Perinatal Missed Nursing Care: An Integrative Review

To identify the prevalence and patterns of perinatal missed nursing care, potential factors contributing to perinatal missed care, and understand the impact of perinatal missed nursing care on patient outcomes.

Integrative review following the methodology of Whittemore and Knafl. Data were sourced from PubMed, CINAHL, EMBASE, Web of Science, and Scopus and appraised using the Mixed Methods Appraisal Tool. Data were extracted and iteratively compared to identify patterns, themes, and relationships.

Seventeen studies from eight countries met inclusion criteria. Use of different adapted instruments covering diverse aspects of perinatal care made comparison across studies challenging. The prevalence of perinatal missed nursing care was 21.9% to 78.9% depending on the aspect of care assessed and measure used. Inadequate staffing, competing demands, and lack of material resources were commonly reported antecedents to perinatal missed nursing care. Limited maternal and neonatal outcomes have been explored; however, missed nursing care during labor and birth was significantly associated with lower hospital-level rates of initiation and exclusivity of breast milk feeding.

Missed nursing care is a recognized indicator of quality of care across hospital settings. The prevalence of missed perinatal nursing care was driven by inadequate staffing and other structural factors which may also contribute to nurse burnout and job dissatisfaction. National standards for registered nurse staffing in perinatal units should be budgeted for and followed to ensure safe, high-quality perinatal care. A universal measure for the perinatal context could advance understanding of perinatal missed care.