EVIDENCED-BASED NURSING

1. General Question: What is breastfeeding and its importance? What is the impact of
maternal education and source of knowledge on breast feeding practices?
2. Reconstruction of General Question related to client’s problem identified in the
RLE: What are nursing educational strategies and materials by means of health teaching
promote breastfeeding practices?

PICO (Population Focus, Intervention, Comparison, & Outcome)

Patient Focus Intervention Comparison Outcome
Population

201 women, who had Educational None Intervention was

been hospitalized intervention using the beneficial because
immediately for at flip chart titled “I Can mothers in the
least 6 hours, Breastfeed My Child. intervention group had
postpartum in a higher self-efficacy
hospital located in scores, more mothers
Fortaleza, Ceará, continued
Brazil; breastfeeding and
mothers had a longer
duration of exclusive
breastfeeding, both at
the time of hospital
discharge and at the
second month
postpartum, with
statistically significant
associations.

1. Critical Review with Summary of the Literature

Exclusive breastfeeding is highly recommended throughout the first six months of

life and should be continued as a supplementary feeding to at least two years of age. This
recommendation yields to promote prevention of infant mortality rates in the world.
Given that breastfeeding is effective intervention, promotion of it has the greatest
potential to reduce child mortality in a given country. Brazil has several strategies that
have been implemented under the National Policy on Promotion, Protection and Support
of Breastfeeding, one of which is giving importance to self-efficacy. Self-efficacy is the
belief in one’s personal skill to successfully perform certain tasks or behaviors to achieve
desirable outcomes(10) and it is a modifiable factor mainly through health education
(Dodt et. al, 2015). Herewith, they developed Breastfeeding Self-Efficacy Scale (BSES)
—an instrument to assess the self-efficacy of breastfeeding mothers. In Brazil, they have
a short form version of the BSES designed to be utilized in a hospital environment to
optimize nursing support for the promotion of breastfeeding; which has already been
validated in the said country.

The study entitled “ An experimental study of an educational intervention to

promote maternal self-efficacy in breastfeeding” was a research that included a pretest,
intervention and posttest, as well as a control group. According to the study, the
intervention that will be use was a flip chart and the process of construction and
validation occurred in five stages:
1. the construction and validation of the flip chart were based on literature research
and the Breastfeeding Self Efficacy Scale-Short Form (BSES-SF)
2. BSES-SF was administered to all of the mothers in the study 6 hours postpartum
(1st contact);
3. The intervention group received an explanation from the researcher using the flip
chart, while the control group did not receive this explanation;
4. The second application of the BSES-SF and an assessment of the infant’s diet
were performed before hospital discharge (2nd contact); and
5. The third application of the BSES-SF and an assessment of the infant’s diet at two
months after childbirth were conducted by telephone (3rd contact).

Herewith, the independent variable was the flip chart application and the
dependent variable was the maternal self-efficacy and breastfeeding rates. The study was
conducted in a large public maternity hospital that provided tertiary neonatal and
perinatal care located in Fortaleza, Ceará, Brazil. Overall, flip chart titled “I Can
Breastfeed My Child” was beneficial because:

● mothers in the intervention group had higher self-efficacy scores;

● more mothers continued breastfeeding and mothers had a longer duration
of exclusive breastfeeding, and;
● both at the time of hospital discharge and at the second month postpartum,
with statistically significant associations.

In conclusion, the educational strategy mediated via the flip chart titled “I Can
Breastfeed My Child” has been effective both in improving self-efficacy and increasing
the duration of breastfeeding sessions.

On the top of that, there is a study that says health professionals, including
nursing students, do not always receive adequate breastfeeding education during their
foundational education programme to effectively help mothers. The paper reports
describing nursing and other health professional students’ knowledge and attitudes
 towards breastfeeding, and examines educational interventions designed to increase
breastfeeding knowledge and attitudes amongst health professional students. Most
importantly, the results of the research reports that nursing curriculum, or specialized
programmes that emphasise the importance of breastfeeding initiation, can improve
breastfeeding knowledge and attitudes and students’ confidence in helping and guiding
breastfeeding mothers.

As we all know, breastfeeding has numerous benefits. So as health care

promoters, we should have interventions like educational teaching strategies to ensure
enhancing knowledge, promoting awareness, and guarantee the continuity of
breastfeeding. All of the health educators must enhance the improvement of breastfeeding
initiation by ,eams of having also knowledge to impart and initiative to provide
information. Based on the research study, it yielded positive results and provided
increased maternal self-efficacy to adhere to breastfeeding in longer duration or period of
time. Therefore, it is best and important for us health educators to strategize educational
materials to promote breastfeeding as well health educators to be knowledgeable also and
initiate awareness and practices.

References:

Main research journal:

Dodt, R. C., Joventino, E. S., Aquino, P. S., Almeida, P. C., & Ximenes, L. B. (2015). An
experimental study of an educational intervention to promote maternal self-efficacy in
breastfeeding. Revista Latino-Americana De Enfermagem, 23(4), 725-732. doi:10.1590/0104-
1169.0295.2609

Supporting research journal:

Yang, S., Salamonson, Y., Burns, E., & Schmied, V. (2018). Breastfeeding knowledge and
attitudes of health professional students: A systematic review. International Breastfeeding
Journal, 13(1). doi:10.1186/s13006-018-0153-1