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BABY 2 BBABY 2 BBABY 2 BBABY 2 B

Training Program for Training Program for Training Program for Training Program for

Expectant Parents Expectant Parents Expectant Parents Expectant Parents

MAN 6359

Janaína Ribeiro

ID 2103143

"A baseball manager has learned a lot about his job from having played the game,

but a parent has not learned a thing from having once been a child." Bill Cosby

TABLE OF CONTENTS

Introduction______________________________________________________________ 2

Training Needs Analysis____________________________________________________ 3

Training Design __________________________________________________________ 7

Training Objectives_______________________________________________________ 10

Training Methods ________________________________________________________ 12

Training Development ____________________________________________________ 13

Training Evaluation ______________________________________________________ 14

APPENDIX I ___________________________________________________________ 15

APPENDIX II___________________________________________________________ 16

Introduction

Parents today are entering parenthood with little experience and knowledge of their own to

rely upon. Nearly all parents think parenting is the most important job they will ever undertake.

Their view of parenthood before their first baby arrives is often idyllic. Although many do their

best to educate themselves, after their baby arrives many see their expectations crash. They feel

incompetent and unsupported, they become personally demoralized, their marital relationship

suffers, and likewise, their parenting. 1

Being an immigrant in the United States with the intention to raise my family and live here, I

felt the need to research about the steps for childcare. My first source of concern is that I will be

my own and I will not be able to rely on any help from my family and close friends. This was

my first source of concern: how to become prepared by learning in one single place the

knowledge and skills necessary to raise a child.

As I am planning to have a child next year, I started my own research. I found several

prenatal and childbirth education classes. The amount of information is overwhelming and

scattered, which led me to develop a training program targeting first-time parents that would be

given in a hospital, but differently from the existing programs, this training would serve as a

more comprehensive learning source for parents. I took the example of Baptist Hospital of

Miami, in which more than 4,100 babies are born annually at the hospital's Family Birth Place.

The hospital already offers a course to educate first-time parents called “Healthy Beginnings” 2 .

The training I designed will be an improved version of Healthy Beginnings and it will comprise

comprehensive and yet practical tips that go beyond the regular content of similar trainings

currently offered at Baptist and other hospitals in the Miami area.

The applied effect of this training would impact Baptist Hospital by reinforcing its

commitment and reputation for quality care and patient safety. The new training will demystify

of the early stages of parenthood providing parents with the confidence they need to care for a

newborn. The training would serve as a support tool to assist on the job of nurses and physicians

as the expectant parents would become more familiarized with the medical procedures and

physiological changes that are at stake with the coming of a newborn.

1 RUSSELL, Carol Crill, M.S.W., Ph.D. PARENT EDUCATION: What is Required To Build The Skills Parents Need To Raise Healthy Children? 2 Prenatal Classes at Baptist Hospital. Retrieved from http://www.gifts.com/search/product/motherhood-

necklace?ideaID=8239&prodID=81881

Training Needs Analysis

ORGANIZATIONAL ANALYSIS

1) Baptist’s Mission - To improve the health and well-being of individuals, and to promote the sanctity and preservation of life, in the communities we serve (…). We are committed

to maintaining the highest standards of clinical and service excellence, rooted in utmost

integrity and moral practice. Consistent with its spiritual foundation, Baptist Health is

dedicated to providing high-quality, cost-effective, compassionate healthcare services to

all, regardless of religion, creed, race or national origin, including, as permitted by its

resources, charity care to those in need.

2) Baptist’s Vision - Baptist Health and its physicians will offer a broad range of services with superior clinical outcomes, and attain the highest levels of patient satisfaction

through the high quality and compassionate treatment we provide. 3

FINDINGS (1,2):

• Rigorous culture for quality and service excellence (strategic objectives)

• Seek to provide patients with high-quality, diverse and yet cost efficient

healthcare services to its patients

• Innovative medical practices

3) Organization design Baptist Hospital network of services extends throughout Miami- Dade and Monroe Counties with Baptist, Baptist Children's, South Miami, Homestead,

Mariners and Doctors Hospitals. Through these and other facilities, Baptist Health serves

more than 100,000 people each year. 4

FINDINGS (3):

•••• Baptist had last year more than 4,200 childbirths

•••• Constant investment due to population growth in the Miami metropolitan area

•••• Each hospital unit has its own facilities and independent operations

•••• Concern with patients education (including open-door policy with hospital tour)

•••• Various classes available throughout the year

•••• Other community and charitable services are part of the healthcare provided

3 Baptist Hospital Website – General Information Section

http://www.baptisthealth.net/bhs/en/general_information/article/0,2494,3150_43043255_34849,00.html 4 History of Baptist Health South Florida

http://www.baptisthealth.net/bhs/en/general_information/article/0,2494,3150_43043255_20304172,00.html

OPERATIONAL ANALYSIS

4) Prenatal class services program performance review - Healthy Beginnings is a one of the series of programs offered to expectant parents by Baptist Hospital. The program’s

goal is prepare parents for their baby's arrival by adding understanding of pregnancy, the

birth process and the transition to parenthood. The course is coordinated with the

hospital’s OB-Gyn Department and involves nurses, physicians, and psychologists.

FINDINGS:

•••• Current training does not offer advices on how to prepare the home for the baby’s

arrival and how to shop for baby gear

•••• Lack of financial orientation in current training

•••• More than 40% of trainees are not the mother and father, but the mother and the

child’s grandmother

•••• Physicians reported that expectant mothers seek from them answers to questions

concerning childcare, infant development, and related issues (e.g., diet during

pregnancy, co-sleeping, children’s sleeping problems, and effects of short-term

maternal separation, stress management).

ORGANIZATIONAL OBJECTIVES: to create a training program for expectant parents that

will be an improved version of the existing Healthy Beginnings program. The new training will

continue the hospital’s mission to provide patients with higher quality healthcare. The Baby 2 B

training will aim: 1) higher patient (parents) satisfaction; 2) less stress and anxious for both

parents and healthcare professionals dealing with first-time parents; 3) promote Baptist’s

Hospital constant concert with its patients and innovative corporate culture.

RESOURCES: this training would be part of the Health Services provided by Baptist Hospital

under the Pregnancy & Childbirth education. Participants in this training include nurses,

physicians, and expectant parents.

ENVIRONMENT: The new training format will aim to:

• Promote more access to information to parents

• Serve as helpful tool for physicians and nurses dealing with the trainees

• Serve as a network tool for parents and increase the sense of community of the

services offered at Baptist Hospital

• Help leverage the current Baptist’s Hospital reputation for quality healthcare

services and concern with its patients

PERSON ANALYSIS - The decision to have a baby is one which throws up future parents with

a number of issues and the concerned about support or how best to do things. With childbearing

families, family dynamics, family socio-economics, and family responses to stress and culture

have proved very important in determining the readiness of a family to welcome a new child.

Children definitely change relationships and often discussing such anticipated changes plus

being flexible to those unexpected changes can ease the transition from couple to family. 5 The

KSA’s necessary for both parents include:

• Hand-on skills to handle a newborn: Picking up, holding and carrying the baby, bathing

the baby, changing a diaper, feeding and burping, dressing and swaddling, taking

temperature, preventing accidents and injuries

• Knowledge of the changes a women’s body go through

• Knowledge of the fetus development during pregnancy

• Knowledge of how to manage sexual life during and after pregnancy

• Handling stress: coping with crying and colicky babies, dealing with pain during and

after labor, dealing with sleep deprivation, sharing house-hold chores

• Knowledge of infant safety at home and when traveling (how to buy, and install baby gear

such as car seat, stroller, changing table, crib, etc)

• Sense of organization: adjusting work and family responsibilities, organizing a budget for

the coming of the baby

• Communication skills: bonding and attachment with the baby, dealing with relatives,

handling challenges as a couple

• Understand the medical vocabulary: to identify health issues on both the mother and the

baby (important for illnesses, immunizations, doctor visits, health and nutrition)

• Understand the newborn characteristics

• Father’s ability to coach mother while she is in labor

• Mother’s ability to express her physical experiences before, during and after labor in

order to help the father and hospital personal to help her

• Mother’s ability to breastfeed the baby

5 Birth Source Official Website of Perinatal Education Associates Inc.

Retrieved from http://www.birthsource.com/scripts/article.asp?articleid=164

PERFORMANCE DISCREPANCIES Expectant and new parents have to juggle many new

changes all at the same time. For example, financial pressures – who knew a tiny baby could cost

so much? Then there is interference from in-laws, differences in parenting styles, balancing life

at work and at home on top of which, our research shows, many parents lack real support from

their families and neighborhood community. They are doing it all on their own.” 6

Today, as most couples work outside home, they have little time to attend classes, read books

about childbearing. From my research in books, courses and websites and also through

interviews with some friends and relatives, I found some performance discrepancies:

• Complaints from both parents about not feeling prepared for parenthood (fear and

anxiety)

• Changes in marriage due to the coming of the new baby

• Stressed and overwhelmed parents pass it onto the child creating a vicious circle

• Complaints and frustration from mothers who were not able to breastfeed

• Complaints from fathers about prenatal courses not motivating them

• Complaints from parents about the unsatisfactory treatment they received in the hospital

• Conflicts due to lack of economic resources due to lack of financial planning

• Injuries and accidents involving the infant may increased due to parents’ lack of skills

and improper installation of baby gear

• Parents are spending less time in the doctor’s office in between antenatal visits, thus

parents are unable to discuss the changes they are experiencing and ask questions

• Communication issues between parents, nurses and doctors due to lack of medical

vocabulary knowledge

• Post-partum depression or baby blues not identified by the either parent

• Unbalance on the division of tasks between the couple involving both the baby care and

the house chores

• Complaints about isolation and a lack of a community where the parents can relate and

socialize about their parenthood experiences

• Conflict between parents because the father is afraid to hurt the baby

• Lack of patience that leads to argument and more stress

6 Ibid note 1

Needs that cannot be addressed using this training

• Conflict between parents

• Personal relationships and conflicts between parents their relatives and friends

• Post-partum depression or baby blues

• Ability to naturally breastfeed (the research suggests that this is not a skill…)

• Parents tolerance for stress and level of patience

• Quality of the healthcare services provided

• Baptist Hospital organizational culture

• Parent’s choice of practitioner

• Parent’s choice of type of labor (natural or cesarean)

• Parent’s budget decisions

Needs to be addressed through this training

• Parent’s lack of confidence on parenting hands-on skills

• Interaction and social networking with other parents (affiliation)

• Change in the parents mindset towards pain during labor

• Inclusiveness and motivation for fathers

• Financial planning to diminish economic distress that may affect the couple and the baby

• Knowledge of medical terms and illnesses that may affect the baby and the mother

• How to buy and properly install baby gear

• Nutrition hints for the parents and the baby

Training design

Since expectant parents may not feel the urgency, or may not have time to take childbirth and

health education at the early stages of pregnancy, we suggest a variety of courses offered in

modules so that we will be able to attend the right trainee population and therefore addressing

some diversity issues we may encounter. Each module was designed from the perspective of the

stage of pregnancy the couples are in. We also took into consideration modules that would be

suitable for second-time parents that did not have a chance to take classes like these. This design

has the advantage of not making this lock-step training for second-time parents.

MODULE METHOD

1) Baby’s Birth - Ideal for expectant parents who need

practical orientation solely on labor, types of labor and

newborn handling and care.

Target: (Families with pregnancies of 28 weeks or more)

• Lectures

• Videos

• Demonstration/role play

2) Your pregnancy- A comprehensive module targeted to

families in the early stages of pregnancy. This course

includes detailed information from the conception until

caring for the newborn. This course is divided in the

following lessons:

Target: (Families with pregnancies in the earlier stages

starting from week 12-14)

•

• Excerpts of the movie :

“Happy Healthy Babies

and Moms: The first 90

days”

• Demonstration by midwife

Lesson 2.1 – You and your baby:

1) Fetus development

2) Essential healthy tips for expectant mothers during

gestation

3) Discomforts of pregnancy

4) How to prepare you home for the baby (safe and

cheap baby gear hints)

5) Financial advice (hints on budget planning)

• Video demonstration

• Game involving all

participant parents

• Spreadsheet template

Lesson 2.2 -Understanding labor and delivery:

1) Choosing a hospital or birthing center

2) Types of labor and anesthesia

3) Pain Management

4) Mental and physical wellness for the expectant

mother and father

• Lecture with nurse

• Demonstrations

• Respiratory training

• Relaxation

• Hospital tour

Lesson 2.3 – The Parents after post-partum

1) Mom’s body after the delivery

2) Nutrition and weight loss tips

3) The role of the father

4) Emotional changes/post-partum depression

5) Rest and sleep for the new parents

6) Sexual life after the baby

• Discussions

• Role play with doll

• Video

Lesson 2.4 - Caring for your newborn:

1) Bonding with your baby (soothing techniques)

2) Managing visitors or crowds

3) Bathing baby and caring for umbilical cord and

circumcised baby

4) Immunization (schedules and adverse symptoms)

5) Breastfeeding (how to breastfeed, how to buy a

breastfeed pump and store breast milk)

• Video

• Lecture with nurse

• Handouts

• Orientation with

lactation consultant

MODULE METHOD

3) Your Pregnancy - Intensive Module A fast-paced with

quick information about pregnancy and newborn care. and

some financial advice on how to adjust finances before the

baby comes

** Indicated for pregnancies over 28 weeks OR second time

parents

• Lecture with nurse

• Demonstrations

• Respiratory/Relaxation

training

• Hospital tour

4) CPR and First-aid for parents • Demonstrations

• Video

• Role play

TRAINING SCHEDULE: We recommend that first-time parents follow the program as if it

was a lock-step program because KSA’s acquired in one module are dependant on KSA’s

acquired in the previous ones. For second-time parents, as we mentioned above, we would allow

them to register in any module they wish.

MODULE TIME ALLOCATION

1) Baby’s Birth Duration: 6 hours (for three non-consecutive days)

Mondays, Wednesdays and Fridays from 5:45 pm to 8:45 pm

2) Your pregnancy Duration: 3 weeks

Tuesday and Thursday from 5:45 pm to 7:45 pm

Duration: 4 weeks

Saturday or Sunday from 9:00 am to 12:00 pm OR from 1:30 pm to

4:30 pm

3) Your pregnancy

Intensive module

Duration: 8 hours

Thursday or Saturday from 9:30 am to 5:30 pm

4) CPR and First-

aid

Duration: 6 hours

Saturday from 9:30 am to 3:30 pm

Number of trainees - 20 people in total: the expectant mother and one person (a family member,

friend or her partner). For the modules where we would allow second time parents, we can have

a maximum number of 28 people in the classroom.

Voluntary Training - This training is not mandatory but once the trainees are registered, no

certificate will be given for those who do not complete at least 2 modules. Only the CPR module

is mandatory for parents and for the person who will accompany the mother in the labor room.

Venue of training - In order to save cost and to be more available to expectant parents, the

training will be conducted in the premises of a hospital. However this training can also be

conducted in any community setting such as a church or community center.

Training objectives

Trainee Reaction Objectives

Since parenthood involves two people and the mother is directly involved and physically

attached to the child before he is born, my research shows that the reactions to training are

different from father and mother in the sense the father initially does not feel included, but once

the training starts, both parents share similar reaction objectives:

• Eagerness to learn about pregnancy and fetus development

• Excitement for the opportunity to clarify their doubts and reduce their anxiety

• Show interest in the lectures and actively interact during the training

• Find handouts and materials provided useful for future reference

• Feeling of affiliation (there are other parents in the same situation)

• Overcome their fears and misconceptions about pregnancy

• Sense of accomplishment of challenges as a couple

Learning objectives

Childbirth classes or prenatal classes are useful tools that help the expectant couple and to

socialize with other pregnant women and their families. At the end of this training, parents will

have acquired KSAs on:

• Acquire hands-on experience on handling and taking care of the baby

• Understand the process of childbirth as well as labor procedures and childbirth options

• Utilize the information on relaxation, comfort measures, breathing techniques 7

• Awareness of pain management techniques

• Develop a budget and prepare themselves financially for the arrival of the baby

• Expanding their network of friends composed by other expectant parents

7 Parent resources at Awaited Arrivals Canada. Retrieved from http://awaitedarrivals.com/parentforum.php

Transfer of training objectives: after completing this training, expectant parents will be able to:

• Articulate expectations, and make joint plans in advance for childcare, housework,

leisure, personal time, couple time and social relations away from the baby

• Handle stressful situations before, during and after the baby is born

• Utilize the network of pregnant couples they met during the training and continuing to

share their experiences

• Interact with doctors and nurses utilizing the medical knowledge they acquire about baby

development and mother’s health

• Identify situations that may put the baby’s safety at risk

• Adjust their budget and finances for the arrival of the baby

Organizational objectives: Baptist Hospital may beneficiate from this training because it will

• Accomplish its goal of ensuring the best possible education to its patients

• Support patients in their role of parents and in their couple relationship, helping them to

be better prepared to raise a child.

• Increase parents confidence, knowledge and skills

• Reduce conflicts between parents due to higher confidence level in parenting

• Build the parents’ network of other parents with children leveraging its current

community services

• Provide parents with access to caring and knowledgeable experts

The final outcome: better prepared patients (parents) will have a stress-free relationship with

doctors and nurses at Baptist Hospital

Training methods

• Lectures with nurse: although lectures will be brief, they will be necessary to guide parents

though the material will be distributed. In certain examples, a guest/former patient may come

with his/her child to give testimony of his/her experiences

• Game/store sharing involving all participant parents: this will help to break the ice and

also to help in the socialization between the trainees, since several parents complained about

isolation, this method would give trainees the chance to networking with other parents and to

building relationships. The games may have questions about their pregnancy, the names they

have already chosen. Couples may be separated by due date week or by the due month.

• Videos: will provide trainees with the declarative knowledge of some concepts and will help

them to grasp the ideas of skills they will be acquiring along the training

• Role play: important to simulate situations and demonstrate conflicts, problems and its

solutions to trainees. Its interactive feature promotes interesting and gives the opportunity for

ice-break moments. The role plays will present scenarios involving: 1) both parents and the

child, 2) one of the parents and the child; 3) both parents before the child is born. The role

play facilitates learning

• Demonstration by midwife this would allow the midwife or nurse to teach both parents the

positioning they should be at in the labor room. Usually fathers get really nervous and do not

know exactly what to do. This method would also serve to emphasize

• Spreadsheet template: a PowerPoint slide may be offered to show parents how to organize a

budget and a shopping list for buying the baby gear they will need. Handouts may also be

provided.

• Respiratory/Relaxation training: this method aims to teach parents breathing techniques

for tension control during pregnancy. For the later stages of pregnancy, the respiratory

method may include techniques for the father to be able to coach the mother during labor to

cope with contractions.

• Hospital tour will serve to show parents the facilities they will be available once the baby is

ready to be born. Parents will have access to a delivery room, baby nursery, recovery room

and the room where they may stay after the baby is born

• Orientation/Demonstration with lactation consultant: this will serve more as a coaching

experience coming from the nurse specialized in lactation. Although we mentioned that the

ability to breastfeed is something that may not be accomplished through this training, women

will have an idea of what to do in case they so desire to try. This method will also show

fathers how to buy and operate a breastfeeding pump and how to safely store breast milk and

sterilize the bottles.

Training development

Facilities: Meeting room at Baptist Hospital premises (it can be multiple rooms across the

various branches of the hospital. The room should be organized in the following manner to

facilitate from the beginning of the session communication and interaction among trainees.

Trainees will be asked to change tables and meet different trainees in each session.

Trainers: include nurses, anesthesiologists, psychologists and former patients.

Some instructions such as CPR and breastfeeding techniques can only be ministered by

certified professionals.

Equipment:

• TV/ VCR to play the videos

• Small projector

• Dolls for role playing

• Baby gear to facilitate demonstrations: diapers, 2 strollers, 2 cribs

• Handouts of lectures and spreadsheet

• Book offered to every couple: “The Gift of Motherhood”

• Floor mats for breathing and relaxation techniques

• The Empathy Belly"® Pregnancy Simulator

• Computer for Powerpoint presentations

• Mannequin of pregnant woman for demonstrations

Training Evaluation

1) Trainees’ reactions will be evaluated through training assessment questionnaires (sample

included in the appendix). Feedback may be opened or anonymous

2) Learning: Since training objective was to reduce parents’ anxiety and to promote a more

harmonic and stress-free environment for the new child, the results of questionnaires sent to

parents and physicians may answer questions about the training outcomes and its impact.

3) Transfer: Actual learning of some hands-on skills can only be verified after the baby is born.

But changes in the trainees’ behavior may be identified through:

• Results of follow-up/survey forms available in their physicians office

• Reduction in the number of emergency calls to nurses/physicians (high confidently

parents do not go to the hospital for simple reasons)

4) Results will be measured through:

• Surveys with parents and physicians about the change in the parents level of confidence

in handling the child.

• Attitude survey will be conducted to measure the change in the amount of complaints

parents had before taking this training session

• Follow through of former trainees recommending this training session to friends and

family

• Decreasing in the number of sick newborns due to lack of preparedness and skill of the

parents

• Trainees seek to continue education following this training by taking classes for the other

development stages of their baby (also offered at the Hospital: Baby’s First Year and

Your Todler)

• Overall ratings for Baptist Hospital compared to others offering similar training

programs

APPENDIX I

ICE BREAKER QUIZ (to be given at session one of the training)

1) You should always supplement a breastfeeding baby with...

a) water

b) diluted apple juice

c) formula

d) none of the above

2) During their first week of life, the average baby...

a) loses 5-10 percent of their birth weight

b) loses 10-15 percent of their birth weight

c) gains an extra 5-10 percent of their birth weight

d) gains an extra 10-15 percent of their birth weight

3) By the time they are five days old, one way that you can tell if your breastfed baby is

getting enough to eat is if she is having at least...

a) 1-2 wet diapers each day

b) 3-4 wet diapers each day

c) 4-5 wet diapers each day

d) 6 or more wet diapers each day

4) If your baby has a moro reflex, you should...

a) call your Pediatrician right away

b) make sure that their immunizations are up-to-date

c) change his diaper

d) none of the above

5) You should not heat your baby's bottles in the microwave because...

a) of the radiation

b) your baby might get burned

c) they will melt

d) both a and b

6) When riding in the car, your baby will be the safest when...

a) facing backwards in the front seat

b) facing forward in the front seat

c) facing backward in the back seat

d) facing forward in the back seat

7) To reduce your baby's risk of SIDS, he should sleep on his:

a) back

b) side

c) stomach

d) side or stomach

APPENDIX II

TRAINING EVALUATION QUESTIONNAIRE

Page 1

8 International Federal of the Red Cross Evaluation Questionnaire Retrieved from

http://www.ifrc.org/docs/pubs/health/psycholog/pspmanual_evaluation.pdf

** Note that Question 13 is missing and it read:

The modules listed below were covered adequately:

1) Baby’s birth

2) Your pregnancy

3) Your pregnancy Intensive Module

4) CPR and First Aid for parents

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