RUNNING HEAD: BACK TO THE BASICS OF BREASTFEEDING 1

Back to the basics of breastfeeding:

Educating nurses so they can empower patients!

Melissa W. Candler

Anderson University
BACK TO THE BASICS OF BREASTFEEDING 2

Back to the basics of breastfeeding:

Educating nurses so they can empower patients!

Introduction and Background

Healthcare is ever-changing. To keep current with the most up-to-date evidence-

based practice (EBP) we must continue to educate our staff on the best practices. These best

practices will ensure that patients are receiving care that will provide them with the best possible

outcomes after spending time on our respective hospital units. The postpartum mother/baby

(MB) units at Greenville Memorial Hospital (GMH) and Patewood Memorial Hospital (PMH)

care for mothers that feed their babies breastmilk or artificial milk (formula) for nourishment.

Since July 2014, GMH has been designated as a Baby-Friendly Hospital (BFH) through the

Baby Friendly Hospital Initiative (BFHI). The BFHI has a set of goals and guidelines to be

followed to ensure that postpartum mothers and babies are receiving the best EBP during their

hospital stay. Doctor Jennifer Hudson M.D., Greenville Health System (GHS) Medical Director

of Newborn Services, believes that our facilities have an obligation to help families apply the

scientifically proven practices of Baby-Friendly Hospitals to ensure the healthiest of outcomes

(GHS, n.d.). A recent article reveals that evidence-based maternity care practices that support

breastfeeding have been reported to increase breastfeeding initiation, exclusivity, and duration

(Anstey, et al., 2017). The National Institute of Health (2017) includes health care providers as a

factor that influences successful breastfeeding habits. This fact can be beneficial or detrimental

based on the nursing staff’s knowledge and skill set when dealing with breastfeeding mothers

and babies. To echo what Dr. Hudson said, it is every staff member’s duty to ensure that every

postpartum mother is receiving coherent evidence-based information to ensure newborn babies

have the opportunity to the best possible start to life. We now know that this is achieved through
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feeding exclusive breastmilk for at least 6 months of life. Two of the factors that influence

exclusive breastfeeding habits have been reported as inadequate breastfeeding education and

early supplementation of artificial milk (Teles, et al., 2017). Through proper re-education with

emphasis on the benefits of breastfeeding along with the risks of formula supplementation, I

hope to inspire the staff to feel more confident in supporting mothers who plan to breastfeed.

Theoretically, this will help provide mothers with correct information and reduce the amount of

formula that will be supplemented to breastfed babies.

Problem Statement

Unjustified formula supplementation in the hospital leads to early breastfeeding

cessation, eliminates the ability to exclusively breastfeed for six months, decreases babies’

overall health and undermines mothers’ confidence in her breastfeeding abilities.

Purpose Statement

To empower nurses with the knowledge of exclusive breastfeeding benefits to help

reduce the amount of unwarranted formula supplementation to breastfed babies.

Review of Literature

GHS pediatricians support the American Academy of Pediatrics (AAP). “The American

Academy of Pediatrics recommends exclusive breastfeeding for approximately the first 6 months

of life and continued breastfeeding with complementary foods through at least the first year”

(Anstey, et al., 2017). The World Health Association (WHO) also recommends exclusive

breastfeeding for the first 6 months of life. A recent study concluded that the lack of exclusive

breastfeeding to be associated with adverse consequences on the health and nutritional status of

children (Nuruzzaman & Mofizul, 2017). Many studies have revealed that in-hospital “formula
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supplementation during the maternity stay is associated with shortened duration of both

exclusive as well as ‘any’ breastfeeding,” which suggests a direct correlation (Chantry, et al.,

2014). Avoidance of artificial formula on postpartum units predicts longer exclusive

breastfeeding rates (O’Connor, et al., 2017). Anstey, et al (2017) identified lack of knowledge

about breastfeeding as a factor that influenced a woman’s decision to start and continue to

breastfeed.

Change Theory

Lippitt’s change theory fits this project proposal well because it relates easily to the

nursing process elements of assessment, planning, implementation, and evaluation. Phase one of

diagnosing the problem has been collected over the past year with our lactation department

noticing an increase of unjustified formula supplementation to breastfeeding infants. The second

and third phases of assessing our staff’s motivation has been ongoing throughout this year also.

Our department has been discussing strategies within the department along with the educator on

the postpartum unit. Both the manager and educator of the postpartum unit have supported our

department’s wishes to provide nurses with the best evidence-based research about

breastfeeding. Phase four of Lippitt’s change theory reveals the presented change objective in

detail below in the ‘methods’ section of this proposed project. For the fifth phase, this learner

will lead the project as a change agent then will include other members of my department to be

made available for in-services to cover all shifts. In our recent Unit Council meeting, the

lactation consultants supported this task in theory and by offering their flexibility to be available

to all nursing shifts for in-services. The most important, in my opinion, sixth phase is the

implementation stage where the lactation consultants will ensure the change process is

maintained. During the execution of this project, the lactation consultants will ensure evidence-
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based information is provided to staff in a motivating forum. For the final phase of termination, I

propose that we evaluate our process to ensure that the proposed plan achieved our desired

outcomes. It will also be beneficial for the lactation consultants to remain available for

clarification, advice, and reinforcement as needed.

Methods

The idea for this project proposal originated after an obvious increase in

inexcusable formula supplementation to breastfeeding babies was identified by lactation

consultants at GMH. Following this observation, objective data supported this theory when our

exclusive breastfeeding rates began to decrease. As opposed to perceiving this habit is related to

nurse’s noncompliance, it is acknowledged that this practice could be due to the postpartum

nurse’s lack of understanding of our facility’s breastfeeding policies. The nurse’s corresponding

charting to providing formula supplementation to breastfeeding babies supports that they may be

misinformed about the risks of offering formula when it is not medically necessary.

Furthermore, it is crucial to re-educate the postpartum nurses of the many scientifically proven

benefits of providing breastmilk exclusively for the first 6 months of a baby’s life. The Baby-

Friendly USA website’s “Ten Steps to Successful Breastfeeding” includes training all healthcare

staff on necessary skills of breastfeeding and to give infants no food or drink other than breast-

milk unless medically indicated (Baby Friendly USA, n.d.).

This proposed project will take the form of several educational tools for the postpartum

nurses. First, The LC’s of the Women’s Education Department will research the best current

evidence-based practices for newborns’ nutrition. This method is ongoing in our department as

our LC’s are required to obtain continuing education hours regularly. Four staff members
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recently attended the 29th Annual Conference on Breastfeeding whose topics included

“promoting and protecting babies’ health” this year. Evidence synthesizing summaries will be

developed from credible scholarly studies and articles. Second, the LC’s will compile this

helpful information in a three-ring binder that will remain on the postpartum unit to serve as a

reference guidebook. This data will also be composed of PowerPoint and poster presentations.

The LC’s will present the evidence-based information, GHS’s breastfeeding policies and

procedures, along with tips and recommendations for the postpartum staff in an in-service.

During the in-service, LC’s will present the PowerPoint presentation, poster exhibit, and

guidebook. This arrangement will clearly provide necessary means to meet the objectives of the

purpose statement to empower nurses with knowledge. The intentions of this plan will outline

many important breastfeeding specifics including but not limited to; stating the “Ten Steps to

Successful Breastfeeding” that is supported by AAP and UNICEF/WHO, describing the

scientifically proven benefits of breastfeeding, along with defining medically indicated reasons

to supplement a breastfed baby with formula. Portions will provide the staff with evidence-based

research that supports step #6 of the BFHI stating that our facility should “give infants no other

food or drink other than breast-milk, unless medically indicated” (Baby Friendly USA). This

step clearly supports the problem statement that unjustified formula supplementation in the

hospital increases breastfeeding cessation and the purpose statement that knowledge will inspire

the staff to provide better care for their patients. This demonstration will be presented by a LC to

the postpartum staff at GMH and PMH on all shifts within a specified number of weeks to be

determined after approval of this proposal.

Outcomes
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Desired outcomes include providing our postpartum mothers who intend to breastfeed

their newborns with the best evidence-based care that can be provided. This care involves

receiving only information that has been proven systematically, researched currently and taught

coherently by the postpartum nursing staff. It is believed that the postpartum nurses will have a

better understanding of the BFHI after attending a comprehensive in-service presentation and

having access to the reference guidebook that will remain on the postpartum unit at all times.

Once this system has taken place, we will have a roster for nurses to sign as confirmation that

she is up-to-date on the current BFH recommendations and goals of our facility. This roster will

ensure that every nurse had the opportunity to learn and become familiar with the correct

information. It is further projected the nurse’s extended breastfeeding knowledge will directly

impact our breastfeeding population by increasing exclusivity and decreasing unnecessary

formula supplementation. This will be revealed through quantitative statistics outlined data of

GMH’s exclusive breastfeeding rates that is published monthly.

Conclusion

The most important conclusion of this proposal will be that mother’s will be better

informed and supported by their postpartum nurse which will lead to providing breastmilk for

longer periods of time to help increase a babies’ overall health. When this project is effective at

empowering nurses with knowledge and resources to be able to better care for their patients, the

unit will be able to use this presentation for new employee’s education. Once educated through

this process it may be necessary to identify nurses who continue to be noncompliant with the

GHS BFHI goals and objectives. Those nurses will be requested to have remediation guidance.

The Center for Disease Control (2018) reports that only 1 in every 4 babies exclusively receives

breastmilk for 6 months as recommended. There is much work to do to ensure all breastfeeding
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mothers and babies are receiving the information they deserve from a staff member who is

qualified to support them. This project serves as additional steps to the implementation of Baby-

Friendly practices that were started in July of 2014 at GMH. Furthermore, GMH is due for

reinstatement of BFH in 2019. PMH has aspirations of being designated as a BFH. The actions

outlined in this proposal will certainly positively impact our site visit in 2019.

“Breastfeeding provides unmatched health benefits for babies and

mothers. It is the clinical gold standard for infant feeding and nutrition, with

breast milk uniquely tailored to meet the health needs of a growing baby. We

must do more to create supportive and safe environments for mothers who

choose to breastfeed.” (Dr. Ruth Petersen, Director of CDC’s Division of

Nutrition, Physical Activity, and Obesity).

There is no doubt that the postpartum nurses at GMH and PMH can positively

influence the health of our communities directly through providing evidence-based care

to newborn babies. The Cleveland Clinic (2015) urges healthcare professionals to “learn

about the potential health benefits of breastfeeding in order to better counsel their

patients.” The first step in this process will be to hinder the unjustified formula

supplementation in the hospital. This small effort will start all breastfeeding babies off

with the best potential to exclusively provide breastmilk for as long as possible with a

goal of 6 months. The next step should be to complete annual competencies for all

postpartum nurses. This is a simple cost-effective process that involves allowing the

expert lactation consultants staffed in our hospitals to annually ensure basic breastfeeding

information and techniques are updated, taught and understood in our healthcare system.
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Nguyen et al. (2016) proves that the perceived attitudes of nurses in the hospital setting

can increase the duration of breastfeeding. Together we can make a positive impact

through the joint efforts of lactation consultants and postpartum nurses providing mothers

and their new babies with gold standard breastfeeding information and support that is

expected and deserved.

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References:

Anstey, E. H., Jian, C., Elam-Evans, L. D., Perrine, C. G., & Chen, J. (2017). Racial and

Geographic Differences in Breastfeeding - United States, 2011-2015. MMWR: Morbidity

& Mortality Weekly Report, 66(27), 723-727. doi:10.15585/mmwr.mm6627a3

Baby-Friendly USA (n.d.). 10 Steps and International Code: The Ten Steps to Successful

Breastfeeding. Retrieved from: https://www.babyfriendlyusa.org/about-us/10-steps-and-

international-code

Cleveland Clinic (2015). Breastfeeding Your Baby May Reduce Childhood Leukemia Risk:

Researches say breast milk influences infant’s immune system. Retrieved from:

https://health.clevelandclinic.org/breastfeeding-your-baby-may-reduce-childhood-

leukemia-risk/

CDC, Centers for Disease Control and Prevention (2018). Breastfeeding; Why it Matters.

Retrieved from: https://www.cdc.gov/breastfeeding/about-breastfeeding/why-it-

matters.html

Chantry, C. J., Dewey, K. G., Peerson, J. M., Wagner, E. A., & Nommsen-Rivers, L. A. (2014).

Original Article: In-Hospital Formula Use Increases Early Breastfeeding Cessation

Among First-Time Mothers Intending to Exclusively Breastfeed. The Journal Of

Pediatrics, 1641339-1345.e5. doi:10.1016/j.jpeds.2013.12.035

Greenville Health System (n.d.). Greenville Midwifery Care & Birth Center: Hospital Births.
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Retrieved from: http://www.greenvillemidwiferycare.com/hospital-

births.php?gclid=EAIaIQobChMI6I-T-

fj42QIVErbACh0yBwZPEAAYASAAEgIzL_D_BwE

Nguyen, M., Snow, G., Wheeler, H., & Owens, T. (2016). Clinical Question: In post-partum

first-time mothers, what interventions are successful for helping women sustain exclusive

breast feeding for one month or more?. The Journal Of The Oklahoma State Medical

Association, 109(11), 521-524.

NIH, National Institute of Health. (2017). Eunice Kennedy Shriver National Institute of Child

Health and Human Development: What are the recommendations for breastfeeding?

Retrieved from:

https://www.nichd.nih.gov/health/topics/breastfeeding/conditioninfo/recommendations

Nuruzzaman, K., & M. Mofizul, I. (2017). Effect of exclusive breastfeeding on selected adverse

health and nutritional outcomes: a nationally representative study. BMC Public Health,

Vol 17, Iss 1, Pp 1-7 (2017), (1), 1. doi:10.1186/s12889-017-4913-4

O’Connor, M., Allen, J., Kelly, J., Gao, Y., & Kildea, S. (2017). Original Research –

Quantitative: Predictors of breastfeeding exclusivity and duration in a hospital without

Baby Friendly Hospital Initiative accreditation: A prospective cohort study. Women And

Birth, doi:10.1016/j.wombi.2017.10.013

Teles, M. B., Ferreira da Silva Junior, R., Gualberto dos Santos Júnior, G., Prates Fonseca, M., &
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Karoline Eugênio, K. (2017). KNOWLEDGE AND PRACTICES OF

BREASTFEEDING OF USERS FROM THE FAMILY HEALTH STRATEGY. Journal

Of Nursing UFPE / Revista De Enfermagem UFPE, 11(6), 2302-2308.

doi:10.5205/reuol.10827-96111-1-ED.1106201707