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Lubbe W, Kubeka Z, Behr A, Tshitaudzi G, Dlamini-Nqeketo S, Botha J. Revival of the mother-baby friendly initiative (MBFI) in South Africa: towards a quality improvement project. Int Breastfeed J 2024; 19:28. [PMID: 38650000 PMCID: PMC11036704 DOI: 10.1186/s13006-024-00634-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 04/06/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND The discontinuation of "Mother-Baby Friendly" accreditation, coupled with the impact of the COVID-19 pandemic, has contributed to reduced breastfeeding rates observed in parts of South Africa. Consequently, the Child, Youth and School Health cluster of the National Department of Health, with support from the World Health Organization and United Nations Children's Fund, organised a Mother-Baby Friendly initiative revitalisation workshop. METHODS Held in Johannesburg, South Africa, on June 29-30, 2022, the workshop brought together local and international breastfeeding promotion experts to engage on issues related to the revitalisation of the Mother-Baby Friendly Initiative. The workshop included presentations and group sessions aimed at setting expectations, evaluating the Ten Steps to Successful Breastfeeding, and developing actionable revitalisation strategies. RESULTS Inadequate monitoring of the Mother-Baby Friendly Initiative implementation and adherence to the Ten Steps was identified as a major implementation bottleneck. Participants identified steps ten (coordinating discharge so that parents and their infants have timely access to ongoing support and care), five (supporting mothers to initiate and maintain breastfeeding and manage common difficulties), and two (ensuring that staff have sufficient knowledge, competence, and skills to support breastfeeding) of the Baby-Friendly Hospital Initiative as the most difficult to implement. Step seven (enabling mothers and their infants to remain together and to practise rooming-in 24 h a day) was the least difficult to implement. Workshop participants identified the following proposed solutions to revitalise breastfeeding promotion: strengthening capacity building and mentorship, improving monitoring and accountability measures, and certification of facilities meeting the initiative's standards. CONCLUSION Current breastfeeding policies and practices must be evaluated by the National Department of Health in collaboration with provincial and private representatives of the initiative to effectively revitalise the Mother-Baby Friendly Initiative. Moreover, an integrative monitoring framework must be developed through stakeholder engagement, role clarification, and ownership. While collaboration between the private and public sectors is required to promote training and communication within healthcare facilities and communities.
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Affiliation(s)
- Welma Lubbe
- NuMIQ Research Focus Area, North-West University, Potchefstroom, South Africa.
| | | | - Ann Behr
- National Department of Health, Pretoria, South Africa
| | | | | | - Jessica Botha
- NuMIQ Research Focus Area, North-West University, Potchefstroom, South Africa
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Denge TT, Bam NE, Lubbe W, Rakhudu A. Essential components of an educational program for implementing skin-to-skin contact for preterm infants in intensive care units: an integrative literature review. BMC Pregnancy Childbirth 2024; 24:281. [PMID: 38627706 PMCID: PMC11022346 DOI: 10.1186/s12884-024-06447-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 03/26/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Globally, prematurity is the primary factor behind the mortality of children under the age of 5 years, resulting in approximately 1 million children dying annually. The World Health Organization (WHO) recommends Skin-to-Skin Contact (SSC) as part of routine care for preterm infants. Evidence shows that SSC reduces mortality, possibly by improving thermoregulation, facilitating the earlier initiation of breastfeeding and reducing the risk of nosocomial infection. An educational program for implementing SSC has been demonstrated to enhance the knowledge and practice of parents and nurses in intensive care units. This study, the first of its kind in the North West Province (NWP), aims to identify the essential components of an educational program for implementing SSC for premature infants in intensive care units. OBJECTIVE This paper presents an integrative literature review that critically synthesizes research-based literature on essential components of an educational program for implementing SSC for preterm infants in intensive care units. METHODS A comprehensive search of electronic databases, such as CINAHL, MEDLINE, PsycINFO, ProQuest and Health Source: Nursing/Academic Edition and Health Source-Consumer Edition, was conducted using different keywords and references lists from the bibliography. RESULTS Twelve articles relevant to this review were identified, read and synthesized to answer the research question. Three essential components emerged from the findings of this review, namely (1) the necessity of policy and role players for implementing SSC, (2) the availability of education and training, and (3) counseling and support for parents of preterm infants. CONCLUSIONS The outcomes of this study have the potential to facilitate the implementation and expansion of SSC in intensive care units. This could aid program implementers, policymakers, and researchers to implement and scale up this important tool in intensive care units.
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Affiliation(s)
- Takalani T Denge
- NuMIQ (Quality in Nursing and Midwifery), Faculty of Health Sciences, North-West University, Potchefstroom, South Africa.
| | - Nokwanda Edith Bam
- NuMIQ (Quality in Nursing and Midwifery), Faculty of Health Sciences, North-West University, Mafikeng, South Africa
| | - Welma Lubbe
- NuMIQ (Quality in Nursing and Midwifery), Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Annah Rakhudu
- NuMIQ (Quality in Nursing and Midwifery), Faculty of Health Sciences, North-West University, Mafikeng, South Africa
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Barnard NB, Rothmann S, De Beer LT, Lubbe W. Burnout of emergency nurses in a South African context: the role of job demands and resources, and capabilities. Front Psychol 2023; 14:1119063. [PMID: 37275737 PMCID: PMC10233105 DOI: 10.3389/fpsyg.2023.1119063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 04/21/2023] [Indexed: 06/07/2023] Open
Abstract
Emergency nurses are prone to burnout due to the nature of their profession and working environment, potentially putting their sustainable employability at risk and so too the care provided by and success of emergency departments. Psychological research has predominantly focused on samples drawn from western, educated, industrialized, rich, and democratic (WEIRD) societies, concerning a small part of the world population. Consequently, this study investigated emergency nurses' burnout in a non-WEIRD society and assessed the role of job demands-resources and work capabilities on their burnout levels. A total of 204 emergency nurses in a South African context participated in a cross-sectional survey. The Job Demands-Resources Scale, the Capability Set for Work Questionnaire, and the Burnout Assessment Tool-Short Form were administered. Using and developing knowledge and skills and building and maintaining meaningful relationships were the strongest work capabilities of emergency nurses. In contrast, earning a good income, involvement in important decisions, and contributing to something valuable were the weakest capabilities. Latent class analysis resulted in three capability sets: a robust capability set, an inadequate capability set, and a weak capability set. Regarding job resources, emergency nurses with a robust capability set reported better relationships with their supervisors and higher job autonomy than the inadequate and weak capability sets. In addition, emergency nurses with a robust capability set reported better co-worker relationships and better access to good equipment than those with a weak capability set. Nurses with an inadequate capability set experienced significantly more challenging job demands than the other two sets. Finally, nurses with a weak capability set (compared to the robust capability set) experienced significantly higher levels of exhaustion and mental distance. Improving emergency nurses' job resources (especially relationships with co-workers and supervisors, job autonomy, and equipment sufficiency) would increase their capabilities, decreasing their burnout levels, especially exhaustion and mental distance.
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Affiliation(s)
- Neil B. Barnard
- Optentia Research Unit, North-West University, Vanderbijlpark, South Africa
| | | | - Leon T. De Beer
- WorkWell Research Unit, North-West University, Potchefstroom, South Africa
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Welma Lubbe
- Quality in Nursing and Midwifery Research Focus Area, North-West University, Potchefstroom, South Africa
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Lubbe W, Springer L, Maastrup R, Haiek LN, Nyaloko M. Baseline status regarding compliance with neo-BFHI recommendations in South African neonatal wards: a cross-sectional survey. BMC Health Serv Res 2023; 23:420. [PMID: 37127608 PMCID: PMC10152633 DOI: 10.1186/s12913-023-09396-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 04/12/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND In 2009, the World Health Organization and the United Nations Children's Fund issued a revised Baby-friendly Hospital Initiative (BFHI) package to encourage all healthcare facilities to promote the advice of exclusive breastfeeding. The scope of the BFHI was expanded to include neonatal units by the Nordic and Quebec Working Group. AIM To determine the level of compliance with the recommendations outlined in the "Baby-friendly Hospital Initiative for neonatal wards" (Neo-BFHI) in the South African neonatal wards. METHOD In this cross-sectional survey, the sample included neonatal wards (N = 33) from public and private hospital facilities. Using EasyTrial software, the Neo-BFHI self-assessment questionnaire was utilized to collect the data. The data was transferred to MS Excel (version 15.0.5127.1000) and analysed with the Statistical Package for Social Sciences version 24. RESULTS The South African median score for Neo-BFHI compliance was 77. Neonatal wards in public hospitals scored higher (85) than those in private hospitals (73). Neonatal wards in hospitals that were accredited Baby-friendly had higher compliance scores than those without accreditation. The country had the highest compliance scores (100, 90) on Guiding Principle 1 (respect towards mothers) and step 5 (breastfeeding support), respectively. However, it scored low (71, 58) on steps 4 (enhancing kangaroo mother care) and 7 (maternal infant "togetherness"), respectively. Level 1 and 2 care facilities scored significantly higher than level 3. CONCLUSION Although South Africa successfully implemented the Neo-BFHI recommendations, private hospitals had a smaller number of BFHI-accredited facilities and lower compliance than public hospitals. Strategies should be developed to strengthen and improve BFHI accreditation and compliance, particularly in private hospitals.
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Affiliation(s)
- Welma Lubbe
- NuMiQ Research Focus Area, North-West University South Africa, Potchefstroom, South Africa
| | - Lisa Springer
- NuMiQ Research Focus Area, North-West University South Africa, Potchefstroom, South Africa
| | - Ragnhild Maastrup
- Department of Neonatology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Laura N Haiek
- Ministère de la Santé et des Services sociaux, Direction générale de la santé publique, Quebec, Canada
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
- St. Mary's Hospital, St. Mary's Research Centre, Montreal, Quebec, Canada
| | - Madimetja Nyaloko
- NuMiQ Research Focus Area, North-West University South Africa, Potchefstroom, South Africa.
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Lubbe W, Niela-Vilén H, Thomson G, Botha E. Impact of the COVID-19 Pandemic on Breastfeeding Support Services and Women's Experiences of Breastfeeding: A Review. Int J Womens Health 2022; 14:1447-1457. [PMID: 36225180 PMCID: PMC9549794 DOI: 10.2147/ijwh.s342754] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 09/08/2022] [Indexed: 11/06/2022] Open
Abstract
Objective The aim of this systematic review was to explore the impact of the COVID-19 pandemic on breastfeeding support services and continuation rates. Methods Electronic searches were undertaken in seven databases: Academic Search Complete, Springer Nature Journals, CINAHL Medline, Health Source: Nursing/Academic Edition, Masterfile premier, and SocINDEX. Publications following the COVID-19 pandemic between January 2020 and March 2022 were searched for using the following keywords: impact or effect or influence and breastfeeding support and breastfeeding continuation and COVID-19 or coronavirus. Fifteen studies were included for investigation and extracted to identify seven themes related to breastfeeding support during COVID-19. Results Factors which impacted breastfeeding support during the COVID-19 pandemic included separation, lack of skin-to-skin contact, insufficient support, online breastfeeding support, the impact of the pandemic on breastfeeding rates and experiences, fears of the pandemic, and the need for additional support. The pandemic mostly influenced breastfeeding support negatively, with a small exception occurring where some mothers experienced lockdown as positive since it protected the mother-infant dyad from unwanted visitors. Virtual breastfeeding support was introduced in many contexts; however, practitioners and mothers reported that this could not replace the need for face-to-face support. Conclusion Breastfeeding is a lifesaving intervention, especially in the face of a disruption such as a pandemic. This work highlights the need for clear, consistent, and evidence-based information about risks, and for key practices to be maintained including not separating mothers and infants, promoting skin-to-skin contact, and ensuring availability of high-quality breastfeeding support.
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Affiliation(s)
- Welma Lubbe
- School of Nursing Science/NuMIQ Research Focus Area, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa,Correspondence: Welma Lubbe, Email
| | | | - Gill Thomson
- School of Community Health and Midwifery, University of Central Lancashire, Preston, UK
| | - Elina Botha
- School of Social Services and Health Care, Tampere University of Applied Sciences, Tampere, Finland
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Rothberg AD, Smith J, Lubbe W. Evidence of an active Cushing reflex in a preterm neonate with hyaline membrane disease: a case report. J Med Case Rep 2021; 15:592. [PMID: 34903289 PMCID: PMC8670276 DOI: 10.1186/s13256-021-03161-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 10/20/2021] [Indexed: 11/30/2022] Open
Abstract
Background The Cushing reflex does not appear to have been described in preterm neonates. This case report shows the presence of an active Cushing reflex in a 32-week preterm neonate with hyaline membrane disease. Case presentation The 1.94 kg Caucasian infant was delivered by caesarean section following concerns about possible maternal infection and fetal compromise. Chest X-ray showed mild-to-moderate hyaline membrane disease and treatment was initiated with supplemental oxygen and nasal continuous positive airway pressure. It is probable that a pneumothorax occurred at 5–6 hours of age, with progression during the day. Interstitial air, pneumomediastinum, and tension pneumothorax were diagnosed on subsequent X-ray, and ultrasound of the brain showed a grade IV intraventricular hemorrhage. A review of the nurses’ recordings of heart rate, blood pressure, and respiratory rate showed a progressive increase in blood pressure accompanied by slowing of the heart rate and irregular respiration. These are features of the Cushing reflex that is elicited in response to raised intracranial pressure. Conclusion While well-described in older children and adults, in neonates the Cushing reflex has mainly been described in animal experiments and infants who have developed hydrocephalus. It is likely that in this case, the reflex was elicited as a result of a progressive increase in intracranial pressure due to the combination of elevated intrathoracic pressure, obstructed venous return from the brain, and concurrent intraventricular hemorrhage.
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Affiliation(s)
- Alan D Rothberg
- School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Parktown, Johannesburg, 2193, South Africa.
| | - Johan Smith
- Division of Neonatology, Department of Paediatrics and Child Health, Stellenbosch University, Stellenbosch, South Africa
| | - Welma Lubbe
- School of Nursing Science, North-West University, Potchefstroom, South Africa
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Rheeder A, Lubbe W, van der Walt CSJ, Pretorius R. Compliance With Best Practice Guidelines for Neurodevelopmental Supportive Care in South Africa: A Situational Analysis. J Perinat Neonatal Nurs 2021; 35:E83-E96. [PMID: 29194079 DOI: 10.1097/jpn.0000000000000275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Neurodevelopmental supportive care provides preterm infants with evidence-based care to ensure the best possible neurological outcomes. The study aimed to determine the compliance of current nursing care practices with best practice guidelines by means of a situational analysis. The situational analysis was done in 2 cycles in the neonatal intensive care units (n = 25) of a private healthcare provider in South Africa. Structured observations were done in cycle 1 using the Implementation of Neurodevelopmental Supportive Care checklist. Cycle 2 comprised focus group discussions to verify findings from cycle 1. Seventeen conclusion statements were formulated, which were thematically combined to be presented as 9 categories: neonatal intensive care unit design, individualized care, family-centered care, infant positioning, handling techniques, environmental manipulation, pain management, knowledge of infant behavior, and feeding. The conclusion statements identified improvement opportunities in current practice and offer suggestions, which can be used to guide an implementation strategy for best practice guidelines of neurodevelopmental supportive care in the neonatal intensive care units of the private healthcare group in future. Addressing improvement opportunities in all the categories will ensure that all aspects of the guideline requirements are met, resulting in a comprehensive strategy improving practice and patient outcomes.
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Affiliation(s)
- Aletta Rheeder
- INSINQ-Research to Advance Quality in Nursing and Midwifery, North-West University, Potchefstroom, South Africa (Ms Rheeder and Drs Lubbe and van der Walt); and Africa Unit for Transdisciplinary Health Research, North-West University, Potchefstroom, South Africa (Dr Pretorius)
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Abstract
BACKGROUND The COVID-19 pandemic is disrupting normal life globally, every area of life is touched. The pandemic demands quick action and as new information emerges, reliable synthesises and guidelines for care are urgently needed. Breastfeeding protects mother and child; its health benefits are undisputed and based on evidence. To plan and support breastfeeding within the current pandemic, two areas need to be understood: 1) the clinical characteristics of COVID-19 as it applies to breastfeeding and 2) the protective properties of breastfeeding, including the practice of skin-to-skin care. This review aims to summarise how to manage breastfeeding during COVID-19. The summary was used to create guidelines for healthcare professionals and mothers. METHODS Current publications on breastfeeding during the COVID-19 pandemic were reviewed to inform guidelines for clinical practice. RESULTS Current evidence states that the Coronavirus is not transmitted via breastmilk. Breastfeeding benefits outweigh possible risks during the COVID-19 pandemic and may even protect the infant and mother. General infection control measures should be in place and adhered to very strictly. CONCLUSIONS Breastfeeding should be encouraged, mothers and infant dyads should be cared for together, and skin-to-skin contact ensured throughout the COVID-19 pandemic. If mothers are too ill to breastfeed, they should still be supported to express their milk, and the infant should be fed by a healthy individual. Guidelines, based on this current evidence, were produced and can be distributed to health care facilities where accessible information is needed.
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Affiliation(s)
- Welma Lubbe
- NuMIQ - Quality in Nursing and Midwifery, North-West University, 11 Hoffman St, Potchefstroom, South Africa.
| | - Elina Botha
- School of Health, Midwifery, Tampere University of Applied Sciences, Tampere, Finland
| | | | - Penny Reimers
- Department of Paediatrics and Child Health, University of KwaZulu Natal, Durban, South Africa
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Botha E, Helminen M, Kaunonen M, Lubbe W, Joronen K. Mothers' parenting self-efficacy, satisfaction and perceptions of their infants during the first days postpartum. Midwifery 2020; 88:102760. [PMID: 32521409 DOI: 10.1016/j.midw.2020.102760] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 05/13/2020] [Accepted: 05/19/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The first aim of this study was to describe mothers' self-efficacy, satisfaction and perceptions when parenting their infants during the first days postpartum. Furthermore, the study aimed to explore the distinct sociodemographic as well as mother and infant related factors that are associated with the above parenting aspects. DESIGN A descriptive and cross-sectional study design was used. SETTING Three separate postpartum wards 1-7 days after childbirth in one university level hospital in Finland. PARTICIPANTS All mothers who gave birth during March 1st to May 20th, 2019 and filled the inclusion criteria, were invited to participate in this study. A convenience sample of 250 mothers with healthy singleton infants agreed to participate. MEASUREMENTS AND FINDINGS The following instruments were used: The Parenting Self-Efficacy (PSE) scale, the Evaluation subscale of What Being the Parent of a New Baby is Like-revised (WBPL-R) and the Perception of Infant scale. Mothers' parenting self-efficacy and parenting satisfaction were high during the first days postpartum. Age, marital status, education and type of birth were not associated with parenting self-efficacy nor satisfaction. Mothers who were unemployed or working only part-time reported higher scores across all categories of parenting self-efficacy, compared to full time employed mothers (p < .001). A higher number of children (≥ 3) were positively associated with both parenting self-efficacy and satisfaction. Mothers who reported poor breastfeeding initiation success also reported significantly lower scores in parenting self-efficacy and parenting satisfaction across all categories. Mothers' perceptions of their infants' fussiness were not associated with parenting self-efficacy (p = .113) nor parenting satisfaction (p = .091). KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE The results of this study can benefit postpartum maternity health care professionals by suggesting factors that could be focused on during the very short period that mothers stay in hospital. Discussing prior mothering experiences, work life before maternity leave, breastfeeding initiation experiences and perception of infant with the mothers after childbirth, may lead to better PSE and PS during the postpartum period.
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Affiliation(s)
- Elina Botha
- Doctoral Researcher, MHSc, RM, RN, Faculty of Social Sciences, Health Sciences, Tampere University, 33014 Tampere University, Finland.
| | - Mika Helminen
- MSc, Biostatistician, Faculty of Social Sciences, Health Sciences, Tampere University, Research, Development and Innovation Centre, Tampere University Hospital, 33521 Tampere, Finland.
| | - Marja Kaunonen
- PhD, Professor, Faculty of Social Sciences, Health Sciences, Tampere University, General Administration, Pirkanmaa Hospital District, 33014 Tampere University, Finland.
| | - Welma Lubbe
- PhD, Associate Professor, School of Nursing Science/ NuMIQ research unit, North-West University, Private Bag X6001, Potchefstroom, 2520, South Africa.
| | - Katja Joronen
- PhD, Adjunct Professor, Faculty of Social Sciences, Health Sciences, Tampere University, 33014 Tampere University, Finland.
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Lubbe W, Oosthuizen CS, Dolman RC, Covic N. Stakeholder Attitudes towards Donating and Utilizing Donated Human Breastmilk. Int J Environ Res Public Health 2019; 16:ijerph16101838. [PMID: 31126144 PMCID: PMC6572701 DOI: 10.3390/ijerph16101838] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 04/24/2019] [Accepted: 05/06/2019] [Indexed: 11/16/2022]
Abstract
The promotion and support of human milk banks (HMBs) can enhance exclusive breastfeeding rates. The success and sustainability of HMBs depend on the support from relevant healthcare workers and related communities. This study aimed to determine attitudes of key stakeholders, including mothers, healthcare workers and grandmothers, regarding the donation and receipt of human breastmilk. This study was conducted at a public hospital and clinics in the North West Province, South Africa. Eight focus group discussions explored the attitudes regarding donating and receiving human breastmilk: three groups with mothers of infants (n = 13), three with grandmothers (>60 years old) (n = 17) and two with healthcare professionals working with infants (n = 11). Four main themes emerged: perception regarding breast and formula feeding; exposure to the concept of “wet nursing”; breastmilk donation; and utilization and opinions of community members and traditional healers. Specific barriers identified included the processes for donating and receiving milk, safety, human immuno-deficiency virus (HIV) screening and cultural beliefs. Mothers’ fears included having insufficient milk for their own infants, changes in the quality of donated milk during pasteurization and transportation and HIV transmission. Despite barriers towards donations to and the use of HMBs, sufficient information could enhance donations by mothers and breastmilk utilization.
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Affiliation(s)
- Welma Lubbe
- Quality in Nursing and Midwifery (NuMIQ) research unit, School of Nursing Science, North-West University, Potchefstroom 2520, South Africa.
| | - Charlene S Oosthuizen
- Centre of Excellence for Nutrition, North-West University, Potchefstroom 2520, South Africa.
| | - Robin C Dolman
- Centre of Excellence for Nutrition, North-West University, Potchefstroom 2520, South Africa.
| | - Namukolo Covic
- Centre of Excellence for Nutrition, North-West University, Potchefstroom 2520, South Africa.
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Lubbe W. Clinicians guide for cue-based transition to oral feeding in preterm infants: An easy-to-use clinical guide. J Eval Clin Pract 2018; 24:80-88. [PMID: 28251754 PMCID: PMC5901413 DOI: 10.1111/jep.12721] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 01/16/2017] [Accepted: 01/16/2017] [Indexed: 11/26/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES This article aims to provide evidence to guide multidisciplinary clinical practitioners towards successful initiation and long-term maintenance of oral feeding in preterm infants, directed by the individual infant maturity. METHOD A comprehensive review of primary research, explorative work, existing guidelines, and evidence-based opinions regarding the transition to oral feeding in preterm infants was studied to compile this document. RESULTS Current clinical hospital practices are described and challenged and the principles of cue-based feeding are explored. "Traditional" feeding regimes use criteria, such as the infant's weight, gestational age and being free of illness, and even caregiver intuition to initiate or delay oral feeding. However, these criteria could compromise the infant and increase anxiety levels and frustration for parents and caregivers. Cue-based feeding, opposed to volume-driven feeding, lead to improved feeding success, including increased weight gain, shorter hospital stay, fewer adverse events, without increasing staff workload while simultaneously improving parents' skills regarding infant feeding. Although research is available on cue-based feeding, an easy-to-use clinical guide for practitioners could not be found. A cue-based infant feeding regime, for clinical decision making on providing opportunities to support feeding success in preterm infants, is provided in this article as a framework for clinical reasoning. CONCLUSIONS Cue-based feeding of preterm infants requires care providers who are trained in and sensitive to infant cues, to ensure optimal feeding success. An easy-to-use clinical guideline is presented for implementation by multidisciplinary team members. This evidence-based guideline aims to improve feeding outcomes for the newborn infant and to facilitate the tasks of nurses and caregivers.
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Affiliation(s)
- Welma Lubbe
- School of Nursing Science, INSINQ, North-West University (Potchefstroom Campus), South Africa
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Lubbe W, ten Ham-Baloyi W. When is the use of pacifiers justifiable in the baby-friendly hospital initiative context? A clinician's guide. BMC Pregnancy Childbirth 2017; 17:130. [PMID: 28449646 PMCID: PMC5408445 DOI: 10.1186/s12884-017-1306-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 04/11/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The use of pacifiers is an ancient practice, but often becomes a point of debate when parents and professionals aim to protect and promote breastfeeding as most appropriately for nurturing infants. We discuss the current literature available on pacifier use to enable critical decision-making regarding justifiable use of pacifiers, especially in the Baby-Friendly Hospital Initiative context, and we provide practical guidelines for clinicians. DISCUSSION Suck-swallow-breathe coordination is an important skill that every newborn must acquire for feeding success. In most cases the development and maintenance of the sucking reflex is not a problem, but sometimes the skill may be compromised due to factors such as mother-infant separation or medical conditions. In such situations the use of pacifiers can be considered therapeutic and even provide medical benefits to infants, including reducing the risk of sudden infant death syndrome. The argument opposing pacifier use, however, is based on potential risks such as nipple confusion and early cessation of breastfeeding. The Ten Steps to Successful Breastfeeding as embedded in the Baby-Friendly Hospital Initiative initially prohibited the use of pacifiers in a breastfeeding friendly environment to prevent potential associated risks. This article provides a summary of the evidence on the benefits of non-nutritive sucking, risks associated with pacifier use, an identification of the implications regarded as 'justifiable' in the clinical use of pacifiers and a comprehensive discussion to support the recommendations for safe pacifier use in healthy, full-term, and ill and preterm infants. The use of pacifiers is justifiable in certain situations and will support breastfeeding rather than interfere with it. Justifiable conditions have been identified as: low-birth weight and premature infants; infants at risk for hypoglyceamia; infants in need of oral stimulation to develop, maintain and mature the sucking reflex in preterm infants; and the achievement of neurobehavioural organisation. Medical benefits associated with the use of pacifiers include providing comfort, contributing towards neurobehavioural organisation, and reducing the risk of sudden infant death syndrome. Guidelines are presented for assessing and guiding safe pacifier use, for specific design to ensure safety, and for cessation of use to ensure normal childhood development.
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Affiliation(s)
- Welma Lubbe
- North-West University, School of Nursing Science, Private Bag X6001, Potchefstroom, 2520 South Africa
| | - Wilma ten Ham-Baloyi
- Nelson Mandela Metropolitan University, Faculty of Health Sciences, Private Bag 77000, Port Elizabeth, 6031 South Africa
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Lubbe W, Li T, Hughes M, Ottesen R, Cristofanilli M, Weeks J, Wong YN. P4-20-02: Inflammatory Breast Cancer (IBC) in the National Comprehensive Cancer Network (NCCN): The Disease, the Recurrence Pattern and the Outcome. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p4-20-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
Inflammatory breast cancer (IBC) is a unique clinicopathologic entity that is characterized by rapid progression and aggressive behavior from the onset. The clinical presentation consists of erythema, rapid enlargement of the breast, skin ridging, and a characteristic peau d'orange appearance of the skin secondary to dermal lymphatic tumor involvement. Because of its uncommon presentation leading to frequent misdiagnosis, most reports are from small single institution series which describe a predictable pattern of recurrence in spite of appropriate multidisciplinary treatments. We sought to confirm these observations using the large multi-institutional National Comprehensive Cancer Network (NCCN) outcomes database.
Methods: Patients (pts) with newly diagnosed IBC treated between 1999 and 2009 at 12 participating NCCN institutions were identified. The clinical diagnoses of IBC was based on the AJCC definition and staged as clinical T4d, N0-3, M0-1. The baseline pathological characteristics included histological type, estrogen receptor (ER), progesterone-receptor (PR), and HER-2/neu status. Pts were classified as receiving multimodality therapy if they received two of the following three treatments: surgery (lumpectomy or mastectomy), perioperative (neoadjuvant or adjuvant) systemic therapy, or perioperative radiation therapy.
Results: We identified a cohort of 673 pts with newly diagnosed IBC with a median follow-up of 28.9 months. Of which 195 (29%) had metastatic disease at presentation. The median age at presentation was 52.6 years. Caucasians were 79.4% of the cohort, African American 9.7%, and 11.0% other ethnic groups. Invasive ductal type comprised 84% of histologies. Biomarker assessment revealed ER+ (44.7%), PR+ (34.3%), and Her2/neu+ (33.4%). LVI was documented in 53.3%. Of stage III patients, 75.7% pts received perioperative radiation, 82% received perioperative systemic therapy and 70.7% underwent surgery. All three modalities were received by 64.4% of women. Of the stage III pts, 203 recurred. The most frequent sites of recurrence for were CNS (20.2%), bone (17.2%), chest wall (13.8%), lung (12.3%), liver (11.3%), distant (7.4%) and regional lymph nodes (6.9%). With a median of 30 and 20 months of follow-up for stage III & IV respectively, the median survival was 66 months (95% CI 54–107) for stage III pts and 26 months (95% CI: 22–33) for stage IV Among the 82% of stage III pts who received multimodality therapy, the 5 year and 10 year OS of 62% and 47%.
Discussion: This is a large retrospective multiinstitutional study that confirms the aggressive clinical features, recurrence patterns and adverse prognosis of IBC described in previous single institution series. Even with aggressive multimodal therapy, the long term survival of IBC shorter is than non-IBC. Future investigations are needed to address the aggressive biology of IBC to improve diagnosis and therapy.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P4-20-02.
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Affiliation(s)
- W Lubbe
- 1Fox Chase Cancer Center, Philadelphia, PA; Dana-Farber Cancer Institute, Boston, MA; City of Hope Cancer Center, Duarte, CA
| | - T Li
- 1Fox Chase Cancer Center, Philadelphia, PA; Dana-Farber Cancer Institute, Boston, MA; City of Hope Cancer Center, Duarte, CA
| | - M Hughes
- 1Fox Chase Cancer Center, Philadelphia, PA; Dana-Farber Cancer Institute, Boston, MA; City of Hope Cancer Center, Duarte, CA
| | - R Ottesen
- 1Fox Chase Cancer Center, Philadelphia, PA; Dana-Farber Cancer Institute, Boston, MA; City of Hope Cancer Center, Duarte, CA
| | - M Cristofanilli
- 1Fox Chase Cancer Center, Philadelphia, PA; Dana-Farber Cancer Institute, Boston, MA; City of Hope Cancer Center, Duarte, CA
| | - J Weeks
- 1Fox Chase Cancer Center, Philadelphia, PA; Dana-Farber Cancer Institute, Boston, MA; City of Hope Cancer Center, Duarte, CA
| | - Y-N Wong
- 1Fox Chase Cancer Center, Philadelphia, PA; Dana-Farber Cancer Institute, Boston, MA; City of Hope Cancer Center, Duarte, CA
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Turaka A, Li T, Lubbe W, Smith MR, Millenson MM, Schilder RJ, Borghaei H, Cohen AD, Al-Saleem TI, Nicolaou N. Curative radiation therapy for primary ocular lymphomas: Demonstration of dose response. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e18503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Lubbe W, Bornman J. Early intervention care programme for parents of neonates. Curationis 2005; 28:73-82. [PMID: 16509099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
Parents with neonates in the neonatal intensive care unit (NICU) experience different needs at different stages of their neonates' stay in the NICU. The needs of parents with neonates in NICU's play an important role in aspects such as the ability to cope with changing parental roles and emotions, the relationship between parent and infant and the managing of the parents' own needs. The aim of this study was to develop an intervention care programme for parents with neonates in the NICU. This intervention care programme will empower parents to manage their own needs and the needs of their neonates while the neonate is admitted to the NICU and after discharge from the NICU/hospital. Literature is available on care programmes for neonates, but not on programmes for the parents of neonates in NICU. The study was a multi-phased study, using qualitative methodologies to determine the needs of South African parents with neonates in level III NICU's. In phase I, the needs of parents with neonates in NICU were elicited qualitatively. The needs were identified from the data and the results led to the implementation of phase II. In phase II the question was adjusted and new data was collected. Phase III was implemented to validate the data derived from phases I and II. The data was categorised in different need categories and these categories were used to plan an intervention care programme for parents with neonates in NICU's. The programme provides information to address needs as identified by parents in the research study and as derived from the literature. Need categories identified from the study and literature were as follows: information, communication, emotional, learning, discharge and individual needs. This programme is available in electronic format to enable parents to obtain information according to their changing needs and to provide unlimited access to updated information. The "Early intervention care programme for parents of neonates" will empower parents to manage their own needs and the needs of their neonates while the neonate is admitted to the NICU and after discharge from the NICU/hospital.
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Affiliation(s)
- W Lubbe
- Tshwane University of Technology.
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Abstract
Parents with neonates in the neonatal intensive care unit (NICU) experience different needs at different stages of their neonates’ stay in the NICU. The needs of parents with neonates in NICU’s play an important role in aspects such as the ability to cope with changing parental roles and emotions, the relationship between parent and infant and the managing of the parents’ own needs. The aim of this study was to develop an intervention care programme for parents with neonates in the NICU. This intervention care programme will empower parents to manage their own needs and the needs of their neonates while the neonate is admitted to the NICU and after discharge from the NICU / hospital. Literature is available on care programmes for neonates, but not on programmes for the parents of neonates in NICU. The study was a multi-phased study, using qualitative methodologies to determine the needs of South African parents with neonates in level III NICU’s. In phase I, the needs of parents with neonates in NICU were elicited qualitatively. The needs were identified from the data and the results led to the implementation of phase II. In phase II the question was adjusted and new data was collected. Phase III was implemented to validate the data derived from phases I and II. The data was categorised in different need categories and these categories were used to plan an intervention care programme for parents with neonates in NICU’s. The programme provides information to address needs as identified by parents in the research study and as derived from the literature. Need categories identified from the study and literature were as follows: information, communication, emotional, learning, discharge and individual needs. This programme is available in electronic format to enable parents to obtain information according to their changing needs and to provide unlimited access to updated information. The “Early intervention care programme for parents of neonates” will empower parents to manage their own needs and the needs of their neonates while the neonate is admitted to the NICU and'after discharge from the NICU / hospital.
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Lubbe W. Early intervention care programme for parents of neonates. Curationis 2005; 28:54-63. [PMID: 16245480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
Parents with neonates in the neonatal intensive care unit (NICU) experience different needs at different stages of their neonates' stay in the NICU. The needs of parents with neonates in NICU's play an important role in aspects such as the ability to cope with changing parental roles and emotions, the relationship between parent and infant and the managing of the parents' own needs. The aim of this study was to develop an intervention care programme for parents with neonates in the NICU. This intervention care programme will empower parents to manage their own needs and the needs of their neonates while the neonate is admitted to the NICU and after discharge from the NICU / hospital. Literature is available on care programmes for neonates, but not on programmes for the parents of neonates in NICU. The study was a multi-phased study, using qualitative methodologies to determine the needs of South African parents with neonates in level III NICU's. In phase I, the needs of parents with neonates in NICU were elicited qualitatively. The needs were identified from the data and the results led to the implementation of phase II. In phase II the question was adjusted and new data was collected. Phase III was implemented to validate the data derived from phases I and II. The data was categorised in different need categories and these categories were used to plan an intervention care programme for parents with neonates in NICU's. The programme provides information to address needs as identified by parents in the research study and as derived from the literature. Need categories identified from the study and literature were as follows: information, communication, emotional, learning, discharge and individual needs. This programme is available in electronic format to enable parents to obtain information according to their changing needs and to provide unlimited access to updated information. The "Early intervention care programme for parents of neonates" will empower parents to manage their own needs and the needs of their neonates while the neonate is admitted to the NICU and after discharge from the NICU / hospital.
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Affiliation(s)
- W Lubbe
- Little Steps Preemie Parenting Consultancy, Highveld.
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Bruyneel K, Owen P, Lubbe W, Simson E, Berman M, Opie LH. Factors influencing onset of ventricular fibrillation following coronary artery occlusion in a subhuman primate (Cape Chacma baboon). Heart 1972; 34:964. [PMID: 4627593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
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