NUR 601 Matrix Assignment Instructions and Rubric

Alexandrea Badolato Literature Review Matrix Assignment

Topic: Breastfeeding

Author/Journal Methodology Level of Evidence

Analysis & Results

Conclusions Implications for Future research

Implications For practice

Chuisano, S. A., & Anderson, O. S./ Journal of Human Lactation

A qualitative review was conducted to assess the existing literature on types of application based breastfeeding management learning tools for medical professionals, along with the evaluation of the methods used for learner patient outcomes.

Level III B Analysis: The authors created a data abstraction tool in a google sheet that aided the review of the studies. The google sheets contained the number of participants, type of learner, profession of the learner, development of curriculum content, outcome measures, measurement tool and year of study. Results: 10 articles matched the criteria and were used in the final review. The use of real patients was a common method for application-based skills training, as well as role playing. Teaching and evaluation methods varied during the study.

Guidelines for best practices in providing breastfeeding education to professionals, as well as evaluating the effectiveness of various teaching methods are vital for quality patient care and long-term health of the patient.

Future research on the success of duration of breastfeeding after patients experience breastfeeding education with various teaching methods.

Future breastfeeding education curriculum should include multidisciplinary and interprofessional application-based experiences for successful breastfeeding outcomes in patients.

Cohen, S. S., Alexander, D. D., Krebs, N. F., Young, B. E., Cabana, M. D., Erdmann, P., Hays, N. P., Bezold, C. P., Levin- Sparenberg, E., Turini, M., & Saavedra, J. M.

A systemic review was performed using PubMed and CINAHL to identify characteristics that have been studied in relation to breastfeeding initiation and continuation.

Level II A Analysis: For analysis, papers were included in 1 or both categories (initiation and continuation) for breastfeeding outcomes. Time windows were used in analysis as well as the highest levels of multiple categories of education attainment compared with the lowest. Results: Six factors were identified (smoking, delivery type, parity, dyad separation, maternal education and maternal breastfeeding education). Models for breastfeeding initiation were highest for high vs. low maternal education, dyad connection vs. not and maternal non- smoking vs smoking. Results were similar for breastfeeding continuation.

Consistent results were seen for the perinatally identifiable factors associated with breastfeeding initiation and duration.

Future research in birth factors such as hypoglycemia, jaundice, birth weight, and gestational age since they’re clinically important predictors of early breastfeeding success.

Developing targeted interventions in practice to provide education and support for successful breastfeeding in more families.

Esselmont, E., Moreau, K., Aglipay, M., & Pound, C. M./ The Journal of Pediatrics

Descriptive, cross sectional, self-reported online questionnaires were sent to all residents enrolled in a general pediatric residency program in years 1-4. The questionnaire discussed breastfeeding knowledge, comfort level, clinical practices, educational experience, perceptions, and education preferences.

Level II A Analysis: For the resident survey, descriptive statistics were used to summarize the respondent’s demographic characteristics, clinical practice, comfort level, perceptions, and educational preferences. Knowledge on breastfeeding were analyzed as the percent of correct responses. Linear regression was used to identify demographic variables that were associated with the knowledge score. For the program directors, descriptive statistics were used to summarize time allotted on breast feeding education in residency programs, levels of education provided, and directors’ perceptions on breastfeeding education adequacy. Results: 201 pediatric residents and 14 program directors completed the surveys. Residents mean overall breastfeeding knowledge score was 71%. Only 4% of residents were very comfortable with evaluating latch, educating parents positioning, and addressing patient questions about breastfeeding difficulties. ¼ had ever witnessed a patient breast feed. Almost all agreed breastfeeding promotion is a part of their role. Less than half reported receiving education on breastfeeding during their residency and almost all wanted more education. Less than a quarter of directors felt that the breastfeeding education residence receive in the program were adequate.

Pediatric residents in Canada are aware of their important role in breastfeeding support. Most residents lack the knowledge and training to manage breast feeding difficulties but are motivated to learn. Directors are aware of the breastfeeding education required.

Once implementation of breastfeeding curriculum is developed and utilized. Re- surveying residents and directors to assess the breastfeeding knowledge and experience in comparison to previous surveys to test adequacy of program implementation.

These results suggest future implementation of breastfeeding curriculum in Canadian pediatric residency training programs to ensure resident preparedness to address breastfeeding difficulties to increase breastfeeding rates and duration.

Hamad, R., Modrek, S., & White, J. S. /American Journal of Public Health

Conducted difference-in- difference analyses, comparing pre and post policy changes in California and New Jersey with

Level III A Analysis: Difference-in-difference approach to see if the implementation of the paid family leave policy changed breastfeeding practices. This compared the pre and post change in California and New Jersey with the pre-post change in other states without paid family leave. It compared the average change in breastfeeding outcomes in the “treatment”

Exclusive breastfeeding improved after the implementation of the paid family leave policy.

Future research can be performed to examine how differences in implementation (benefit duration and generosity) influence employment,

This study suggests paid family leave policies should be implemented and designed to target more vulnerable mothers in order to increase

changes in states where there were no paid family leave policies. A large diverse sample of children were examined during 2001-2013. Outcomes included if they were ever breastfed, breastfed exclusively at 3 and 6 months, and still at 12 months, as well as duration of any breastfeeding.

group with the change in the “control” group before and after the policy was implemented. Results: Paid family leave policies resulted in an increased likelihood of exclusively breastfeeding for 6 months. Various breastfeeding outcomes were consistently higher among married, white, older mothers with higher income.

breastfeeding and other health outcomes as additional states implement paid family leave policies.

breastfeeding rates.

Kim, J. H., Shin, J. C., & Donovan, S. M.

A systemic search was performed of seven databases through September of 2017. A systemic review of existing literature was conducted to evaluate the evidence of workplace lactation programs and the effects of breastfeeding outcomes.

Level I A Analysis: Effectiveness was defined as which workplace lactation initiatives or individual components contributed to changes in breastfeeding practices (initiation, duration and exclusivity). A 12- item quality assessment tool was used, and scores were summed by scoring an answer of yes with 1 and no as 0. Results: Services provided included breast pumps, lactation rooms, breastfeeding classes and support. Breastfeeding initiation was high, ranging from 87%-98%. Multiple factors were associated with breastfeeding exclusiveness such as receiving a breast pump for one year, return to work consultations, and telephone support. Each service increased exclusive breastfeeding at 6 months as well as maternal age, working part-time, longer maternity leave, and white ethnicity were associated with increased breastfeeding duration.

Workplace lactation support increased breastfeeding duration, initiation, and exclusivity. Greater changes were observed with more available services.

Future research on the impact of workplace support in low- income populations, and the cost- effectiveness of these programs in decreasing costs of healthcare.

Suggests establishing lactation programs in small businesses including time and space to pump to increase breastfeeding. Ensuring lactation policies to all employees and creating a breast- feeding friendly work environment for future success.

Mercado, K., Vittner, D., & McGrath, J./ National Association of Neonatal Nurses

A literature review using CINAHL PLUS, PubMed, Cochrane Library, and OVID databases yielded a total of 10 studies that assess lactation support on breastfeeding outcomes. Key words were neonatal intensive care unit, lactation support, breastfeeding, lactation- consultant, low birth weight, preterm or premature infants. The purpose of the evidence-based practice is to analyze the literature pertaining to the impact of NICU dedicated lactation consultants and breastfeeding outcomes.

Level III B Analysis: Literature reviews were performed demonstrating positive breastfeeding outcomes with interventions of LC. Out of the 10 article reviews, they only included 1 systemic review, 1 randomized controlled trial, and 1 pilot randomized control trial. Breastfeeding outcomes were defined as breastfeeding initiation, receipt of any mom during hospitalization, and/or breastfeeding rates during hospitalization and discharge. 8 of the studies were specific to NICU population, and 2 were on healthy preterm infants. 6 of the studies discussed LC interventions, 1 discussed any lactation consultant or counselor support, 1 study reviewed the effects of LC support with the use of video viewing on breastfeeding preterm infants, and 2 studies reviewed the effect of peer counselors. Results: During hospitalization, NICUs staffed with board certified lactation consultants have increased potential for increased breastfeeding rates through discharge, increased number of infants receiving mothers breast milk, and increased duration of breastfeeding.

Evidence thus far supports the conclusion of lactation consultants in positively impacting breastfeeding outcomes in the NICU.

Further research pertaining to NICU-specific lactation consultants and impact on breastfeeding outcomes.

Breastmilk nutrition is related to improved outcomes for high- risk infants. Neonatal intensive care units-specific lactation consultants can potentially benefit maternal breastfeeding practices and improve neonatal outcomes.

Odar Stough, C., Khalsa, A. S., Nabors, L. A., Merianos,

Conducted a secondary analysis of the NSCH by randomized

Level I A Analysis: A multinomial logistic regression discovered whether child/maternal/family demographics predicted exclusive breastfeeding for a substandard duration or for 6 months.

Rate of exclusive breastfeeding for 6 months are low in the U.S.

Future research should explore rates of implementation of breastfeeding

Population wide efforts are required to increase exclusive breastfeeding rates

A. L., & Peugh, J./ American Journal of Health Promotion

telephone-based survey in the U.S. with a child anywhere from 0-17 years old as the subject of questions. Interviews were conducted to complete the NSCH survey questions in 2011 through 2012.

Results: About 79% was ever breast fed and 17% breastfed exclusively for 6 months. Child ethnicity, maternal education, tobacco exposure in the home, family dynamic, and family income predicted odds of both exclusive breastfeeding for 6 months and for a suboptimal time frame or not exclusive. Normal and high birth weight and maternal health had greater odds of exclusive breastfeeding for 6 months.

Families with single parents, stepfamilies, lower income, non-Hispanic black children, children with tobacco exposure, and children to mothers with lower education are most at risk.

recommendations for breastfeeding- friendly pediatrician offices and the Ten Steps to Support Parents’ Choice to Breastfeed their Baby, including barriers and physicians and their practice in related to breastfeeding implementation rates.

for at risk populations. Initiatives in the public health, policy changes, and breastfeeding support during child well check visits may be implications for practice to promote better adherence to breastfeeding.

Patterson, J. A., Keuler, N. S., & Olson, B. H./ Maternal and Child Nutrition

Data for this study was collected from three sources: The Joint Commission, the U.S. Census Bureau, and Baby Friendly USA. The joint commission requires hospitals who have 1,100 births a year or more, to report their exclusive breastfeeding rates. The purpose was to examine the relationships between population demographics

Level IV A Analysis: Linear regression models contained one of the demographic independent variables (race/ethnicity/income/education) with breastfeeding designation, as well as interaction between the two. This determined whether baby friendly hospital designation affected relationships between the dependent and independent variables. Results: EBF rates were significantly higher for hospitals with the breastfeeding designation (62%) as compared to those without (48%). Education, income, and proportion of the population of White or Asian was positively correlated with exclusive breastfeeding rates. Population that identified as African America, Hispanic, no college education, and living below the poverty line were negatively associated with excusive breastfeeding rates.

Those hospitals with the breastfeeding designation had higher EBF rates than those hospitals without. Higher EBF rates shown across the demographic variables of ethnicity/race/in come and education.

Future research to strengthen the model’s ability to predict EBF rates other maternity practices, such as those measured by the CDC Maternity Practices in Infant Nutrition and Care survey could be evaluated.

Hospitals achieving a baby friendly designation to help move EBF rates towards goals set by Healthy People 2020.

and the Baby Friendly hospital designation on EBF rates in hospitals across the U.S.

Schwarz, E., Ross-Cowdery, M., Corbelli, J., Lewis, C., & Papic, M./ Maternal Child Health Journal

Women seeking prenatal care at an urban university hospital completed surveys before and after receiving a 5- minute counseling on the maternal health effects of breastfeeding.

Level I B Analysis: Participants were asked the likelihood that breastfeeding affects maternal risk of various chronic health conditions using 7-point Likert scales. Pre and post changes were compared and a summary score of knowledge on lactation health benefits. Multivariable logistic regression was used to analyze the impact of maternal health benefits of lactation (MHBL) on participants intentions to breastfeed. Results: 65 participants were involved, (72%) African American, (9%) had college degrees, (50%) had previously given birth, and few (21%) had previously breastfed. Before counseling, few were aware of the MHBL. After counseling, knowledge of MHBL increased as well as the intention to try breastfeeding, wanting to breastfeed, and the importance of breastfeeding.

Brief counseling on the maternal health benefits of breastfeeding can increase awareness and strengthen women’s intentions to breastfeed.

Future research can be performed to confirm whether the short-term improvements in knowledge noted in this study produce long term knowledge of the effects of lactation on maternal health.

Future practice should implement counseling on maternal health benefits of breast feeding to increase breastfeeding rates and educate women on the maternal health benefits.

Wouk, K., Stuebe, A., & Meltzer-Brody, S./ Maternal Child Health Journal

A secondary analysis of the data from the 2010-2011 Pregnancy Risk Assessment Monitoring System were analyzed for NYC and the 29 states for which data was available. Data regarding maternal

Level I A Analysis: Multivariable logistic regression was utilized to study the association between a pre-pregnancy mental health visit and subsequent breastfeeding initiation as well as postpartum depression and 3 month any and excusive breastfeeding. Results: Women who reported a pre- pregnancy mental health visit had 0.61 times the odds of initiating breastfeeding compared to those who had no pre- pregnancy visit. At 3 months post-partum, women who had PPD symptoms since birth had 0.79 times the odds of any breastfeeding and reduced odds of exclusive breastfeeding modified by ethnicity/race.

The study highlights the importance of breastfeeding support to women with postpartum depression symptoms since they are at most risk of early breastfeeding cessation. Women with early

Qualitative studies are needed to explore how depression and anxiety symptoms might differently lead to weaning within different ethnic groups. Future research is needed to identify policies and services that will allow

Implementation of providing targeted breastfeeding support to women with postpartum anxiety symptoms since they are at risk for early breastfeeding cessation.

attitudes and health behaviors before, during, and after pregnancy were performed. PRAMS questionnaires were administered via mail or telephone interview about 2-4 months postpartum.

breastfeeding cessation may also be at risk for PPD.

women to both address their perinatal mental health needs and meet their breastfeeding goals.

References:

Chuisano, S. A., & Anderson, O. S. (2019). Assessing Application-Based Breastfeeding Education for Physicians and Nurses: A Scoping Review.

Journal of Human Lactation : Official Journal of International Lactation Consultant Association, 890334419848414.

Cohen, S. S., Alexander, D. D., Krebs, N. F., Young, B. E., Cabana, M. D., Erdmann, P., Hays, N. P., Bezold, C. P., Levin-Sparenberg, E., Turini,

M., & Saavedra, J. M. (2018). Factors Associated with Breastfeeding Initiation and Continuation: A Meta-Analysis. The Journal of Pediatrics,

203, 190.

Esselmont, E., Moreau, K., Aglipay, M., & Pound, C. M. (2018). Residents’ breastfeeding knowledge, comfort, practices, and perceptions: results of

the Breastfeeding Resident Education Study (BRESt). BMC Pediatrics, 18(1), 170.

Hamad, R., Modrek, S., & White, J. S. (2019). Paid Family Leave Effects on Breastfeeding: A Quasi-Experimental Study of US Policies. American

Journal of Public Health, 109(1), 164–166.

Kim, J. H., Shin, J. C., & Donovan, S. M. (2019). Effectiveness of Workplace Lactation Interventions on Breastfeeding Outcomes in the United

States: An Updated Systematic Review. Journal of Human Lactation : Official Journal of International Lactation Consultant Association,

35(1), 100–113.

Mercado, K., Vittner, D., & McGrath, J. (2019). What Is the Impact of NICU-Dedicated Lactation Consultants? An Evidence-Based Practice Brief.

Advances in Neonatal Care : Official Journal of the National Association of Neonatal Nurses, 19(5), 383–393.

Odar Stough, C., Khalsa, A. S., Nabors, L. A., Merianos, A. L., & Peugh, J. (2019). Predictors of Exclusive Breastfeeding for 6 Months in a National

Sample of US Children. American Journal of Health Promotion : AJHP, 33(1), 48–56.

Patterson, J. A., Keuler, N. S., & Olson, B. H. (2018). The effect of Baby-friendly status on exclusive breastfeeding in U.S. hospitals. Maternal &

Child Nutrition, 14(3), e12589.

Schwarz, E., Ross-Cowdery, M., Corbelli, J., Lewis, C., & Papic, M. (2017). Counseling About the Maternal Health Benefits of Breastfeeding and

Mothers’ Intentions to Breastfeed. Maternal & Child Health Journal, 21(2), 234–241.

Wouk, K., Stuebe, A., & Meltzer-Brody, S. (2017). Postpartum Mental Health and Breastfeeding Practices: An Analysis Using the 2010-2011

Pregnancy Risk Assessment Monitoring System. Maternal & Child Health Journal, 21(3), 636–647.