Lisa Smith

Introduction/Problem

The benefits of exclusive breastfeeding are well documented in the literature. There are both short- and long-term health benefits for the woman and infant including enhanced bonding, better postpartum transitions, and decreased stress. Women who exclusively breastfeed have reduced risk of ovarian and breast cancer, hypertension, and type 2 diabetes. Infants who receive exclusive human milk have a lower risk of ear infections, gastrointestinal illness, asthma, obesity, type 1 diabetes, and sudden infant death syndrome (SIDS). Nursing knowledge of breastfeeding and the benefits of human milk does not always translate into supportive practice at the bedside. Traditionally nurses use their own experiences with breastfeeding when providing education and support rather than utilizing evidence-based practices. At our organization we identified opportunities with exclusive breastfeeding. A retrospective chart review revealed low breastfeeding exclusivity rates on a mother baby unit at a community hospital.

Methods

This quality improvement (QI) project combined education, immersive simulations, debriefing, and reinforcements on a mother baby unit bundled with implementation of evidence-based interventions. The outcomes measured were nurse pre/post knowledge, human milk feeding importance ranking, and human milk feeding exclusivity rates for well term mother baby dyads two months before and after implementation. QI project interventions, rooming-in and breastfeeding assessment documentation, were also measured for change compliance.

Findings

Thirty-three nurses participated in the project with similar knowledge scores pre/post implementation. Nurses were asked to rank the importance of human milk feeding on a 1-10 scale (1=least important to 10=most important). Importance rankings pre/post increased 10%. Infant charts were retrospectively reviewed two months pre/post-implementation. Human milk feeding exclusivity rates increased, although not statistically significant after project implementation, an increase in exclusivity rates is a clinically significant improvement towards better health outcomes for mothers and infants.

Practice Implication

Knowledge about breastfeeding techniques alone does not translate into practice change. Understanding the importance of exclusive breastfeeding, including the rationale, such as health benefits, can enhance participation in evidence-based practice. Strategic planning for practice changes and sustainment including stakeholder buy in, resources, and reinforcements is crucial. Implementation of an evidence-based bundle may give nurses the necessary tools to understand and support human milk feeding exclusivity. Simulation with a standardized patient and post- event debriefing provides a safe space to practice new psychomotor skills, ask questions, have open discussions, and receive feedback. Funding: This study was not funded.