Breastfeeding Support Experiences of Registered Nurses in a Large Children’s Hospital System

Work experience of breastfeeding nurses returning to work after maternity leave in Liaoning Province of China: A qualitative study

AIM

With the implementation of China's three-child policy in 2021, the nurse population faces an increase in the number of breastfeeding nurses returning to work after maternity leave. This study aims to describe the work experience of breastfeeding nurses returning to work after maternity leave.

DESIGN

A qualitative descriptive design.

METHODS

The data were collected through semi-structured interviews with eight nurses and analysed through Braun and Clarke's thematic analysis.

RESULTS

Three themes and nine sub-themes emerged from the analysis of the interviews: changes in nurses (emotional changes, physical changes and changes in work); needs for an improving work environment (needs for a supportive workplace and nurse shortage); support for breastfeeding nurses (support from coworkers, support from the manager, support from the organisation and own need for work).

PUBLIC CONTRIBUTION

This study highlighted that breastfeeding nurses need an adjustment period when they return to work after maternity leave. Successful breastfeeding requires support from coworkers, managers and the organisation. In addition, workplace support for breastfeeding and management for nurses needs to be improved.

Psychometric Properties of the Breastfeeding and Employment Scale

OBJECTIVE

To evaluate the psychometric properties of the Breastfeeding and Employment Scale (BES).

DESIGN

Secondary analysis of data from the Infant Feeding Practices Study II survey, a longitudinal study on infant feeding practices.

SETTING

United States.

PARTICIPANTS

Women who were employed, breastfeeding, and completed the Infant Feeding Practices Study II BES at the 3-month postpartum assessment (N = 508).

METHODS

Participants reported their perceived level of breastfeeding support in the workplace by responding to the nine binary items on the BES. We evaluated the instrument's internal consistency reliability (Kuder-Richardson 20), test-retest reliability (Cohen's kappa), construct validity (principal component analysis), and convergent validity (relationship with a similar item).

RESULTS

The internal consistency of the BES (Kuder-Richardson 20 = 0.72) supported the reliability of scale. The test-retest reliability was moderate (0.41-0.60). The Spearman's rho correlation coefficient was 0.66, indicating adequate test-rest reliability for the total BES score between the 3-month and 6-month assessments (p < .01). The factor analysis demonstrated that the items cluster into one factor (psychosocial and structural barriers to breastfeeding in the workplace). Participants who reported more barriers to breastfeeding in the workplace also reported a less supportive workplace environment, which supported the convergent validity of the scale.

CONCLUSION

The psychometric testing of the BES provided initial support for the reliability and validity of the instrument. It may be a useful tool for measuring workplace lactation support in a concise manner.

Uncovering the Experience: Return to Work of Nurses After Parental Leave

INTRODUCTION

To understand the experiences of emergency nurses who have returned to work after parental leave, specifically relating to the return to work transition, work-life balance, work engagement, and opportunities to continue human milk expression.

METHODS

Nurses (N = 19) were recruited from 5 emergency departments within 1 hospital system in the United States Midwest. Nurses (n = 11) were eligible to participate in a one-on-one interview if they had returned from parental leave within 6 months of the interview date. Nurses (n = 8) were eligible to participate in a focus group if they had returned from parental leave within 2 years of the interview date. Interviews were structured and data collection concluded when researchers believed data saturation was reached. Interviews were audio recorded and transcribed verbatim. Data were analyzed using Braun and Clarke's qualitative thematic analysis 6-phase framework.

RESULTS

Three major themes from the data were identified: (1) work engagement, (2) lactation, and (3) childcare. Work engagement was broken down into the subthemes: lack of communication, perceived engagement expectations, and actual engagement. Lactation was broken down into the subthemes: the act of pumping, lactation breaks, and lactation rooms. The coronavirus disease 2019 pandemic impact on return-to-work is described under each major theme.

DISCUSSION

Our findings provide insight into the unique challenges and experiences of nurses navigating parental leave and return-to-work in the emergency department. Strategies such as provision of managerial check-ins, return to work reorientation, lactation break coverage, enhanced supplementary lactation support, and leadership-provided accommodation may lighten the burden of these challenges and improve the returning nurse's job satisfaction.

Women's Health and Working Life: A Scoping Review

Women's health matters for participation in working life. The objective of this study was to explore female physiology in a work-life context and to investigate possible associations between women's health, sickness absence and work ability. A scoping review was conducted to develop a systematic overview of the current research and to identify knowledge gaps. The search strategy was developed through a population, concept and context (PCC) model, and three areas of women's health were identified for investigation in the context of work. A total of 5798 articles were screened by title and abstract and 274 articles were screened by full text; 130 articles were included in the review. The material included research from 19 countries; the majority of the studies used quantitative methods. The results showed an impact on the occupational setting and an association between sickness absence, work ability and all three areas of women's health, but a holistic and overall perspective on female biology in the work context is missing. This review calls for more knowledge on health and work and possible gender differences in this regard. Women's health and working life involve a complex connection that has the potential to develop new knowledge.

How do breastfeeding workplace interventions work?: a realist review

BACKGROUND

Women are representing an increasing share of the labor force, thus, raising the need to accommodate breastfeeding working mothers at the workplace. While there is an emerging body of evidence supporting the positive influence of workplace lactation programs on breastfeeding outcomes, there is a lack of literature on the mechanisms underlying those interventions. Aims of this realist review were three-fold: to uncover underlying mechanisms, determine who benefits the most from such interventions and important contextual factors influencing uptake.

METHODS

Purposive bibliographic searches on Medline, Web of Science Core Collection, CINAHL, Global Health, LILACS, Global Index Medicus, Business Source Complete, Proquest Dissertations and Theses and Open Access Theses and Dissertations were conducted to identify relevant publications. Included publications (qualitative and quantitative) described interventions aiming to improve the breastfeeding behavior of working mothers, that were initiated by the employer, reported on breastfeeding outcomes and had a clearly defined workplace. Publications only focusing on maternity leave or that were not published in English, Spanish, Portuguese or German were excluded. A realist approach was followed to identify how workplace interventions work, who benefits the most and the important contextual factors.

RESULTS

The bibliographic search yielded a total of 4985 possible publications of which 37 publications were included in the realist analysis. Effective workplace breastfeeding interventions activate three mechanisms: 1) awareness of the intervention, 2) changes in workplace culture, manager/supervisor support, co-worker support and physical environments, and 3) provision of time. Contextual factors such as the distance between the workplace and the infant and the type of workplace may influence the degree of activation of the underlying mechanisms for programs to positively impact breastfeeding outcomes.

CONCLUSIONS

In order to be effective, workplace breastfeeding interventions need to: raise awareness of the intervention(s) available among working mothers as well as their work environment, change the workplace culture, foster manager/supervisor support and co-workers support, provide enough time and adequate space and facilities for women to breastfeed or express breastmilk during the workday.

Breastfeeding at the workplace: a systematic review of interventions to improve workplace environments to facilitate breastfeeding among working women

BACKGROUND

Breastfeeding can be affected by maternal employment. This is important considering that in 2019, 47.1% of women globally participated in the labor force. The aim of this study was to review workplace interventions to promote, protect and support breastfeeding practices among working mothers globally.

METHODS

A systematic review was conducted following the guidance of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Observational, experimental and qualitative peer-reviewed studies in English and Spanish, published between 2008 and 2019 were included. The review focused on working women who were pregnant, breastfeeding or who recently had a child, and women's working environments. The outcomes of interest included breastfeeding intentions, initiation, exclusivity and duration, confidence in breastfeeding or breastmilk extraction, and perceived support at workplace. Quality was assessed according to National Institute for Health and Care Excellence (NICE) checklist for systematic reviews. It was registered on PROSPERO (#140624).

RESULTS

Data was extracted from 28 quantitative and 9 qualitative studies. The most common interventions were designated spaces for breastfeeding or breastmilk extraction (n = 24), and the support from co-workers (n = 20). The least common interventions were providing breast pumps (n = 4) and giving mothers the flexibility to work from home (n = 3). Studies explored how interventions affected different breastfeeding outcomes including breastfeeding duration, breastfeeding exclusivity, confidence in breastmilk expression, and breastfeeding support. The evidence suggests that workplace interventions help increase the duration of breastfeeding and prevent early introduction of breastmilk substitutes. Having a lactation space, breastmilk extraction breaks, and organizational policies are key strategies. However, to achieve equitable working conditions for breastfeeding mothers, organizational and interpersonal changes need to occur as well.

CONCLUSIONS

The systematic review revealed that interventions at the workplace are important in protecting, promoting and supporting breastfeeding among working mothers. To achieve equitable work environments and fair nutritional opportunities for infants of working mothers, interventions should focus at the three ecological layers - individual, interpersonal, and organizational. The quality of studies can be improved. There is a need for studies assessing impacts of workplace interventions on infant feeding practices, mothers' self-esteem and outcomes such productivity and abstentionism.

A Socioecological Approach to Understanding Workplace Lactation Support in the Health Care Setting

Introduction: The percentage of working women with children under the age of 3 has nearly doubled since the 1970s, elevating the importance of understanding and improving workplace lactation support. This study aimed to examine employee perceptions of and experiences with workplace lactation support within a single health care system. We used a socioecological approach and included the views of a broad range of employees with and without lactation experience to capture diverse perspectives at multiple levels. Materials and Methods: Employees were recruited from an integrated health care system in the southeastern United States. Five focus groups were conducted during June to August 2017. Transcripts were analyzed using qualitative content analysis, with key themes organized at four levels of analysis: individual, interpersonal, departmental, and organizational. Results: Thirty-five clinical and nonclinical employees participated. Employees shared varied perspectives on workplace lactation support, which emphasized the: (1) importance of having a lactation policy, (2) critical role of leadership in setting the tone for workplace lactation, and (3) differential experience between clinical and non-clinical lactating employees. Conclusion: Employee experiences with lactation support in the health care setting are influenced by individual, interpersonal, departmental, and organizational factors that must be considered in the design of effective workplace lactation support programs. Policies and programs that align with organizational values and accommodate the needs of employees in varying roles are recommended. By using a socioecological perspective, this study identifies practical strategies for implementing, improving, and sustaining workplace lactation support across multiple levels of a large health care organization.

Awareness of Breastfeeding Laws and Provisions of Students and Employees of Institutions of Higher Learning in Georgia

BACKGROUND

Over the past 2 decades, southern states in the United States have recorded the lowest breastfeeding rates. It is not known whether awareness of breastfeeding laws and provision of resources play any role in their breastfeeding practices.

RESEARCH AIMS

The aims were (a) to describe awareness of breastfeeding laws and provisions by students and employees of institutions of higher learning in the state of Georgia, (b) to describe awareness by race and ethnicity, and (c) to determine factors associated with awareness of breastfeeding laws and provisions among students and employees within Georgia institutions of higher learning.

METHODS

A cross-sectional online survey of students ( n = 1,923) and employees ( n = 1,311) associated with five institutions within the University System of Georgia ( N = 3,271) was completed. Convenience sampling was used. Data were collected through Qualtrics. Chi-square test was used to examine differences between groups, while logistic regression was used to examine associations.

RESULTS

Participants included 33.3% undergraduate, 26.2% graduate students, 24.6% staff, 14.2% faculty, and 1.7% administrators. Over two thirds were female and white. Almost one third reported having a child or children. Awareness of breastfeeding laws and provisions was very low among respondents, with 26.6 and 9.6% aware of federal and state provisions, respectively. While less than 10% were familiar with the Baby Friendly Hospital Initiative program, 52.6% reported their institution provides a supportive environment for breastfeeding. Being a student and being a minority were negatively associated with awareness of laws and provisions that support breastfeeding.

CONCLUSION

The need for focused efforts on increasing awareness of legislative and institutional provisions and support for breastfeeding exists.