Lactation Knowledge, Attitudes, Beliefs, and Intentions of NICU Nurses: An Intervention Study

Premature or sick infants who are hospitalized in the neonatal intensive care unit (NICU) and who receive OMM (own mother’s milk) are at reduced risk for sepsis, necrotizing enterocolitis (NEC), and gastrointestinal complications, and have shorter NICU hospital stays. Despite these facts, mothers of these infants often do not choose to breastfeed or are unsuccessful in their lactation efforts. Literature suggests that NICU nurses may negatively influence these mothers, as nurses are often construed as negative and not helpful by the mothers. This quasi-experimental study, which was guided by the Theory of Reasoned Action (Ajzen & Fishbein, 1980), used a time series design to test an educational intervention designed to improve lactation knowledge, attitudes, and beliefs of NICU nurses and to improve their intentions to provide mothers with lactation support. A sample of 64 NICU nurses completed the Nursing Support of Breastfeeding Questionnaire (measuring attitudes, beliefs, and intentions) and the Nurse Lactation Knowledge Survey at multiple time points, beginning with two weeks before and ending at 3 months after the attendance to a four-hour educational program. To further test the effectiveness of this program, two separate convenience samples of mothers of infants hospitalized in the NICU completed the Mothers’ Perceived Support Questionnaire in order to obtain a cross-sectional sense of the “supportive atmosphere for lactation” in the NICU, both before and after the intervention (n=19 and n=13, respectively). Analysis included descriptive statistics, psychometric evaluation of instruments, and repeated measures ANOVA. Among the results, a significant increase in lactation knowledge from the pre-intervention baseline scores (M=13.72, SD=2.90) was noted immediately after the intervention (M=18.27, SD=2.28) and at two-weeks post-intervention (M=18.45, SD=2.34). An increase in knowledge was also noted at the three-month follow-up (M=14.64, SD=1.36), however it was not significant. Mothers’ perceived support scores also improved (from M=142.74 to M=161.92), however the increase was not significant. Findings suggest that this educational intervention, which included practical how-to’s and motivational encouragement for staff, was effective for improving NICU nurses’ lactation knowledge and attitudes, and that these improvements were maintained over time. Further, the supportive atmosphere for lactation in this NICU did improve following the implementation of the educational intervention for nurses. This suggests that lactation support behaviors by NICU nurses are recognized and valued by the mothers they are assisting and that nurses can play a crucial role in the mothers’ breastfeeding efforts. Nurses, however, need the skills to educate and support mothers in breastfeeding initiation and maintenance. Efforts should be made by NICU administrators to assure that periodic lactation education programs are provided to staff and that staff efforts in lactation support are recognized and valued.