Elizabeth B. Froh

Improving Practice at the Point of Care Through the Optimization of the Breastfeeding Resource Nurse Model

OBJECTIVE To describe and understand the Breastfeeding Resource Nurse (BRN) role and program. DESIGN The primary study was a multimethod prospective study in which quantitative surveys and qualitative interviews of nurses who received education through the BRN program were used. Results presented herein are from the quantitative arm of the primary study. SETTING A large free-standing urban childrens hospital with a birthing unit for specialized deliveries and a primary and specialty care network. PARTICIPANTS A total of 425 of 600 nurses who took the BRN course responded to the survey. These nurses worked in all settings throughout the enterprise. METHODS The research team created a Survey Monkey interview that was e-mailed to all current nurses with valid hospital e-mail addresses who had taken the BRN course. Monthly e-mail reminders were sent and nurse managers were asked to encourage their staff to fill out the survey. RESULTS Nurses who received specialized education through BRN course integrated the provision of evidence-based breastfeeding support and care into their daily routines. Furthermore, nurses became breastfeeding advocates and supported family, friends, and members of their communities in their breastfeeding experiences. CONCLUSIONS The type of education needed for nurses who work at childrens hospitals and in neonatal intensive care units is different than traditional breastfeeding education for birth hospitals. Implementation of the BRN course resulted in positive outcomes for staff; the course is transferrable to other facilities worldwide.

An ethical case for the provision of human milk in the NICU.

Despite recommendations from the World Health Organization, the United Nations Childrens Fund, the American Academy of Pediatrics Section on Breastfeeding, and others, only a small percentage of infants in the United States receive exclusive human milk for the first 6 months of life. In the United States, decisions related to infant feeding are determined by surrogate or proxy in place of the neonatal voice, using the “best interest principle” as the guiding ethical focus. Given the established research on the benefits of an exclusive human milk diet compared with artificial nutrition (infant formula), infant feeding decisions made for the critically ill neonate should rest entirely in the infants best interest, not solely in parental authority. If the mothers own milk is not available or its use is contraindicated, the American Academy of Pediatrics recommends donor human milk.1 However, the preverbal voice of the neonate makes it difficult to isolate the best interest of the infant separated from the family unit. Using a case exemplar, it is proposed that the means in which infant feeding decisions are made for the critically ill infant should rest entirely in the infants best interest, not parental authority, during the course of care in the hospital setting. The best interest principle, surrogate decision making, parental authority, and proxy consent are reviewed. Furthermore, a case for the best interest principle to further illustrate the importance of the infants voice in relationship to enteral feeding decisions is provided. Finally, implications for clinical practice are offered.

The Voices of Breastfeeding Resource Nurses

OBJECTIVE To describe and evaluate the Breastfeeding Resource Nurse (BRN) role and program at The Childrens Hospital of Philadelphia (CHOP). DESIGN The primary study was a multimethod study including a survey and key informant interviews to meet the studys objectives: to describe how the BRN implements his or her role at the unit level throughout the hospital, to describe the successes and challenges of the BRN role, to provide data on how BRNs may be better supported in their roles, and provide data for the translation of the BRN program to other institutions. We present the qualitative descriptive component from the primary study. SETTING The Childrens Hospital of Philadelphia enterprise. PARTICIPANTS Eighteen BRNs within the CHOP enterprise. METHODS Semistructured interviews were conducted with the BRN participants. The data were analyzed with conventional content analysis. RESULTS Four major themes emerged from the BRN interview data: Empowering through evidence, Advocacy, Going the extra mile, and Personal connections to breastfeeding. CONCLUSIONS Compelling stories illustrated the role of the BRN as patient advocate and educator for staff and families. Knowing the evidence about lactation and breastfeeding empowered the BRN to be successful in his or her role. The BRNs derived great personal and professional satisfaction from their roles. The BRN program can be easily adapted to other pediatric care centers and will enable improved breastfeeding outcomes at the point of care.

What Nurses Need To Know Regarding Nutritional and Immunobiological Properties of Human Milk

In this article, we discuss the nutritional and immunobiological components of human milk that nurses need to know to offer optimal care and education to their patients and families. We describe the major macronutrients and micronutrients in human milk that are essential to the growth and development of the newborn infant, and we discuss the immunobiological components of human milk that supplement and boost the newborns immune system.

Co-creation of a pedagogical space to support qualitative inquiry: An advanced qualitative collective

BACKGROUND Situated in a research-intensive School of Nursing, the Advanced Qualitative Collective (AQC) provides an innovative educational forum for the study of qualitative research by doctoral and postdoctoral scholars. This long-standing collective is guided by a faculty facilitator using a collaborative co-learning approach to address individual and group needs, from the conception of research projects through dissemination of completed qualitative research. This article describes the dynamics of the AQC and the ways a co-created pedagogical entity supports professional development among its diverse members. The informal, participatory style, and dynamic content used by the AQC resists a course structure typical of doctoral education in health sciences, and promotes engagement and self-direction. The AQC provides opportunities for members to examine theoretical frameworks and methodologies rarely addressed within a positivism-dominant learning environment while simultaneously serving as an alternative exemplar for the pedagogy of research.

Pump Early, Pump Often: A Continuous Quality Improvement Project.

ABSTRACT Research demonstrates that although many mothers initiate pumping for their critically ill children, few women are successful at maintaining milk supply throughout their infants’ entire hospital stay. At the Garbose Family Special Delivery Unit (SDU) at the Children’s Hospital of Philadelphia, we care for mothers who have critically ill infants born with complex cardiac and congenital anomalies. Human milk is viewed as a medical intervention at our institution. Therefore, nurses on the SDU wanted to ensure best practice in terms of pumping initiation. This article describes a continuous quality improvement project that ensured mothers pumped early and often. Childbirth educators can play a key role in preparing mothers who are anticipating an infant who will require hospitalization immediately post-birth.

Human milk and breastfeeding: An intervention to mitigate toxic stress

The American Academy of Nursing has identified toxic stress in childhood as a health policy concern of high priority. Adult diseases (e.g., obesity, diabetes, hypertension and cardiovascular disease) should be viewed as developmental disorders that begin early in life that could be reduced with the alleviation of toxic stress in childhood. The provision of human milk/breastfeeding is an evidence-based intervention that may hold the greatest potential to mitigate the effects of toxic stress from the moment of birth. Assisting families to make an informed choice to initiate and continue breastfeeding from birth has the potential to address both the disparity in the quality of nutrition provided infants and the economic stress experienced by families who purchase formula. The Expert Panel on Breastfeeding endorses initiatives to improve the initiation, duration, and exclusivity of breastfeeding to mitigate the effects of toxic stress in this call to action for research to build the evidence to support these critical relationships.

Breastfeeding the infant with congenital diaphragmatic hernia post extracorporeal membrane oxygenation.

Infants born with congenital diaphragmatic hernia (CDH) often require extracorporeal membrane oxygenation (ECMO). Infants on ECMO may experience a long period of being nothing by mouth (NPO) while receiving parenteral nutrition. Once the infant with CDH is repaired and off ECMO, human milk should be used to initiate enteral feedings. Human milk provides immunologic, developmental, and nutritional protection for these high-risk infants and may be crucial in decreasing morbidities commonly associated with post-ECMO survivors. These mother–infant dyads require extensive lactation support to ensure maintenance of milk supply and successful transition to direct breastfeeding. Three case studies are presented as exemplars to demonstrate how breastfeeding success can be achieved even in the most vulnerable infants.

The Use of Technologies to Support Human Milk & Breastfeeding

The application of lactation technologies is not limited to the NICU or the hospital setting. These technologies can be implemented within the home or hospital setting to promote the use of human milk and protect the breastfeeding relationship. Through the use of breast pumps, scales, and nipple shields, women can be supported to achieve their personal breastfeeding and lactation goals.

Associated morbidities to congenital diaphragmatic hernia and a relationship to human milk.

The majority of what is known in the recent literature regarding human milk studies in the neonatal intensive care setting is specific to term and/or preterm infants (including very-low-birth-weight preterm infants). However, there is a lack of human milk and breastfeeding literature concerning infants with congenital anomalies, specifically infants diagnosed with congenital diaphragmatic hernia (CDH). By applying human milk research conducted among other populations of infants, this article highlights how human milk may have a significant impact on infants with CDH. Recent human milk studies are reviewed and then applied to the CDH population in regard to respiratory and gastrointestinal morbidities, as well as infection and length of stay. In addition, clinical implications of these relationships are discussed and suggestions for future research are presented.