Breastfeeding Education in Undergraduate Nursing Programs
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BREASTFEEDING EDUCATION IN UNDERGRADUATE NURSING PROGRAMS A Project Presented to the faculty of the Department of Nursing California State University, Sacramento Submitted in partial satisfaction of the requirements for the degree of MASTER OF SCIENCE in Nursing by Martel Elizabeth Costa SPRING 2012 BREASTFEEDING EDUCATION IN UNDERGRADUATE NURSING PROGRAMS A Project by Martel Elizabeth Costa Approved by: _______________________________________, Committee Chair Dr. Alexa Curtis __________________________ Date ii Student: Martel Elizabeth Costa I certify that this student has met the requirements for format contained in the University format manual, and that this project is suitable for shelving in the Library and credit is to be awarded for the project. _______________________________, Department Chair ___________________ Dr. Carolynn Goetze Date Department of Nursing iii Abstract of BREASTFEEDING EDUCATION IN UNDERGRADUATE NURSING PROGRAMS by Martel Elizabeth Costa When nurses educate new mothers on breastfeeding, the quality and content of their teaching influences a mother’s decision to breastfeed and for how long. Thus, it is important that nursing students receive comprehensive breastfeeding instruction in their nursing programs to be proficient at assisting new mothers during clinical rotations or upon graduation. According to researchers, however, nursing schools have failed to adequately train students in breastfeeding education, citing students’ knowledge deficits as one of their concerns. At Sacramento State University’s School of Nursing, third- semester undergraduate nursing students are taught breastfeeding content in obstetrical nursing lecture and must complete 45 hours of related clinical experience. A student survey revealed that very few of them were completely satisfied with the breastfeeding instruction they had received. In addition, nearly 40% of those who had not yet completed their clinical rotation stated that they felt “insecure” to only “somewhat confident” in their ability to educate breastfeeding mothers. To remedy any possible gaps in breastfeeding instruction, four online breastfeeding modules were developed to assist students in obtaining the knowledge required to achieve lactation competency and allow iv them to review the information as often as needed. ASBSN students will evaluate the modules in an upcoming school session, and it is anticipated that they will be successful in helping prepare students to educate mothers on breastfeeding. __________________________________, Committee Chair Dr. Alexa Curtis ___________________ Date v ACKNOWLEDGEMENTS I gratefully acknowledge the assistance of Dr. Brenda Hanson-Smith with the development of this project. vi TABLE OF CONTENTS Page Acknowledgements………………………………………………………………… vi INTRODUCTION……………….........……………………………………….…... 1 Problem…………………………………………………………………….. 1 Purpose…………………………………………………………………….. 2 Benefits……………………………………………………………………. 2 BACKGROUND OF THE STUDY………….....……………………………….… 3 Major Themes……………………………………………………………… 3 Confirmed Findings…………………………………………..……………. 4 Inconsistencies/Gaps……………………………………………………….. 5 OVERVIEW OF PROJECT……………………………………………………...... 7 Intent of Project……………………………………………………………. 7 Process……………………………………………………………………... 7 Conception of the idea………………………………….....…………... 7 Persuading others of the project value…………………………………. 9 Development of project materials……………………………………… 9 Implementation………………………………………………………… 10 Number of People Involved………………………………………………... 10 Products for Project…………………………………………………………11 FINDINGS AND INTERPRETATIONS………….....……………………………. 12 vii Appendix A. Undergraduate Breastfeeding Questionnaire……………………….. 15 Appendix A1. Results of Undergraduate Breastfeeding Questionnaire…………... 18 Appendix B. Evaluation of Breastfeeding Modules………………………………. 22 Appendix C. Breastfeeding Modules........................................................................ 23 References………………………………………………………………………….. 94 viii 1 Introduction Nurses who work in obstetrics are responsible for educating new mothers on breastfeeding. The quality and content of their teaching can affect whether a new mother chooses to breastfeed her infant and for how long. Consequently, it is essential that nursing students planning to work with childbearing families receive sufficient education and training to effectively support breastfeeding mothers. Researchers, however, have uncovered problems in the clinical breastfeeding practice of undergraduate nursing students, citing students’ knowledge deficits and difficulty with assisting mothers with breastfeeding among their concerns. Since the advantages of breastfeeding are far reaching, benefitting mother and child, families, communities, and even the economy (Spatz, Pugh, & The American Academy of Nursing Expert Panel on Breastfeeding, 2007), it is imperative that undergraduate nursing programs address the problems related to breastfeeding education. Problem At Sacramento State University’s nursing program, breastfeeding content is taught in obstetrical nursing lecture. Students are also required to complete 45 hours of related clinical experience. However, competency at breastfeeding education is not one of the stated objectives. Rather, according to the clinical syllabus, “Students will spend a total of 45 laboratory hours applying knowledge of the childbearing family mastering assessment skills, perinatal and newborn procedures, and exploring community services for pregnant families” (Sacramento State University, 2011). If nursing students do not receive adequate breastfeeding instruction and practice to become competent at educating 2 breastfeeding mothers, they will not be able to provide effective and accurate breastfeeding support. Purpose Four breastfeeding modules were developed for the purpose of providing comprehensive educational materials on various concepts related to breastfeeding to third-semester undergraduate nursing students enrolled in the maternal-newborn nursing course N136 and the corresponding clinical rotation N137. The content of the modules was specifically chosen to prepare these students to be proficient in the obstetrical skills assessment setting prior to working with breastfeeding mothers in the hospital. Benefits The benefits which result from using the breastfeeding modules to educate Sacramento State nursing students are potentially far reaching. Nursing students will gain confidence and competence in their ability to educate breastfeeding mothers in the clinical setting. The mothers’ increased knowledge of breastfeeding and ability to breastfeed effectively makes them prone to breastfeed for a longer duration, resulting in significant health benefits for both the mother and infant. Society benefits as well. If 90 percent of families breastfed exclusively for 6 months, this would prevent the deaths of nearly 1,000 infants and save the United States $13 billion per year (U.S. Department of Health and Human Services Office on Women’s Health, 2011). 3 Background of the Study Major Themes Much of the available research focused on undergraduate nursing students’ lack of knowledge surrounding breastfeeding. For instance, Bernaix (2000) stated that academic preparation within nursing schools fails to adequately educate nurses about breastfeeding. In one study, 69% (n=201) of nurses stated that they had either not been taught or did not remember having been taught breastfeeding management in their nursing program (Anderson & Geden, 1991). Lewinski (1992) reported that less than 20 percent of the practicing nurses surveyed considered their own basic nursing education as a source of breastfeeding information. And Spatz, Pugh, and The American Academy of Nursing Expert Panel on Breastfeeding (2007) claim that nursing programs across the United States currently lack comprehensive breastfeeding content in their curricula. Another prevalent theme throughout the research is that the insufficient breastfeeding training in nursing programs can lead to inadequate, inappropriate, or no breastfeeding assistance and advice for new mothers, which often results in mothers choosing not to breastfeed their infants (Spatz, 2005). According to Wellstart International (2004, p.1), “Lack of knowledge of lactation management among health care providers is one contributing factor of failure to reach breastfeeding rates set by the U.S. government for the Year 2000/2010 National Health Objectives. An important reason for this lack of knowledge is that schools of medicine, nursing, and nutrition are not integrating lactation management education into their curricula.” Miller, Cook, Brooks, Heine, and Curtis (2007) also stressed this point when they wrote that women’s 4 decisions of whether or not to breastfeed are based in part on information provided by their health care providers, many of whom lack sufficient knowledge about breastfeeding. Freed, Clark, Harris, & Lowdermilk (1996) elaborate on this theme. In their study they found that despite students’ lack of fundamental breastfeeding knowledge and limited clinical experience with breastfeeding education, many of them expressed a false confidence in their own abilities and perceived themselves as effective in assisting breastfeeding patients. When these students finish nursing school and go out into practice, chances are they will give incorrect advice to breastfeeding patients – but will be confident in the opinions they express. Rather than seek assistance from more knowledgeable and experienced nurses such as lactation consultants, these