Elizabeth Reifsnider

Effects of support on the initiation and duration of breastfeeding

Researchers attempted to increase the initiation of breastfeeding and its duration to 6 months among a group of low-income, Hispanic women through an intervention program which included prenatal education and home based postpartum support. All participants were telephoned after delivery to determine infant feeding method. Duration of breastfeeding was determined by counting the number of days from initiation to the last day the baby was put to the breast. The Bayesian approach was used for the statistical analyses. In the intervention group, the propensity to initiate breastfeeding exceeded that of the control group. Results indicate the intervention group had twice (2.31) the odds of starting breastfeeding, twice (1.84-3.15) the odds of continuing to breastfeed for 6 months, and only half (.50-.54) the tendency to quit at any one time than did the control group.

Prenatal Breastfeeding Education: Its Effect on Breastfeeding Among WIC Participants

The effect of prenatal breastfeeding education on breastfeeding incidence and duration was determined among 31 prenatal WIC participants. The subjects, assigned to a control group (n= 17) or experimental group (n= 14), received prenatal nutrition education through the WIC program. The experimental group received at least one breastfeeding education class. There was no significant difference in breastfeeding incidence between the groups, however, there was a significant difference in breastfeeding incidence by parity (p<0.05). There was a significantly higher percentage of women still breastfeeding at 3 and 4 months postpartum in the experimental versus the control group (p<0.05). The control group breastfed for 29.5 + 43.6 days, while the experimental group breastfed for 76 days + 104.3 (p=.05). Multiparous women who had bottle-fed previous children breastfed for a shorter duration (18 + 22 days) than primiparous women (60 87 days) (p<.07).

Cultural competency of graduating BSN nursing students.

ABSTRACT Providing culturally appropriate care is an essential nursing competency for new graduates. Multiple curricular approaches are being used to achieve this end. When measured by Campinha‐Bacotes Inventory for Assessing the Process of Cultural Competency Among Healthcare Professionals‐R®, graduating students (n = 515) from six different BSN programs scored, on average, in the culturally aware range. These results suggest that no one curricular approach is proving to be more effective than another in achieving essential cultural competency.

Assessing Infant Breastfeeding Beliefs Among Low-Income Mexican Americans

Focus groups were conducted with low-income, pregnant women and new mothers receiving services from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC program) along with their male partners and their mothers. All participants were Hispanics of Mexican American origin. The topics for the focus-group discussions were breastfeeding beliefs and perceptions. All participants were aware of the benefits of breastfeeding. Participants identified time, embarrassment, and pain as barriers to breastfeeding; discussed decision-making efforts regarding breastfeeding; identified cultural beliefs related to breastfeeding; and discussed the lack of care-provider support for breastfeeding.

Reduced breastfeeding rates among obese mothers: a review of contributing factors, clinical considerations and future directions.

Maternal obesity is associated with significantly lower rates of breastfeeding initiation, duration and exclusivity. Increasing rates of obesity among reproductive-age women has prompted the need to carefully examine factors contributing to lower breastfeeding rates in this population. Recent research has demonstrated a significant impact of breastfeeding to reduce the risk of obesity in both mothers and their children. This article presents a review of research literature from three databases covering the years 1995 to 2014 using the search terms of breastfeeding and maternal obesity. We reviewed the existing research on contributing factors to lower breastfeeding rates among obese women, and our findings can guide the development of promising avenues to increase breastfeeding among a vulnerable population. The key findings concerned factors impacting initiation and early breastfeeding, factors impacting later breastfeeding and exclusivity, interventions to increase breastfeeding in obese women, and clinical considerations. The factors impacting early breastfeeding include mechanical factors and delayed onset of lactogenesis II and we have critically analyzed the potential contributors to these factors. The factors impacting later breastfeeding and exclusivity include hormonal imbalances, psychosocial factors, and mammary hypoplasia. Several recent interventions have sought to increase breastfeeding duration in obese women with varying levels of success and we have presented the strengths and weaknesses of these clinical trials. Clinical considerations include specific techniques that have been found to improve breastfeeding incidence and duration in obese women. Many obese women do not obtain the health benefits of exclusive breastfeeding and their children are more likely to also be overweight or obese if they are not breastfed. Further research is needed into the physiological basis for decreased breastfeeding among obese women along with effective interventions supported by rigorous clinical research to advance the care of obese reproductive age women and their children.

CHANGES IN FAMILY VARIABLES AMONG NORMAL AND OVERWEIGHT PRESCHOOLERS

Purpose: The purpose of this study was to examine differences in the weight and height of normal and overweight children in variables relating to the individual, home/family and community across a six month time period. Research Questions/Hypotheses: What are the ecological factors that influence the body mass index (BMI) of preschool children? Significance: The rate of overweight preschool children aged 2 to 5 years has more than doubled in the past 30 years. Low socioeconomic and ethnic minority groups have higher rates. Research shows a strong correlation between a childs size (height, weight, and BMI) and the ecological factors present in the familys environment. Methods: This study is a secondary data analysis from a cross sectional study of 200 Mexican American children ages 2–3 years old receiving WIC services. The sample consisted of 100 children with a BMI > 95% for age and 100 children with a BMI of <85% for age. Variables and measurements included: host/child (BMI percentile, diet, TV watching hours); agent/food (feeding assistance); microsystem/parent (parental BMI, acculturation level, employment, physical activities); microsystem/home (stimulation, TV hours); and microsystem/mother-child relationship (NCAST Teaching Scale).This study is limited to populations with similar characteristics. Results: Both overweight and normal weight children showed decreases in BMI, but maintained their between group differences even while slimming down (p = .000). Overweight children consumed significantly more fruit, bread and other carbohydrates, and total calories, than did normal weight children. Both groups of children increased significantly in their consumption of water, fruit juice and juice drinks, as well as meat and other protein. Maternal BMIs for overweight children were higher than those for the mothers of the normal weight children and increased across time. More overweight children ate in the presence of another person. The interaction patterns between mothers and overweight children were significantly more positive and responsive than were the interaction patterns of mothers and normal weight children. Discussion/Conclusion: multiple ecological factors influence the BMI of the preschooler leading to obesity. Nurses can use these findings to teach parents about the importance managing the environmental factors that contribute to childhood obesity and growth.

Predicting breast-feeding attrition: adapting the Breast-feeding Attrition Prediction Tool

ContextCurrent breast-feeding rates fall short of the recommendations set forth in Health People 2010. The Breast-feeding Attrition Prediction Tool (BAPT), administered in the postpartum period, has been useful in predicting breast-feeding attrition. However, assessing a womans intention to breast-feed prior to birth would identify women at risk for breast-feeding attrition. PurposeThe purpose of this study was to describe a revised BAPT, administered antepartally that measures intention to breast-feed. MethodsThe BAPT, comprising 94 items on a 6-point Likert-type scale, was translated into Spanish and back-translated for accuracy. The BAPT was then revised by reducing the number of items to 35 (32 were used for analysis) and contracting the 6-point scale to 3 categories. A Bayesian item response model provided the psychometric properties of the revised BAPT. ResultsThe revised BAPT was completed by 143 Mexican American pregnant women. Items, some reverse scored, were recoded as “agree” versus “disagree.” Item analyses indicated a wide range of item discriminabilities, with most items being useful measures of intention to breast-feed. Person analyses provided scores for intention to breast-feed. A simpler scoring system was devised for applications. ConclusionsThe revised BAPT shows promise as a measure of intention to breast-feed. The scoring system also indicates which women may need additional interventions to promote breast-feeding.

Creative approaches to increasing hospital-based nursing research.

Magnet®-designated and aspiring hospitals use research and evidence-based practice initiatives to demonstrate new knowledge and innovation, a key component of the Magnet Recognition Program®. Four creative approaches to supporting and conducting institutional nursing research and the implementation of evidence-based care are illustrated, along with examples of successful nurse staff-led projects.

Risk Factors for Low Birth Weight Infants of Hispanic, African American, and White Women in Bexar County, Texas

OBJECTIVES The aim of this study was to compare the risk factors in women who delivered an infant of low birth weight (LBW, <2,500 g) versus women who delivered an infant weighing >2,500 g in a large metropolitan county (Bexar) in South Texas. DESIGN An exploratory case comparison design was used to identify factors related to LBW outcomes in women receiving prenatal care. SAMPLE The cases were obtained from community hospitals. A stratified random sample was selected from a population of 38,064 infant births, of which 2,910 were identified as LBW. The final sample size was N=321 (<2,500 g, n=151; >or=2,500 g, n=170). MEASUREMENTS Dependent variable of infant birth weight; independent variables of maternal age, maternal race/ethnicity, education, smoking, prior pregnancy history, timing of and number of prenatal visits, prepregnancy body mass index and weight gain during pregnancy, and past medical history and medical problems during pregnancy. RESULTS Independent variables found to be predictive of LBW in this study included maternal race/ethnicity, timing of first prenatal visit, number of prenatal visits, prior pregnancy history, and maternal weight gain. CONCLUSIONS This study confirmed previous findings that African American women are at a higher risk for LBW deliveries and demonstrated that Anglo and Hispanic women have similar rates of LBW deliveries.

Shaking and rattling: developing a child obesity prevention program using a faith-based community approach.

This article describes the creation of a faith-based, community action research intervention aimed at reducing childhood obesity among a vulnerable population. Of particular concern to the community was the prevalence of obesity among its minority children. Engaging parents in a childhood obesity initiative through faith-based organizations (churches, community organizations with a common religious focus) was a method to provide a research intervention. It is important for researchers to be culturally competent, employ community-based participatory research methods, carefully plan interventions that have clear outcome criteria, and build evaluation of the process into every step of the research.