45(5):254-264, September/October 2020.

There is very little research about missed nursing care in the neonatal and pediatric inpatient setting. In this integrated review, missed neonatal and pediatric nursing care was associated with workload, patient acuity, work environment, nurse characteristics, and prolonged hospitalization of preterm infants. Missed nursing care and related patient and nurse outcomes in diverse pediatric samples remain an area for future research.

Nurses' Experiences of “Being Swamped” in the Clinical Setting and Association with Adherence to AWHONN Nurse Staffing Guidelines

Roth, Cheryl; Brewer, Melanie A.; Bay, R. Curtis; More

MCN, The American Journal of Maternal/Child Nursing. 45(5):271-279, September/October 2020.

When nurses are faced with high census and acuity without enough nurses to provide required care, they can feel overwhelmed and stressed. This phenomenon was characterized as “being swamped” in this study of 1,198 members of the Association of Women's Health, Obstetric, and Neonatal Nurses (AWHONN). Nurses described their experiences of being swamped. Nurses practicing in hospitals following the AWHONN nurse staffing guidelines always or most of the time reported less frequency of being swamped as compared to those in hospitals that followed the guidelines some of the time, or rarely.