The process of implementing a new baby-friendly hospital initiative for nurses: a grounded theory study

Maternity nursing practice is changing across Canada with the movement toward becoming “baby friendly.” The World Health Organization (WHO) recommends the Baby-Friendly Hospital Initiative (BFHI) as a standard of care in hospitals worldwide. Very little research has been conducted with nurses to explore the impact of the initiative on nursing practice. The purpose of this study, therefore, was to examine the process of implementing the BFHI for nurses. The study was carried out using Corbin and Strauss’s method of grounded theory. Theoretical sampling was employed, which resulted in recruiting and interviewing 13 registered nurses whose area of employment included neonatal intensive care, postpartum, and labour and delivery. The data analysis revealed a central category of resisting the BFHI. All of the nurses disagreed with some of the 10 steps to becoming a baby-friendly hospital as outlined by the WHO. Participants questioned the science and safety of aspects of the BFHI. Also, participants indicated that the implementation of this program did not substantially change their nursing practice. They empathized with new mothers and anticipated being collectively reprimanded by management should they not follow the initiative. Five conditions influenced their responses to the initiative, which were (a) an awareness of a pro-breastfeeding culture, (b) imposition of the BFHI, (c) knowledge of the health benefits of breastfeeding, (d) experiential knowledge of infant feeding, and (e) the belief in the autonomy of mothers to decide about infant feeding. The identified outcomes were moral distress and division between nurses. The study findings could guide decision making concerning the implementation of the BFHI.

Baby-friendly hospital accreditation, in-hospital care practices and breastfeeding : a population based survey

OBJECTIVES: To investigate the effect of Baby-Friendly Hospital Initiative (BFHI) accreditation and hospital care practices on breastfeeding rates at 1 and 4 months. METHODS: All women who birthed in Queensland, Australia, from February 1 to May 31, 2010, received a survey 4 months postpartum. Maternal, infant, and hospital characteristics; pregnancy and birth complications; and infant feeding outcomes were measured. RESULTS: Sample size was 6752 women. Breastfeeding initiation rates were high (96%) and similar in BFHI-accredited and nonaccredited hospitals. After adjustment for significant maternal, infant, clinical, and hospital variables, women who birthed in BFHI-accredited hospitals had significantly lower odds of breastfeeding at 1 month (adjusted odds ratio 0.72, 95% confidence interval 0.58–0.90) than those who birthed in non–BFHI-accredited hospitals. BFHI accreditation did not affect the odds of breastfeeding at 4 months or exclusive breastfeeding at 1 or 4 months. Four in-hospital practices (early skin-to-skin contact, attempted breastfeeding within the first hour, rooming-in, and no in-hospital supplementation) were experienced by 70% to 80% of mothers, with 50.3% experiencing all 4. Women who experienced all 4 hospital practices had higher odds of breastfeeding at 1 month (adjusted odds ratio 2.20, 95% confidence interval 1.78–2.71) and 4 months (adjusted odds ratio 2.93, 95% confidence interval 2.40–3.60) than women who experienced fewer than 4. CONCLUSIONS: When breastfeeding-initiation rates are high and evidence-based practices that support breastfeeding are common within the hospital environment, BFHI accreditation per se has little effect on both exclusive or any breastfeeding rates.C

A practice-based culminating experience with Texas Children's Hospital: A hospital's journey to baby-friendly status

Breastfeeding and the use of human milk are widely accepted as the most complete form of nutrition for infants. Breastfeeding is shown to be associated with many positive health outcomes for both infants and mothers. Healthy People 2000 goals to increase breastfeeding rates in the early postpartum period to 75% fell short, with only 64% of mothers meeting this objective. Lack of support from healthcare providers, and unsupportive hospital policies and practices are noted as barriers to the initiation and duration of breastfeeding. The purpose of this study was to evaluate implementation of the BFHI Ten Steps to Successful Breastfeeding at Texas Children's Hospital. ^ The Baby-Friendly Hospital Initiative (BFHI) was developed in 1991 by the World Health Organization and the United Nations Children's Fund (UNICEF) to ensure that healthcare facilities offering maternity services adhere to the Ten Steps of Successful Breastfeeding and the International Code of Marketing of Breast-Milk Substitutes, and create legislation to protect the rights of breastfeeding women. The instrument used in this study was the BFHI 100 Assessment Tool created by Dr. Laura Haiek, Director of Public Health in Monteregie, Quebec, and her staff at Health and Social Services Agency of Quebec. The BFHI 100 tool utilizes 100 different indicators of compliance with BFHI through questionnaires administered to staff and administrators, pregnant and postpartum mothers, and an observer. ^ The study concluded that although there is much room for improvement in educating breastfeeding mothers, overall, the mothers interviewed were satisfied with their level of care in regards to breastfeeding support. Areas of improvement include staff training, as some nursing staff admitted to relying on the lactation consultants to provide most of the breastfeeding education for mothers. Only a small percentage of mothers interviewed reported that their baby “roomed-in” on average of 22 hours per day during their hospital stay. Staff encouragement of the rooming-in practice will help to increase the proportion of mothers who allow their babies to room-in. The current breastfeeding policy will also need to be revised and strengthened to be compliant with the Ten Steps. Ideally, Baby-Friendly practices will become the norm after staff are trained and policy revisions are made. Staff training and acceptance of breastfeeding as optimal nutrition for infants are the most critical factors that will ultimately drive change for the organization. ^

Infant and young child feeding indicators and determinants of poor feeding practices in India : secondary data analysis of National Family Health Survey 2005–06

Background: In India, poor feeding practices in early childhood contribute to the burden of malnutrition and infant and child mortality. Objective. To estimate infant and young child feeding indicators and determinants of selected feeding practices in India. Methods: The sample consisted of 20,108 children aged 0 to 23 months from the National Family Health Survey India 2005–06. Selected indicators were examined against a set of variables using univariate and multivariate analyses. Results: Only 23.5% of mothers initiated breastfeeding within the first hour after birth, 99.2% had ever breastfed their infant, 89.8% were currently breastfeeding, and 14.8% were currently bottle-feeding. Among infants under 6 months of age, 46.4% were exclusively breastfed, and 56.7% of those aged 6 to 9 months received complementary foods. The risk factors for not exclusively breastfeeding were higher household wealth index quintiles (OR for richest = 2.03), delivery in a health facility (OR = 1.35), and living in the Northern region. Higher numbers of antenatal care visits were associated with increased rates of exclusive breastfeeding (OR for ≥ 7 antenatal visits = 0.58). The rates of timely initiation of breastfeeding were higher among women who were better educated (OR for secondary education or above = 0.79), were working (OR = 0.79), made more antenatal clinic visits (OR for ≥ 7 antenatal visits = 0.48), and were exposed to the radio (OR = 0.76). The rates were lower in women who were delivered by cesarean section (OR = 2.52). The risk factors for bottle-feeding included cesarean delivery (OR = 1.44), higher household wealth index quintiles (OR = 3.06), working by the mother (OR=1.29), higher maternal education level (OR=1.32), urban residence (OR=1.46), and absence of postnatal examination (OR=1.24). The rates of timely complementary feeding were higher for mothers who had more antenatal visits (OR=0.57), and for those who watched television (OR=0.75). Conclusions: Revitalization of the Baby Friendly Hospital Initiative in health facilities is recommended. Targeted interventions may be necessary to improve infant feeding practices in mothers who reside in urban areas, are more educated, and are from wealthier households.

Tio steg för lyckad amning : En granskning av en BB-avdelning i Mellansverigeoch hur de uppfyller UNICEF/WHO´s mål för en amningsvänlig vård

Syftet med denna studie var att undersöka om en BB-avdelning i Mellansverige uppfyllde UNICEF/WHO´s kriterier för en amningsvänlig vård, samt att jämföra resultaten med tidigare utvärderingar från åren 1996, 1997, 1998 och 2002. Syftet var också att undersöka vad som påverkat mammorna i beslutet att vilja amma. Amningsvänlig vård utgår från ”Tio steg till lyckad amning” och är en global amningsstrategi. Studien genomfördes i form av intervjuer med 40 nyförlösta mammor samt 22 intervjuer med personal. Vidare gjordes observationer på BB-avdelningen samt genomgång av avdelningens skrivna material angående amning, riktat till personal och mammor. Kriterierna för att amningsvänlig vård bedrivs är att, åtta av tio steg i amningsstrategin ska vara uppfyllda. Den undersökta avdelningen uppfyllde fem av de tio stegen. Genomgående i studien framkom att personalen hade goda praktiska amningskunskaper. Mammornas kunskap om hur de upprätthöll amningen var inte tillräckliga. Vidare hade inte mammorna fått tillräcklig kännedom om var de kunde vända sig för att få råd och stöd angående amning efter hemgång. Resultatet var jämförbart med studierna från 1996 och 2002, men en försämring jämfört med studierna 1997 och 1998 då de klarade åtta respektive nio av de tio stegen. Mammorna tillfrågades också om vad som påverkat dem mest i sitt beslut att amma. För förstföderskorna var det rådgivningen de fått på MVC och för omföderskor betydde tidigare erfarenheter mest.

Desmame em recém-nascidos de muito baixo peso ao nascer no primeiro retorno ambulatorial após a alta hospitalar

Investigate intrahospital and neonatal determinants associated to the weaning of very low birth weight (VLBW) infants. Methods: 119 VLBW (<1500g) infants 81 were monitored from July 2005 through August 2006, from birth to the first ambulatory visit after maternity discharge. This maternity unit uses the Kangaroo Method and the Baby Friendly Hospital Initiative. Results: Out of 119 VLBW infants monitored until discharge, 88 (75%) returned to the facility, 22 (25%) were on exclusive breastfeeding (EB) and 66 (75%) were weaned (partial breastfeeding or formula feeding). Univariate analysis found an association between weaning and lower birth weight, longer stays in the NICU and longer hospitalization times, in addition to more prolonged enteral feeding and birth weight recovery period. Logistic regression showed length of NICU stay as being the main determinant of weaning. Conclusion: The negative repercussion on EB of an extended stay in the NICU is a significant challenge for health professionals to provide more adequate nutrition to VLBW infants

Length of stay in a neonatal intensive care unit and its association with low rates of exclusive breastfeeding in very low birth weight infants

OBJECTIVE: To identify the inpatient maternal and neonatal factors associated to the weaning of very low birth weight (VLBW) infants. METHODS: One hundred nineteen VLBW (<1500 g) infants were monitored from July 2005 through August 2006, from birth to the first ambulatory visit after maternity discharge. This maternity unit uses the Kangaroo Method and the Baby Friendly Hospital Initiative. Out of 119 VLBW infants monitored until discharge, 88 (75%) returned to the facility, 22 (25%) were on exclusive breastfeeding (EB), and 66 (75%) were weaned (partial breastfeeding or formula feeding). RESULTS: Univariate analysis found an association between weaning and lower birth weight, longer stays in the neonatal intensive care unit (NICU), and longer hospitalization times, in addition to more prolonged enteral feeding and birth weight recovery period. Logistic regression showed length of NICU stay as being the main determinant of weaning. CONCLUSION: The negative repercussion on EB of an extended stay in the NICU is a significant challenge for health professionals to provide more adequate nutrition to VLBW infants.

Length of stay in a neonatal intensive care unit and its association with low rates of exclusive breastfeeding in very low birth weight infants

OBJECTIVE: To identify the inpatient maternal and neonatal factors associated to the weaning of very low birth weight (VLBW) infants. METHODS: One hundred nineteen VLBW (<1500 g) infants were monitored from July 2005 through August 2006, from birth to the first ambulatory visit after maternity discharge. This maternity unit uses the Kangaroo Method and the Baby Friendly Hospital Initiative. Out of 119 VLBW infants monitored until discharge, 88 (75%) returned to the facility, 22 (25%) were on exclusive breastfeeding (EB), and 66 (75%) were weaned (partial breastfeeding or formula feeding). RESULTS: Univariate analysis found an association between weaning and lower birth weight, longer stays in the neonatal intensive care unit (NICU), and longer hospitalization times, in addition to more prolonged enteral feeding and birth weight recovery period. Logistic regression showed length of NICU stay as being the main determinant of weaning. CONCLUSION: The negative repercussion on EB of an extended stay in the NICU is a significant challenge for health professionals to provide more adequate nutrition to VLBW infants.

Breastfeeding self-efficacy and alternative techniques to overcome maternal or infant breastfeeding challenges : a retrospective descriptive study

Background: Breastfeeding is the internationally accepted ideal in infant feeding. Ensuring mothers and babies receive optimal benefits, in both the short and long term, is dependent upon the successful establishment of breastfeeding in the first week. Many maternal and infant challenges can occur during the establishment of breastfeeding (Lactogenesis II). There are also many methods and devices (alternative techniques) which can be used to help, but the majority do not have an evidence-base. The mother.s self-confidence (self-efficacy) can be challenged by these unexpected circumstances, but understanding of the relationship is unclear. Method: This descriptive study used mail survey (including the Breastfeeding Self-Efficacy Scale . Short Form) to obtain the mother.s reports of their self-efficacy and their breastfeeding experience during the first week following birth, as well as actual use of alternative techniques. This study included all mothers of full term healthy singleton infants from one private hospital in Brisbane who began any breastfeeding. The data collection took place from November 2008 to February 2009. Ethical approval was granted from the research site and QUT Human Research Ethics Committee. Results: A total of 128 questionnaires were returned, a response rate of 56.9%. The sample was dissimilar to the Queensland population with regard to age, income, and education level, all of which were higher in this study. The sample was similar to the Queensland population in terms of parity and marital status. The rate of use of alternative techniques was 48.3%. The mean breastfeeding self-efficacy score of those who used any alternative technique was 43.43 (SD=12.19), and for those who did not, it was 58.32 (SD=7.40). Kruskal-Wallis analysis identified that the median self efficacy score for those who used alternative techniques was significantly lower than median self efficacy scores for those who did not use alternative techniques. The reasons women used alternative techniques varied widely, and their knowledge of alternative techniques was good. Conclusion: This study is the first to document breastfeeding self-efficacy of women who used alternative techniques to support their breastfeeding goals in the first week postpartum. An individualised clinical intervention to develop women.s self-efficacy with breastfeeding is important to assist mother/infant dyads encountering challenges to breastfeeding in the first week postpartum.

Proteção, promoção e apoio ao aleitamento materno em um hospital universitário

Estudo de natureza quantitativa descritiva em um Hospital Universitário do Estado de São Paulo, teve como objetivo avaliar a promoção, proteção e apoio ao aleitamento materno através da verificação do cumprimento dos dez passos para o sucesso do aleitamento de acordo com a iniciativa Hospital Amigo da Criança, proposta pelo Ministério da Saúde. A avaliação revela práticas facilitadoras da amamentação, no entanto, faz-se necessário algumas mudanças nas rotinas hospitalares para a efetivação dos dez passos. em média, 79% das respostas foram afirmativas para o cumprimento dos passos, o que está próximo aos 80% preconizado. No entanto, se analisarmos as respostas para cada passo, identificamos pontos para serem melhorados. Chamou-nos a atenção o fato de que a prática de colocar o recém-nascido junto à mãe logo após o nascimento, permitindo a amamentação na primeira meia hora, foi relatada por 100% das mães entrevistadas que tiveram parto normal e por 80% daquelas que tiveram parto cesárea. Investimentos e mudanças em direção ao cumprimento dos dez passos contribuirão para um melhor atendimento à população e para a formação de profissionais amigos da criança.

Interações iniciais mãe-bebê: uma comparação entre díades de bebês prematuros e nascidos a termo

O estudo das interações iniciais entre mãe e bebê é fundamental para a compreensão da ontogênese humana (Seidl-de-Moura, et al., 2008) e para ajudar a promover a saúde relacional da díade. Nos estudos sobre as interações inicias entre mãe e bebê prematuro, ainda há um questionamento sobre se o nascimento prematuro e a internação em uma UTI-Neonatal fortalecem ou enfraquecem as trocas entre os membros da díade. Assim, neste estudo observou-se e analisou-se as interações iniciais entre mãe e bebê prematuro na UTI-Neonatal, observou o desenvolvimento das interações ao longo de dois meses, e comparou com interações de um grupo de mães-bebês nascidos a termo, de acordo com categorias predefinidas para a análise de vídeos. Também analisou, através de entrevistas, as características que as mães de cada tipo de díade relataram sobre seus filhos, bem como as metas de desenvolvimento apontadas e as emoções que expressaram em relação ao bebê. Participaram da pesquisa 20 díades mãe-bebê de nascidos a termo, e 20 díades de mãebebê de prematuros, nascidos entre 28 e 36 semanas de idade gestacional. Entre outras evidências, enquanto os bebês estavam na UTI-Neonatal, foram encontradas associações significativas entre as características maternas e as do bebê. Após a alta hospitalar, houve associações significativas entre a sincronia da díade e os comportamentos dos bebês. Não houve diferenças significativas entre as características de interações quando a díade estava na UTI-Neonatal e após dois meses. Não foram observadas diferenças significativas entre as díades de mães-bebês prematuros e mães-bebês a termo em relação à sincronia da díade, nem tampouco entre os comportamentos maternos nos dois momentos de observação, mas uma diferença significativa foi encontrada entre os comportamentos autorregulatórios dos bebês nascidos a termo e os dos prematuros. Verificou-se que para os dois grupos de mães, as emoções mais frequentemente relatadas foram as de amor e apego. As metas de desenvolvimento mais apontadas enquanto as mães estavam com seu bebê na UTI-Neonatal foram voltadas para o desenvolvimento físico do bebê, e quando os bebês estavam com dois meses, as metas eram mais voltadas para o desenvolvimento emocional, da mesma forma como ocorreu com as mães de bebês a termo. As características mais apontadas pelas mães ao pensarem em seus bebês enquanto eles estavam na UTI-Neonatal foram as físicas, enquanto após a alta, foram as pessoais e emocionais, assim como ocorreu com as mães de bebês nascidos a termo. Os resultados se contrapõem a afirmações de que em episódios de interação as mães de prematuros são menos sensitivas, mais intrusivas, e seus bebês, menos atentos e responsivos. Apontaram, ao contrário, para uma certa continuidade entre o que se observou na UTI-Neonatal e aos dois meses. Também não foram identificadas diferenças significativas na maioria das características de interações entre mães e bebês prematuros e mães e bebês nascidos a termo. Assim, tais resultados suavizam possíveis estigmatizações sobre estas mães e apontam a importância de se fortalecer essa relação na UTI-Neonatal através de estratégias de promoção de saúde.

Os (Des) caminhos da sífilis congênita em Botucatu/São Paulo

Pós-graduação em Enfermagem (mestrado profissional) - FMB

Estratégias de coping de mães e pais de bebés prematuros hospitalizados

Dissertação de Mestrado apresentada ao Instituto Superior de Psicologia Aplicada para obtenção de grau de Mestre na especialidade de Psicologia Clínica.

Understanding the determinants of Australian hospital nurses' hand hygiene decisions following the implementation of a national hand hygiene initiative

Hand hygiene is the primary measure in hospitals to reduce the spread of infections, with nurses experiencing the greatest frequency of patient contact. The ‘5 critical moments’ of hand hygiene initiative has been implemented in hospitals across Australia, accompanied by awareness-raising, staff training and auditing. The aim of this study was to understand the determinants of nurses’ hand hygiene decisions, using an extension of a common health decision-making model, the theory of planned behaviour (TPB), to inform future health education strategies to increase compliance. Nurses from 50 Australian hospitals (n = 2378) completed standard TPB measures (attitude, subjective norm, perceived behavioural control [PBC], intention) and the extended variables of group norm, risk perceptions (susceptibility, severity) and knowledge (subjective, objective) at Time 1, while a sub-sample (n = 797) reported their hand hygiene behaviour 2 weeks later. Regression analyses identified subjective norm, PBC, group norm, subjective knowledge and risk susceptibility as the significant predictors of nurses’ hand hygiene intentions, with intention and PBC predicting their compliance behaviour. Rather than targeting attitudes which are already very favourable among nurses, health education strategies should focus on normative influences and perceptions of control and risk in efforts to encourage hand hygiene adherence.