jennifer l. bailey dejong, ph.d., fnp-bc, cle, cne golden start breastfeeding educational consultant...

Bailey’s Golden Start Breastfeeding Curriculum forNursing Students

Jennifer L. Bailey DeJong, Ph.D., FNP-BC, CLE, CNEGolden Start Breastfeeding Educational ConsultantAssociate Professor of Nursing Concordia College Nursing Department, Moorhead, MN

Property of MN Department of Health/DeJong 2

Intro Objective 1: why study lactation in the first place?

The Curriculum was written by Dr. DeJong during the 2011-2012 academic year to assist faculty in teaching undergraduate nursing students about breastfeeding and human lactation using a multi-dimensional team-based and interactive approach. Golden Start Breastfeeding Education acknowledges that much of the information in the curriculum was designed as teaching modules for The Golden Start Community Leadership Team by Lactation Consultant Molly Pessl, BSN, IBCLC, from Evergreen Perinatal Education, Washington. The program was funded by a grant by the MN Department of Health. Photos were used with permission from Jane Stockton, RN, CLC, Iowa Department of Public Health, Bureau of Nutrition and Health Promotion. Others are cited on the slide itself, within the text, or within the notes section of each slide.


Acknowledgements

The writing of this curriculum was a direct result of the research conducted at the NDSU Data Center on Nurses’ Perception of the Need for Lactation Education.

You can find the study and its results here: http://www.ndsu.edu/sdc/publications/reports/LactationReport_FINAL.pdf


Basis for the Curriculum

The overall purpose of this curriculum is to educate nursing students on breastfeeding and lactation so that they may become thoughtful and informed men and women dedicated to providing evidence-based care to the clients and communities they serve, in order to protect, promote, and support breastfeeding.


Purpose of the Curriculum

The following assumptions were presumed by Dr. DeJong while writing this curriculum:

1. Direct breastfeeding or providing human milk is the optimal choice for infant nutrition.

2. Almost all mothers have the physiologic capability to successfully breastfeed.

3. Breast milk is the best feeding option for most infants, with few exceptions (WHO/UNICEF, 2009).


Assumptions:

4. Artificial formulas should only be used in circumstances where human milk is not available or when medically advised.

5. Lactation offers short- and long-term benefits to the mother and child that synthetic formula and cow’s milk cannot.

6. The aim of nurses and other health professionals is to support individuals, families, and communities in attaining and sustaining holistic health and wellness.


7. Patients trust nurses to inform them of research findings that impact their choices.

8. Nurses, educators, and other stakeholders can influence the health of society through instruction, support, and the development of policies and procedures that change practice.

9. Patients and other consumers expect to receive care and instruction that is consistent with best practice recommendations based on sound science and not anecdotal reports.


10. Nurses must stay well-informed of current recommendations in order to maintain competency in their professional role as provider, educator, and client advocate.

11. Nurses have an ethical responsibility to the individual, family, and group as “client” to discuss health promotion, risk reduction, illness management, and disease prevention based on research.


Upon completion of The Golden Start Breastfeeding Curriculum, nursing students should be able to:


1. Analyze why breastfeeding and lactation research are vital topics to study in an undergraduate nursing curriculum.

2. Examine at least three biological advantages of lactation and breastfeeding for the mother and child.

3. Analyze the composition of human milk.


4. Examine at least three risks of not breastfeeding for the mother and child.

5. Analyze at least two contraindications to breastfeeding.

6. Analyze at least three advantages of breastfeeding for the community/environment.

7. Discuss the anatomy and physiology of lactation.

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8. Discuss the role of the nurse in assessing and encouraging the breastfeeding dyad.

9. Compare and contrast various breastfeeding positions.

10. Discuss the history and current trends of breastfeeding in the United States and internationally.

11. Discuss best practices as well as “The Code” and “The Ten Steps to Successful Breastfeeding.”


12. Analyze the components of The Breastfeeding Report Card, Healthy People 2020 Objectives, and The 2011 Surgeon General’s Call to Action to Support Breastfeeding.

13. Analyze problem-based case studies.

14. Write appropriate nursing diagnoses for breastfeeding-related issues.

15. Appraise lactation-related information available on the internet.


16. Role-play selected scenarios with one another.

17. Analyze the role of the registered nurse in providing support to mothers in a variety of settings.

18. Evaluate how public health programs in particular impact breastfeeding and education.

19. Examine factors that impact breastfeeding in communities and discuss ways to support breastfeeding where you work and live.


Objective 1

Analyze why breastfeeding and lactation research are vital topics to study in an undergraduate nursing curriculum.


Why is education about lactation and breastfeeding important for nursing students?

What does the evidence say?

Why take Time to Study Lactation and Breastfeeding?


Several national and international health organizations have developed position statements and practice guidelines supporting the importance of breastfeeding, including: ◦ the American Academy of Family Physicians (AAFP); ◦ the American Academy of Pediatrics (AAP); ◦ the American College of Nurse-Midwives (ACNW); ◦ the American College of Obstetricians and Gynecologists (ACOG); ◦ the National Medical Association (NMA); ◦ the Association of Women’s Health, Obstetric, and Neonatal Nurses

(AWHONN); ◦ the American Public Health Association (APHA); ◦ the American Dietetic Association (ADA); ◦ the National Association of Pediatric Nurse Practitioners (NAPNP);◦ the World Health Organization (WHO); ◦ the United Nations Children’s Fund (UNICEF); and, ◦ the United States Department of Health and Human Services

(USDHHS).Property of MN Department of

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Position Statements and Practice Guidelines

Nurses play an important role in educating the public and other healthcare professionals about the significance of breastfeeding, and can empower mothers and their support systems in maintaining lactation according to the evidence-based recommendations of HP, the WHO, the Centers for Disease Control and Prevention (CDC), the Academy of Breastfeeding Medicine (ABM), and other leading experts in the field of lactation.


Nurses Play an Important Role

What Does “Evidence-Based” Nursing Mean as it relates to Breastfeeding and Lactation?


Evidence-based practice means the nurse bases their practice of professional nursing on:◦ A. What the unit they work on deems satisfactory

based on patient feedback and confidential surveys.

◦ B. What the hospital or agency they work for gets reimbursed for by insurance companies.

◦ C. What they have time for in their practice; it depends on the shift and how demanding it is.

◦ D. Research-based recommendations and best practices of leading authorities.

NCLEX-Type Question


Nurses are in a position to use research findings from robust investigations to influence and change practice, to be a voice for underrepresented populations, and to educate society about the role that breastfeeding has in sustaining health and preventing unnecessary morbidity and mortality.


Nurses Influence and Change Practice

Health Professionals and Many Mothers agree that Breastfeeding is Best…

Then why is breastfeeding promotion, protection, and support so difficult?

Why are some mothers choosing formula?


Brainstorm the factors that you think may impact breastfeeding initiation and duration.

◦ Who chooses to breastfeed? Imagine a picture of this mother. Who is she? What does she look like?

◦ Who chooses to feed formula? Imagine a picture of this mother. Where does she live? What job does she have?


Why Do Some Mothers Breastfeed while Others Choose Formula?

For some answers to this question, let us turn to The Bailey DeJong Adaptation of Bronfenbrenner’s Social Ecological Systems Framework for Breastfeeding Mothers Conceptual Framework (May 2011)


Microsystem

Mesosystem

Exosystem

Macrosystem


Definitions of Each System

The Social-Ecological Framework can be readily applied within the context of health to explain the levels of bidirectional influence that affect or could potentially impact personal behavior.

Numerous variables, besides microsystem-related influences, exist that may improve or impair the physical, emotional, or spiritual well-being of a patient (McLeroy, Bibeau, Steckler, & Glanz, 1988).


Application to Health

What Impact does the Mother’s Significant Other have on

Breastfeeding?


Support from the father is associated with increased breastfeeding rates nationally and abroad (Alikasifoglu, Erginoz, Gur, Beker, & Arvas, 2001; Bar-Yam & Darby, 1997; Humphreys et al., 1998; Isabella & Isabella, 1994; Khoury, Mitra, Hinton, Carothers, & Sheil, 2002; Littman, Medendorp, & Goldfarb, 1994; Mahoney & James, 2000; Matich & Sims, 1992; Scott & Binns, 1999).

Image used with permission from http://wicworks.nal.usda.gov/wicworks/resources/images.html

What Impact does a Grandmother have on a Mother’s Decision to Breastfeed?


According to Morse and

Harrison (1987), the attitudes of

others toward the

breastfeeding mother and the

support she received are

among the most important

determinants of breastfeeding

duration.


What Impact does the Mother’s Age have on Breastfeeding?


Research suggests that the opinions of others significantly affect the breastfeeding decisions of mothers.


What Impact does a Mother’s Social Network have on Breastfeeding?

According to Humphreys, Thompson, and Miner (1998); Roe et al. (1999); Smith (1985); Starbird (1991); Winikoff (1980); and Wright (1988), women in the U.S. who have graduated from college are more likely to breastfeed than their less-educated counterparts.

Studies report that more highly educated women in the U.S. recognize the benefits of breastfeeding and are more likely to choose breastfeeding as opposed to bottle feeding.


What Impact does a Mother’s Educational Preparation have on

Breastfeeding?

Buxton and colleagues (1991) found that, among mothers who initiated breastfeeding, significant predictors of failure to breastfeed for more than seven days included lower confidence in the ability to breastfeed, delayed first breastfeeding experience, and lack of rooming-in with the baby after delivery.


What Impact does a Mother’s Level of Confidence have on

Breastfeeding?

How is the bottle inconvenient?How is the breast inconvenient?Discuss both now.


What Impact does a Mother’s Perception of “Inconvenience”

have on Breastfeeding?

Currently in the U.S., 3 of 4 (75%) of all mothers breastfeed their infants in the early postpartum period and 29% report feeding any human milk to their infants at six months.

However, racial disparities exist with Black women breastfeeding at a rate much lower than that of White women. According to the USDHHS (2010), only 45% of Black women initiate lactation postpartum. At six months, the breastfeeding rate is 31% for White women compared with 19% for Black women and 28% for Hispanic women.

What Impact does a Mother’s Race have on Breastfeeding?


African American Breastfeeding Network of Milwaukee at http://city.milwaukee.gov/breastfeeding

View advertising campaign at: http://www.iwantastrongbaby.com/

Reaching Our Sisters Everywhere (ROSE) at http://www.breastfeedingrose.org/

HHS about to release new campaign called “It’s Only Natural: Mother’s Love, Mother’s Milk”


Review the Content of the Following Websites Now

http://city.milwaukee.gov/breastfeeding

http://city.milwaukee.gov/breastfeeding

It’s Only Natural: Mother’s Love, Mother’s Milk found at: www.womenshealth.gov/itsonlynatural

What are your impressions?


Watch the Following Video Campaign Now

http://www.womenshealth.gov/itsonlynatural

Although the decision to breastfeed is a personal one for every mother, the choice not to breastfeed often results from a lack of material, informational, or emotional support (Kong & Lee, 2004; Logsdon, Usui, Birkimer, & McBride, 1996).

The use of supplemental formula feeding prior to discharge, or in the first month postpartum when milk supply is being established, has been associated with breastfeeding failure and premature weaning (Barber, Abernathy, Steinmetz, & Charlebois, 1997; Chezem, Friesen, Montgomery, Fortman, & Clark, 1998; Hill et al., 1997; Perez-Escamilla et al., 1993; Sheehan et al., 1999).


What Impact do Health Care Professionals have on

Breastfeeding?

Bartick et al. (2009) reported that, in some maternity centers, greater than 99% of breastfed infants receive formula.

To combat this growing trend, certain progressive hospitals now handle infant formula the same way as medications: available only with a provider order.

Formula is locked in a medication machine and strictly regulated.


The Impact of Supplementation

Some hospitals require parents and legal caregivers to sign a consent form, indicating they understand the inherent risk to their infant’s health, before providing formula for non-medical reasons (Bartick et al., 2009).

When such measures have been undertaken, the results speak for themselves. For instance, one hospital-based intervention to reduce formula supplementation of breastfed newborns found that breastfeeding at six months’ duration increased from 66% to 87% when supplementation was discouraged (Nylander, Lindemann, Helsing, & Bendvold, 1991).


Signed Consent for Supplementation

Women’s early experiences with breastfeeding considerably affect whether and how long they will continue to breastfeed (Caulfield et al., 1998; Taveras et al., 2004).

Lack of support from professionals who report reluctance to “push” mothers to breastfeed (Bartick et al., 2009) has been identified as a major barrier to breastfeeding promotion, especially among African-American women.


Women’s Early Experiences

Satcher (2001), former U.S. Surgeon General, advised, “To encourage breastfeeding, the health care system should support the training of health care professionals on the basics of lactation counseling and management, and establish hospital and maternity center practices that promote breastfeeding” (p. 72).


The current Surgeon General., Dr. Regina Benjamin, concurs with her predecessors’ remarks on the importance of provider support, writing, “Hospitals, work sites, and communities should make it easy for mothers to initiate and sustain breastfeeding as this practice has been shown to prevent childhood obesity” (USDHHS, Office of the Surgeon General, p. 1).


We Should Make it Easy for Mothers to Initiate and Sustain BF

Healthcare providers’ advice and support have a considerable influence on a mother’s decision to breastfeed and on her ability and desire to maintain breastfeeding (Arora et al., 2000; DiGirolamo, Grummer-Strawn, and Fein, 2003; Perez-Escamilla, Pollitt, Lonnerdal, & Dewey (1994). Phillipp, Merewood, & O’Brien, 2001; Register, Eren, Lowdermilk, Hammond, & Tully, 2000; Ryan, 1997).


Emotional and Educational Support

According to Sikorski, Renfrew, and Pindoria (2003), a Cochrane review indicated that a mostly in-person intervention significantly increased breastfeeding duration while an intervention using mainly telephone contact did not.


Educational Delivery Methods

Practicing rooming-in has been associated with a longer duration of breastfeeding (Anderson, Moore, Hepworth, & Bergman, 2004).


Rooming-in Provided by HealthCare Providers

Immediate skin-to-skin contact between the mother and infant and practicing rooming-in has been associated with longer duration of breastfeeding (Anderson, Moore, Hepworth, & Bergman, 2004).


The Impact of Skin-to-Skin Contact Between Mother and Infant: It’s More than Thermal Regulation

Why Don’t Some Professionals Want to Actively Support and

Promote Breastfeeding?

There are concerns about creating anxiety and guilt.

◦Nurses may have difficulty thinking of breastfeeding like they think of other healthcare issues.


Nurses Should De-Personalize Breastfeeding Education

While it may be beneficial to share personal breastfeeding stories, nurses need not have personal experience in order to support or promote breastfeeding.

This is about the evidence - not about your attitude, story, belief, or opinion.


Nursing Care of the Breastfeeding Mothers Need not Focus on Pathophysiology or Disease

Breastfeeding assistance and encouragement has everything to do with providing individualized care, of which nurses are educated to do.

Nurses need to emphasize the 3 P’s in their individualized CarePlan:◦PERFECT, PLENTY, and PREVENTATIVE


Breastfeeding is one of the best preventative health practices we have, and we will talk about this more in the slides to come.


Preventative Health Care

Nursing Care of the Breastfeeding Mother is about Anticipatory Guidance

Breastfeeding is “normal”

Breastfeeding is “do-able”

You can do this!

Image used with permission from William Burleson, Office of Statewide Health Improvement Initiatives, Minnesota Department of Health on 2/10/2012.


What has this child learned about breastfeeding?


Nursing Care of the Breastfeeding Mother is About Making it NORMAL


What Impact does a Mother’s Culture have on Breastfeeding?

How Does your Culture Typically View the Female Breast?



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For instance, if a mother is in public, does she have to use a blanket to “cover up” while nursing?

Do you live in a culture where

breastfeeding in public is the norm? Watch the following videos

and discuss.

http://www.youtube.com/watch?v=2cLlmFk35E4&feature=relmfu

http://www.youtube.com/watch?v=kWihxpKTaJo

Image used with permission from wicworks.nal.usda.gov/wicworks/resources/images.html







Breastfeeding Mother at Denver International Airport

End of: Intro Objective 1: Why study lactation in the

first place?

Next: Objective 2: Advantages Objective 3: Composition Objective 4: Risks of not breastfeeding Objective 5: Contraindications


jennifer l. bailey dejong, ph.d., fnp-bc, cle, cne golden start breastfeeding educational consultant...

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