Improving Breastfeeding Initiation Practices through Online Theory Based Education
- Identify evidence-based best practices related to breastfeeding initiation.
- Describe the relationship between hospital policy and nurses’ breastfeeding initiation support behaviors.
- Examine policies at your hospital and determine whether policies are recent, evidenced-based, and support breastfeeding initiation best practices
To determine whether a one-credit online course (with an eight-hour in-person practicum) results in changes in hospital-based nurses’ knowledge, behaviors, skills, and attitudes related to breastfeeding initiation best practices.
Design:
Descriptive qualitative and historical quantities data were collected.
Setting:
6-week online course
Patients/Participants:
Registered nurses.
Methods:
A one-credit online course and practicum were designed to increase nurses’ knowledge of breastfeeding initiation. Data were collected from an intervention (N = 50) and comparison (N = 45) group before and after the course and practicum to assess change in knowledge, behaviors, skills, and attitudes.
Assessment tools included the Coventry University Breastfeeding Assessment; an online attitudes and skills pre- and post- test survey created by researchers and tested for reliability and validity; and a hospital chart review to assess changes in nursing skills and behaviors related to evidence-based breastfeeding initiation best practices.
Interviews were also conducted with management teams at three Colorado hospitals 12 months after nurses completed the online course. Managers were interviewed in person and by phone about changes that occurred related to breastfeeding initiation policies and best practices during the preceding year. The interviews served to gauge the managers’ perception of changes that occurred related to breastfeeding initiation best practices and breastfeeding policies.
Results:
The intervention group demonstrated an increase in knowledge of the Baby Friendly Hospital Initiative standards, positioning and milk transfer, managing breastfeeding difficulties, and use of supplementation, compared to the control group. While there was little change in nursing behaviors (self reported or from chart review) related to skin-to-skin, first breastfeeding, latch and milk transfer, and documentation of evidenced-based best practices, there were changes in nurses’ behavior related to use of formula supplementation per chart review (p<.05). Management interviews indicated hospital policy and procedures changed during the 12 months after nurses completed the online course in two hospitals. Changes were driven by the nurses’ desire for evidence-based best practices. Establishment of breastfeeding policies allowed the environment of best practices to remain the “norm” even as nurses or nurse managers left and were replaced by other nurses.
Conclusion/Implications for nursing practice:
The online course produced changes in knowledge, but not in behavior. This is likely due to nurses being unable to change their behaviors related to breastfeeding initiation best practices until hospital policy and culture change. As evidenced by the management interviews, once policy changed nurses were able to make behavior change.
Keywords:
breastfeeding, hospital policy, evidence-based best practices, RN education,
