A Statewide Evaluation of the Breastfeeding Resource Nurse Model

Abstract

Objective: To evaluate a statewide initiative to increase the provisioning of human milk in NICUs.

Design: A survey of nurses before participation in an educational session, immediately after education, and again 9 months later.

Setting: Nurses from 22 hospitals throughout Florida.

Participants: We surveyed 121 participants, including some nurses who had prior breastfeeding education or certification as well as those without specialized breastfeeding training.

Intervention: An educational project called the Breastfeeding Resource Nurse Master program was intended to educate NICU nurses to implement the "Ten Steps to Promote and Protect Human Milk and Breastfeeding in Vulnerable Infants."

Measurement: A quantitative needs assessment survey was administered to participants to determine current hospital practices, policies, and perceived areas for improvement. Pre- and immediate posttraining surveys assessed NICU nurses' knowledge, attitudes, and beliefs about human milk feeding of critical care infants and their self-efficacy for implementing the program in their respective NICUs. A follow-up, open-ended survey was administered at 9 months to yield information on program implementation.

Results: NICU breastfeeding practices varied widely at baseline. Nurses' scores for knowledge, beliefs, and behavioral intentions improved postsession, but the implementation of practice changes related to the Ten Steps for Vulnerable Infants proved difficult. Nurses identified insufficient time and resources as barriers to educating others and changing practice.

Conclusions: Policies and regulations that make hospitals accountable for increasing human milk provision to vulnerable infants may be necessary to ensure that hospitals devote adequate resources to implementing practice changes in this area.

Keywords: Baby-Friendly; NICU; breastfeeding; human milk; infant; neonate; nurse education.