Emily Drake

Evaluation of an Office Protocol to Increase Exclusivity of Breastfeeding

OBJECTIVE: The purpose of this study was to determine whether implementing a program based on a clinical protocol affects breastfeeding rates within a pediatric primary care setting. Increasing breastfeeding rates is an important public health initiative identified by multiple agencies. METHODS: The Academy of Breastfeeding Medicine (ABM) clinical protocol (“The Breastfeeding-Friendly Physician’s Office, Part 1: Optimizing Care for Infants and Children”) was used as a template for the provision of breastfeeding services within a pediatric primary care clinic. There were 757 mother–infant pairs included in the study. A retrospective before-and-after study design was used. Data collection points included the hospital stay, the newborn visit, and the 2-, 4-, and 6-month health maintenance visits. The 2 groups were compared to estimate the protocol’s effectiveness as a method of increasing breastfeeding rates. RESULTS: The results of this evaluation were positive for exclusive breastfeeding, with group comparisons showing a statistically significant increase in exclusive breastfeeding rates at all 5 time points. CONCLUSIONS: Our diverse patient population within a pediatric practice had increased initiation rates and exclusive breastfeeding rates after implementation of the ABM’s breastfeeding-friendly protocol. Families who receive care in a pediatric primary care setting that has implemented the ABM clinical protocol may have increased rates of exclusive breastfeeding.

Bringing Technology to the Bedside: Using Smartphones to Improve Interprofessional Communication

The purpose of this project was to evaluate the impact of using Smartphones at the bedside on the quality of interprofessional communication and measure the response time between nurses and physicians compared with the usual paging device. Smartphones were provided to nurses and physicians on a 26-bed medical unit during a 2-month study period. Data were collected using Nurse-Physician Communication Questionnaires and Time and Motion data collection tools. Baseline data gathered from a convenience sample of general medicine nurses (n = 61) and physicians (n = 44) indicated that both nurses and physicians were dissatisfied with the current one-way paging devices and were frequently interrupted during patient care (P = .000). Postimplementation data suggested that the use of Smartphones significantly reduced patient interruptions (P = .021), allowed nurses to stay with patients (P = .002), and reduced wait times for a returned call (P = .001). Nurse travel time to answer a telephone call and time spent on hold by nurses and physicians also decreased by 100% from a range of 8 to 79 minutes down to 0 minutes. Staff reported improvement in quality of communication, and significant workflow efficiency was noted. Further research on the impact on patient safety and satisfaction is needed and other nursing units should consider implementing Smartphones within their medical centers.

Update on Expanded Newborn Screening: ISSUES FOR CONSIDERATION

Newborn screening has stimulated much controversy. Although screening is performed on babies, the implications of a diagnosis from such screening can last a lifetime. Nurses perform newborn screening on nearly every baby born in the U.S. That adds up to 4 million heel-stick blood samples every year in this country. Its estimated that one of every 800 of these babies will screen positive for a serious disorder.

The Impact of a Prenatal Education Video on Rates of Breastfeeding Initiation and Exclusivity during the Newborn Hospital Stay in a Low-income Population

Background: Guidelines recommend prenatal education to improve breastfeeding rates; however, effective educational interventions targeted at low-income, minority populations are needed as they remain less likely to breastfeed. Objective: To determine whether a low-cost prenatal education video improves hospital rates of breastfeeding initiation and exclusivity in a low-income population. Methods: A total of 522 low-income women were randomized during a prenatal care visit occurring in the third trimester to view an educational video on either breastfeeding or prenatal nutrition and exercise. Using multivariable analyses, breastfeeding initiation rates and exclusivity during the hospital stay were compared. Results: Exposure to the intervention did not affect breastfeeding initiation rates or duration during the hospital stay. The lack of an effect on breastfeeding initiation persisted even after controlling for partner, parent, or other living at home and infant complications (adjusted odds ratio [OR] = 1.05, 95% CI, 0.70-1.56). In addition, breastfeeding exclusivity rates during the hospital stay did not differ between the groups (P = .87). Conclusion: This study suggests that an educational breastfeeding video alone is ineffective in improving the hospital breastfeeding practices of low-income women. Increasing breastfeeding rates in this at-risk population likely requires a multipronged effort begun early in pregnancy or preconception.

Internet Technology: Resources for Perinatal Nurses

The Internet and the World Wide Web (WWW)are being discussed in many forums. This huge body of information is becoming a widely used research tool. Within the last few years, the WWW has grown enormously. In 1993, there were approximately 130 WWW sites. By 1997, experts estimated there were over a million sites on the web, many of them useful for nurses and accessible from the nearest computer. For perinatal nurses in practice, research, or education the need for information is great. Nurses need current data for clinical decision making, policy writing, patient education, continuing education, and research. Understanding how to use the Internet, being aware of its advantages and disadvantages, and knowing how to critically examine what is available will assist perinatal nurses in making use of this newest form of information technology.

The Effect of Nursing Quality Improvement and Mobile Health Interventions on Infant Sleep Practices: A Randomized Clinical Trial.

Importance Inadequate adherence to recommendations known to reduce the risk of sudden unexpected infant death has contributed to a slowing in the decline of these deaths. Objective To assess the effectiveness of 2 interventions separately and combined to promote infant safe sleep practices compared with control interventions. Design, Setting, and Participants Four-group cluster randomized clinical trial of mothers of healthy term newborns who were recruited between March 2015 and May 2016 at 16 US hospitals with more than 100 births annually. Data collection ended in October 2016. Interventions All participants were beneficiaries of a nursing quality improvement campaign in infant safe sleep practices (intervention) or breastfeeding (control), and then received a 60-day mobile health program, in which mothers received frequent emails or text messages containing short videos with educational content about infant safe sleep practices (intervention) or breastfeeding (control) and queries about infant care practices. Main Outcomes and Measures The primary outcome was maternal self-reported adherence to 4 infant safe sleep practices of sleep position (supine), sleep location (room sharing without bed sharing), soft bedding use (none), and pacifier use (any); data were collected by maternal survey when the infant was aged 60 to 240 days. Results Of the 1600 mothers who were randomized to 1 of 4 groups (400 per group), 1263 completed the survey (78.9%). The mean (SD) maternal age was 28.1 years (5.8 years) and 32.8% of respondents were non-Hispanic white, 32.3% Hispanic, 27.2% non-Hispanic black, and 7.7% other race/ethnicity. The mean (SD) infant age was 11.2 weeks (4.4 weeks) and 51.2% were female. In the adjusted analyses, mothers receiving the safe sleep mobile health intervention had higher prevalence of placing their infants supine compared with mothers receiving the control mobile health intervention (89.1% vs 80.2%, respectively; adjusted risk difference, 8.9% [95% CI, 5.3%-11.7%]), room sharing without bed sharing (82.8% vs 70.4%; adjusted risk difference, 12.4% [95% CI, 9.3%-15.1%]), no soft bedding use (79.4% vs 67.6%; adjusted risk difference, 11.8% [95% CI, 8.1%-15.2%]), and any pacifier use (68.5% vs 59.8%; adjusted risk difference, 8.7% [95% CI, 3.9%-13.1%]). The independent effect of the nursing quality improvement intervention was not significant for all outcomes. Interactions between the 2 interventions were only significant for the supine sleep position. Conclusions and Relevance Among mothers of healthy term newborns, a mobile health intervention, but not a nursing quality improvement intervention, improved adherence to infant safe sleep practices compared with control interventions. Whether widespread implementation is feasible or if it reduces sudden and unexpected infant death rates remains to be studied. Trial Registration clinicaltrials.gov Identifier: NCT01713868

Mortalidade materna por hemorragia no Brasil

Objetivo: analizar las tasas de mortalidad materna debida a hemorragia, identificadas en Brasil durante el periodo de 1997 a 2009. Métodos: fueron examinados los datos de series temporales y de población del Ministerio de la Salud de Brasil, del Sistema de Información de Mortalidad y del Sistema de Información de Nacidos Vivos. Del Sistema de Información de Mortalidad, inicialmente seleccionamos todos los informes sobre muerte de mujeres con edad entre 10 y 49 años, que ocurrieron entre el 01 de enero de 1997 y el 31 de diciembre de 2009, en Brasil, clasificadas como “muertes maternas”. Resultados: durante el periodo de investigación, fueron identificadas 22.281 muertes maternas, entre las cuales 3.179 se debieron a hemorragia, siendo responsables por 14,26% del total de muertes. La tasa más alta de mortalidad materna fue encontrada en las regiones Norte y Noreste de Brasil. Conclusiones: el escenario brasileño muestra desigualdades regionales en lo que se refiere a mortalidad materna; este presenta la hemorragia como un síntoma y no como la causa de la muerte.

Active Duty Women's Perceptions of Breast-Feeding Support in the Military Setting.

BACKGROUND The purpose of this study is to evaluate the current perceptions of breast-feeding support for active duty women serving in the U.S. Armed Forces. METHODS An online survey based on the Workplace Breastfeeding Support Scale (WBSS) was used to collect data from active duty military mothers. Data were collected and analyzed using SPSS software to evaluate active duty womens perceptions of breast-feeding support in the military. RESULTS 318 active duty women participated in the online survey. The average WBSS scores for active duty women was 50.20 (SD = 15.75). Comparing WBSS scores and branch of service, women in the Army had significantly lower WBSS scores (M = 45.85) then women in the Air Force (M = 53.96, p < 0.001). Enlisted women had significantly lower scores (M = 47.12) than officers (M = 54.62, p < 0.001). Also noted were significantly lower scores of active duty women who were Hispanic (M = 44.30) and women who had lower levels of education (M = 46.90, p = 0.006). CONCLUSIONS The Department of Defense may be able to improve breast-feeding rates for all active duty mothers by implementing and adhering to lactation policies and focusing support efforts for enlisted women in all branches of service.

TodaysBaby Quality Improvement: Safe Sleep Teaching and Role Modeling in 8 US Maternity Units

A multicenter safe sleep QI campaign in 8 US maternity units to teach and role model safe sleep practices during the newborn hospital stay. BACKGROUND AND OBJECTIVES: Nursing education and role modeling can increase adherence to safe sleep practices. Eight US hospital maternity units with variable baseline approaches to education participated in a national multicenter nursing quality improvement (QI) intervention to promote safe sleep practices. The goals at participating maternity units were to (1) increase the rate of mothers who reported receiving safe sleep information from nurses to ≥90% and (2) increase the rates of infants observed sleeping supine in a safe environment to ≥90%. METHODS: A safe sleep QI toolkit, designed for and provided to all sites, included an educational curriculum and tools to use for staff and parent education. Local teams implemented safe sleep education using the tools as plan-do-study-act cycles. After each cycle, audits assessing maternal report of nursing education on safe sleep and inpatient infant sleep position and environment were performed. RESULTS: The QI interventions lasted a median of 160 days (range, 101–273). Mothers reported receiving information on 4 primary safe sleep topics 72% to 95% of the time (a 24%–57% increase over the baseline). Additionally, 93% of infants were observed in a supine sleep position, and 88% of infants were observed in a safe sleep environment (a 24% and 33% increase over baseline, respectively). These rates were sustained up to 12 months later. CONCLUSIONS: Implementation of a multisite QI intervention for safe sleep parenting education and role modeling led to increased knowledge of and compliance with safe sleep practices during postpartum hospitalization.

Call for improved military policy to support breastfeeding among U.S. armed forces

Humanmilk saves lives, reduces health care costs, and improves the health of both mother and infant. For a small investment to support breastfeeding among active-duty women, the payoff for the U.S. military would be significant: retention of loyal and welltrained service personnel, improved health of women, and a reduction in Tricare costs. Providing breastfeeding support can help the U.S. armed forces retain valued servicewomen after childbirth. A model policy to support breastfeeding women would include on-site lactation support services and peer support, suitable areas available for milk expression and storage, reasonable break time, and a leave policy that incentivizes breastfeeding.