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Success of an Educational Intervention on Nurses JOGNN R ESEARCH Success of an Educational Intervention on Maternal/Newborn Nurses’ Breastfeeding Knowledge and Attitudes Laura W. Bernaix, Margaret L. Beaman, Cynthia A. Schmidt, Judith Komives Harris, and Linda Mitchell Miller Correspondence ABSTRACT Laura W. Bernaix, PhD, RN, Objective: To test the effect of a breastfeeding educational program for improving breastfeeding knowledge, atti- Primary Care & Health Systems Nursing, School of tudes, and beliefs of maternal/newborn nurses, and to improve their intentions to provide breastfeeding support to new Nursing, Southern Illinois mothers. University Edwardsville, Design: Quasi-experimental, pretest/posttest design. Box 1066, Edwardsville, IL 62062. Setting: Maternity units of 13 hospitals located in midwestern and east coast states. [email protected] Participants: Nine experimental and three control hospital sites resulted in a convenience sample size of 240 Keywords registered nurses (RNs); 206 RNs in the experimental sites and 34 RNs in the control sites. breastfeeding Methods: Participation in the experimental groups involved the completion of two questionnaires upon study entry education and then again after completion of a self-study module. Participants in the control groups completed the two ques- nurses tionnaires twice with a 4- to 6-week interval between them without access to the self-study module. Main Outcome Measures: Nurses’ breastfeeding knowledge, attitudes, beliefs, and intentions to support postpartum mothers who are breastfeeding. Results: Findings suggest that this educational strategy was effective in improving maternal/newborn nurses’ breastfeeding knowledge, attitudes, and beliefs, and intentions to support breastfeeding mothers. Conclusion: This self-paced, study module, which is guided by an on-site, trained staff member, may be a cost- effective strategy for improving nurses’ breastfeeding knowledge and support to new breastfeeding mothers. Nurses may find this type of teaching modality to be less intimidating than a structured classroom setting, and more desirable for their busy schedules. JOGNN, 39, 658-666; 2010. DOI: 10.1111/j.1552-6909.2010.01184.x Accepted August 2010 Laura W. Bernaix, PhD, RN, ver the last several decades, advocates for mothers breastfeeding at time of postpartum hospi- is a professor and department O breastfeeding have worked diligently to im- tal discharge, the trend for duration rates is not as chair, Primary Care & Health prove the breastfeeding initiation and duration positive. Systems Nursing, School of rates in the United States. Promotional e¡orts by Nursing, Southern Illinois University Edwardsville, key professional organizations and experts have The duration rates of breastfeeding, through 6 Edwardsville, IL. tried to convey to the general public that there is a months into 1-year postbirth, continue to re£ect a wealth of evidence demonstrating that breast milk is steep decline beyond the ¢rst few weeks. Accord- the optimal food for infants and that breastfeeding ing to the National Immunization Survey, (Continued) is associated with decreased infant and maternal conducted in 2005 by the CDC, the percentage of morbidity and mortality. Consequently, breastfeed- U.S. children receiving any breast milk through 6 ing initiation rates have increased; as of 2004, 74% months was 43% and only 23% through 1 year. Ex- Judith Harris and Linda Miller are officers of Rising of all women were breastfeeding their infants at time clusive breastfeeding (nothing but breast milk) was Star Education, Inc. and of hospital discharge, which represents an increase reported to only reach 33% at 3 months and14% at receive income for the edu- of approximately 4% since 2000 (Centers for 6 months. Further, much of the drop-o¡ in breast- cational program discussed. Disease Control and Prevention [CDC], 2008). Al- feeding was noted to occur within 2 weeks The other authors report no conflict of interest of rele- though this trend is encouraging and very close to postdelivery. Although there are a myriad of inter- vant financial relationships. the Healthy People 2010 goal of having 75% of all related factors that in£uence the initiation and 658 & 2010 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses http://jognn.awhonn.org Bernaix, L. W., Beaman, M. L., Schmidt, C. A., Harris, J. K., and Miller, L. M. R ESEARCH continuation of breastfeeding, the quality of the breastfeeding instruction and support the mother Unfortunately, still today, new mothers often receive receives during the immediate hospital postpartum inconsistent and/or inaccurate breastfeeding support period is an important in£uencing factor. Unfortu- while in the hospital. nately, new mothers often receive inconsistent and/ or inaccurate breastfeeding support while in the hospital. According to the ¢rst national Maternity 63% at 17 weeks. Chien, Tai, Chu, Ko, and Chiu Practices in Infant Nutrition and Care (mPINC) Sur- (2007) reported a strong positive association be- vey, conducted by the CDC in 2007, a signi¢cant tween the number of 10-step practices of the WHO/ number of facilities provide maternity care that is UNICEF Baby Friendly Hospital initiative and the not evidence based and potentially detrimental to prevalence of any breastfeeding (partial or exclu- breastfeeding (CDC, 2008). Several maternal prac- sive) at three di¡erent time points (during the tices are known to promote breastfeeding success: hospital and at 1 and 3 months postpartum). (a) skin-to-skin contact between the mother and her infant immediately after birth; (b) early, frequent, Repeatedly, the literature also illustrates that nurses and exclusive breastfeeding during the hospital vary in their ability to provide breastfeeding support stay; (c) rooming-in; (d) instruction and assistance to new mothers. Many nurses lack knowledge about provided by the hospital sta¡; and (e) providing the practices that promote breastfeeding initiation and mother with postdischarge resources and follow- duration, and/or have negative or indi¡erent atti- up. In the CDC study, none of these practices was tudes about breastfeeding. Bernaix (2000) found consistently reported across all sampled facilities that nurses’ability to provide breastfeeding support (N 5 2,687). For instance, though 88% of the facili- was in£uenced by their attitudes and knowledge. ties reported that they taught breastfeeding Spears’ (2004) sample of 151 nurses had poor technique to their postpartum mothers, 65% of knowledge about the nutritional value of breast these same facilities told their patients to limit suck- milk; 41.9% believed breast milk and formula were ling time at each breastfeeding, and 45% and 24%, comparable. respectively, gave paci¢ers and supplements to more than one half of the healthy, full-term breast- An apparent lack of agreement between what is and fed infants born in their facility (CDC, 2008). is not ‘‘breastfeeding support’’ was explored in a study by Nelson (2007); interviews of 12 maternal/ The CDC study supports reports from several small- newborn nurses were conducted to determine the er studies. In Spears’ (2004) study of 151 maternal/ signi¢cance and meaning of the elements of incon- newborn nurses, 41% reported that they limited sistent professional breastfeeding support. Nurses the infants’ time at the breast. Gagnon, Leduc, Wag- recognized that inconsistencies still remain and are horn,Yang, and Platt (2005) found that 47.9% of the often a function of some nurses’ failure to ‘‘buy in’’ to healthy, term infants in their study received the importance of promoting breastfeeding, nega- formula supplementation in the hospital, with tive personal breastfeeding experiences, use of the median age for supplementation occurring at personal anecdotes by the nurse instead of relying 8.4 hours. Other studies have reported the similar on current evidence, reliance on formula supple- Margaret L. Beaman, PhD, RN, is a professor emeritus, routine practice of in-hospital formula supplement- mentation when time for promoting exclusive School of Nursing, Southern ation (Labarere, Castell, Fourny, Durand, & Pons, breastfeeding was limited, concern for the new Illinois University 2003; Semenic, Loiselle, & Gottlieb, 2008). mother’s fatigue and frustrations levels, percep- Edwardsville, Edwardsville, tions that breastfeeding promotion is not part of IL. In a study analyzing the e¡ects of speci¢c hospital their role, and fear that they were encroaching on Cynthia A. Schmidt, PhD, practices on breastfeeding duration, ¢ve practices a mother’s right to choose. RN, is a professor in the were identi¢ed to be positively related to breast- School of Nursing, Southern feeding duration: breastfeeding within the ¢rst Although there have been attempts to improve the Illinois University Edwardsville, Edwardsville, hour after birth, rooming-in, exclusive breastfeed- breastfeeding knowledge and attitudes of nurses IL. ing, no paci¢er use, and receipt of telephone working at clinics (Khoury, Hinton, Mitra, Carothers, breastfeeding ‘‘hotline’’ for postdischarge use & Foretich, 2002) and in neonatal intensive care Judith Komives Harris, EdD, ARNP, is co-owner of Rising (Murray, Ricketts, & Dellaport, 2007). Of the 2,172 units (Bernaix, Schmidt, Arrizola, Iovenilli, & Star Education Inc., sampled women, only one in ¢ve women (18.7%) Medina-Poeliniz, 2008; Spatz, 2005), few studies Edmond, OK. experienced all of these practices. Breastfeeding have been reported where programs have been rates declined more slowly over time when more
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