Inconsistencies Among Nurses in Breastfeeding Knowledge and Counseling

Two hundred three nurses involved in the hospital care of women and their newborn completed a pre-test survey associated with a telephone conference in support of the breastfeeding mother. Inconsistencies among the majority of nurses in their ability to support the breastfeeding women and understand the mechanisms of successful breastfeeding were demonstrated. Results of the survey are presented as well as implications for education of nurses who care for the childbearing family.     

What Do Nurses Know About Breastfeeding Problems?

A small sampling of nurses completed a questionnaire designed to determine a) whether nurses can identify common problems mothers have with breastfeeding after they are discharged from the hospital and b) whether ability to identify the problems is affected by the nurse's date of graduation from nursing school, age, direct or indirect experience with breastfeeding, or her attitude toward breastfeeding. The nurses were unable to identify the problems, and the variables tested did not influence their ability. This points to a deficiency in nurses'knowledge about breastfeeding problems and in the guidance offered to mothers who chose to breastfeed.     

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

ObjectiveTo describe the experiences of registered nurses (RNs) who support breastfeeding women and to understand the factors that they believe affect practices that support breastfeeding.Data SourcesWe conducted an online search using five databases: Scopus, MEDLINE, Cumulative Index of Nursing and Allied Health Literature (CINAHL), the Cochrane Database of Systematic Reviews, and Joanna Briggs Institute of Systematic Reviews.Study SelectionWe included original research articles on the experiences of RNs who support breastfeeding women that were published in 2009 or after and were available in English. After title and abstract review of 785 articles, we included 22 articles for full text review. Nine articles met the eligibility criteria and were included in the review.Data ExtractionWe used Whittemore and Knafl’s five-step framework and the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines to guide this integrative review. Three authors reviewed and appraised the articles independently.Data SynthesisWe categorized the findings into three themes: Workplace Issues, Personal Experiences, and Breastfeeding Knowledge and Education. Workplace Issues included the subthemes Lack of Time and Workload and Infant Health Stability. Personal Experiences included the subthemes Attitudes, Individual Experiences With Breastfeeding, and The Experiences of Family and Friends. Breastfeeding Knowledge and Education included the subthemes Prelicensure Education and Workplace Education and Training. Most researchers identified deficits in knowledge and education among RNs. The concept of confidence was influenced by all the other themes. Participants in the included studies reported that they developed confidence after learning from lactation consultants and having role models who supported the development of their knowledge and skills.ConclusionDespite the heterogeneity among the studies, findings highlighted the need for an increased focus on the preparation of RNs to support women to effectively breastfeed within health care organizations. Multitargeted efforts, such as orientation programs and in-depth breastfeeding education using role modeling, mentorship, and role playing with practical scenarios, may improve RNs’ abilities and confidence to support breastfeeding women.     

An Institutional Ethnography of Nurses’ Support of Breastfeeding on the Night Shift

ObjectiveTo describe nurses’ support of breastfeeding on the night shift and to identify the interpersonal interactions and institutional structures that affect this support.DesignInstitutional ethnography.SettingThe mother/baby unit of a tertiary care hospital with 4200 births per year.ParticipantsRegistered nurses (N = 16) who provided care on the night shift to mother/infant dyads in the immediate postpartum period.MethodsData were collected using focus groups, individual and group interviews, and mother/baby unit observations. The focus groups were held before the night shift and had five participants. The nine individual and group interviews were conducted between 0100 and 0230 on the mother/baby unit. Three unit observations were conducted. Interviews were recorded, professionally transcribed, and analyzed using a content analysis method.ResultsData analysis yielded three themes that described these nurses’ support of breastfeeding on the night shift: competing priorities, incongruent expectations, and influential institutional structures. The need of visitors to see their new family members competed with the needs of mothers to rest and breastfeed their newborns. Helping breastfeeding dyads who experienced difficulties competed with providing care to other patients. Parents’ expectations regarding newborn behavior were incongruent with the reality of newborn feeding and sleeping patterns. Institutional structures that affected the provision of breastfeeding support by nurses included hospital breastfeeding practices, staffing, and policies.ConclusionNurses’ support of breastfeeding on the night shift encompasses a complex interplay of interpersonal interactions with new families and visitors regarding priorities and expectations and negotiating institutional structures such as feeding policies and staffing.     

Personal Infant Feeding Experiences of Postpartum Nurses Affect How They Provide Breastfeeding Support

Objective

To describe the experiences of postpartum nurses when feeding their own infants and explore how these experiences influence the breastfeeding support they provide to new mothers.

Use of a Web‐based Education Program Improves Nurses’ Knowledge of Breastfeeding

ObjectiveTo evaluate the baseline knowledge and knowledge gained of nurses, nursing students, midwives, and nurse practitioners who completed Breastfeeding Basics, an online educational program.DesignThis study reports on an anonymous evaluation of an online breastfeeding education program developed and maintained to promote evidence‐based breastfeeding practice.ParticipantsIncluded in the study were 3736 nurses, 728 nurse practitioners/midwives, and 3106 nursing students from the United States who completed ≥ one pretest or posttest on the Breastfeeding Basics website between April 1999 and December 31, 2011.MethodsBaseline scores were analyzed to determine if nurses’ baseline knowledge varied by selected demographic variables such as age, gender, professional level, personal or partner breastfeeding experience, and whether they were required to complete the website for a job or school requirement and to determine knowledge gaps. Pretest and posttest scores on all modules and in specific questions with low pretest scores were compared as a measure of knowledge gained.ResultsLower median pretest scores were found in student nurses (71%), males (71%), those required to take the course (75%), and those without personal breastfeeding experience (72%). The modules with the lowest median pretest scores were Anatomy/Physiology (67%), Growth and Development of the Breastfed Infant (67%), the Breastfeeding Couple (73%), and the Term Infant with Problems (60%). Posttest scores in all modules increased significantly (p < .001).ConclusionBreastfeeding Basics was used by a large number of nurses and nursing students. Gaps exist in nurses’ breastfeeding knowledge. Knowledge improved in all areas based on comparison of pretest and posttest scores.     

The Management of Breastfeeding

ABSTRACT: The physiology of engorgement, its etiology and methods to avoid it are discussed. The mechanics of milk ejection and nursing are described. Treatment for sore nipples includes frequent nursing, changing the position of the baby's mouth on the nipple, increased sun and air exposure, and pain medication as necessary. The management of other related nursing problems is covered.     

The Breastfeeding Answer Book

By Nancy Mohrbacher and Julie Stock. Schaumburg (Il): La Leche League International, 1997. 586 pages. $52.00, hardcover. Reviewed by : Donna B. Malmgren, RN, MSN, IBCLC, The Nursing Mothers' Place at Presbyterian Hospital, Charlotte, North Carolina.     

The Infant''s Contribution to Breastfeeding

Criteria are presented to evaluate the effectiveness of an infant's contribution to the dynamics of breastfeeding. Systematic assessment of the infant's breastfeeding behavior provides a framework for directing parent education, documenting correct breastfeeding techniques, recognizing problems early, and guiding interventions.     

The Romance and Power of Breastfeeding

ABSTRACT: The romantic qualities of the breastfeeding relationship include elemental physicality, intensity, and transience. The paper explores the implications of nursing in terms of a woman's sexuality, competence and power, and offers breastfeeding as an economic model of a renewable resource.     

Breastfeeding

Standards for research and study design which allow the study of health effects of breastfeeding and its role in controlling fertility have been developed. Better designed studies and evaluations of breastfeeding promotion programs guide health policy makers to promote and protect breastfeeding. Currently, most breastfeeding surveys do not provide many details. They do not address bottle feeding, night feeding, supplementation patterns, and frequency of feeding. International standards deem exclusive breastfeeding adequate for 4-6 months, but the evidence is not clear whether that means mothers should start supplementing at the end of 3 months or at the end of 6 months. The median time for faltering in exclusively fed infants in Jordan was 6 months. 25% grew adequately for 9 months, yet 20% began to falter at 4 months. Breast milk protects against diarrhea (especially cholera and shigellosis) and respiratory infections. Exclusive breastfeeding provides the most protection against infection; partial breastfeeding also provides more protection than not breastfeeding at all. Heating appears to destroy the protective factors. Breastfeeding also plays a key role in regulating fertility. It significantly delays ovulation in postpartum women. Introduction of supplementary food causes a fall in suckling frequency and duration. Moreover in 98% of lactating women, 1st ovulation followed the introduction of supplementary foods. Thus health workers should advise lactating women to begin contraception, such as IUDs or progestin-only oral contraceptives, after 6 months, since breastfeeding protects them from pregnancy during the 1st 6 months postpartum. In developing countries, there has been a trend away from breastfeeding especially for mothers who stay at home whereas, in developed countries, the opposite is true.     

Breastfeeding

A large and growing body of scientific evidence suggests that breastfeeding provides immediate and long-lasting health advantages for the mother and her infant. In the United States, breastfeeding rates currently are the highest recorded in 30 years, although premature weaning owing to the largely avoidable problems of breast pain and concern about adequate milk supply is still common. The advantages of breastfeeding will be more widely appreciated when all health care professionals acquire competence in evidence-based lactation management strategies. These strategies include helping women to position and attach their newborns correctly, encouraging frequent and effective feedings at the breast from birth onward, teaching new parents the signs of adequate milk intake, and providing the resources for promoting breastfeeding without the competition of commercial product promotion.