Evidence-based nursing: making changes in the clinical practice through the collaboration of nursing students and practicing nurses

The collaboration between student nurses and practicing clinical nurses on an evidence-based project is described. This collaboration sought to answer a question pertinent to the needs of the clinical nurses, while providing the students with an excellent practical learning opportunity. The changes in both knowledge and practice resulting from this partnership are described.     

Comfort Measures in Breastfeeding, Primiparous Women

Objective: To examine various comfort measures and evaluate their effects in alleviating nipple soreness.
Design: Prospectively randomized, experimental study.
Setting: Postpartum unit of a community teaching hospital.
Patients: Seventy-three primiparous, postpartum, breastfeeding women.
Interventions: Subjects were randomly assigned to four groups, with all women receiving instruction about breastfeeding and using one of the following treatments: warm moist tea bag compress, warm water compress, expressed milk massaged into the nipple and areola and air dried, Instruction only (control group). The subjects completed a questionnaire each morning for 7 days regarding nipple soreness.
Main Outcome Measure: Effect of treatments on postpartum nipple pain.
Results: Subjects in the warm water compress group demonstrated significantly less pain on Day 3 than did the tea or breast milk group.
Conclusions: Anticipatory guidance by obstetric nurses may assist breastfeeding women in treating their pain nonpharmacologically.     

LATCH: A Breastfeeding Charting System and Documentation Tool

Nurses most often use a subjective "well/fair/poor" system to assess and document breastfeeding. LATCH is a breastfeeding charting system that provides a systematic method for gathering information about individual breastfeeding sessions. The system assigns a numerical score, 0, 1, or 2, to five key components of breastfeeding. Each letter of the acronym LATCH denotes an area of assessment. "L" is for how well the infant latches onto the breast. "A" is for the amount of audible swallowing noted. "T" is for the mother's nipple type. "C" is for the mother's level of comfort. "H" Is for the amount of help the mother needs to hold her infant to the breast. The system is visually represented in the same form as the Apgar scoring grid, and the numbers are handled in the same way. With the LA TCH system, the nurse can assess maternal and infant variables, define areas of needed intervention, and determine priorities in providing patient care and teaching.     

Transitioning Preterm Infants With Nasogastric Tube Supplementation: Increased Likelihood of Breastfeeding

OBJECTIVE: To compare nasogastric tube and bottle supplementation as two means of transitioning preterm infants to breastfeeding within an established breastfeeding support program. DESIGN: Prospective, randomized controlled trial; mothers and health care providers, who were not blinded. SETTING: Metropolitan private regional perinatal center; 40-bed intensive-care nursery. PARTICIPANTS: Eighty-four preterm breastfed infants whose birth weight was 1,000-2,500 g. MAIN OUTCOME MEASURES: Rates of exclusive and partial breastfeeding at discharge from the intensive-care nursery, and at 3 days, 3 months, and 6 months after discharge. RESULTS: Compared with infants receiving bottle supplements, infants receiving nasogastric tube supplements were more likely to be breastfeeding at discharge and at 3 days, 3 months and 6 months, after adjusting for confounding variables. Odds ratios (confidence intervals = 95%) showed that the group receiving nasogastric supplements was 4.5 times (1.4 to 15) more likely to be breastfed at discharge and 9.4 times more likely to be fully breastfed (3.1 to 28.4). There were significantly fewer apnea and bradycardia episodes in the group receiving nasogastric supplements, although they had more episodes that required stimulation for resolution. Groups were not different with respect to length of hospitalization and infant weight at discharge. CONCLUSIONS: Using nasogastric tube supplementation during transition to oral feedings increases the likelihood of breastfeeding at discharge, 3 days, 3 months, and 6 months. This intervention requires a program with skilled personnel and an environment that allows the mother and infant to be in close physical proximity. Further study should investigate differences in the effects on maternal confidence, imprinting, and suck mechanism when preterm infants are bottle fed and breastfed.     

Home Visits: Strategies to Protect the Breastfeeding Newborn at Risk

The breastfeeding mother whose infant is at risk for lactation failure that may lead to dehydration, weight loss, and hyperbilirubinemia can be assisted and supported in the home by maternal-child nurses, certified as lactation consultants, working collaboratively with the attending physician, midwife, or nurse practitioner. In this article, case reports illustrate interventions carried out in the home. Risk factors and clinical indicators of breastfeeding problems usually are present before hospital discharge. Health care providers should be on the alert for them so that management strategies can be started immediately after hospital discharge to ensure good patient outcomes.