Knowledge and attitudes of pediatric office nursing staff about breastfeeding

Medical and Nursing Students' Perceptions of and Advice for Extended Breastfeeding: An Exploratory Study

Although the health benefits to both mother and child produced by breastfeeding have been documented, and numerous efforts have been made to promote breastfeeding rates in the United States, extended breastfeeding (breastfeeding beyond 12 months) research has been largely overlooked. Guided by the Framework of Integrative Normative Influences on Stigma, this study examined how extended breastfeeding was perceived among medical and nursing students and how perceptions of extended breastfeeding were translated into stigmatizing outcomes including attitudes, behavioral predispositions, and behavioral intention to encourage weaning. One hundred and sixteen medical and nursing students enrolled at a large mid-western University completed an online survey. Participants were asked to provide answers to questions regarding their knowledge of extended breastfeeding, attitudes toward it, perception about stigma associated with breastfeeding, and their behavioral intention to encourage future patients to wean. A lack of knowledge about extended breastfeeding was evident among the medical and nursing students; they also exhibited increasingly negative attitudes toward extended breastfeeding as the child's age increased. Medical and nursing students' behavioral intention to encourage weaning is associated with their pre-dispositional stigma of extended breastfeeding. Addressing stigma and negative attitudes toward extended breastfeeding in pre-healthcare students' curriculum may help future healthcare providers understand that while cultural norms in the United States do not tend toward extended breastfeeding, it is more common in other parts of the world, as well as help them understand health benefits to the child and to the mother.

Knowledge of health professionals about breastfeeding and factors that lead the weaning: a scoping review

Abstract This review evaluated the knowledge of health professionals (HP) about breastfeeding and factors that leading the weaning. A search was performed in four electronics databases and the grey literature. The search strategy included Mesh terms and synonyms. No language or date restrictions were adopted. Studies that evaluated the knowledge of HP about breastfeeding and weaning were considered eligible. The studies retrieved by the searches were evaluated by two independently examiners. From 1,417 studies retrieved, 35 were included. Many countries and professionals from different health areas were analyzed. No studies evaluated the dentists’ knowledge. Although the included HP know the benefits of breastfeeding for health, the length of breastfeeding recommended by the World Health Organization, exclusive or not, was not aligned with all professionals’ endorsement. Information about weaning is scarce; however, HP are mindful of the main potential causes of early weaning. The knowledge of HP is conflicting about breastfeeding and unusual about weaning. Furthermore, no studies were found that presented data on the knowledge of dentists on the subject. Thus, assessments of dentists’ knowledge and education measures for HP are necessary since they are frequently questioned about these issues.

"Why Even Bother; They Are Not Going to Do It?" The Structural Roots of Racism and Discrimination in Lactation Care

Through semi-structured interviews with 36 International Board Certified Lactation Consultants (IBCLCs) who assist mothers with breastfeeding, this study takes a systematic look at breastfeeding disparities. Specifically, this study documents race-based discrimination against patients in the course of lactation care and links the implicit bias literature to breastfeeding disparities. IBCLCs report instances of race-based discrimination against patients such as unequal care provided to patients of color and overt racist remarks said in front of or behind patient's backs. This study connects patient discrimination in lactation to institutional inequality and offers suggestions to address these inequities.

Breastfeeding Curricular Content of Family Nurse Practitioner Programs

INTRODUCTION

Health care provider support is essential for breastfeeding success. Family Nurse Practitioners (FNP) are in a unique position to promote and manage breastfeeding. There is a gap in the literature regarding the amount and type of breastfeeding curricular content in FNP programs.

METHOD

An online survey of FNP programs was conducted. Data collection included program descriptors, didactic breastfeeding coursework, and clinical breastfeeding opportunities available to students.

RESULTS

No programs offered courses specific to breastfeeding: 82% of programs devoted 1 to 2 hours of didactic lactation content. More than three quarters of the programs offered students breastfeeding counseling opportunities; no programs, however, identified specific breastfeeding clinical competencies.

DISCUSSION

FNPs can play an integral role in breastfeeding promotion and counseling. There appears to be a lack of education provided to FNPs regarding breastfeeding management. Creative approaches that incorporate lactation education into FNP programs may increase FNPs' breastfeeding knowledge and enhance their ability to provide support to breastfeeding families.

Health Professionals' Attitudes and Beliefs About Breastfeeding

The aim of this descriptive study was to investigate how health-care providers perceived their role in breastfeeding and maternal support. Data was collected via interviews of 53 health-care professionals that provided care to breastfeeding women. The emerging themes included (a) understanding the benefits of breastfeeding: often lacking current knowledge, (b) lacking consistency: gaps between knowledge of benefits and actual clinical practice, (c) not knowing how to help: lack of assessment and therapeutic skills, and (d) understanding the barriers to breastfeeding: how health-care providers can make a difference. Data analysis suggests inconsistencies between the health-care provider's perceived support and behaviors, lack of knowledge, and significant lack of skill in the assessment and management of breastfeeding couples.

Developing and testing an online breastfeeding training among undergraduate nursing students

The benefits of breastfeeding for mothers and babies have been well documented in the scientific literature, with new evidence about the benefits continuing to emerge. The Surgeon General's call to action to support breastfeeding recommends mandatory breastfeeding education and training for all healthcare providers that deliver care to mothers and babies. The purpose of this study is to analyze the development of an online computer based breastfeeding training (BT) and the preliminary outcomes of this training. The development of this training included consultation with content and technology experts. The collection of preliminary outcomes related to breastfeeding knowledge data and evaluation of the online BT was pre and posttest study. Eighty six undergraduate nursing students completed the online BT using Blackboard Learn. The online component of the BT consisted of five modules with a combined length of approximately 16 hours. After the completion of the modules, the students increased their levels of knowledge related to breastfeeding and the majority believed that they were fully able to perform skills to support breastfeeding. The results of this study indicate that a successful BT for nursing students can be effectively designed, which can in the future be disseminated to other healthcare providers and students. In addition, this online BT was cost-efficient and effective in improving students' knowledge and skills to support breastfeeding.

Long-term breastfeeding support: failing mothers in need

This qualitative study analyzes mothers' reports of breastfeeding care experiences from pregnancy through infancy. Most research on medical support for breastfeeding examines a specific practice or intervention during an isolated phase of care. Little is know about how mothers experience breastfeeding education and support from the prenatal period through their child's first year. A convenience sample of 75 black and white WIC participants with infants was recruited at three Maryland WIC agencies. In-depth interviews covered mothers' comprehensive experiences of breastfeeding education and support from pregnancy through the interview date. Most mothers received education or support from a medical professional prenatally, at the hospital, or during the child's infancy, but most also reported receiving no education or support at one or more of these stages. Mothers often felt provided education and support was cursory and inadequate. Some mothers received misinformation or encountered practitioners who were hostile or indifferent to breastfeeding. Mothers were not given referrals to available resources, even after reporting breastfeeding challenges. Mothers received inconsistent messages regarding breastfeeding within and across institutions. Mothers need consistent, sustained information and support to develop and meet personal breastfeeding goals. Medical professionals should follow guidelines issued by their own organizations as well as those from the US Surgeon General, Healthy People 2020, and the Baby Friendly Hospital Initiative. Prenatal, postnatal, and pediatric care providers should coordinate to provide consistent messages and practices within and across sites of care.

Conhecimento de estudantes de um curso de Enfermagem sobre aleitamento materno

OBJETIVO: Investigar os conhecimentos dos estudantes do 1º e 4º ano de um curso de Bacharelado em Enfermagem, sobre aleitamento materno. MÉTODOS: Estudo de abordagem quantitativa, observacional, transversal e descritivo desenvolvido em uma universidade pública do estado de São Paulo. O instrumento de coleta de dados continha 25 questões, distribuídas em sete blocos. A análise fundamentou-se na estatística descritiva e Teste de Mann-Whitney. RESULTADOS: Participaram da pesquisa 66 alunos do 1º ano e 64 do 4º ano. A média de acertos dos alunos do 1º ano foi de 9,9 questões e do 4º ano foi de 17,8 questões (Teste de Mann-Whitney: 35,1 vs. 96,8 [p<0,000]). Em todos os blocos de perguntas os alunos do 4º ano obtiveram maiores escores. CONCLUSÕES: Verificou-se a necessidade de maiores esforços e incentivo para o aproveitamento de outras oportunidades durante a graduação, que possibilitem ao aluno um melhor desempenho para atuar com confiança na prática em prol da amamentação.

A critical review of the impact of continuing breastfeeding education provided to nurses and midwives

This review of 15 studies from nine different countries analyzes the practice of continuing education on breastfeeding for health professionals, with a specific focus on nurses and midwives. Continuing breastfeeding education improves the knowledge, clinical skills and practices, and counseling skills of nurses and midwives, and it improves the Baby-Friendly Hospital Initiative compliance of institutions. Education of any duration is beneficial; however, findings support the recommendation of the World Health Organization that at least 18 hours' education for all health professionals who advise pregnant women and mothers should be undertaken.

A descriptive qualitative review of the barriers relating to breast-feeding counselling

The purpose of this review was to describe barriers in breast-feeding counselling considering it from the viewpoint of health professionals. CINAHL, MEDLINE and Cochrane databases were searched from 1950 to 2008. In total, 40 scientific research articles in English, Swedish or Finnish related to breast-feeding counselling were included and analysed using thematic analysis. The quality of the studies was also assessed. The main barriers were deficits in knowledge, resources, counselling skills and the counsellor's negative attitude. Conflicting advice, lack of guidelines, sufficiency of counselling and perceiving of the personal education needs were examples of the indicated barriers. The most commonly described barriers in breast-feeding counselling were limitations in breast-feeding knowledge. Developing of the measurements to assess the barriers in breast-feeding counselling is needed.

Breastfeeding knowledge and attitudes among Egyptian baccalaureate students

AIM

To assess the breastfeeding knowledge, attitudes and perceived adequacy of breastfeeding education among baccalaureate nursing students in Cairo, Egypt. Self-confidence to provide breastfeeding support for mothers was also investigated.

BACKGROUND

Nurses play a crucial role in promoting breastfeeding. Studies in Western countries have found inadequate breastfeeding knowledge among undergraduate nursing students. No published literature about breastfeeding knowledge and attitudes among nursing students in Egypt was found.

METHOD

An exploratory descriptive study used a sample of 110 baccalaureate nursing students from Cairo, Egypt. Students who had completed maternal/child nursing didactic and clinical courses were eligible to participate. Ninety two (83.6%) students completed the survey during spring 2009. We used a Breastfeeding Knowledge Questionnaire adapted from Brodribb et al. to measure breastfeeding knowledge and the Iowa Infant Feeding Attitude Scale to test students' breastfeeding attitudes.

RESULTS

Students' age ranged from 18 to 21 years with a mean of 19.5±1.2 with 75% being female. The mean breastfeeding knowledge score was 12.41 points out of 24, which represents 52% of the total score. The attitudes mean score was 3.13±0.64. There was a significant relationship between the students' knowledge and attitudes scores (r=0.236, P=0.011). Eighty per cent of the students reported that they received adequate breastfeeding knowledge and skills in their nursing programme, and 70% were confident in their ability to provide breastfeeding support.

CONCLUSION

Results revealed weak breastfeeding knowledge scores among students and neutral breastfeeding attitudes. Strategies to improve breastfeeding education in nursing curriculum focusing on breastfeeding management skills are warranted.

Predictors of breastfeeding and breastmilk feeding among very low birth weight infants

OBJECTIVE

This study investigated associations between maternal and infant factors and breastfeeding practices in infants born <30 weeks gestation in the neonatal intensive care unit (NICU).

STUDY DESIGN

This study was a retrospective cohort. Mother and infant characteristics were investigated for associations with breastfeeding outcomes using multivariate logistic regression.

RESULTS

Seventy-eight percent of infants initiated breastmilk feedings, 48% of those continued to have breastmilk at discharge, and 52% were breastfed in the hospital. The average duration of breastmilk feedings was 43 days. Mothers who were married and had a multiple-infant birth were more likely to initiate breastmilk feeds, African American mothers and younger mothers had less success with maintaining breastmilk feeds until hospital discharge, and African American mothers and mothers of lower socioeconomic status were less likely to participate in direct breastfeeding in the NICU.

CONCLUSIONS

Infant factors, such as birth weight and gestational age, were not associated with breastfeeding behaviors. Mothers can succeed with breastfeeding the premature infant. By understanding what maternal groups are at risk for breastfeeding failure, targeted interventions in the NICU can be implemented.

Improving the use of human milk during and after the NICU stay

The feeding of human milk (milk from the infant's own mother; excluding donor milk) during the newborn intensive care unit (NICU) stay reduces the risk of costly and handicapping morbidities in premature infants. The mechanisms by which human milk provides this protection are varied and synergistic, and appear to change over the course of the NICU stay. The fact that these mechanisms include specific human milk components that are not present in the milk of other mammals means that human milk from the infant's mother cannot be replaced by commercial infant or donor human milk, and the feeding of human milk should be a NICU priority. Recent evidence suggests that the impact of human milk on improving infant health outcomes and reducing the risk of prematurity-specific morbidities is linked to specific critical exposure periods in the post-birth period during which the exclusive use of human milk and the avoidance of commercial formula may be most important. Similarly, there are other periods when high doses, but not necessarily exclusive use of human milk, may be important. This article reviews the concept of "dose and exposure period" for human milk feeding in the NICU to precisely measure and benchmark the amount and timing of human milk use in the NICU. The critical exposure periods when exclusive or high doses of human milk appear to have the greatest impact on specific morbidities are reviewed. Finally, the current best practices for the use of human milk during and after the NICU stay for premature infants are summarized.

Breastfeeding changes for VLBW infants in the NICU following staff education

PURPOSE

To assess the effectiveness of an educational intervention aimed at staff and parents in changing breastfeeding practices in the NICU.

DESIGN

The breastfeeding education initiative consisted of three parts: breastfeeding training for NICU staff, issuance of complementary breastfeeding materials to mothers of infants in the NICU, and addition of a breastfeeding pathway to the individualized care plan. Infants admitted before and after the initiative were compared to evaluate for changes in breastfeeding practices.

SAMPLE

The study sample included very low birth weight (VLBW) infants hospitalized in the NICU for more than seven days and born weighing <1,500 g. Infants were grouped based on whether they were admitted before (pre-intervention) or after (post-intervention) implementation of the education initiative.

MAIN OUTCOME VARIABLES

Health care professional (HCP) knowledge of breastfeeding interventions in the NICU was measured using a posttest following training. Breast milk feeding initiation rates, breastfeeding rates, and rates of breast milk feeding at discharge were measured via retrospective chart review among pre- and post-intervention infant groups.

RESULTS

The post-intervention group demonstrated significant improvement in rates of breastfeeding (infants being put directly to the breast) in the NICU compared with the pre-intervention group. General positive trends in breast milk feeding initiation (up 11 percent) and breast milk feeding at discharge (up 5 percent) were observed, but these increases failed to reach significance.

Health professional knowledge of breastfeeding: are the health risks of infant formula feeding accurately conveyed by the titles and abstracts of journal articles?

Effective promotion of breastfeeding is constrained if health professionals' knowledge on its importance is deficient. This study asks whether formula feeding is named as the risk factor in published research or whether it is considered the unspoken norm. A systematic analysis is conducted of the information content of titles and abstracts of 78 studies that report poorer health among formula-fed infants. This shows a surprising silence in the studies examined; formula is rarely named in publication titles or abstracts as an exposure increasing health risk. In 30% of cases, titles imply misleadingly that breastfeeding raises health risk. Only 11% of abstracts identify formula feeding as a health risk exposure. Initiatives to increase breastfeeding have described the importance of accurate language and well-informed health professional support. If widespread, this skew in communication of research findings may reduce health professionals' knowledge and support for breastfeeding.

Assessing midwives' breastfeeding knowledge: properties of the Newborn Feeding Ability questionnaire and Breastfeeding Initiation Practices scale

BACKGROUND

There are few reliable and valid tools to assess lactation and infant feeding knowledge and practices. This study tested the psychometric properties of two new scales, the Newborn Feeding Ability (NFA) questionnaire and Breastfeeding Initiation Practices (BIP) scale to assess midwives' breastfeeding knowledge and practices specific to breastfeeding initiation.

METHODS

A national postal survey of Australian midwives (n = 3500) was conducted in October 2001. Reliability was determined through Cronbach's alpha coefficient and stability determined by a test-retest. Content validity was established through a critical review of literature and review by an expert panel. Construct validity was informed by an exploratory factor analysis and principle component analysis with varimax rotation. Correlations between NFA and BKQ knowledge subscale scores and BIP and BKQ practice subscale scores assessed criterion validity. A multiple hierarchical regression analysis determined predictive validity of the NFA and BIP.

RESULTS

A response rate of 31.6% (n = 1107) was achieved. Adequate internal consistency was established for both instruments. Five factors on the NFA questionnaire were congruent with knowledge about effects of skin-to-skin contact, physiological stability, newborn innate abilities, work practices and effective breastfeeding. The BIP revealed three factors related to observing pre-feeding behavior, mother/baby care and attachment and positioning practices. Predictive validity of knowledge was moderate (r = 0.481, p < 0.01) and contributed to 31.5% of variance in reported practice. Midwives with high knowledge scores were more likely to report best practice when assisting mothers to initiate breastfeeding. Midwives with more personal breastfeeding experience scored higher on all scales.

CONCLUSION

The Newborn Feeding Ability questionnaire and the Breastfeeding Initiation Practices scale can contribute to practice development by assessing lactation and infant feeding knowledge and practice deficits. Individual learning needs can be identified, and effectiveness of education interventions evaluated using these tools. Further testing is required with other samples of midwives and health professionals involved in the promotion of breastfeeding.

Maternal-newborn nurses? experiences of inconsistent professional breastfeeding support

AIM

This paper is a report of a study to describe the meaning and significance of common, essential elements of inconsistent professional breastfeeding support as revealed through the experiences of maternal-newborn nurses in a hospital.

BACKGROUND

Professional breastfeeding support has been found to have a beneficial effect on breastfeeding, although mothers also report that inconsistent professional breastfeeding support has a negative influence on their breastfeeding efforts.

METHOD

An existential-phenomenological approach was used, and interviews were conducted with 12 maternal-newborn nurses between October 2005 and January 2006. Interview transcripts were subjected to thematic analysis.

FINDINGS

Inconsistency in professional breastfeeding support was directly related to the fact that 'supporting' breastfeeding is a dynamic, multidimensional process with relational, contextual and situational components. Eight themes were identified: Inconsistencies still exist but things are changing; A need for 'buy in'; There is no escaping personal experience; What works for one does not work for all; Time impacts recommendations; We have a privileged vantage point; 'My job': what it is and what it is not and After all, breastfeeding is a maternal 'choice'.

CONCLUSION

Addressing inconsistent professional breastfeeding support involves understanding the multiple institutional and personal factors that influence this phenomenon. Because multiple practitioners assist each mother-infant dyad in learning to breastfeed, fostering strong collaborative relationships within this support team is essential. Regular opportunities for all team members to dialogue and actively participate in the updating of breastfeeding policies may increase 'buy in', promote greater collaboration and decrease both conflict and inconsistencies.

Student nurses' attitudes and beliefs about breast-feeding

This study explored the breast-feeding attitudes and beliefs of students newly enrolled in an urban university baccalaureate nursing program. A qualitative approach was used to conduct in-depth semistructured interviews with 12 students prior to their formal course work in maternal-child nursing. Four themes emerged from the data analysis: 1. Personal experiences are important in the development of breast-feeding attitudes and beliefs. 2. The students generally believed that breast-feeding offered benefits for babies and mothers, but the beliefs were stronger for those who grew up with breast-feeding as the norm. 3. All the students believed that there were barriers to breast-feeding in the United States that they identified as the societal view of the breast, dependence/independence conflicts, and concerns about intimacy. 4. The students identified an educational rather than promotional role for nurses in breast-feeding because of conflicts about personal choice. This study suggests that students need help identifying their attitudes and beliefs about breast-feeding and reflecting how their personal experiences influence breast-feeding promotion.

The education of health practitioners supporting breastfeeding women: time for critical reflection

The protection, promotion and support of breastfeeding has now become a major international priority as emphasized in the Global Strategy for Infant and Young Child Feeding. Health practitioners, such as midwives, nurses and doctors, have a key role to play in providing support to breastfeeding women. This paper provides a critical discussion of educational requirements of health practitioners to equip them for their supportive role. The effective integration of embodied, vicarious, practice-based and theoretical knowledge requires opportunities for deep critical reflection. This approach should facilitate personal reflection and critical engagement with broader socio-political issues, thus allowing for collective understandings and change. Practitioners also need to understand breastfeeding as a biopsychosocial process that is dynamic, relational and changes over time. Recommendations are outlined with regards to multidisciplinary undergraduate education; mentorship schemes with knowledgeable role models supporting student practitioners; involvement of voluntary and peer supporters; post-registration education; setting of national standards for breastfeeding education; tailored education for specific groups; designated funding; and involvement of breastfeeding specialists.

Baccalaureate nursing students' breastfeeding knowledge: a descriptive survey

This descriptive survey study assessed the breastfeeding knowledge of junior and senior baccalaureate nursing students (N=80) who had successfully completed their obstetric nursing course. With a possible perfect knowledge score of 100, participants' scores ranged from 35 to 85 with a sample mean score of 60. Surprisingly, most (85%) did not know that breastfeeding is recommended for the first year of an infant's life, and only five participants knew the proper management of mastitis. Well over one third (41.3%) of the participants opposed breastfeeding in public. Findings reveal the need to strengthen both the didactic and clinical components of the obstetric course curriculum. The acquisition of breastfeeding knowledge at the student level will better equip novice nurses to provide more effective breastfeeding counsel and support for childbearing women and to promote the achievement of the breastfeeding objectives of both the United States and the World Health Organization.

Designing a university-based lactation course

A university-based lactation course was developed to provide lactation education to health care providers, with the goal of improving their knowledge, attitude, and skills in assisting American women to breastfeed. This is a key strategy for achieving the Healthy People 2010 objectives, and it addresses the identified need for education among health care professionals. The university as well as an enthusiastic lactation community provided multidisciplinary clinical experiences and classroom lectures to prepare public health students, nurses, midwives, and nurse practitioners to encourage and assist women in breastfeeding. It is hoped that the success of this class and the experiences of the instructors will motivate other lactation consultants to develop similar educational strategies.

Advocacy for breastfeeding: making a difference one community at a time

In response to the need for health care professionals skilled in lactation management, a breastfeeding course was developed and taught at the University of Pennsylvania. Since 1995, Nursing 361 has been offered to undergraduate junior and senior students. The aim of this article is to discuss how through coursework, nursing students can provide breastfeeding advocacy and change the breastfeeding culture one community at a time. This article provides guidelines for others to conduct such projects, as well as exemplars to demonstrate how advocacy can change communities. Through development of an advocacy project during the course of a semester, a student learns about his or her identified community and is able to make an impact that often lasts years after his or her project is completed.

How midwives learn about breastfeeding

Little is known about how midwives learn about breastfeeding. This study asked midwives to identify breastfeeding information resources used and perceived value for their learning. A mail questionnaire was sent to midwives (n = 3500) through the Australian College of Midwives Inc. (ACMI). A response rate of 31.6% (n = 1105) was obtained. On-the-job experience was the most common source accessed and continuing education the most valuable. Very few respondents (3.1% n = 34) acknowledged either their hospital or university midwifery education program as a valuable breastfeeding information source. There is scope for continuing education programs to address evidence-based lactation and infant feeding information. Midwifery curricula need to teach in-depth knowledge of human lactation and develop clinicians' skill base to assist breastfeeding women. The development of national standards for course accreditation on lactation and infant feeding by ACMI, Baby Friendly Hospital Initiative (BFHI) and Australian Breastfeeding Association (ABA) would be a useful quality measure.

An Australian study of midwives' breast-feeding knowledge

OBJECTIVE

To investigate midwives' breast-feeding knowledge, assess associations between knowledge and role, and report on the validity and reliability of the Breast-feeding Knowledge Questionnaire for the Australian context.

DESIGN

Postal questionnaire.

SETTING

National Australia.

PARTICIPANTS

Midwives (n=3500) who are members of the Australian College of Midwives Inc (ACMI).

FINDINGS

A response rate of 31% (n=1105) was obtained. Respondents were knowledgeable of the benefits of breast feeding and common management issues. Key areas requiring attention included management of low milk supply, immunological value of human milk, and management of a breast abscess during breast feeding. Participants over the age of 30, possessing IBCLC qualifications; having personal breast-feeding experience of more than three months; and more clinical experience achieved higher knowledge scores. Role perceptions were positive with 90% of midwives reporting being confident and effective in meeting the needs of breast-feeding women in the early postnatal period. Midwives' role perception contributed 39% of the variance in general breast-feeding knowledge scores and was a significant predictor of participants' breast-feeding knowledge.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

The level of basic breast-feeding knowledge of Australian midwives was adequate but there are deficits in key areas. Knowledge variations by midwives may contribute to conflicting advice experienced by breast-feeding women. Further research is needed to investigate in-depth breast-feeding knowledge, breast-feeding promotion practices, and associations between knowledge and practice.

Breastfeeding knowledge and practice of pediatric nurse practitioners

INTRODUCTION

The purpose of this secondary analysis is to examine and report on pediatric nurse practitioners' (PNPs') attitudes, experience, and knowledge about breastfeeding and to compare the results with those from a sample of pediatricians and other nurse practitioners and nurse-midwives.

METHOD

A breastfeeding study questionnaire was sent to all PNPs (N = 95) in a northwestern state. The response rate was 81%.

RESULTS

Respondents were nearly unanimous in their belief that "breast is best" and that it was their role to recommend breastfeeding to expectant mothers. In general, 74% of respondents believed they were effective or very effective in meeting the needs of breastfeeding patients. Although they were very supportive of breastfeeding, they were less knowledgeable about specific management strategies. Personal experience (nearly three fourths had themselves breastfed) was named by many as the most valuable source of information. Although PNPs appeared to have a more supportive attitude and better information than pediatric physicians, they reported themselves to be less effective in providing breastfeeding assistance than did their pediatric physician colleagues.

DISCUSSION

PNPs generally agreed about the importance of promoting breastfeeding and their effectiveness in doing so. However, many PNPs did not gain experience in breastfeeding support and management in their educational programs and incorrectly answered questions on basic management strategies.

Evaluation of an educational intervention on breastfeeding for NICU nurses

The effect of breastfeeding education on breastfeeding knowledge and attitudes of nurses in a neonatal intensive care unit (NICU) was evaluated. NICU nurses (intervention) and pediatric nurses (untreated control) working at a northeastern US children's hospital participated in the pretest/posttest design study. Both groups answered the same breastfeeding questionnaire on 2 occasions. NICU nurses completed the questionnaire the second time after attending the education session. Outcome measures evaluated by questionnaire items were (1) breastfeeding knowledge, (2) pro-breastfeeding attitudes, (3) baby-focused care attitudes, and (4) nurse-focused care attitudes. Comparison groups were similar at pretest on demographic variables and remained so despite attrition between pretesting and posttesting. A significant increase (P < .001) occurred in NICU nurses' breastfeeding knowledge after the education session. Findings suggest that an educational intervention has potential for improving NICU nurses' knowledge and certain attitudes about breastfeeding but may not alter other attitudes of interest in the desired direction.