Maternity care experiences and breastfeeding at discharge among Maryland WIC participants: A qualitative analysis.

BACKGROUND: Breastfeeding imparts numerous health and social benefits for families. Barriers deter some individuals from breastfeeding. Rates are lower among certain populations, including participants of the federally funded Women, Infants, and Children's Program (WIC). Women, Infants, and Children's Program provides low-income pregnant and postpartum women and children under 5 with nutrition education, supplemental foods, breastfeeding education and support, and resource linkages. Investigation of WIC participants' hospital experiences and breastfeeding decisions is limited. We explore qualitative themes associated with breastfeeding-related hospital maternity care practices experienced by WIC participants. METHODS: Thirty pregnant individuals intending to breastfeed were recruited at WIC clinics to complete in-depth interviews at 2 weeks, 3 months, and 6 months of postpartum. Using the Thematic Framework methodology, we analyzed data from the two-week interviews of 29 participants with respect to hospital breastfeeding experiences. RESULTS: Fourteen participants were exclusively breastfeeding at discharge (EBFD). Fifteen were partially breastfeeding at discharge (PBFD). Differences between groups were found in hospital breastfeeding experiences, particularly in staff support. All participants EBFD reported positive breastfeeding-related staff experiences. Most participants PBFD reported limited and ineffective staff interaction, leading to formula introduction. CONCLUSIONS: Individuals EBFD and those PBFD reported about the same rate of hospital breastfeeding difficulties, yet half introduced formula within the first few days postpartum. Results reiterate the importance of hospital staff support to breastfeeding exclusivity at 2-3 days postpartum. The challenges that these individuals faced may have been resolved through available, responsive, and effective intervention. Data-driven breastfeeding education programs for hospital health professionals are critical to affect patient breastfeeding outcomes.

Nursing Students with Disabilities: A Guide to Providing Accommodations.

The number of nursing students with disabilities entering nursing school continues to rise along with the critical need for nurses. According to federal law, accommodations must be implemented in the classroom and clinical area for nursing students with disabilities. Faculty and administrators must protect the civil rights of those with disabilities by addressing barriers to student success and establishing accommodations. By using adaptive equipment, service animals, and other accommodations, nursing students with disabilities can be successful in providing safe and effective care to patients and add to diversity and inclusion in the nursing profession.

Baby Friendly Hospital Designation and Breastfeeding Outcomes Among Maryland WIC Participants.

OBJECTIVES: The Baby-Friendly Hospital Initiative is an effective intervention to support maternal practices around breastfeeding. However, little is known about its impact on participants of the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). The purpose of this study was to evaluate whether Baby Friendly Hospital (BFH) designation in Maryland improved breastfeeding practices among Special Supplemental Nutrition Program for Women, Infants and Children (WIC) participants. METHODS: Breastfeeding practices of WIC participants (22,543 mother-infant dyads) were analyzed utilizing WIC management information system de-identified data from four Maryland WIC agencies during 2010-12 and 2017-19. Participants lived in areas served by a hospital that became BFH in 2016 or remained non-BFH. Pre-post implementation breastfeeding practices (breastfeeding initiation, at 3 months and 6 months) of women associated with a BFH were compared to women associated with a non-BFH using propensity score weighting and a difference-in-difference modeling. RESULTS: From pre to post intervention no differences in breastfeeding initiation or any breastfeeding at 6 months were attributable to BFH status. There was some evidence that BFH designation in 2016 was associated with an absolute percent change of 2.4% (P = 0.09) for any breastfeeding at 3 months. DISCUSSION: Few differences in breastfeeding outcomes among WIC participants were attributable to delivery in a BFH. Results from this study inform policy about maternity practices impacting WIC breastfeeding outcomes. More study needed to determine the impact of BFH delivery on differences in breastfeeding outcomes between sub-groups of women.

Exposure to Baby-Friendly Hospital Practices and Breastfeeding Outcomes of WIC Participants in Maryland.

BACKGROUND: The Baby-Friendly Hospital Initiative is an effective intervention to support maternal practices around breastfeeding. However, adherence of hospitals to the Baby-Friendly 10 Steps, as determined from the perspective of women participating in the United States Special Supplemental Nutrition Program for Women, Infants, and Children, has not been assessed. RESEARCH AIMS: (1) To compare maternal perceptions about maternity practices in Baby-Friendly Hospitals and non-Baby-Friendly Hospitals; (2) to evaluate the associations between degree of exposure to the Baby-Friendly 10 Steps and breastfeeding practices through the first 6 months; and (3) to evaluate whether the receipt of specific Steps was associated with breastfeeding practices through 6 months. METHODS: This study was a cross-sectional 2 group comparison, using prospective data collected through a self-report telephone survey and retrospective data gathered from participants' records. Women (N = 182) participating in four Maryland Special Supplemental Nutrition Program for Women, Infants and Children agencies were recruited. One hundred and eight (59%) participants delivered at designated Baby-Friendly Hospitals; 74 (41%) delivered in non-Baby-Friendly designated hospitals. Logistic regression models were utilized to determine the influence of perceived Step adherence on exclusive breastfeeding. RESULTS: Reported adherence to 10-Steps policies ranged from 10%-85% (lowest for Step 9, highest for Step 10) and only Step 9 (give no pacifiers or artificial nipples to breastfeeding infants) differed according to Baby-Friendly Hospital status. Greater exposure to the 10 Steps was positively associated with exclusive breastfeeding during hospitalization. The lack of perceived adherence to Step 6 (no food or drink other than human milk), Step 9, and the International Code of Marketing of Breast-milk Substitutes (no formula, bottles, or artificial nipples) significantly decreased the likelihood of exclusive breastfeeding through 6 months. CONCLUSION: Maternal perception of Baby-Friendly Step adherence was associated with exclusive breastfeeding.

Breastfeeding Plan of Care for the Late Preterm Infant From Birth Through Discharge.

The focus of this clinical practice case is on the initiation of successful breastfeeding in the late preterm infant. The exploration of a case of a late preterm infant born at 360/7 weeks' gestation, delivered via cesarean section, at risk for breastfeeding challenges. Common difficulties encountered in the late preterm, defined as 340/7 to 366/7 weeks' gestation, include delayed lactogenesis, decreased milk transfer, and ineffective suck and swallow. This may lead to hospital readmission due to inadequate weight gain, dehydration, and/or hyperbilirubinemia. These difficulties often result in premature breastfeeding cessation. A management strategy incorporating an individualized mother's breastfeeding plan of care across 2 care continuums is a unique feature in this case presentation. Assessment of the mother-infant dyad provides the foundation to develop clinical strategies to initiate prompt individualized lactation support for the late preterm infant. Interventions focus on establishing maternal milk supply, facilitating milk transfer, and providing breast milk to the newborn. This case illustrates how developing an individualized in-hospital breastfeeding plan for the late preterm infant, followed by comprehensive primary care follow-up at discharge, can reduce the risk factors that lead to readmission in the late preterm birth and promote breastfeeding success.

Federal, state, and institutional regulations regarding a nursing student with a service animal.

Several universities are reporting increasing numbers of students using a service animal. Understanding the three types of assistance animals-service animal, therapy animal, and emotional support animal-will assist nursing educators in determining which animals are trained to provide a specific service to the student. Students with conditions as varied as diabetes, anxiety disorder, and seizures may benefit from a service animal. Reviewing the types of support these animals provide and federal, state, and local regulations related to service animal use will guide faculty members in preparing for a high quality learning experience for students who use a service animal. Query: Embase, CINAHL, PubMed.

Preparing for a student with a service animal.

This article offers guidance to nursing programs to assist in planning for a quality educational experience for a student with a service animal while ensuring patient safety and the continuation of efficient clinical operations. Nursing faculty should be aware of misperceptions about service animals in the workplace, address fears, concerns, and communicate plans for educating the student with the service animal to all faculty, staff and clinical personnel involved with the student. Examples are provided from experiences with multiple students using service dogs at two schools of nursing. Query: Embase, CINAHL, PubMed.

Academic-clinical service partnerships are innovative strategies to advance patient safety competence and leadership in prelicensure nursing students.

Nurse-graduates today must be prepared to practice in a complicated healthcare system with numerous safety challenges. Although patient safety and quality competencies are a priority in nursing education, effective strategies for applying this knowledge into practice are needed. To meet this challenge, the Helene Fuld Leadership Program for the Advancement of Patient Safety and Quality at Johns Hopkins School of Nursing has developed an academic-clinical service partnership. Students are assigned to mentored, quality improvement projects in which they complete 100 hours over 2 semesters. This partnership links the Fuld Fellows with an interprofessional network of Johns Hopkins Medical Entity clinical Quality Improvement leaders. The partnerships have lead to manuscripts, professional job opportunities, and quality networking for both our students and mentors. Our strategic, academic-service partnership has improved student knowledge of patient safety principles and promoted nursing competence in patient safety with the development of future patient safety and QI nurse leaders.

Results of a study on nursing students' success in taking advanced level (Graduate) pathophysiology in their basic nursing program.

Schools of nursing are encouraged to provide a course of study offering unique educational models that support the learning needs of adult students who attained a non-nursing Bachelor's Degree prior to enrolling in nursing school, Also known as nontraditional students, graduates of these programs often go on to seek graduate degrees in nursing (McKenna and Brooks, 2018). Non-traditional students may be older and desire to complete graduate education in a timely manner. The study focus was to determine if pre-licensure BSN students can successfully complete graduate course work during their pre-licensure BSN Program. The motivation for the student in the study would be to decrease the time and expense required to obtain a graduate degree. This study examined the success of the 39 students enrolled in a pre-licensure program who were permitted to enroll in a graduate pathophysiology course as their required pathophysiology course in their pre-licensure program in place of the required undergraduate pathophysiology course. While students enrolled in three other graduate courses in place of the comparable undergraduate course, pathophysiology has been identified as a particularly challenging course and a predictor of success in passing the nursing certification examination. (Dunn et al. 2013). Thus, success in this course is the focus of the study. The 39 students who enrolled in this study successfully completed the graduate pathophysiology course. There was no statistically significant difference in the final grade in the course between the 39 students in the study and the comparison group of 147 graduate students. The 39 students would be granted entry into the Masters Clinical Nurse Specialist Program after receiving their BSN if they achieved a 3.0 Grade Point Average (GPA) and received no grades below a B- in their graduate courses Thus, motivational theory was used as a theoretical framework for this study.

Comparing N-PASS and NIPS: Improving Pain Measurement in the Neonate.

BACKGROUND: Proper assessment of pain is essential to allow for safe and compassionate care of infants in the neonatal intensive care unit (NICU). The Neonatal Infant Pain Scale (NIPS) used in an urban level IV NICU addresses acute pain but may not adequately measure chronic neonatal pain. PURPOSE: The purpose of this quality improvement study was to improve acute and chronic pain measurements for neonates in an NICU through implementation of the Neonatal Pain, Agitation, and Sedation Scale (N-PASS). METHODS/SEARCH STRATEGY: An evidence search for a comprehensive tool to assess neonatal pain in the setting of a 45-bed level IV NICU was completed. The N-PASS was found to be inclusive of measuring acute and chronic neonatal pain. Participants for a quality improvement study, including NICU nurses and providers, were educated on the N-PASS. Nurses documented in the N-PASS and the NIPS during routine pain assessments for NICU infants for comparison. Participants completed a survey assessing knowledge of the N-PASS. FINDINGS/RESULTS: When compared, the N-PASS generated 98% of pain scores greater than the NIPS. Surveys demonstrated an increase in staff knowledge for the N-PASS. IMPLICATIONS FOR PRACTICE: Implementation of a multidimensional pain tool that measures acute and chronic pain is essential for proper pain assessment. Providers can manage neonatal pain when accurate documentation is available. IMPLICATIONS FOR RESEARCH: Further research evaluating guided management of acute and chronic pain scores on the N-PASS would aid hospital policies on therapies for neonatal pain.

Opioid Use Dependency in the Mother Who Desires to Breastfeed Her Newborn: A Case Study.

The number of infants born to mothers with opioid dependence is increasing at an alarming rate, indicating a 5-fold increase for women using opiates and a 3-fold increase in infants born with neonatal abstinence syndrome (NAS; Tsai & Doan, 2016 ). Pediatric Nurse Practitioners providing primary care, who lack experience with this clinical presentation, require evidence-based knowledge to provide the appropriate care to infants born with neonatal abstinence syndrome. Mothers with opioid dependence often desire to breastfeed their newborns, and the PNP may unknowingly discourage them from breastfeeding. In this case discussion, we describe how breastfeeding is possible and is beneficial. Current evidence-based practice recommendations and resources are included demonstrating that human breast milk has the potential to substantially improve health outcomes for all mothers and their newborns, especially this unique dyad (Tsai & Doan, 2016; Reece-Stremtan & Marinelli, 2015).

Management of natural health products in pediatrics: a provider-focused quality improvement project.

INTRODUCTION: The use of natural health products by pediatric patients is common, yet health care providers often do not provide management guidance. The purpose of this project was to improve management of natural health products by pediatric nurse practitioners. METHOD: Pediatric nurse practitioners from large metropolitan city were recruited (n = 32). A paired pretest-posttest design was used. Study participants were engaged to improve knowledge of natural health products, and a management toolkit was created and tested. RESULTS: Mean knowledge scores increased from 59.19 to 76.3 (p < .01). Management practices improved with regard to patient guidance (p < .01) and resource utilization (p < .01). Assessments of product use (p = .51) and drug/herb interactions (p = .35) were not significant. DISCUSSION: This investigation is the first known study to improve knowledge and management of natural health products in pediatric clinical practice.

Developing community partnerships in nursing education for children's health.

Community partnerships are central to educating nurses and providing much-needed services to underserved children in Baltimore City. Johns Hopkins University School of Nursing (JHUSON) collaborates with Head Start programs and a local elementary school for faculty practice and child-health clinical Service Learning experiences. At local Head Start programs, undergraduate nursing students annually screen > 1000 children for height, weight, hearing, vision, and blood pressure. Results are sent to parents with referral information if indicated. In addition, graduate and baccalaureate nursing students implement skills and knowledge learned in the classroom in a nurse-run clinic in a local elementary school, a faculty practice site. The Service Learning community partnerships benefit nursing students because they can apply principles of growth and development while providing important health screening to children in underserved populations. All students gain from practicing in the community and applying their classroom instruction to the care of children.