Nursing Research And Evidence Based Practice Ten Steps To Success PdfBy Wanda A. In and pdf 22.05.2021 at 09:54 9 min read
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- For Health Care Providers
- Determinants of an evidence-based practice environment: an interpretive description
Health care providers play an integral role in promoting and supporting a woman's decision to breastfeed.
A non-breastfed child is 14 times more likely to die in the first six months than an exclusively breastfed child, according to The Lancet. Breast milk gives a baby everything they need and costs only what it takes to feed the mother. Thereafter, local, nutritious foods should be introduced, while breastfeeding continues for up to two years or beyond. Followup formula is therefore unnecessary. In addition, follow-up formula is not a suitable substitute for breast milk, due to its content.
For Health Care Providers
Leite 2. To asses the performance of the Ten Steps to Successful Breastfeeding in an university hospital. Although the hospital does not have a policy that addresses promotion, protection and support for breastfeeding, The greatest difficulty was to inform pregnant women about the importance and the management of breastfeeding step 3.
Therefore, visits to pregnant women are recommended, in order to prepare them for breastfeeding and to explain about the infants' healthy feeding habits. Pesquisa descritiva e quantitativa.
In , in order to promote successful breastfeeding, the World Health Organization and the United Nations Children's Fund implemented the Baby-Friendly Hospital Initiative BFHI 1 , a program that mobilizes maternity health care professionals to make changes in routines and conducts based on the completion of the "Ten Steps to Successful Breastfeeding" 2 , 3 Chart 1.
Introduced by the Brazilian Ministry of Health BMH in , with the support of state and municipal departments, the BFHI qualifies professionals by performing evaluations and encourage hospitals to seek accreditation 3 , 4.
In addition to becoming a referral for other health institutions, accreditation enables the hospital linked to the Brazilian Unified Health System to receive financial incentive for obstetric procedures, paid by the BMH, according to Ordinance GM , of June 07, 5 , which is a unique initiative in the world 4. The hospital or health care unit with maternal-child services that is interested in becoming Baby-Friendly is firstly required to evaluate its current practices regarding the "Ten Steps to Successful Breastfeeding.
This evaluation allows managers and heads of hospital units to make an initial appraisal and analyze the practices that encourage or discourage breastfeeding, so that they can request for a global evaluation later 6.
Currently, the BFHI have more than 20 thousand accredited hospitals in nearly countries 6. In view of the foregoing, this study evaluated a university hospital to analyze its maternity policies and practices regarding the "Ten Steps to Successful Breastfeeding. The institution provides health care services with wide social repercussion, assisting the population of the state itself and of the neighboring regions of the states of Bahia and Minas Gerais.
Additionally, it is a referral center for high complexity cases and for primary and secondary health care, with outpatient services. The maternity unit has a rooming-in policy, allowing mothers to remain together with their newborns 24 hours a day. In , there were deliveries, The unit has also a human milk bank, which performs the collection, processing and quality control of the milk to subsequent distribution, according to medical prescription, in addition to strengthening breastfeeding promotion.
The questionnaire includes 59 closed questions; however, in order to facilitate data collection and organization, it was subdivided into five specific questionnaires for each respondent. Respondents were randomly selected, as recommended by the same document.
All participants were informed on the purpose of the study and signed a written informed consent. Finally, the result was measured by the concordance index CI , the percentage corresponding to the affirmative answers to the global criteria for each step. Data analysis was based on BFHI evaluator's handbook 8. To facilitate the understanding of the results, we decided to present them in ten sub-items, according to the steps proposed by the self-assessment tool Chart 1.
Step 1: The maternity service does not have a breastfeeding policy that addresses the Ten Steps to Successful Breastfeeding. Step 2: The Institution does not have written documents with the content of training courses for breastfeeding promotion and support, confirming what Step 3: To evaluate this step, the nurse responsible for the prenatal care service was interviewed.
Subsequently, information was confronted with the answers of 20 pregnant women in the third trimester of pregnancy who attended to at least two visits at the service. The hospital provides prenatal care. The nurse responsible for the service pointed out that pregnant women are not informed about the importance and the management of breastfeeding during visits; in addition, there were no records of this topic on medical charts.
According to the nurse, the outpatient records of prenatal follow-up are not made available to the hospital staff that will perform the delivery. Another relevant data show that professionals do not consider woman's intention to breastfeed when deciding about the use of sedatives and analgesics during delivery, although being aware of the effects of these drugs on breastfeeding. The nurse also states that future mothers are not protected from commercial promotion, whether oral or written, and emphasizes that no group meetings are held with pregnant women to deal with any topic.
Step 4: According to the BFHI 6 , this step is interpreted as: "putting babies in direct contact with their mothers immediately after birth for at least one hour and encourage mothers to identify if their baby is ready to be breastfed, offering help if needed. One recently delivered mother 3. Of the mothers interviewed, one underwent cesarean section with general anesthesia and, as soon as she was able to meet her baby's needs, was encouraged by the staff to breastfeed for at least one hour.
Already in the delivery room, Step 5: As for instructing recently delivered mothers about the breastfeeding process, However, Of the 30 professionals of the clinical staff, Step 6: The hospital does not have data on the number of exclusively breastfed babies.
Of the 30 babies observed, Only However, none of them were able to mention at least two of these signs and Step The questions of this step aimed to identify if the hospital referred mothers to breastfeeding support groups on discharge.
Thus, Table 1 summarizes the situation of each step based on the concordance index proposed by the BFHI. Data indicated that six out of the ten steps are completed by the hospital, showing that, despite the lack of a policy to protect breastfeeding, the institution adopts infant's feeding practices that are in accordance with current scientific evidence 9 - A study carried out with Baby-Friendly Hospitals in Brazil 12 revealed that steps 1, 3, 6, 7, 8 and 9 are the most completed by institutions, a fact that is in agreement with the findings of the present research, which shows the completion of steps 4, 5, 6, 7, 8 and 9.
Breastfeeding experiences a positive impact when influenced by hospital routines and by training professionals in lactation management Having a policy that addresses the "Ten Steps to Successful Breastfeeding" is important to accredit the maternity facility as a Baby-Friendly Hospital and to guide professionals on appropriate infants' feeding practices, in order to ensure the continuation of lactation up to six months 6. It is important to disseminate this information to all health care staff and to train professionals on "baby-friendly" practices 6.
It is essential that mothers are instructed about the proper latch-on to breastfeed already in the prenatal period, because having this information contributes to successful breastfeeding 14 , Hence, the lack of guidance about breastfeeding during pregnancy may result in breast problems related to lactation and thus influences early weaning Following the premise that guidance about breastfeeding in the prenatal period positively reflects on the rates of maintenance of exclusive breastfeeding, it is suggested to conduct individual and group discussions with pregnant women, in order to prepare them to breastfeed and explain about healthy infant feeding.
With regard to the forth step, according to Carvalho and Tamez 16 , the first contact between mother and child, already in the delivery room, is an experience that has a beneficial effect on breastfeeding, because, from the first half an hour of life on, there is the onset of newborn reflexes, making lactation easier.
However, the maternity unit of the evaluated hospital allows infants to remain in the "baby unit" for observation during more than one hour, which may lead to prolonged fasting and thus to hematologic dysfunctions, such as jaundice In normal delivery, whenever possible, newborn's care should be provided close to the mother, until both are able to be transferred to the rooming-in unit, with the establishment of a physical and emotional bond.
This is the ideal situation, because it gives the opportunity to the early interaction that allows the mother to initiate breastfeeding within the first half an hour of birth, ensuring a better long-term performance These practices meet BFHI criteria established for step 5.
In Northeastern, Middle-Western and Southeastern Brazil, step 6 is completed by ten out of the 13 states investigated, highlighting the decrease in the use of breast milk substitutes in Brazilian maternity units and hospitals Although the hospital evaluated in this study complies with what is required for completing this step, the institution does not keep medical records about the reason why and for how long infant formula was given, which is necessary to meet acceptable medical reasons to supplement or replace breast milk 6 , The possibility of rooming-in contributes to on demand breastfeeding, allowing infants to suckle without following a restricted schedule, determining their own pace regarding the frequency and duration of feeds, so that lactation is fully established before hospital discharge 18 , The issue of pacifiers and bottles should be highlighted, since all mothers reported that they were not used, confirming the observations conducted in the rooming-in unit.
By referring mothers to breastfeeding support groups, the hospital ensures the continuation of breastfeeding Mothers mentioned the hospital human milk bank as a support group to this practice. Although not being considered a group, mothers took the milk bank as a reference when they needed help to breastfeed. It is possible to improve the quality of breastfeeding support groups by providing consultancy services by phone, to offer help and clarify doubts, especially in the first days postpartum 3 , Instructions about breastfeeding provided by health care professionals are essential for the success and continuation of lactation.
The first step to accreditation should be considered the improvement of all staff, since, like the mothers, professionals should know and be convinced of the benefits and the importance of breastfeeding. Thus, a well trained and prepared staff strongly influences the incidence of breastfeeding in the community in which it acts. After the self-evaluation, it is suggested to start the accreditation process, with the creation of a Breastfeeding Committee, in order to organize the health unit for BFHI implementation and monitoring.
This team would be responsible for coordinating accreditation activities and organizing the training of professionals. Finally, this diagnosis is considered to promote discussions and changes regarding breastfeeding in the hospital, contributing to improve breastfeeding conditions and allowing its continuation for up to six months.
Effects of breastfeeding on children's health in the short and long run. J Brazilian Soc Food Nutr ; IHAC [cited Jan 28]. J Pediatr Rio J ; Nascimento MB, Issler H. Breastfeeding in premature infants: in-hospital clinical management. Rev Bras Saude Matern Infant ; The impact of training based on the Baby-Friendly Hospital Iniative on breastfeeding practices in the Northeast of Brazil. The importance of instructing pregnant women in pregnancy breastfeeding: factor for reduction of painful process of breast.
ConScientiae Saude ; Directions on breast feeding in prenatal care: an integrative review. Rev Rene ; Rio de Janeiro: Guanabara Koogan; Rego JD. Aleitamento materno. Pediatria Sao Paulo ; Breastfeeding protection, promotion and support at an university hospital. Cienc Saude Coletiva ; Lee F. Porto Alegre: Artmed; All the contents of this journal, except where otherwise noted, is licensed under a Creative Commons Attribution License. Services on Demand Journal. Introduction In , in order to promote successful breastfeeding, the World Health Organization and the United Nations Children's Fund implemented the Baby-Friendly Hospital Initiative BFHI 1 , a program that mobilizes maternity health care professionals to make changes in routines and conducts based on the completion of the "Ten Steps to Successful Breastfeeding" 2 , 3 Chart 1.
Results To facilitate the understanding of the results, we decided to present them in ten sub-items, according to the steps proposed by the self-assessment tool Chart 1. Discussion Data indicated that six out of the ten steps are completed by the hospital, showing that, despite the lack of a policy to protect breastfeeding, the institution adopts infant's feeding practices that are in accordance with current scientific evidence 9 -
Determinants of an evidence-based practice environment: an interpretive description
Leite 2. To asses the performance of the Ten Steps to Successful Breastfeeding in an university hospital. Although the hospital does not have a policy that addresses promotion, protection and support for breastfeeding, The greatest difficulty was to inform pregnant women about the importance and the management of breastfeeding step 3. Therefore, visits to pregnant women are recommended, in order to prepare them for breastfeeding and to explain about the infants' healthy feeding habits. Pesquisa descritiva e quantitativa. In , in order to promote successful breastfeeding, the World Health Organization and the United Nations Children's Fund implemented the Baby-Friendly Hospital Initiative BFHI 1 , a program that mobilizes maternity health care professionals to make changes in routines and conducts based on the completion of the "Ten Steps to Successful Breastfeeding" 2 , 3 Chart 1.
Metrics details. Despite the available research to inform nursing practice, many patients still fail to receive evidence-based care. Several evidence-based practice EBP models have been developed to guide nurses through the steps in the process, yet these models have not been uniformly adopted or consistently used. The original purpose of this research was to gather perspectives and experiences of nurses using the Iowa Model of EBP to help inform its introduction into other practice settings. As a more in-depth understanding was gained, the emphasis of the study shifted towards understanding the determinants of the EBP environment.
Crit Care Nurse 1 August ; 31 4 : — Keele R. ISBN:
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Return to Contents. What is it specifically that you want to "fix" or improve? The following key actions should be performed in the order they appear:. Did it work? If time and resources are limited, select only one aim for testing. Base your selection on the importance of the aim and on the feasibility of testing it.
Read Nursing Research and Evidence-Based Practice PDF | Ten Steps to Success (Keele, Nursing Research & Evidence-Based Practice).