Breastfeeding and human lactation: education and curricular issues for pediatric nurse practitioners

Benefits and issues of education program for nurse-midwives on milk expression care for preterm mothers in postpartum period

Background and aims

Breastfeeding is important for preterm mothers and infants. However, evidence-based practice and standardized education remain inadequate. To implement evidence-based practice, continuous education is mandatory for nurse-midwives. We previously implemented our developed education program on early essential milk expression care for preterm mothers among Japanese nurse-midwives. Herein, we aimed to assess the effects of our education program on nurse-midwives' knowledge of milk expression care for preterm mothers in terms of changes in their correct answer rates for 20 specific knowledge items before and after the education program implementation. We also aimed to identify program-related issues from nurse-midwives' comments to improve the program.

Methods

We conducted a secondary analysis of our previous data and surveyed the knowledge of 36 nurse-midwives who received a similar face-to-face education program on milk expression care for mothers three months before (Pre-1), just before (Pre-2), just after (Post-1), and three months after (Post-2) the program. We obtained their comments at Post-2 and identified issues for program improvement.

Results

The knowledge items, in which the correct answer rates of Post-1 were significantly higher than those of Pre-2, were Verification of the motivation and intent, Benefits of breastfeeding for mothers and infants, Milk volume on the fourth day and at around the second week after birth, Lactogenesis stage 3, Autocrine control, Time between birth and the initiation of milk expression, Early initiation of milk expression, Frequent milk expression, and Duration of pumping. The issues identified were practical training, knowledge retention, and misunderstanding knowledge.

Conclusions

Nurse-midwives' unacquired knowledge of milk expression care for preterm mothers was effectively supplemented by the education program. Pre-education knowledge items with low correct answer rates must be strengthened during in-service education. Practical training, knowledge retention, and misunderstanding knowledge can be improved.

Implementing Health Policy Initiatives: An Effective Breastfeeding Teaching Strategy for Prelicensure Nursing Students

BACKGROUND

Exclusive breastfeeding for 6 months is recommended by all health professional organizations. However, women cite lack of support from health professionals as a barrier to breastfeeding. Foundational nursing education does not prepare students (future nurses) to support breastfeeding women. Therefore, an evidence-based breastfeeding curriculum "toolkit" supporting health policy was developed and implemented.

OBJECTIVE

The study was performed to determine the effectiveness of the toolkit education compared with standard education in an associate degree nursing program.

METHODS

A pretest-posttest survey design with intervention and comparison groups was used. Students (N = 102) completed pre- and posttests. A 15-item survey derived from Marzalik's (2004) instrument was used to measure nursing student knowledge about breastfeeding.

RESULTS

The mean number of pretest questions correct were statistically the same for the control and intervention groups. Both groups showed growth in their posttest scores, however the intervention group scored significantly higher on the posttest (intervention mean = 12.34, control mean = 10.73, t value (100 df) = -4.12, p < .0001).

CONCLUSION

The toolkit provides a curriculum that demonstrated enhanced student learning about breastfeeding.

IMPLICATIONS FOR NURSING

Use of a reliable intervention like this breastfeeding toolkit is essential in the development of nurses who can provide effective breastfeeding support.

Development and evaluation of a high-fidelity lactation simulation model for health professional breastfeeding education

BACKGROUND

A key reason for premature cessation of breastfeeding is inadequate support from healthcare providers. Most physicians and nurses do not feel confident in their ability to support families with breastfeeding initiation or maintenance. Increasing health professional confidence in clinical lactation skills is key to improving maternal and child health outcomes. High-fidelity (realistic) simulators encourage learner engagement, resulting in increased clinical skills competency, confidence, and transfer to patient care. Lactation educators teach with low-fidelity cloth and single breast models. There are no high-fidelity breast simulators for health professional education in clinical lactation. DEVELOPMENT AND EVALUATION OF A HIGH-FIDELITY LACTATION SIMULATION MODEL: In this commentary we describe the development of a high-fidelity Lactation Simulation Model (LSM) and how physician residents, nurse-midwifery students, and clinical lactation experts provided feedback on LSM prototypes.

LIMITATIONS

The user-testing described in this commentary does not represent comprehensive validation of the LSM due to small sample sizes and the significant conflict of interest.

CONCLUSION

For breastfeeding rates to improve, mothers need support from their nurses, midwives, pediatricians, obstetricians and gynecologists, and all healthcare staff who interact with pregnant and lactating women. Clinical education with high-fidelity breastfeeding simulators could be the ideal learning modality for trainees and hospital staff to build confidence in clinical lactation skills. The ability of a high-fidelity breastfeeding simulator to increase a learner's lactation knowledge and psychomotor skills acquisition, retention, and transfer to patient care still needs to be tested.

Testing the feasibility and safety of feeding preterm infants fresh mother's own milk in the NICU: A pilot study

Necrotizing enterocolitis (NEC) is the leading cause of death among infants born at <30 weeks’ gestation, but donor human milk can reduce the incidence of NEC. Unfortunately, freezing or pasteurizing human milk deactivates beneficial bioactive components. We evaluated the feasibility, safety, and impact of feeding very preterm infants fresh (unprocessed) mother’s own milk within 4 hours of expression. In our multicentre prospective cohort analytic study, we fed 109 control and 98 intervention infants previously frozen donor or mother’s own milk; only the intervention group was fed fresh mother’s own milk once daily from enrollment until 32 weeks’ corrected age. Control group mothers could not commit to provide fresh milk daily and were less likely receive antenatal corticosteroids than mothers in the intervention group. In the intervention group, 87.5% (98/112) of mothers were able to provide at least one feed of fresh milk a day. No critical incidents or non-compliance with the protocol were reported. The duration of mechanical ventilation and total parenteral nutrition use were shorter in the intervention group than controls (P < 0.01) but the length of hospital stay was similar (P = 0.57). Although the study might be underpowered, the intervention group had lower unadjusted rates of the composite outcome NEC ≥ stage 2 or mortality (8% vs 20%, P = 0.04), sepsis (22% vs 38%, P = 0.02), retinopathy of prematurity (17% vs 39%, P < 0.01) and bronchopulmonary dysplasia (32% vs 47%, P < 0.01) than the control. These results indicated that feeding fresh mother’s own milk once daily was safe, feasible, and may reduce morbidity.

Pediatric Nurse Practitioner Barriers to Supporting Breastfeeding by Mothers and Infants

Infant health and development outcomes are positively affected by breastfeeding. Despite the multitude of breastfeeding benefits to mothers and infants along with strong recommendations for exclusive breastfeeding from government agencies and professional associations, the rate of exclusive breastfeeding during the first six months of life remains low. Strongly positive attitudes make pediatric nurse practitioners, especially those in primary care settings, ideally positioned to encourage, support, and provide breastfeeding management to mothers and infants. However, pediatric nurse practitioners may report breastfeeding education and breastfeeding skills deficits along with other barriers to optimal breastfeeding care.

Attitudes, Practices, and Knowledge About Human Lactation Among Nursing Students

Background

Nurses are on the front line of the healthcare system and should, therefore, have the evidence-based knowledge to manage breastfeeding.

Objective

The objective of this study was to assess the attitudes and knowledge about human lactation among a group of nursing students.

Methods

An anonymous online survey was sent to all College of Nursing students at a local university in Kentucky.

Results

Nursing students participating in the survey favored breastfeeding over formula-feeding for infants. Lack of knowledge and various misconceptions about breastfeeding were reported. Whether a nursing student has or has not completed a class about human lactation during the nursing program, and has had or not children, significantly influences their attitudes and knowledge towards breastfeeding.

Conclusion

Future studies should focus on identifying if nursing faculty members and nursing students recognize human lactation as a value and central knowledge for nurses.

Implementing a Breastfeeding Toolkit for Nursing Education

All health professional organizations recommend exclusive breastfeeding for at least 6 months, with continued breastfeeding for 1 year or more after birth. Women cite lack of support from health professionals as a barrier to breastfeeding. Meanwhile, breastfeeding education is not considered essential to basic nursing education and students are not adequately prepared to support breastfeeding women. Therefore, a toolkit of comprehensive evidence-based breastfeeding educational materials was developed to provide essential breastfeeding knowledge. A study was performed to determine the effectiveness of the breastfeeding toolkit education in an associate degree nursing program. A pretest/posttest survey design with intervention and comparison groups was used. One hundred fourteen students completed pre- and posttests. Student knowledge was measured using a 12-item survey derived with minor modifications from Marzalik's 2004 instrument measuring breastfeeding knowledge. When pre- and posttests scores were compared within groups, both groups' knowledge scores increased. A change score was calculated with a significantly higher mean score for the intervention group. When regression analysis was used to control for the pretest score, belonging to the intervention group increased student scores but not significantly. The toolkit was developed to provide a curriculum that demonstrates enhanced learning to prepare nursing students for practice. The toolkit could be used in other settings, such as to educate staff nurses working with childbearing families.

Breastfeeding Curricular Content of Family Nurse Practitioner Programs

INTRODUCTION

Health care provider support is essential for breastfeeding success. Family Nurse Practitioners (FNP) are in a unique position to promote and manage breastfeeding. There is a gap in the literature regarding the amount and type of breastfeeding curricular content in FNP programs.

METHOD

An online survey of FNP programs was conducted. Data collection included program descriptors, didactic breastfeeding coursework, and clinical breastfeeding opportunities available to students.

RESULTS

No programs offered courses specific to breastfeeding: 82% of programs devoted 1 to 2 hours of didactic lactation content. More than three quarters of the programs offered students breastfeeding counseling opportunities; no programs, however, identified specific breastfeeding clinical competencies.

DISCUSSION

FNPs can play an integral role in breastfeeding promotion and counseling. There appears to be a lack of education provided to FNPs regarding breastfeeding management. Creative approaches that incorporate lactation education into FNP programs may increase FNPs' breastfeeding knowledge and enhance their ability to provide support to breastfeeding families.

Towards integrated care in breastfeeding support: a cross-sectional survey of practitioners' perspectives

Background

Integrated care is defined as concerted action of healthcare providers ensuring continuity of care within a patient-centered approach, thus contributing to healthcare efficiency and quality. Apart from the WHO/UNICEF Baby-Friendly Initiatives, integrated care has been poorly explored within the context of breastfeeding support. The aim of this study was to investigate the experience of breastfeeding support practitioners, identifying barriers and facilitators towards integrated care.

Methods

A 62-item survey was conducted among 900 participants at 3 international breastfeeding conferences. Analysis included uni-and bivariate descriptive statistics, categorizing of mutually exclusive response groups and thematic networks analysis of responses to 18 open-ended items.

Results

Three-hundred-and-one participants (33 % response), from 34 predominantly industrialized countries (98 %) on nearly all continents, responded to the survey. Norwegian residents alone, felt sufficiently supported in providing breastfeeding support by other healthcare providers, the work environment, society, the media and their National Breastfeeding Committee (P < 0.05). Out of 11 suggested measures for effective breastfeeding promotion, 96 % of respondents ranked integrated care as the most important. The largest response group identified in open-ended items, as a major barrier to integrated care in breastfeeding support, was “lacking or failing health promotion strategies” (n = 454), followed by “a lack of vertically integrated care” (n =268), described mainly as unsatisfactory cooperation within healthcare. This inconsistency of care also impairs “shared decision-making” on infant feeding for parents, including accessibility of information and support (n = 265). Among other measures, 29 % of respondents recommended incentivizing integrated breastfeeding support within healthcare. Two figures, based on open-ended response evaluations, illustrate participants’ ideas of the National Breastfeeding Committees’ role in coordinating policies and protagonists towards integrated breastfeeding support, and a family-centered model of integrated care to facilitate successful breastfeeding.

Conclusions

According to practitioners in breastfeeding support, integrated care is essential for successful breastfeeding. Quality and accessibility of breastfeeding support should be motivated by healthcare system incentives, to counter the reported lack of consistency of care within and beyond healthcare. To effectively integrate a continuum of breastfeeding support into healthcare and society, a policy consensus and strong political action are indispensable, with coordination by an empowered National Breastfeeding Committee.

Electronic supplementary material

The online version of this article (doi:10.1186/s13006-016-0072-y) contains supplementary material, which is available to authorized users.

Breastfeeding: What are the Barriers? Why Women Struggle to Achieve Their Goals

Despite recognized health benefits for both mothers and infants, significant disparities still exist in the rates of breastfeeding in the United States. Major organizations representing the health of women and children (including the Centers for Disease Control and Prevention [CDC], American Academy of Pediatrics [AAP], American Congress of Obstetrics and Gynecology [ACOG], American Academy of Family Physicians [AAFP], United Nations International Children's Emergency Fund (UNICEF), the World Health Organization [WHO], and the United States Public Health Service [PHS]) recommend exclusive breastfeeding, but statistics show that although many women initiate breastfeeding, few meet the recommended goals for duration and exclusivity. This article reviews the evidence related to barriers (prenatal, medical, societal, hospital, and sociocultural) that many mothers face, and explore the known barriers and the impact they have on a woman's ability to breastfeed her infant. Strategies will be discussed to address (and potentially overcome) some of the most common barriers women face along with a list of resources that can be useful in this effort. Gaps in care and areas that need further research will be noted. This article is targeted toward physicians and other healthcare providers who work with women and who can assist with and advocate for the removal of barriers and thereby improve the health of women and children by increasing the rates of breastfeeding initiation, duration, and exclusivity in the United States.