The bumpy road to implementing the Baby-Friendly Hospital Initiative in Austria: a qualitative study

Working dilemmas in care for breastfed newborns: An exploratory study in a single center in Taiwan

BACKGROUND

Clinical medical staff should be aware of and examine the correlation between breastfeeding and neonatal hospitalization. Additional attention should be paid to work dilemmas experienced by the nursing staff caring for newborns to avoid exposing newborns to hospitalization risk.

OBJECTIVE

The present study investigated the working dilemmas by neonatal nurses caring for breastfed newborns and risk of newborn hospitalization.

METHODS

This hospital-based study in Taiwan surveyed 84 neonatal nurses using a structured questionnaire entitled "Working Dilemmas in Clinical Care for Breastfed Newborns."

RESULTS

Collected data were analyzed statistically (descriptive analysis, chi-square test, and t test) using Statistical Package for the Social Sciences (SPSS) software. Neonatal intensive care unit (NICU) staff noted that breastfed newborns showed a high risk of hospitalization and nursery staff highlighted a lack of manpower and time. NICU staff experienced more working dilemmas (117.460±12.260) than nursery staff (87.410±15.820) when caring for breastfed newborns (t = 1.080, P < 0.001). NICU staff reported a higher risk of hospitalization in breastfed newborns and experienced more working dilemmas caring for these patients compared with nursery staff, who reported a lack of manpower and time.

CONCLUSION

Our findings highlight the working dilemmas by neonatal nurses and can serve as a foundation for further critical studies.

Improving breastfeeding support through the implementation of the Baby-Friendly Hospital and Community Initiatives: a scoping review

BACKGROUND

Improved breastfeeding practices have the potential to save the lives of over 823,000 children under 5 years old globally every year. The Baby-Friendly Hospital Initiative (BFHI) is a global campaign by the World Health Organization and the United Nations Children's Fund, which promotes best practice to support breastfeeding in maternity services. The Baby-Friendly Community Initiative (BFCI) grew out of step 10, with a focus on community-based implementation. The aim of this scoping review is to map and examine the evidence relating to the implementation of BFHI and BFCI globally.

METHODS

This scoping review was conducted according to the Joanna Briggs Institute methodology for scoping reviews. Inclusion criteria followed the Population, Concepts, Contexts approach. All articles were screened by two reviewers, using Covidence software. Data were charted according to: country, study design, setting, study population, BFHI steps, study aim and objectives, description of intervention, summary of results, barriers and enablers to implementation, evidence gaps, and recommendations. Qualitative and quantitative descriptive analyses were undertaken.

RESULTS

A total of 278 articles were included in the review. Patterns identified were: i) national policy and health systems: effective and visible national leadership is needed, demonstrated with legislation, funding and policy; ii) hospital policy is crucial, especially in becoming breastfeeding friendly and neonatal care settings iii) implementation of specific steps; iv) the BFCI is implemented in only a few countries and government resources are needed to scale it; v) health worker breastfeeding knowledge and training needs strengthening to ensure long term changes in practice; vi) educational programmes for pregnant and postpartum women are essential for sustained exclusive breastfeeding. Evidence gaps include study design issues and need to improve the quality of breastfeeding data and to perform prevalence and longitudinal studies.

CONCLUSION

At a national level, political support for BFHI implementation supports expansion of Baby-Friendly Hospitals. Ongoing quality assurance is essential, as is systematic (re)assessment of BFHI designated hospitals. Baby Friendly Hospitals should provide breastfeeding support that favours long-term healthcare relationships across the perinatal period. These results can help to support and further enable the effective implementation of BFHI and BFCI globally.

Barriers and Strategies for Successful Implementation of Baby-Friendly Hospital Initiative: A Scoping Review

Introduction

Implementation of the Baby-Friendly Hospital Initiative (BFHI) with maternal and/or neonatal services in all health care facilities is valuable to protect, promote and support breastfeeding and the well-being of young children. It is essential to identify challenges that hinder the successful implementation of BFHI and explore strategies to overcome those barriers to promote, protect and support breastfeeding practices of mothers all over the world.

Methods

A scoping review of evidence-based literature was undertaken. A total of 44 articles on BFHI published globally between the years 2000 and 2021 were reviewed and analyzed.

Results

The barriers to the successful implementation of the BFHI include the absence of clearly stated policies on breastfeeding, lack of uniform understanding of BFHI, insufficient support and resources, disagreements/lack of collaboration among health care professionals, maternal circumstances, and hospital routines and practices. The strategies for successful implementation of BFHI include health care providers’ leadership, teamwork/collaboration, adequate staffing and financial resources, education, mentoring and skills training opportunities for healthcare professionals, continuous monitoring of the BFHI steps, compliance with every step of BFHI, mother-centred approach, and regulation on marketing and sale of breastmilk.

Conclusions

GThe role of multi-layered interventions, interdisciplinary collaboration and partnership-based approach is critical in minimizing barriers and promoting the successful implementation of BFHI in all healthcare settings.

Ethical Considerations for Hospital-Based Infant Feeding Support

I applied a systematic ethical decision-making approach to evaluate how health care professionals in hospital settings should provide infant feeding support after childbirth. Human milk is recommended as the optimal source of nutrition for infants because of the health benefits it provides for infants and their lactating parents. However, health consequences of insufficient oral intake in infants and psychological distress in the lactating parent may occur when infant feeding does not go according to plan. Infant feeding support should be provided in a way that is objective, sensitive, individualized, equitable, and supportive of autonomy and avoids harm. I provide recommendations for ethical infant feeding support that can be applied by individual health care professionals and on postpartum units in hospitals.

Factors Associated with (Exclusive) Breastfeeding Duration-Results of the SUKIE-Study

The WHO European Region has the lowest exclusive breastfeeding (EBF) rates at 6 months in the world. In Austria, 55.5% of infants are EBF at the age of one week, although breastfeeding initiation is 97.5%. The study was conducted in 2019/2020 and considered 1214 mothers of legal age, who received four online questionnaires during their child's first year of life. The influence of different variables on total/exclusive breastfeeding duration were analysed by using a Cox model (Extension of the Cox Proportional Hazards Model) with time-dependent covariates. Multivariate analyses showed a significant influence of maternal BMI, lifestyle factors, such as smoking, and breastfeeding support on total breastfeeding duration. Remarkable differences in the median duration of any breastfeeding were found for breastfeeding support, where mothers breastfed twice as long. Support came primarily from hospital staff, the midwife and the partner. A higher monthly household net income, delivery in a baby-friendly certified hospital (BFH) and breastfeeding support were associated with a longer EBF duration. Obese mothers started feeding infant formula earlier and had a higher risk of early weaning. The results offer valuable insights into the importance of breastfeeding-friendly structures such as BFHs, a focus on breastfeeding aftercare and support of the mother to promote and protect breastfeeding.

Six-month breastfeeding maintenance after a self-efficacy promoting programme: an exploratory trial

BACKGROUND

Breastfeeding care plays a fundamental role in establishing breastfeeding and longer duration after discharge. Practices though vary among professionals involved and are often inconsistent with good practices recommended, being a threat to women's breastfeeding self-efficacy. Breastfeeding self-efficacy is considered a predictor for successful breastfeeding and a significant variable amenable to intervention for promoting lactation AIM: To evaluate the efficacy, feasibility and acceptability of a new breastfeeding self-efficacy promoting programme (SIALAC) on 6-month breastfeeding maintenance.

METHODS

In this exploratory multi-centre controlled trial, participants were allocated into control and intervention groups sequentially. Professionals in charge of the treatment groups were trained in between, with an especial focus on reducing practice variability. Control and intervention group women received usual care, and the intervention group received in addition SIALAC, a three-stage breastfeeding self-efficacy promoting programme. Primary outcome was breastfeeding maintenance up to 6 months analysed by Kaplan-Meier and Cox proportional hazard regression analysis. Student's t-test or chi-square tests were also used for continuous and categorical variables. Data on breastfeeding status and breastfeeding self-efficacy were collected at baseline, and 4, 8 and 24 weeks after birth.

RESULTS

From May 2014 through November 2015, participants were enrolled. The sample consisted of 112 women. No relevant socio-demographic or obstetric difference was found between groups. The intervention achieved a significant difference between groups in breastfeeding survival (X²  = 4.94, p = 0.026). Six-month breastfeeding maintenance was significantly higher in the intervention group (67% vs. 55%; X²  = 5.384, p = 0.020). Breastfeeding dropout in the control group was 3.3 (CI 1.1, 10.1) times higher than that of the intervention group at 6 months. Breastfeeding self-efficacy scores were higher in the intervention group although without significant statistical difference. The programme showed good acceptability.

CONCLUSION

Breastfeeding self-efficacy promoting programme SIALAC was beneficial in fostering 6-month breastfeeding survival. Full-scale trial should consider feasibility-related issues identified.

Overcoming Rooming-In Barriers: A Survey on Mothers' Perspectives

Background: The importance of rooming-in in promoting breastfeeding initiation and continuation within the 10 Steps for Successful Breastfeeding is widely acknowledged. However, adherence to this practice by healthcare facilities is lower than that of other Steps. A deeper knowledge of maternal rooming-in experience has been advocated to identify the most effective rooming-in policies, thus enabling mothers to have a positive experience when practicing it in the postpartum period. Aim: To investigate maternal knowledge of rooming-in and the most frequently encountered barriers and possible facilitators of adherence to the practice, according to their experience. Study Design and Methods: We enrolled mothers who delivered healthy term or late preterm infants during the month of January 2019 in a tertiary referral center for neonatal care in Milan, Italy. At discharge, a structured interview about mothers' rooming-in experience was administered by healthcare professionals. Basic subjects' characteristics and mode of feeding were recorded. Results: The enrolled population included 328 mothers and 333 neonates. The great majority of mothers knew of rooming-in and 48.2% practiced it continuously. The 86.3% of mothers was aware of the beneficial effects of rooming-in; promotion of mother-infant bonding, increased confidence in taking care of the baby and ability to recognize baby's feeding cues were the most frequently cited, whereas improving breastfeeding was reported by a limited number of mothers, unless they were asked a specific question about it. The main reported obstacles were fatigue (40.5%) and cesarean section related difficulties (15.5%); night was the most critical time of the day for rooming-in. Strategies suggested by mothers for improving rooming-in were increased assistance to the dyad, organizational and structural changes and the possibility to have a family member during the night. Additionally, mothers who adhered to rooming-in practice continuously during hospital stay had a higher exclusive breastfeeding rate at discharge compared to mothers who did not. Conclusions: Our study contributes to a deeper knowledge of maternal rooming-in experience in an Italian tertiary maternity. We underline the importance of providing a tailored support to the mother-infant dyad in order to overcome rooming-in barriers perceived by mothers and promote a positive rooming-in experience.

Nurses' attitudes towards the implementation of the Mother-Baby Friendly Initiative in selected primary healthcare facilities at Makhuduthamaga Municipality, Limpopo province

BACKGROUND

 The implementation of the Mother-Baby Friendly Initiative (MBFI) strategy demonstrated its capabilities to improve global children's health and maternal survival. However, its implementation in primary healthcare (PHC) facilities remains a challenge as many nurses are reluctant to adopt it for the improvement of child and maternal healthcare services in their respective clinics.

OBJECTIVES

 The primary objective of this study was to determine the attitudes of nurses towards the implementation of the MBFI in selected PHC facilities in the Makhuduthamaga Municipality, Limpopo province.

METHOD

 This study used a quantitative, descriptive design, and all respondents were conveniently sampled. A self-administered questionnaire was used to collect data. One-hundred and seventy-seven questionnaires were distributed, and 153 nurses responded and completed the questionnaire. The Statistical Package for Social Sciences version 23 was used to analyse data.

RESULTS

 Results show that the majority of nurses (professional nurses [PNs] = 65, 78%; enrolled nurses [ENs] = 18, 72%; enrolled nursing auxiliaries [ENAs] = 23, 51%) had a positive attitude towards the MBFI strategy implementation as they agreed that it increased breastfeeding rates. Most PNs (n = 58, 70%) and ENs (n = 15, 60%) showed positive attitudes towards exclusive breastfeeding (EBF) as they agreed that it was the ideal feeding option for any child, and most ENAs (n = 38, 84%) showed a negative attitude as they disagreed that EBF was the ideal feeding option for any child.

CONCLUSION

 In this study, most PNs and ENs had a positive attitude in all the aspects that determined their attitudes towards MBFI strategy implementation. A concern is the fact that most ENAs showed negative attitudes in almost all the statements that were in line with the principles of MBFI, as they disagreed in most aspects. Therefore, this study recommends that on-going orientation and trainings should be offered to all nurses including ENAs to equip them with information that can assist in changing their attitudes towards MBFI implementation in PHC facilities.

Nurses’ attitudes towards the implementation of the Mother-Baby Friendly Initiative in selected primary healthcare facilities at Makhuduthamaga Municipality, Limpopo province

Background

The implementation of the Mother-Baby Friendly Initiative (MBFI) strategy demonstrated its capabilities to improve global children’s health and maternal survival. However, its implementation in primary healthcare (PHC) facilities remains a challenge as many nurses are reluctant to adopt it for the improvement of child and maternal healthcare services in their respective clinics.

Objectives

The primary objective of this study was to determine the attitudes of nurses towards the implementation of the MBFI in selected PHC facilities in the Makhuduthamaga Municipality, Limpopo province.

Method

This study used a quantitative, descriptive design, and all respondents were conveniently sampled. A self-administered questionnaire was used to collect data. One-hundred and seventy-seven questionnaires were distributed, and 153 nurses responded and completed the questionnaire. The Statistical Package for Social Sciences version 23 was used to analyse data.

Results

Results show that the majority of nurses (professional nurses [PNs] = 65, 78%; enrolled nurses [ENs] = 18, 72%; enrolled nursing auxiliaries [ENAs] = 23, 51%) had a positive attitude towards the MBFI strategy implementation as they agreed that it increased breastfeeding rates. Most PNs (n = 58, 70%) and ENs (n = 15, 60%) showed positive attitudes towards exclusive breastfeeding (EBF) as they agreed that it was the ideal feeding option for any child, and most ENAs (n = 38, 84%) showed a negative attitude as they disagreed that EBF was the ideal feeding option for any child.

Conclusion

In this study, most PNs and ENs had a positive attitude in all the aspects that determined their attitudes towards MBFI strategy implementation. A concern is the fact that most ENAs showed negative attitudes in almost all the statements that were in line with the principles of MBFI, as they disagreed in most aspects. Therefore, this study recommends that on-going orientation and trainings should be offered to all nurses including ENAs to equip them with information that can assist in changing their attitudes towards MBFI implementation in PHC facilities.

Strengthening patient and family engagement in healthcare - The New Haven Recommendations

OBJECTIVE

Present and discuss the development and basic structure of a multilevel approach to strengthen patient and family engaged care, "The New Haven Recommendations on partnering with patients, families and citizens to enhance performance and quality in health promoting hospitals and health services".

METHODS

A generic literature review was conducted followed by a Delphi procedure to prepare the New Haven Recommendations. From systems theory perspective, three conceptual levels are used to map action areas to enhance patient and family engaged care.

RESULTS

The recommendations propose a multilevel approach to enable patient, family, (and citizen representatives') involvement (a) within direct service provision; (b) among hospitals and health services; (c) in planning healthcare delivery systems and policy.

CONCLUSION

The New Haven Recommendations provide a strategic tool and practical recommendations, which can be used for reflection on current practices or generating new ways of thinking about patient and family engaged care. They support the development of patient and family engaged care as core aspect of high quality healthcare, and can contribute to achieving the Ottawa Charter's claim of reorienting health services.

PRACTICE IMPLICATIONS

The potential benefit of the multilevel approach is to reorient the basic culture of healthcare towards patient- and health-centered care.

Promotion of breastfeeding in Poland: the current situation

Objective

Exclusive breastfeeding is safe and beneficial for healthy infants; it is the optimal feeding method during the first 6 months of life. Infants should be complementary fed in conjunction with breastfeeding until 12 months of age or longer. The aim of the present study was to analyse the duration of breastfeeding through 12 months of age.

Methods

Participants were 1679 women from 42 randomly selected hospitals in Poland. The data were obtained from surveys, including a paper and pencil interview that was conducted after mothers delivered in the hospital and before discharge. Computer aided telephone interviews were administered at 2, 4, 6 and 12 months.

Results

There was a high rate of initiating breastfeeding after birth (97%), a rapid abandonment of exclusive breastfeeding (43.5% at 2 months, 28.9% at 4 months and 4% at 6 months) and an onset of formula feeding during the first days of life, which is contrary to current recommendations.

Conclusions

It is necessary re-educate mothers, medical staff who care for mothers and children during the perinatal period, and other specialists.

Hospital Staff's Perceptions with Regards to the Baby-Friendly Initiative

BACKGROUND

Adherence to Baby Friendly Initiative (BFI) practices is low in Canadian hospitals, despite evidence showing a positive impact of BFI practices on breastfeeding rates and duration. In 2012, the provincial Ontario Ministry of Health and Long Term Care added BFI status to its progress indicators for Public Health Units, which are now required to begin BFI implementation.

OBJECTIVE

This study aims to explore health care workers' self-reported knowledge of the BFI and their perceptions of the importance of its components.

METHODS

A questionnaire was electronically sent to 2237 employees working at our institution.

RESULTS

Questionnaires were completed by 651 participants, of which 110 (16.9%) and 87 (13.5%) participants reported having good knowledge of the BFI and the Ten Steps to Successful Breastfeeding, respectively. Multiple logistic regression showed that having children and having received formal breastfeeding education were associated with higher self-reported knowledge. Additionally, 481 (75%) participants reported that it was important or very important to them that the institution adopt the BFI. Having children and being an allied health professional were associated with perceiving the implementation of the BFI as important.

CONCLUSION

The results of our study have allowed us to identify potential barriers to implementation of the BFI, which can be targeted through system changes and staff education. Through this approach, we hope to facilitate acceptance of the BFI at our institution and increase support for optimal breastfeeding practices among our patients.

The struggle for inter-professional teamwork and collaboration in maternity care: Austrian health professionals' perspectives on the implementation of the Baby-Friendly Hospital Initiative

BACKGROUND

The health benefits of breastfeeding for mothers and babies are well documented in the scientific literature. Research suggests that support of breastfeeding during pre- and postnatal maternity care is an important determinant of breastfeeding initiation and duration. To support and promote breastfeeding on maternity units, the Baby-Friendly Hospital Initiative (BFHI) was launched in 1991. In Austria, however, less than one fifth of hospitals with a maternity unit are currently BFHI-certified. Implementation of BFHI and adjunct changes in work practices seem to represent a major challenge to maternity units. This article builds upon previous research that has identified a number of facilitators of and barriers to BFHI implementation in Austria. A major barrier has been the lack of intra- and inter-professional collaboration. Therefore, this article investigates the ways in which different healthcare professionals struggle to work together to successfully integrate the BFHI into practice.

METHODS

In this study, a qualitative research approach was used. Thirty-six semi-structured interviews with 11 midwives, 11 nurses, 13 physicians, and one quality manager, working across three maternity units, were interviewed on-site. Data analysis followed thematic analysis.

RESULTS

Midwives, nurses, and physicians had diverse approaches to childbirth and breastfeeding (medicalization vs. naturalness) and worked along different jurisdictions that became manifest in strict spatial divisions of maternity units. In their engagement within the BFHI, midwives, nurses, and physicians pursued different strategies (safeguarding vs. circumvention strategies). These differences hindered inter-professional teamwork and collaboration and, therefore, the integration of BFHI into practice.

CONCLUSIONS

Differing approaches to childbirth and breastfeeding, deep seated professional jurisdictions, as well as spatial constraints, challenge inter-professional teamwork and collaboration on maternity units. Inter-professional teamwork and collaboration are widely espoused goals of contemporary healthcare improvement strategies. Yet, critical debate on how these goals can be integrated into practice is needed. To enable collaboration and facilitate the implementation of programs such as BFHI, the different perspectives of health professionals should be brought together and the potential for integrating different forms of knowledge and practices should be considered.