Association between nurse work environment and severe maternal morbidity in high-income countries: A systematic review and call to action

Abstract

Aim: To identify evidence related to association between the nurse work environment and severe maternal morbidity in high-income countries.

Design: Quantitative Systematic review.

Data sources: Cumulative Index of Nursing and Allied Health Literature, Cochrane Database of Systematic Reviews, PubMed/Medline, and Scopus were systematically searched for studies published in English from January 1990-December 2019. Studies were selected based on a priori eligibility criteria.

Review methods: Two independent reviewers used a two-phase screening process. First, the reviewers assessed the eligibility of studies based on titles and abstracts; followed by assessing the full text of all remaining studies based on the eligibility criteria. An adapted version of the Joanna Briggs Institute data extraction tool was created to extract relevant information from studies reviewed during the second screening phase.

Results: Of the 535 de-duplicated articles examined by two independent reviewers, there were no eligible empirical studies that assessed the association between nurse work environment and severe maternal morbidity.

Conclusion: There is a critical gap in knowledge regarding how characteristics of the nurse work environment may influence severe maternal morbidity in high-income countries. Future directions for nursing research include using available maternal health surveillance hospital-level data, conducting high-quality studies, and using evidence-based frameworks to guide future studies. Future directions for nursing practice include leveraging professional learning communities for nursing education and training and leveraging quality improvement initiatives.

Impact: As the first known systematic review of its kind, this 'empty review' provides evidence of a lacking body of literature on the association between nurse work environment, as a modifiable organizational characteristic and preventable severe maternal morbidity in high-income countries. This article provides a call to action in the form of five recommendations for future nursing research and practice, which could serve to elucidate research, practice, and policy opportunities to reduce preventable severe maternal morbidity in high-income countries.

Keywords: developed countries; literature review; maternal mortality; maternal-child nursing; pregnancy complications; systematic review; work environment.