Infant Feeding Beliefs and Day-to-Day Feeding Practices of NICU Nurses

Breastfeeding knowledge & attitudes: Comparison among post-licensure undergraduate and graduate nursing students

RESEARCH AIMS

The aims of this study are to compare the knowledge and attitude scores between undergraduate and graduate nursing students and to identify the variables associated with higher breastfeeding knowledge and attitudes.

BACKGROUND

Nurses' knowledge and attitudes towards breastfeeding greatly impact their roles in promoting and supporting breastfeeding. However, they may not have sufficient knowledge and/or positive attitudes to support and advocate for these families. Many studies focused on professional nurses or undergraduate students' knowledge, attitudes, and beliefs. Few studies included registered nurses enrolled in post licensure undergraduate and graduate nursing programs.

DESIGN

A cross-sectional, prospective, and descriptive study.

METHODS

A convenient sample of 95 nursing students (50 undergraduate and 45 graduate) was recruited from an ethnically diverse, urban university in Southern California. Students voluntarily completed an online survey adapted from Brodribb, et al. (2008). Bivariate analysis was conducted to identify relationships between study variables.

RESULTS

Compared to undergraduates, graduate students scored higher on knowledge and attitudes towards breastfeeding (p < 0.001). Students' perception of their prior academic breastfeeding preparation was not related to their current knowledge and attitudes. Age, having children, exclusively breastfed own baby, and duration of personal breastfeeding were positively associated with attitudes and knowledge (p < 0.05 for all variables). Years of nursing experience (p = .01) was positively associated with attitudes only.

CONCLUSIONS

Compared to academic preparation, age, having children, and personal breastfeeding experiences seem to be better indicators of breastfeeding knowledge and attitudes. Nursing programs should exert more effort in enhancing curricular evidence based breastfeeding education. More research is needed to support these efforts.

Newborn Feeding Knowledge and Attitudes among Medical Students

This study sought to assess newborn feeding knowledge and attitudes among medical students. A sample of 649 Portuguese medical students completed an online survey containing a sociodemographic questionnaire, the Newborn Feeding Ability Questionnaire (NFA), and the Iowa Infant Feeding Attitudes Scale (IIFAS). The overall sample showed moderate scores for all variables. Gender analysis identified significant differences only for the dimension related to the benefits of skin-to-skin contact between mother and newborn where women scored higher. Analysis by year of training found that students with more years of training scored higher on all variables of newborn feeding knowledge that were positively correlated and were positive predictors of newborn feeding attitudes. Students with fewer years of training scored higher on work practices interfering with newborn feeding ability, which were negatively correlated and were negative predictors of newborn feeding attitudes. These results demonstrate that medical students with more years of training are the most prepared, however, the moderate results of the sample raise concerns. Our results point to the importance of providing medical students with adequate knowledge in order to influence their attitudes toward newborn feeding and contribute to better working practices for future health professionals.

Implementing an Evidence-Based Feeding Protocol: Impact on Nurses' Knowledge, Perceptions, and Feeding Culture in the NICU

BACKGROUND

Evidence-based feeding practices are often variable among neonatal providers due to lack of knowledge and neonatal intensive care unit (NICU) feeding culture norms.

PURPOSE

To evaluate changes in NICU nurses' knowledge, perceptions, feeding practices and culture following education about, and implementation of, an evidence-based Infant-Driven Feeding (IDF) protocol.

METHODS

A pre-/postprospective comparative design was used to survey 120 registered nurses employed in a level 3 NICU about feeding practices, knowledge, and culture prior to IDF education and 1 to 2 months after IDF implementation.

RESULTS

The preeducation survey yielded 59 respondents; of these, 30 responded to the same survey after IDF implementation. Postimplementation responses were significant for fewer nurses making decisions to begin oral feedings ( P = .035), greater use of gestational age to increase frequency of oral feeding attempts ( P = .03), less reliance on weight loss to decrease oral feeding attempts ( P = .018), an increase in use of combination interventions to prepare infants for oral feeding ( P = .001), and greater willingness to allow a rest period or stop the feeding if an infant falls asleep after completing 70% of the feeding ( P = .03).

IMPLICATIONS FOR PRACTICE AND RESEARCH

Trends in several survey categories following the education program and implementation of IDF support the use of evidence-based practices (EBPs) such as IDF. Future research focused on nurses' perceptions of how education influences integration of specific EBPs into practice is needed. Evaluating EBP mentorship combined with education about EBPs can provide insights on how best to integrate EBPs into practice.

Influence of patterns of neonatal transfers on breastfeeding outcomes

AIM

To investigate/evaluate the impact of hospital transfers on breastfeeding outcomes for infants requiring neonatal intensive care and to explore approaches to supporting lactation and breastfeeding.

METHODS

A national study of two cohorts of infants admitted to the nine neonatal intensive care units (NICUs) in New South Wales (NSW) Australia using data sourced from a prospectively collected NICUS data collection.

RESULTS

A total of 7829 infants were admitted to the nine NICUs in NSW for two 18-month cohorts (2012/2013 and 2015/2016) and were included in the study. These infants experienced 17 238 transfers to 107 different hospitals during the study period. Multiple transfers and low gestational age were independently associated with lower breastfeeding rates at hospital discharge across both cohorts. Extremely preterm infants and those with the greatest number of hospital transfers are least likely to be breastfed at time of discharge. Breastfeeding rates remained unchanged over time. The level of lactation support varied across NICUs.

CONCLUSION

This study highlights the challenges of establishing and maintaining breastfeeding for infants requiring intensive care who have had multiple hospital transfers for continuing or specialist care. There is wide variation in lactation support across facilities. The importance of a consistent approach, education programmes and the provision of appropriate lactation support is emphasised.

Integrative Review of the Experiences of Registered Nurses Who Support Breastfeeding Women

OBJECTIVE

To describe the experiences of registered nurses (RNs) who support breastfeeding women and to understand the factors that they believe affect practices that support breastfeeding.

DATA SOURCES

We conducted an online search using five databases: Scopus, MEDLINE, Cumulative Index of Nursing and Allied Health Literature (CINAHL), the Cochrane Database of Systematic Reviews, and Joanna Briggs Institute of Systematic Reviews.

STUDY SELECTION

We included original research articles on the experiences of RNs who support breastfeeding women that were published in 2009 or after and were available in English. After title and abstract review of 785 articles, we included 22 articles for full text review. Nine articles met the eligibility criteria and were included in the review.

DATA EXTRACTION

We used Whittemore and Knafl's five-step framework and the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines to guide this integrative review. Three authors reviewed and appraised the articles independently.

DATA SYNTHESIS

We categorized the findings into three themes: Workplace Issues, Personal Experiences, and Breastfeeding Knowledge and Education. Workplace Issues included the subthemes Lack of Time and Workload and Infant Health Stability. Personal Experiences included the subthemes Attitudes, Individual Experiences With Breastfeeding, and The Experiences of Family and Friends. Breastfeeding Knowledge and Education included the subthemes Prelicensure Education and Workplace Education and Training. Most researchers identified deficits in knowledge and education among RNs. The concept of confidence was influenced by all the other themes. Participants in the included studies reported that they developed confidence after learning from lactation consultants and having role models who supported the development of their knowledge and skills.

CONCLUSION

Despite the heterogeneity among the studies, findings highlighted the need for an increased focus on the preparation of RNs to support women to effectively breastfeed within health care organizations. Multitargeted efforts, such as orientation programs and in-depth breastfeeding education using role modeling, mentorship, and role playing with practical scenarios, may improve RNs' abilities and confidence to support breastfeeding women.

Involvement of Civil Society Organization in Facilitating the Implementation of Ten Steps for Successful Breastfeeding: Analysis of Health Care Workers' Perspectives?

Despite the present of national policy support, the prevalence of early breastfeeding initiation in Indonesia are still low. Research has shown that health care workers are the most reliable source for breastfeeding advice, but sadly they were often lacking in capacity. The aim of the study to assess the involvement of civil society organization (CSO) and its associated factors in facilitating the implementation of Ten Steps for Successful Breastfeeding (TSSB) based on health care workers' perspectives in Malang and Sidoarjo districts, East Java Province, Indonesia. We used qualitative approach to in-depth interview 117 participants and conducted 14 FGDs in Sidoarjo and Malang East Java. the PARiHS framework was used to identify the role of CSO in facilitating the BFHI implementation from the health workers perspective to offer insight on the facilitation process and development of future recommendations. The study found that the health care workers' have good knowledge on the benefits of breastfeeding with significant portion of the knowledge that they hold are coming from trainings provided by the CSO. There was cultural context barriers within the community, where grandmothers are considered as an important influence factor esspecially for working mothers. The implementation of training by the CSO was considered appropriate due to its ability to address some pressing structural obstacles and provide not only training to improve evidence but also help in addressing other contextual barriers. The CSO has offered opportunities not only for dissemination of evidence-based intervention but also to close gaps on resources provision to attend courses.

Influence of NICU Nurse Education on Intention to Support Lactation Using Tailored Techniques: A Pilot Study

BACKGROUND

Preterm infants' outcomes improve when fed their mothers' milk. Low percentages of neonatal intensive care unit (NICU) nurses support mothers facing barriers to establishing and sustaining adequate milk supplies. Nurses' motivations and attitudes are instrumental, but understudied, factors in their intention to promote maternal lactation.

PURPOSE

Using the Theory of Reasoned Action, this study explored (1) NICU nurses' attitudes, social pressures, feelings of preparedness, perceptions of comfort, and intention to support lactation; and (2) magnitude of relationships among these concepts before and after undertaking an educational module.

METHODS

A descriptive pre-/postintervention design included a sample of 24 NICU nurses who completed a module, including general lactation and hands-on expressing information. The Nursing Support for Breastfeeding Questionnaire was administered before and after completing the module.

RESULTS

Attitudes, social norms, perception of preparedness, and intention were moderate to high before and after completion of the module. Perception of comfort was moderate. When comparing pre- and postintervention, effect sizes for intention and perception of comfort were moderate. Magnitude of the relationship between attitudes and intention was strong before intervention and moderate after intervention. Subjective norms demonstrated stronger relationships with attitudes and intention after intervention. Preparedness and comfort had stronger relationships with attitudes than with intention both before and after intervention.

IMPLICATIONS FOR PRACTICE

Nurses' attitudes, perception of preparedness, and comfort are modifiable considerations in developing strategies to support evidence-based lactation techniques.

IMPLICATIONS FOR RESEARCH

Additional studies are needed with fully powered and stronger designs to validate findings to guide interventions for nurse support for NICU mothers to optimize lactation.

Implementation of Pre-/Post-Weights to Enhance Direct Breastfeeding in the NICU

Introduction

Mother's own milk (MOM) is recommended as the optimal nutrition for preterm infants. Direct breastfeeding (DBF) is correlated with a longer duration of receiving MOM during hospitalization. Infants' transition to DBF may be enhanced when accurate pre-/post-weights are incorporated into nursing practice. An evidence-based practice change was introduced to promote use and increase consistency in methodology of pre-/post-weights after DBF in the neonatal intensive care unit (NICU), with the ultimate goal of increasing DBF at hospital discharge.

Methods

The practice change was introduced through an educational program, a video demonstrating pre-/post-DBF weighing techniques, and a return-demonstration. A 10-item pre-/posttest was used to evaluate nurses' knowledge gained by an educational intervention that included seven knowledge questions, three attitude questions, and three demographic descriptors.

Results

Nurses' knowledge gained following the educational intervention was statistically significant (p < .001) using a paired t-test.

Conclusions

The use of pre-/post-DBF weights as an accurate assessment of MOM transfer can promote DBF during hospitalization through education of NICU nurses. Understanding nursing characteristics and attitudes can aid in promotion of DBF in the NICU by bedside nurses.

Breastfeeding Practices and Barriers to Implementing the Ten Steps to Successful Breastfeeding in Mississippi Hospitals

BACKGROUND

Mississippi has the lowest rates of breastfeeding in the United States at 6 and 12 months. There is growing evidence that the rates and duration of infant breastfeeding improve after hospitals implement the Ten Steps to Successful Breastfeeding; moreover, the Ten Steps approach is considered the standard model for evaluation of breastfeeding practices in birthplaces. Research aim: This study aimed to examine the implementation level of the Ten Steps and identify barriers to implementing the Ten Steps in Mississippi hospitals.

METHODS

A cross-sectional self-report survey was used to answer the research aim. Nurse managers of the birthing and maternity units of all 43 Mississippi hospitals that provided birthing and maternity care were recruited. A response rate of 72% ( N = 31) was obtained. Implementation of the Ten Steps in these hospitals was categorized as low, partial, moderate, or high.

RESULTS

The researcher classified implementation in 29% of hospitals as moderate and in 71% as partial. The hospital level of implementation was significantly positively associated with the hospital delivery rate along with the hospital cesarean section rate per year. The main barriers for the implementation process of the Ten Steps reported were resistance to new policies, limited financial and human resources, and lack of support from national and state governments.

CONCLUSION

Breastfeeding practices in Mississippi hospitals need to be improved. New policies need to be established in Mississippi to encourage hospitals to adopt the Ten Steps policies and practice in the maternity and birthing units.

Understanding process and context in breastfeeding support interventions: The potential of qualitative research

Considerable effort has been made in recent years to gain a better understanding of the effectiveness of different interventions for supporting breastfeeding. However, research has tended to focus primarily on measuring outcomes and has paid comparatively little attention to the relational, organizational, and wider contextual processes that may impact delivery of an intervention. Supporting a woman with breastfeeding is an interpersonal encounter that may play out differently in different contexts, despite the apparently consistent aims and structure of an intervention. We consider the limitations of randomized controlled trials for building understanding of the ways in which different components of an intervention may impact breastfeeding women and how the messages conveyed through interactions with breastfeeding supporters might be received. We argue that qualitative methods are ideally suited to understanding psychosocial processes within breastfeeding interventions and have been underused. After briefly reviewing qualitative research to date into experiences of receiving and delivering breastfeeding support, we discuss the potential of theoretically informed qualitative methodologies to provide fuller understanding of intervention processes by focusing on three examples: phenomenology, ethnography, and discourse analysis. The paper concludes by noting some of the epistemological differences between the broadly positivist approach of trials and qualitative methodologies, and we suggest there is a need for further dialog as to how researchers might bridge these differences in order to develop a fuller and more holistic understanding of how best to support breastfeeding women.