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Courtwright SE, Turi E, Barr EA, Burns JC, Gigli KH, Bennett CR, Sonney J, Francis L, Poghosyan L. Facilitators and Barriers to Pediatric Nurse Practitioner Practice in the United States: A Systematic Review. J Pediatr Health Care 2024:S0891-5245(23)00365-6. [PMID: 38284964 DOI: 10.1016/j.pedhc.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/21/2023] [Accepted: 12/02/2023] [Indexed: 01/30/2024]
Abstract
INTRODUCTION The pediatric nurse practitioner (PNP) workforce was designed to improve child health equity. We aimed to systematically review the evidence on facilitators and barriers to PNP practice. METHOD We included empirical studies on PNP practice in the United States and excluded studies with non-identifiable PNP data. We applied Joanna Briggs Institute tools to appraise studies and applied critical interpretive synthesis principles to synthesize. RESULTS The final sample is 26 studies, mostly published before 2013 and observational. Prescriptive privileges, training program availability, organizational climate, and telehealth are facilitators. Mandated physician supervision, reduced pediatric curricula, geographically disparate training programs, and poor data infrastructure are barriers. The sample is limited by a moderate to high risk of bias. DISCUSSION Evidence suggests modifiable factors impact PNP practice and could have important implications for child health equity. We offer a theoretical model to guide robust research studying the PNP workforce and health equity.
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Tsiamalou P, Brotis AG, Vrekou E, Georgakopoulou VE, Papalexis P, Aravanatinou-Fatorou A, Tegousi M, Fotakopoulos G, Paterakis K. The nurse's role in managing gout in the modern era: A systematic review of the literature. MEDICINE INTERNATIONAL 2023; 3:40. [PMID: 37680197 PMCID: PMC10481098 DOI: 10.3892/mi.2023.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 07/28/2023] [Indexed: 09/09/2023]
Abstract
The current treatment of gout is largely suboptimal, with up to 89% of hospitalizations being preventable due to inadequate care. The present study performed a systematic review in an aim to identify barriers to optimal gout treatment (Q1), understand how frequently nurses are involved in the management of gout (Q2), and examine the role of the nurse in the management of gout (Q3). A systematic review was performed, focusing on studies reporting on the nurse's role in the management of gout and the quality of the gathered items was appraised based on the risk of bias. In total, 15 records fulfilled the eligibility criteria and were used in the present systematic review. The main barriers were attributed to the patient's experiences with gout and lay beliefs, which affected seeking advice and adherence to treatment (Q1). Recently, however, several advances in patient care, including nurse-led clinics, have expanded the nurse's role, accounting for as much as 26% of the annual visits (Q2). Nurse-led interventions, such as education and lifestyle counseling, increased adherence to treatment (Q3). On the whole, nurses are key players in multidisciplinary teams and should be capable of engaging in shared decision-making processes, goal setting, providing patients with education and information, and making appropriate referrals.
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Affiliation(s)
- Paraskevi Tsiamalou
- Department of Rheumatology, General University Hospital of Larissa, 41221 Larissa, Greece
| | - Alexandros G. Brotis
- Department of Neurosurgery, General University Hospital of Larissa, 41221 Larissa, Greece
| | - Eleni Vrekou
- Department of Rheumatology, General University Hospital of Larissa, 41221 Larissa, Greece
| | - Vasiliki Epameinondas Georgakopoulou
- Department of Infectious Diseases and COVID-19 Unit, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Petros Papalexis
- Unit of Endocrinology, First Department of Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Department of Biomedical Sciences, University of West Attica, 12243 Athens, Greece
| | - Aikaterini Aravanatinou-Fatorou
- First Department of Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Maria Tegousi
- Department of Rheumatology, General University Hospital of Larissa, 41221 Larissa, Greece
| | - George Fotakopoulos
- Department of Neurosurgery, General University Hospital of Larissa, 41221 Larissa, Greece
| | - Konstantinos Paterakis
- Department of Neurosurgery, General University Hospital of Larissa, 41221 Larissa, Greece
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Ray D, Sniehotta F, McColl E, Ells L, O'Neill G, McCabe K. A collaborative approach to develop an intervention to strengthen health visitors' role in prevention of excess weight gain in children. BMC Public Health 2022; 22:1735. [PMID: 36100859 PMCID: PMC9469535 DOI: 10.1186/s12889-022-14092-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 08/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The high prevalence of childhood obesity is a concern for public health policy and practitioners, leading to a focus on early prevention. UK health visitors (HVs) are well-positioned to prevent excessive weight gain trends in pre-school children but experience barriers to implementing guideline recommended practices. This research engaged with HVs to design an intervention to strengthen their role in prevention of early childhood obesity. METHODS We describe the processes we used to develop a behaviour change intervention and measures to test its feasibility. We conducted a systematic review to identify factors associated with implementation of practices recommended for prevention of early childhood obesity. We carried out interactive workshops with HVs who deliver health visiting services in County Durham, England. Workshop format was informed by the behaviour change wheel framework for developing theory-based interventions and incorporated systematic review evidence. As intended recipients of the intervention, HVs provided their views of what is important and acceptable in the local context. The findings of the workshops were combined in an iterative process to inform the four steps of the Implementation Intervention development framework that was adapted as a practical guide for the development process. RESULTS Theoretical analysis of the workshop findings revealed HVs' capabilities, opportunities and motivations related to prevention of excess weight in 0-2 year olds. Intervention strategies deemed most likely to support implementation (enablement, education, training, modelling, persuasion) were combined to design an interactive training intervention. Measures to test acceptability, feasibility, and fidelity of delivery of the proposed intervention were identified. CONCLUSIONS An interactive training intervention has been designed, informed by theory, evidence, and expert knowledge of HVs, in an area of health promotion that is currently evolving. This research addresses an important evidence-practice gap in prevention of childhood obesity. The use of a systematic approach to the development process, identification of intervention contents and their hypothesised mechanisms of action provides an opportunity for this research to contribute to the body of literature on designing of implementation interventions using a collaborative approach. Future research should be directed to evaluate the acceptability and feasibility of the intervention.
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Affiliation(s)
- Devashish Ray
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, NE2 4AX, UK.
| | - Falko Sniehotta
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, NE2 4AX, UK
| | - Elaine McColl
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, NE2 4AX, UK
| | - Louisa Ells
- School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, England
| | - Gill O'Neill
- Department of Public Health, Durham County Council, Durham, England
| | - Karen McCabe
- Department of Public Health, Durham County Council, Durham, England
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Ray D, Sniehotta F, McColl E, Ells L. Barriers and facilitators to implementing practices for prevention of childhood obesity in primary care: A mixed methods systematic review. Obes Rev 2022; 23:e13417. [PMID: 35064723 PMCID: PMC9285925 DOI: 10.1111/obr.13417] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/23/2021] [Accepted: 12/17/2021] [Indexed: 12/16/2022]
Abstract
Primary care providers (PCPs) have an important role in prevention of excess weight gain in pre-school children. Guidelines exist to support PCPs' practices. This systematic review of PCPs' practice behaviors and their perceptions of barriers to and facilitators of implementation of guidelines was the first step toward the development of an intervention aimed at supporting PCPs. Five databases were searched to identify qualitative, quantitative, and mixed methods studies which examined PCPs' practice patterns and factors influencing implementation of recommended practices. The convergent integrated approach of the Joanna Briggs Institute (JBI) methodology for mixed methods reviews was used for data synthesis. Following analyses, the resultant factors were mapped onto the Capability, Opportunity, and Motivation model of Behaviour (COM-B). Fifty studies met the eligibility criteria. PCPs inconsistently implement recommended practices. Barriers and facilitators were identified at the provider (e.g., lack of knowledge), parent (e.g., lack motivation), and organization level (e.g., inadequate training). Factors were mapped to all three components of the COM-B model: psychological capability (e.g., lack of skills), reflective motivation (e.g., beliefs about guidelines), automatic motivation (e.g., discomfort), physical opportunity (e.g., time constraints), and social opportunity (e.g., stigma). These findings reflect the complexity of implementation of childhood obesity prevention practices.
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Affiliation(s)
- Devashish Ray
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Falko Sniehotta
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Elaine McColl
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Louisa Ells
- School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, UK
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Duarte ML, Dias KR, Ferreira DMTP, Fonseca-Gonçalves A. Knowledge of health professionals about breastfeeding and factors that lead the weaning: a scoping review. CIENCIA & SAUDE COLETIVA 2022; 27:441-457. [DOI: 10.1590/1413-81232022272.35672020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 01/07/2021] [Indexed: 11/21/2022] Open
Abstract
Abstract This review evaluated the knowledge of health professionals (HP) about breastfeeding and factors that leading the weaning. A search was performed in four electronics databases and the grey literature. The search strategy included Mesh terms and synonyms. No language or date restrictions were adopted. Studies that evaluated the knowledge of HP about breastfeeding and weaning were considered eligible. The studies retrieved by the searches were evaluated by two independently examiners. From 1,417 studies retrieved, 35 were included. Many countries and professionals from different health areas were analyzed. No studies evaluated the dentists’ knowledge. Although the included HP know the benefits of breastfeeding for health, the length of breastfeeding recommended by the World Health Organization, exclusive or not, was not aligned with all professionals’ endorsement. Information about weaning is scarce; however, HP are mindful of the main potential causes of early weaning. The knowledge of HP is conflicting about breastfeeding and unusual about weaning. Furthermore, no studies were found that presented data on the knowledge of dentists on the subject. Thus, assessments of dentists’ knowledge and education measures for HP are necessary since they are frequently questioned about these issues.
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Carmody E, Richards T, Hayward K, Carson G, Whitfield KC, McClure J, Grant S. In-Hospital Feeding Practices of Infants Born to Mothers With Gestational Diabetes Mellitus or Type 2 Diabetes Mellitus: Evaluating Policy Implementation Effectiveness. Can J Diabetes 2019; 43:580-586. [PMID: 31787244 DOI: 10.1016/j.jcjd.2019.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 10/14/2019] [Accepted: 10/21/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Women with diabetes in pregnancy may experience unique breastfeeding challenges. Few studies have examined the effectiveness of hospital policy to support breastfeeding in this patient population. This study aimed 1) to describe infant feeding practices of mother-infant pairs with gestational diabetes mellitus (GDM) or type 2 diabetes in pregnancy before and after introduction of an in-hospital policy and, 2) to compare feeding practices before and after policy introduction. METHODS A retrospective chart audit of mother-infant pairs (n=120) was performed: 60 at 1 year before and 60 after policy introduction. The primary outcome was provision of breast milk at discharge; a chi-square test was completed to compare pre- and postpolicy groups. Secondary outcomes included participant and infant feeding characteristics. RESULTS There was no significant difference in the number of infants receiving breast milk at discharge between pre- (58% [35 of 60]) and postpolicy (58% [35 of 60]) groups (p=0.64). The number of infants receiving breast milk exclusively throughout the hospital stay also did not differ by group (37% [22 of 60] before; and 43% [26 of 60] after; p=0.39). Information for each feed was infrequently recorded in charts for the method of feeding (34% [704 of 2,064]), infant state (96% [1,991 of 2,064]) and feeding description (96% [1,987 of 2,064]). CONCLUSIONS This practice-based research has highlighted a need for continuation of this work, examining an in-hospital policy to support breastfeeding in those with GDM or type 2 diabetes in pregnancy. Initially, feedback could be collected from health-care providers to understand perceived facilitators and barriers to policy application and the use of job aids (e.g. record keeping tools).
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Affiliation(s)
- Erin Carmody
- Department of Applied Human Nutrition, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
| | - Tiffany Richards
- School of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kathryn Hayward
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Glenda Carson
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada; Women's and Newborn Health Program, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Kyly C Whitfield
- Department of Applied Human Nutrition, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
| | - Janine McClure
- Women's and Newborn Health Program, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Shannan Grant
- Department of Applied Human Nutrition, Mount Saint Vincent University, Halifax, Nova Scotia, Canada; Departments of Obstetrics & Gynecology and Pediatrics, IWK Health Centre, Halifax, Nova Scotia, Canada; Departments of Obstetrics & Gynaecology and Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada.
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Predictors of Exclusive Breastfeeding Among Health Care Workers in Urban Kano, Nigeria. J Obstet Gynecol Neonatal Nurs 2019; 48:433-444. [DOI: 10.1016/j.jogn.2019.04.285] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2019] [Indexed: 11/19/2022] Open
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Brzezinski L, Mimm N, Porter S. Pediatric Nurse Practitioner Barriers to Supporting Breastfeeding by Mothers and Infants. J Perinat Educ 2018; 27:207-219. [PMID: 31073267 DOI: 10.1891/1058-1243.27.4.207] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
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.
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Maternity Nurses' Knowledge and Practice of Breastfeeding in Mississippi. MCN Am J Matern Child Nurs 2018; 43:225-230. [DOI: 10.1097/nmc.0000000000000437] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Alakaam A, Lemacks J, Yadrick K, Connell C, Choi HW, Newman RG. Breastfeeding Practices and Barriers to Implementing the Ten Steps to Successful Breastfeeding in Mississippi Hospitals. J Hum Lact 2018; 34:322-330. [PMID: 29156144 DOI: 10.1177/0890334417737294] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Amir Alakaam
- 1 Department of Nutrition & Dietetics, University of North Dakota, Grand Forks, ND, USA
| | - Jennifer Lemacks
- 2 Department of Nutrition & Food Systems, The University of Southern Mississippi, Hattiesburg, MS, USA
| | - Kathleen Yadrick
- 2 Department of Nutrition & Food Systems, The University of Southern Mississippi, Hattiesburg, MS, USA
| | - Carol Connell
- 2 Department of Nutrition & Food Systems, The University of Southern Mississippi, Hattiesburg, MS, USA
| | - Hwanseok Winston Choi
- 3 Department of Public Health, The University of Southern Mississippi, Hattiesburg, MS, USA
| | - Ray G Newman
- 3 Department of Public Health, The University of Southern Mississippi, Hattiesburg, MS, USA
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Application of the EBP Process: Maximizing Lactation Support with Minimal Education. J Pediatr Nurs 2017; 33:97-100. [PMID: 28132750 DOI: 10.1016/j.pedn.2017.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Pol-Pons Rn Ibclc A, Aubanell-Serra ScB M, Vidal Rn M, Ojeda-Ciurana Rn I, Martí-Lluch PhD R, Ponjoan PhD A. Breast feeding basic competence in primary care: Development and validation of the CAPA questionnaire. Midwifery 2016; 42:87-92. [PMID: 27771592 DOI: 10.1016/j.midw.2016.09.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 07/14/2016] [Accepted: 09/21/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND validated and reliable tools measuring the level of competence about breastfeeding amongst health professionals who attend mothers in primary care are scarce. OBJECTIVE to develop and validate a self-administered online questionnaire to assess basic competence about breastfeeding in the full range of health professionals attending lactating mothers in primary care. DESIGN methodological study. SETTINGS the study was conducted in 33 primary care centers administered by the Catalan Health Institute (Institut Català de la Salut) in the Girona Region (northeast Spain). PARTICIPANTS the questionnaire was sent to 398 health professionals who were likely to be in contact with breast feeding mothers. We included midwives, general practitioners, pediatric nurses (who provide care for children from birth to 14 years old), non-pediatric nurses (who provide care for patients older than 14 year), pediatricians, and gynecologists. The random sampling was stratified by discipline to ensure representativeness. METHODS the development and validation of the self-administered online questionnaire had five phases: (1) literature review, preparation of a draft for evaluation by an expert panel and pilot study; (2) design of a questionnaire based on observations from Phase 1; (3) questionnaire administration to a random sample of 398 health professionals, stratified by discipline; (4) re-testing after four weeks; and (5) assessment of construct validity using factor analysis and hypothesis-testing, comparing scores between professional groups and estimating effect size. Internal consistency was assessed by Cronbach alpha and reproducibility by the intraclass correlation coefficient. FINDINGS The response rate was 69.3%. The final version of the questionnaire has 24 items. The uni-dimensionality of the questionnaire was confirmed by the factor analysis. The score differed significantly between professional groups (F=12.904; p<0.001), among whom midwives achieved the highest score (129±10 points) and non-pediatric nurses the lowest (111±14 points).The effect sized values ranged from 0.6 and 1.5. Cronbach alpha was 0.870 (95% CI: 0.847, 0.891) and intraclass correlation coefficient was 0.856 (95%CI: 0.817, 0.888). CONCLUSIONS this is a valid and reliable questionnaire to assess a basic level of competence about breast feeding among primary care professionals involved in supporting breast-feeding mothers. This questionnaire may help to identify health professionals who require support to improve their capability to manage women who are breast feeding.
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Affiliation(s)
- Anna Pol-Pons Rn Ibclc
- Centre d'Atenció Primària Tordera, Gerència d'Àmbit d'Atenció Primària de Girona, Institut Català de la Salut, Spain
| | - Mercè Aubanell-Serra ScB
- Centre d'Atenció Primària Tordera, Gerència d'Àmbit d'Atenció Primària de Girona, Institut Català de la Salut, Spain
| | - Mireia Vidal Rn
- Línia pediàtrica Maragall, Gerència d'Àmbit d'Atenció Primària de Barcelona Ciutat, Institut Català de la Salut, Spain
| | - Imma Ojeda-Ciurana Rn
- Centre d'Atenció Primària Blanes, Gerència d'Àmbit d'Atenció Primària de Girona, Institut Català de la Salut, Spain
| | - Ruth Martí-Lluch PhD
- Unitat de Suport a la Recerca de Girona, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Spain; Institut d'Investigació Biomèdica de Girona Dr. Josep Trueta (IDIBGI), Spain; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Anna Ponjoan PhD
- Unitat de Suport a la Recerca de Girona, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Spain; Institut d'Investigació Biomèdica de Girona Dr. Josep Trueta (IDIBGI), Spain; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain.
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Deloian BJ, Lewin LO, O'Connor ME. Use of a Web‐based Education Program Improves Nurses’ Knowledge of Breastfeeding. J Obstet Gynecol Neonatal Nurs 2015; 44:77-86. [DOI: 10.1111/1552-6909.12534] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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Vandewark AC. Breastfeeding attitudes and knowledge in bachelor of science in nursing candidates. J Perinat Educ 2014; 23:135-41. [PMID: 25364217 DOI: 10.1891/1058-1243.23.3.135] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Breastfeeding is an important health topic worldwide, although lack of breastfeeding knowledge is noted among health-care professionals. The purpose of this study was to explore the relationship between breastfeeding knowledge and attitudes in undergraduate nursing students at the beginning and end of their clinical education. An electronic survey, based on the Iowa Infant Feeding Attitude Scale and the Breastfeeding Knowledge Questionnaire, was administered. Attitude scores did not differ significantly between groups. Total knowledge scores between groups differed modestly (p = .006). Correlations between total knowledge and total attitude scores were found (r[89] = .482, p < .000). Respondents reported that nursing education effectively teaches breastfeeding and that breastfeeding advocacy through patient education is a crucial nursing role.
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Demirci JR, Bogen DL, Holland C, Tarr JA, Rubio D, Li J, Nemecek M, Chang JC. Characteristics of breastfeeding discussions at the initial prenatal visit. Obstet Gynecol 2013; 122:1263-70. [PMID: 24201684 PMCID: PMC3903394 DOI: 10.1097/01.aog.0000435453.93732.a6] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To describe the observed characteristics of first prenatal visit breastfeeding discussions between obstetric providers and their pregnant patients. METHODS This analysis was part of a larger study involving 69 health care providers and 377 patients attending their initial prenatal visits at a single clinic. Audio recordings and transcripts from the first 172 visits (including 36 obstetric-gynecology residents, six nurse midwives, and five nurse practitioners) were reviewed for breastfeeding discussion occurrence, timing and initiator of discussions, and adherence to American College of Obstetricians and Gynecologists (College) prenatal breastfeeding guidelines. Descriptive statistics were used to characterize the sample and frequency of breastfeeding discussions. Logistic regression and χ tests were used to examine patterns in women's breastfeeding discussion preferences and discussion occurrence. Conversations were qualitatively analyzed for breastfeeding content. RESULTS Breastfeeding discussions were infrequent (29% of visits), brief (mean 39 seconds), and most often initiated by clinicians in an ambivalent manner. Sixty-nine percent of breastfeeding discussions incorporated any College breastfeeding recommendations. Breastfeeding was significantly more likely to be discussed by certified nurse midwives than residents (odds ratio 24.54, 95% confidence interval 3.78-159.06; P<.01), and certified nurse midwives tended to engage patients in more open discussions. Women indicating a preference for breastfeeding discussions at the first visit (n=19) were more likely to actually have the discussion (P<.001). CONCLUSION Observed breastfeeding education at the first prenatal visit was suboptimal. The causes and effect of this deficiency on breastfeeding outcomes remains an important point of investigation. LEVEL OF EVIDENCE : II.
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Affiliation(s)
- Jill R. Demirci
- University of Pittsburgh School of Medicine, Department of Pediatrics
| | - Debra L. Bogen
- University of Pittsburgh School of Medicine, Department of Pediatrics
| | - Cynthia Holland
- University of Pittsburgh School of Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences
| | - Jill A. Tarr
- University of Pittsburgh School of Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences
| | - Doris Rubio
- University of Pittsburgh, Center for Research on Health Care (CRHC)
| | - Jie Li
- University of Pittsburgh, Center for Research on Health Care (CRHC)
| | - Marianne Nemecek
- University of Pittsburgh School of Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences
| | - Judy C. Chang
- University of Pittsburgh School of Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences
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Breastfeeding and human lactation: education and curricular issues for pediatric nurse practitioners. J Pediatr Health Care 2013; 27:83-90. [PMID: 23414973 DOI: 10.1016/j.pedhc.2011.03.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Revised: 03/11/2011] [Accepted: 03/11/2011] [Indexed: 11/21/2022]
Abstract
INTRODUCTION This study explores the breastfeeding and human lactation education offered in pediatric nurse practitioner (PNP) masters-level nursing programs. METHODS An online survey about breastfeeding and human lactation education offered in the PNP curriculum was sent to all PNP programs in the United States with viable contact information (N = 84). The response rate was 42.9%. RESULTS All of the respondents indicated that their PNP program curriculum includes the promotion of breastfeeding. However, 5.9% of programs do not offer any courses that incorporate these topics, and 73.5% teach this content in only one to two courses. More than three quarters of programs (81.8%) offer opportunities to counsel expectant mothers on infant feeding choices, promote breastfeeding in the clinical setting, and teach breastfeeding techniques. However, 18.2% of programs do not offer any of these opportunities. DISCUSSION The breastfeeding and lactation education offered in PNP programs is inconsistent. Formal incorporation of research-based lactation education into PNP curricula will help to standardize knowledge and aid in the PNP clinical role.
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Abstract
Considerable progress has been made in the past decade in developing comprehensive support systems to enable more women to reach their breastfeeding goals. Given that most women in the United States participate in some breastfeeding, it is essential that each of these support systems be rigorously tested and if effective replicated. Additional research is needed to determine the best methods of support during the preconception period to prepare women to exclusively breastfeed as a cultural norm.
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Affiliation(s)
- Lori Feldman-Winter
- Department of Pediatrics, Children's Regional Hospital at Cooper University Hospital, Camden, NJ 08103, USA.
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18
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Ra JS, Chae SM. Breastfeeding Knowledge, Attitude, and Nursing Practice of Nurses in Neonatal Intensive Care Units. CHILD HEALTH NURSING RESEARCH 2013. [DOI: 10.4094/chnr.2013.19.2.76] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Jin-Suk Ra
- College of Nursing, Chungnam National University, Daejeon, Korea
| | - Sun-Mi Chae
- College of Nursing & The Research Institute of Nursing Science, Seoul National University, Seoul, Korea
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19
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Lam EY, Kecskés Z, Abdel-Latif ME. Breast milk banking: current opinion and practice in Australian neonatal intensive care units. J Paediatr Child Health 2012; 48:833-9. [PMID: 22970678 DOI: 10.1111/j.1440-1754.2012.02530.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To find out the knowledge and attitudes of health-care professionals (HCPs) in Australian neonatal intensive care units (NICUs) towards breast milk banking (BMBg) and pasteurised donated breast milk (PDBM). METHODS Cross-sectional structured survey of HCPs in all 25 NICUs in Australia. RESULTS Response rate was 43.4% (n= 358 of 825). Participants included nurses and midwives (291, 81.3%) and the remainder were neonatologists and neonatal trainees (67, 18.7%). A variable number of HCPs agreed that PDBM would decrease the risk of necrotising enterocolitis (81%) and allergies (48.9%), 8.4% thought PDBM will carry risk of infections and 78.8% agreed that PDBM is preferable over formula, but only 67.5% thought that establishing breast milk banks (BMBs) are justifiable. Significant differences were found between doctors and nurses/midwives, with 19.4% of doctors compared with 5.8% of nurses/midwives agreed that PDBM carried an increased risk of infection. Although, over 90% of nurses/midwives and 70% of doctors agreed that the donation of breast milk is important, only 71% of nurses/midwives and 52.2% of doctors thought that setting up a BMB was justifiable. CONCLUSION The opinions about BMBg differ widely between HCPs; however, the majority support the practice. HCPs had different knowledge gaps in regard to BMBg. Nurses/midwives positively view the practice of BMBg more strongly compared with neonatologists.
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Affiliation(s)
- Eva Y Lam
- The Clinical School, Australian National University Medical School, Garran, Australian Capital Territory, Australia
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20
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Cockerham-Colas L, Geer L, Benker K, Joseph MA. Exploring and influencing the knowledge and attitudes of health professionals towards extended breastfeeding. Breastfeed Med 2012; 7:143-50. [PMID: 21854294 DOI: 10.1089/bfm.2011.0027] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Although many U.S. professional health organizations have policy statements that support the breastfeeding of children beyond one year (extended breastfeeding), the actual attitudes of health workers towards this practice have not been explored. The purposes of this study were (1) to explore the knowledge and attitudes of various U.S. health professionals towards extended nursing and (2) to pilot an educational display for U.S. health professionals to promote their knowledge and attitudes towards extended breastfeeding. METHODS A total of 84 participants in a New York City academic medical center provided responses to a structured self-administered questionnaire given before and after an educational display. RESULTS Respondents reported negative attitudes towards extended breastfeeding at baseline, with negative attitudes increasing as the age of the breastfed child increased. After education, the percentage of participants who found breastfeeding acceptable for 1- or 2-year-old children increased from 61% to 89% (p < 0.001). Acceptability of 3- or 4-year-old children breastfeeding increased from 22% to 41% (p < 0.001). CONCLUSIONS Viewing educational media concerning older nursing children may lead to more positive attitudes towards extended breastfeeding among healthcare professionals.
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Affiliation(s)
- Lauren Cockerham-Colas
- School of Public Health, State University of New York Downstate Medical Center, Brooklyn, 11203, USA.
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21
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Ward KN, Byrne JP. A critical review of the impact of continuing breastfeeding education provided to nurses and midwives. J Hum Lact 2011; 27:381-93. [PMID: 21757766 DOI: 10.1177/0890334411411052] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This review of 15 studies from nine different countries analyzes the practice of continuing education on breastfeeding for health professionals, with a specific focus on nurses and midwives. Continuing breastfeeding education improves the knowledge, clinical skills and practices, and counseling skills of nurses and midwives, and it improves the Baby-Friendly Hospital Initiative compliance of institutions. Education of any duration is beneficial; however, findings support the recommendation of the World Health Organization that at least 18 hours' education for all health professionals who advise pregnant women and mothers should be undertaken.
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22
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Kronborg H, Kok G. Development of a postnatal educational program for breastfeeding mothers in community settings: intervention mapping as a useful guide. J Hum Lact 2011; 27:339-49. [PMID: 22048757 DOI: 10.1177/0890334411422702] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Inconsistency in how professionals can best support the breastfeeding mother after discharge call on further investigation. The authors describe how intervention mapping was used to develop a postnatal breastfeeding support intervention for mothers in community settings. Breastfeeding cessation most often occurred in the first weeks among mothers with low self-efficacy, low confidence, or limited previous breastfeeding experience. Besides learning effective breastfeeding techniques, mothers needed to learn how to recognize their baby's cues, let the baby regulate meals, gain confidence in producing enough milk, and handle breastfeeding problems. Theory-based methods-such as individualization, skills training with guided practice, reattribution, planning coping responses, and mobilizing social support-were built into a health visitor-delivered program. An 18-hour training course addressed determinants for implementation. Finally, process and effect evaluations were planned. Support of the breastfeeding mother in community settings should address the psychosocial and practical aspects of breastfeeding to prevent premature cessation.
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Affiliation(s)
- Hanne Kronborg
- Institute of Public Health, Department of Nursing Science, University of Aarhus, Aarhus, Denmark.
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23
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Abstract
OBJECTIVE The aim of this study was to determine the function of newborn nurses given at newborn feeding in the newborn units of public hospitals in Konya, Turkey, besides it was also to determine the effect of nurses which had short-term training, aka education, in practice and in theory. METHODS This was an experimental study conducted with a total of 50 newborn nurses between 15 September 2004 and 30 February 2005. In collecting the data, a survey sheet including the demographic characteristics of newborn nurses and their knowledge on newborn feeding was applied, along with another remark form that shows clinical practices about newborn feeding. RESULTS Considering the nurses, their knowledge mean score 'after education (AE)' was calculated to be 72.4 ± 10.4, which was significantly higher than that of 'before education (BE)', which was 58.0 ± 9.3, (p < 0.05). Likewise, the implementation mean score of these nurses AE (57.2 ± 4.9) was also found higher than the mean score BE (54.4 ± 5.0) (p < 0.05). There were statistically significant differences in the posteducation mean scores of nurses for the number of children they had, and for the hospital they work. CONCLUSION In this study, it was determined that the nurses had knowledge deficits about newborn feeding both in theory and practice, but after a short educational program on newborn feeding their theoretical and practical knowledge had shown increases.
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Affiliation(s)
- Tülay Tengır
- Paediatric Nursing, School of Health, University of Çukurova, Adana, Turkey
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24
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Meier PP, Engstrom JL, Patel AL, Jegier BJ, Bruns NE. Improving the use of human milk during and after the NICU stay. Clin Perinatol 2010; 37:217-45. [PMID: 20363457 PMCID: PMC2859690 DOI: 10.1016/j.clp.2010.01.013] [Citation(s) in RCA: 121] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The feeding of human milk (milk from the infant's own mother; excluding donor milk) during the newborn intensive care unit (NICU) stay reduces the risk of costly and handicapping morbidities in premature infants. The mechanisms by which human milk provides this protection are varied and synergistic, and appear to change over the course of the NICU stay. The fact that these mechanisms include specific human milk components that are not present in the milk of other mammals means that human milk from the infant's mother cannot be replaced by commercial infant or donor human milk, and the feeding of human milk should be a NICU priority. Recent evidence suggests that the impact of human milk on improving infant health outcomes and reducing the risk of prematurity-specific morbidities is linked to specific critical exposure periods in the post-birth period during which the exclusive use of human milk and the avoidance of commercial formula may be most important. Similarly, there are other periods when high doses, but not necessarily exclusive use of human milk, may be important. This article reviews the concept of "dose and exposure period" for human milk feeding in the NICU to precisely measure and benchmark the amount and timing of human milk use in the NICU. The critical exposure periods when exclusive or high doses of human milk appear to have the greatest impact on specific morbidities are reviewed. Finally, the current best practices for the use of human milk during and after the NICU stay for premature infants are summarized.
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Affiliation(s)
- Paula P Meier
- Department of Women, Children and Family Nursing, Rush University Medical Center, 1653 West Congress Parkway, Chicago, IL 60612, USA.
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25
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Smith J, Dunstone M, Elliott-Rudder M. Health professional knowledge of breastfeeding: are the health risks of infant formula feeding accurately conveyed by the titles and abstracts of journal articles? J Hum Lact 2009; 25:350-8. [PMID: 19369684 DOI: 10.1177/0890334409331506] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Effective promotion of breastfeeding is constrained if health professionals' knowledge on its importance is deficient. This study asks whether formula feeding is named as the risk factor in published research or whether it is considered the unspoken norm. A systematic analysis is conducted of the information content of titles and abstracts of 78 studies that report poorer health among formula-fed infants. This shows a surprising silence in the studies examined; formula is rarely named in publication titles or abstracts as an exposure increasing health risk. In 30% of cases, titles imply misleadingly that breastfeeding raises health risk. Only 11% of abstracts identify formula feeding as a health risk exposure. Initiatives to increase breastfeeding have described the importance of accurate language and well-informed health professional support. If widespread, this skew in communication of research findings may reduce health professionals' knowledge and support for breastfeeding.
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Affiliation(s)
- Julie Smith
- Australian Centre for Economic Research on Health, College of Medicine and Health Sciences, College of Medicine, Biology and Environment, Building 62, The Australian National University, ACT, Australia
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26
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Szucs KA, Miracle DJ, Rosenman MB. Breastfeeding knowledge, attitudes, and practices among providers in a medical home. Breastfeed Med 2009; 4:31-42. [PMID: 19196036 DOI: 10.1089/bfm.2008.0108] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Breastfeeding offers numerous health advantages to children, mothers, and society. From obstetrics to pediatrics, breastfeeding dyads come in contact with a wide range of healthcare providers. The American Academy of Pediatrics (AAP) calls for pediatricians to support breastfeeding enthusiastically and for all children to have a medical home. We studied an inner-city healthcare system with a Dyson Community Pediatrics Training Initiative Model Medical Home clinic, to explore how a breastfeeding/baby-friendly medical home might be built upon this framework. We describe breastfeeding knowledge, attitudes, and practices among a full range of providers and healthcare system-level barriers to effective and coordinated breastfeeding services. METHODS We conducted eight focus groups using semistructured interviews: (1) pediatricians; (2) obstetricians; (3) pediatric nurses and allied health professionals; (4) obstetric nurses and allied health professionals; (5) 24-hour telephone triage answering service nurses; (6) public health nurses; (7) Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) personnel; and (8) lactation consultants and peer counselors. RESULTS We identified gaps in providers' breastfeeding knowledge, counseling skills, and professional education and training. Providers' cultures and attitudes affect breastfeeding promotion and support. Providers used their own breastfeeding experiences to replace evidence-based knowledge and AAP policy statement recommendations for breastfeeding dyads. There were communication disconnects between provider groups. Providers underestimated their own, and overestimated others', influence on breastfeeding. The system lacked a coordinated breastfeeding mission. CONCLUSIONS This study illuminated key disconnectedness challenges (and, hence, opportunities) for a model medical home in fostering continuous, comprehensive, coordinated, culturally effective, and evidence-based breastfeeding promotion and support.
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Affiliation(s)
- Kinga A Szucs
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA.
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27
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Kronborg H, Vaeth M, Olsen J, Iversen L, Harder I. Effect of early postnatal breastfeeding support: a cluster-randomized community based trial. Acta Paediatr 2007; 96:1064-70. [PMID: 17524018 DOI: 10.1111/j.1651-2227.2007.00341.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM To assess the impact of a supportive intervention on the duration of breastfeeding. DESIGN AND SETTING A community based cluster-randomized trial in Western Denmark. SUBJECTS Fifty-two health visitors and 781 mothers in the intervention group, and 57 health visitors and 816 mothers in the comparison group. INTERVENTION Health visitors in the intervention group received an 18-h course. The intervention addressed maternal psychosocial factors and consisted of 1-3 home visits during the first 5 weeks post-partum. Health visitors in the comparison group offered their usual practice. MAIN OUTCOME MEASURE Duration of exclusive breastfeeding during 6 months of follow-up. RESULTS Mothers in the intervention group had a 14% lower cessation rate (HR = 0.86 CI: 0.75-0.99). Similar results were seen for primipara, and multipara with previously short breastfeeding experience. Mothers in the intervention group received their first home visit earlier, had more visits and practical breastfeeding training within the first 5 weeks. Babies in the intervention group were breastfed more frequently, fewer used pacifiers, and their mothers reported more confidence in not knowing the exact amount of milk their babies had received when being breastfed. CONCLUSION Home visits in the first 5 weeks following birth may prolong the duration of exclusive breastfeeding. Postnatal support should focus on both psychosocial and practical aspects of breastfeeding. Mothers with no or little previous breastfeeding experience require special attention.
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Affiliation(s)
- H Kronborg
- Department of Nursing Science, Institute of Public Health, University of Aarhus, 8000 Aarhus, Denmark.
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28
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Verschuur EML, Kuipers EJ, Siersema PD. Nurses working in GI and endoscopic practice: a review. Gastrointest Endosc 2007; 65:469-79. [PMID: 17321249 DOI: 10.1016/j.gie.2006.11.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2006] [Accepted: 11/07/2006] [Indexed: 12/29/2022]
Abstract
BACKGROUND Over the last 10 years, nurses increasingly perform tasks and procedures that were previously performed by physicians. OBJECTIVE In this review, we investigated what types of GI care and endoscopic procedures nurses presently perform and reviewed the available evidence regarding the benefits of these activities. DESIGN Review of published articles on nurses' involvement in GI and endoscopic practice. RESULTS In total, 19 studies were identified that evaluated performance and participation of nurses in GI and endoscopic practice. Of these, 3 were randomized trials on the performance of nurses in flexible sigmoidoscopy (n = 2) and upper endoscopy (n = 1). Fourteen nonrandomized studies evaluated performance in upper endoscopy (n = 2), EUS (n = 1), flexible sigmoidoscopy (n = 7), capsule endoscopy (n = 2), and percutaneous endoscopic gastrostomy placement (n = 2). In all studies, it was found that nurses accurately and safely performed these procedures. Two further studies demonstrated that nurses adequately managed follow-up of patients with Barrett's esophagus and inflammatory bowel disease. Four of the 19 studies showed that patients were satisfied with the type of care nurses provided. Finally, it was suggested that costs were reduced if nurses performed a sigmoidoscopy and evaluated capsule endoscopy examinations compared with physicians performing these activities. CONCLUSIONS The findings of this review support the involvement of nurses in diagnostic endoscopy and follow-up of patients with chronic GI disorders. Further randomized trials, however, are needed to demonstrate whether this involvement compares at least as favorably with gastroenterologists in terms of medical outcomes, patient satisfaction, and costs.
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Affiliation(s)
- Els M L Verschuur
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center Rotterdam, 3000 CA Rotterdam, The Netherlands
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29
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30
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Abstract
In response to the need for health care professionals skilled in lactation management, a breastfeeding course was developed and taught at the University of Pennsylvania. Since 1995, Nursing 361 has been offered to undergraduate junior and senior students. The aim of this article is to discuss how through coursework, nursing students can provide breastfeeding advocacy and change the breastfeeding culture one community at a time. This article provides guidelines for others to conduct such projects, as well as exemplars to demonstrate how advocacy can change communities. Through development of an advocacy project during the course of a semester, a student learns about his or her identified community and is able to make an impact that often lasts years after his or her project is completed.
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Affiliation(s)
- Diane L Spatz
- University of Pennsylvania Schoolof Nursing, The Children's Hospital of Philadelphia, PA 19104-6096, USA
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