Running head: CRITIQUE OF THE RESEARCH ARTICLE: PERSPECTIVES OF

Critique of the Research Article: Perspectives of Hospital-Based Nurses on Breastfeeding Initiation Best Practices
Kimberly Baird
Grand Canyon University
Intro. To Nursing Research
NRS-433V
April 21, 2011

Critique of the Research Article: Perspectives of Hospital-Based Nurses on Breastfeeding Initiation Best Practices
The purpose of this research study is to evaluate the differences in breastfeeding knowledge and the implementation of breastfeeding by registered nurses in the postpartum units and the hospital policies, both formal and informal, related to the implementation and support of breastfeeding. Human milk is accepted as the ideal food source for infants for the first 6 months of life. Breastfeeding is then encouraged as a supplement to other foods until the child is 12 months of age and beyond. Both The Academy of Pediatrics and the International Lactation Consultant Association support these recommendations. CDC statistics report that in 2006 73.9% of women breastfed in the early postpartum period. This drops to 33.1% of those that are exclusively breastfeeding at 3 months of age and then drops again to 13.6% exclusively breastfeeding at 6 months. The Healthy People 2010 goals are 75% of women initiating breastfeeding in the early postpartum period and retaining 60% of those that continue to breastfeed at 3 months and 25% continuing until 6 months. These statistics fall short of those goals (Weddig, Baker, & Auld, 2011).
Fetrick, Christiansen, and Mitchell (2003) found that nurses that were well informed about breastfeeding, and are able to provide strong support and consistent messages about breastfeeding can positively influence breastfeeding initiation and continuation. The lack of education and knowledge may have a direct negative effect on breastfeeding initiation and continuation. This also constitutes inconsistent messages from one caregiver to the next providing the mother with confusion. Hospital policies may not be based on the best, current evidence-based practices and differing views by health practitioners based on lack of knowledge regarding current evidence-based practices can send conflicting messages to women. Conflicting advice from caregivers is stated by mothers as the primary reason for discontinuing breastfeeding (Weddig et al., 2011).
This study was set up as a descriptive qualitative study and formed a focus group of nurses to evaluate their perceptions related to breastfeeding best practices. It utilized a purposeful 2X2 cross-section sample to compare large hospitals to small hospitals and high socioeconomic status to low socioeconomic status. The focus group questions addressed formal and informal hospital policies, the nurses’ attitudes and knowledge related to breastfeeding practices during the first 72 hours of life, and actual practice and documentation of breastfeeding attempts. These questions were reviewed by a registered nurse and three International Board Certified Lactation Consultants for content validity (Weddig et al., 2011).
Participants in this study were recruited from each of the selected hospitals by posting flyers in the hospitals, nurses were sent emails and they were signed up for the study during shift changes. The nurses that participated in the study were compensated with $25.00 in cash.
The United Nations Children’s Fund (UNICEF) and World Health Organization (WHO) implemented the Baby-Friendly Hospital Initiative to institute evidence-based practices related to early breastfeeding implementation and support. Hospitals that strongly support these evidence-based practices directly influence the early initiation and continued duration of breastfeeding after discharge from the hospital. These baby friendly hospitals have a higher rate of breastfeeding at 2 days and two weeks, longer exclusive breastfeeding and increased duration of breastfeeding.
When researchers compared Baby-Friendly hospitals (BF) with non-Baby Friendly Hospitals, there was a substantial difference between the two, without regard to the size of the hospital or the socioeconomic status of those hospitals. In BF hospitals, breastfeeding policies were updated regularly allowing nurses to follow current evidence-based practices. These nurses reported that they were able to support and encourage breastfeeding based on clearly defined policies based on current evidence-based best practices. Although these nurses relied on Lactation specialists for assistance, they felt they were the primary resource for questions regarding early breastfeeding initiation. In non-BF hospitals, the nurses reported a lack of clear policies reflecting current evidence-based practices and that the policies in place were not regularly reviewed or updated.
The nurses in BF hospitals reported that they were required to observe and document at least one feeding during their shift. However, they also reported that the documentation is not consistent, does not follow any specific guidelines for the appropriate documentation and that the admission assessment is lacking clear assessment guidelines regarding breasts and nipples. In non-BF hospitals, the information regarding breastfeeding came from many different sources and that the feedings were usually reported by the mother rather than by direct visualization by the nurse. The nurses at the BF hospitals stated that they do observe and assist with at least one feeding per shift and use different assessment tools to document their observation of the feeding. One of these tools is LATCH scoring tool that assesses the newborn’s latch, suck, swallow and also type of nipple the mother has and her comfort level during the feeding.
There is also a lack of policies regarding patient education both during the hospital stay and after discharge in the non-BF hospitals. These nurses state that a discharge packet that included patient education were given to the patients at time of discharge but the contents of the packet were not discussed during the hospital stay or at the time of discharge. In the BF hospitals, there were clear policies regarding patient education and encouraged education throughout the hospital stay regarding such topics as hunger cues exhibited by the newborn, unrestricted breastfeeding, education regarding how to tell if the newborn is getting enough to eat, the rationale for delaying pacifier use, and normal feeding patterns. A discharge packet containing information regarding these topics is provided at time of discharge to reinforce the teaching provided while in the hospital.
While this study anticipated differences between large and small hospitals and high vs. low socioeconomic status, it defined a greater correlation between BF hospitals and non BF hospitals. BF hospitals had clear evidence-based policies regarding breastfeeding initiation and the nurses understood how to promote these practices in the clinical setting. They also had the knowledge and education to further support best evidence-based practice. In the non-BF hospitals, they lacked clear, current policies and the knowledge and understanding to support strong breastfeeding practices.
The results of this research study show a need for emphasis on the education of nurses about breastfeeding and developing clear, concise policies to promote positive outcomes regarding the early initiation of breastfeeding. Those policies need to follow current evidence-based best practice research. Guidelines for appropriately assessing and documenting the effectiveness of breastfeeding prior to discharge need to be outlined and implemented. Ongoing support information needs to be included in the discharge teaching packet to promote continuation of breastfeeding after discharge from the hospital in order to attempt to meet the Healthy People goals in the future. Whether a hospital intends to adopt the Baby Friendly status guidelines, they need to set forth to implement the gold standards of competencies, implement current evidence-based policies, and formulate a documentation plan in order to provide consistency from caregiver to caregiver that will lead to better evidence-based care for mothers. Reference
Weddig, J., Baker, S. S., & Auld, G. (2011). Perspectives of Hospital-Based Nurses on Breastfeeding Initiation Best Practices
. Journal of Obstetric, Gynecologic & Neonatal Nursing, 40(2), 166-178. doi:DOI: 10.1111/j.1552-6909.2011.01232.x