Disaster Preparedness in Home Care: Moving Beyond Checklists.

Disasters have become increasingly common, with hurricanes off the southern, eastern, and western coasts, fires in the northwest, earthquakes, mass shootings, and continuing cases of COVID-19 looming over healthcare systems. Home care agencies have a history of meeting patients' needs during disasters and are strategically positioned to support communities during public emergencies and disasters. However, the "who" and the "how" of engaging the disaster cycle of mitigation, preparedness, response, and recovery is not always understood by clinicians and leadership. A gap in the literature cries out for better preparedness strategies for home care leadership and staff that go beyond the broad guidance of regulatory and accreditation organizations. This article aims to examine current literature and offer direction to home care leaders and staff as they seek to understand the "who" and the "how" in preparing for disasters in an increasingly unstable world.

Walking into a COVID Petri Dish: Home Care Providers' Experiences during a Pandemic.

As we approach the third anniversary of the COVID-19 pandemic, the long-term effects on the health and well-being of those caring for patients in their homes, where less control of the environment can be maintained, remain a concern. The purposes of this study were to describe home care providers' experiences caring for patients during the pandemic, barriers and facilitators to the provision of care, and lessons learned for practice during future healthcare crises. A qualitative descriptive study using semistructured interviews was conducted with 13 home care providers. Four themes emerged from the data: Riding an emotional roller coaster, Putting a fire out with a garden hose, Walking into a COVID petri dish, and I'm just trying to do my job. Support for frontline staff should be initiated early in a healthcare crisis or pandemic. Communication needs to be clear, consistent, and made available at regular intervals. Home care leaders need to be visible and transparent to reduce emotional uncertainties that can negatively influence staff and patient outcomes. Education and planning around emergency preparedness are essential in future crises to mitigate the negative consequences on staff and patients.

Assessing learning needs for breastfeeding: setting the scene.

Breastfeeding has a major contribution to make to public health, yet the UK, like many other developed countries, has low rates of breastfeeding. A contributing factor is that practitioners are ill-prepared to support breastfeeding women. There is a mismatch between the care professionals provide and the support women desire. A national breastfeeding learning needs assessment (LNA) was carried out in England to provide a comprehensive picture of professional and practitioner learning needs and existing training opportunities and resources. The LNA comprised five elements, and sought the views of service users through consumer organizations and voluntary breastfeeding supporters. Two elements of the LNA are reported here. A search of RDLearning, a web-based national resource, provided details of existing accredited courses in the UK for practitioners. Ten short courses provided by higher education institutions were identified, along with a range of courses offered by voluntary and other organizations, such as the National Childbirth Trust and UNICEF Baby Friendly Initiative. Second, an e-mail survey of 28 key stakeholder organizations was undertaken, with a response rate of 68% (n = 18). All but one acknowledged that their members could benefit from further breastfeeding knowledge and expertise and were supportive of a national breastfeeding education initiative. The most popular forms of education provision were workshops and seminars, online and written information. The topic considered most important for all practitioners was the health outcomes of breastfeeding. Other contributions which stakeholder organizations felt they could make were the provision of information resources and setting up specialist interest groups.

Addressing the learning deficit in breastfeeding: strategies for change.

This paper summarizes the findings of the learning needs assessment described in this issue. Limitations and strengths are discussed. The paper describes a national, multi-sectoral, multidisciplinary picture. Our respondents may over-represent those with an interest in breastfeeding; if so, the true picture may be even more problematic than described here. Major deficits were identified in the knowledge and skills of practitioners from all backgrounds and all sectors. Many professionals report poor knowledge about breastfeeding and have low levels of confidence and clinical competence. Organizational constraints and barriers to effective education and practice include fragmentation of care and education, lack of facilities, and a low priority being given to breastfeeding. There is a range of current educational provision, although not all is fit for purpose. Voluntary organizations seem to have higher standards than do some current professional learning opportunities. Preferred methods of training include practical observation and mentorship, volunteer counsellor involvement in training programmes, as well as self-study and online opportunities. Recommendations include: a funded, mandatory, interagency and multidisciplinary approach; appropriate content; support at local and national levels; breastfeeding education to be included in clinical governance and audit mechanisms; and further research and evaluation to examine optimum ways of providing education and training. Organizational barriers could be addressed through a public health policy and evidence-based approach.

The development and delivery of a practice-based breastfeeding education package for general practitioners in the UK.

Growing acceptance that measurable improvements in public health, particularly in lower-income groups, could be achieved by increasing the incidence of breastfeeding has focused attention on the current lack of educational provision in breastfeeding issues for many health professionals. An audit of general practitioners in one area of northern England revealed an interest in receiving breastfeeding training. Department of Health funding was obtained by the breastfeeding subgroup of the local Maternity Services Liaison Committee to develop, deliver and evaluate a practice-based educational session supplemented by a resource pack. Over a 12-month period, 22 practices received the session and the project was evaluated using an illuminative evaluation model. Response rates to two evaluation questionnaires of 81% (133/164) and 62.5% (65/104) were achieved and findings indicated high levels of satisfaction with the session and its accompanying resource pack. Qualitative data related to perceived influence on future practice were subjected to thematic network analysis and revealed four main (organizing) themes: the acquisition of greater knowledge, improved access to resources, a proactive approach to breastfeeding support and the creation of a breastfeeding-friendly environment. The illuminative evaluation also identified recurring issues that could impact on any attempt to replicate or adapt this project; these were the influence of personal breastfeeding experiences, the desire for greater interaction during the training session and the wider implications for practice education of multidisciplinary attendance.

An evaluation of the breastfeeding support skills of midwives and voluntary breastfeeding supporters using the Breastfeeding Support Skills Tool (BeSST).

The promotion of breastfeeding has been established as a global public health issue. Despite this global agenda, breastfeeding initiation and duration rates remain low in many countries. The lack of provision of adequate support to the breastfeeding mother is an important contributory factor to shorter duration of breastfeeding. Health professionals and voluntary breastfeeding supporters are in a prime position to work collaboratively to provide comprehensive support to the breastfeeding mother. However, a comparative evaluation of the breastfeeding support skills of voluntary breastfeeding supporters and health professionals has never been conducted. This study aimed to assess the breastfeeding support skills of midwives and Breastfeeding Network (BfN) supporters. Breastfeeding support skills were assessed using a between-subjects design conducted with 15 midwives and 15 BfN supporters in the north-west of England. Support skills were measured using the prevalidated Breastfeeding Support Skills Tool (BeSST), a questionnaire and video tool. Total scores on the BeSST were significantly higher in the BfN group (mean = 42.5 +/- 6.4 SD) than in the midwife group (mean = 30.7 +/- 8.2 SD) [t (26.5) = 4.4, P < 0.0001]. The BfN group has the breastfeeding support skills necessary to provide adequate assistance for breastfeeding mothers. An interagency and interdisciplinary collaborative model is crucial to developing a coherent and cohesive approach to the support infrastructure for breastfeeding women.

Adolescent mothers and breastfeeding: experiences and support needs--an exploratory study.

The experiences and support needs of adolescent mothers who commenced breastfeeding were elicited using focus groups and in-depth semistructured interviews. The study took place in the North West of England, UK. The qualitative data were analyzed using thematic networks analysis. Five themes related to experiences emerged: feeling watched and judged, lacking confidence, tiredness, discomfort, and sharing accountability. A further 5 themes were developed to describe the adolescents' support needs: emotional support, esteem support, instrumental support, informational support, and network support. These forms of support were most effective when provided together in a synergistic way and within a trusting relationship. Key supporters identified were the mother's mother, the partner, and the midwife employed in a teenage pregnancy coordinator role. Health professionals need to further explore the ways in which relationships may be developed and sustained that provide the range of support required by adolescent mothers to enable them to continue breastfeeding.