Factors Associated With Exclusive Direct Breastfeeding in the First 3 Months.

OBJECTIVE: To identify factors associated with exclusive direct breastfeeding in the first 3 months among mother and infant dyads living in the United States. DESIGN: A secondary analysis of data collected using a cross-sectional online survey completed over a 4-month period in late 2019. PARTICIPANTS: We recruited a convenience sample of 370 mothers with healthy full-term singleton infants between 1 and 12 weeks of age whose feeding methods consisted of direct breastfeeding at least once a day. Mothers had not returned to work/school at the time of the survey completion. MEASUREMENTS: The questionnaire consisted of 34 questions about maternal and infant factors that influence decisions about infant feeding, professional support, and parental preferences. RESULTS: Mothers who practiced feeding on demand (adjusted OR [aOR] = 35.76, 95% confidence interval [CI] [2.04, 500.00]) and mothers of infants 1 to 4 weeks of age (aOR = 2.74, 95% CI [1.54, 4.85]) were more likely to use exclusive direct breastfeeding. The odds of exclusive direct breastfeeding decreased with mothers who breastfed with a nipple shield while in the hospital/birth center/home (aOR = 0.13, 95% CI [0.05, 0.35]), used pacifiers (aOR = 0.31, 95% CI [0.21, 0.65]), or had perceptions of insufficient milk (aOR = 0.11, 95% CI [0.04, 0.26]). CONCLUSION: Demand feeding and an infant's age of 1 to 4 weeks contributed to exclusive direct breastfeeding. Lower rates of exclusive direct breastfeeding were associated with the use of nipple shields immediately after birth, pacifier use, and perceptions of insufficient milk. Further investigation is warranted to fully differentiate exclusive direct breastfeeding from exclusive breastfeeding.

Examination of Factors That Contribute to Breastfeeding Disparities and Inequities for Black Women in the US.

Breastmilk is considered the optimal nutrition for newborns. US Black women continue to have the lowest breastfeeding initiation and duration rates. This Perspective examines factors associated with breastfeeding disparities and inequities among Black women through the lens of critical race theory and the social-ecological model. Recommendations to increase breastfeeding rates in this population include increased communication and educational strategies by health care professionals, education to recognize implicit bias and systemic racism in our health care system, early prenatal and ongoing postpartum breastfeeding support, increased community support, and breastfeeding groups developed by and for Black women. In addition, equity policies such as paid maternity leave and work policies that support milk expression would provide needed institutional support for women in the workplace.

Factors Associated with Perceived Insufficient Milk in the First Three Months of Breastfeeding.

PURPOSE: Perceived insufficient milk is the predominant risk factor for early breastfeeding discontinuation globally. The purpose of this study was to explore the association between perceived insufficient milk in the first 3 months and infant factors, maternal factors, professional support, parenting decisions, and breastfeeding concerns. Sixty-nine mothers who had perceived insufficient milk and 301 mothers who did not were included. STUDY DESIGN AND METHODS: A cross-sectional online survey design was used in a convenience sample of 370 U.S. mothers with a healthy singleton infant between 1 and 12 weeks who were breastfeeding directly on the breast as part of their feeding methods. RESULTS: Using stratified multivariable logistic regression, we found that among 102 mothers of infants < 4 weeks of age, planned breastfeeding duration < 6 months (OR = 13.17; 95% CI [1.42, 122.48], p = .024), and concerns about infant crying or fussing (OR = 4.72; 95% CI [1.10, 20.00], p = .03) were associated with perceived insufficient milk. Among 256 mothers of infants 4 to 12 weeks of age, concerns about frequent feedings (OR = 4.05; 95% CI [1.95, 8.40], p = .000) and latching difficulty (OR = 2.95; 95% CI [1.33, 6.54], p = .008) were associated with perceived insufficient milk. CLINICAL IMPLICATIONS: Association between factors and perceived insufficient milk differed based on infant age. Maternal perceptions of crying or fussing, frequent feedings, and latching difficulty need to be assessed because of its attribution to perceived insufficient milk.

Mobility Programs for the Hospitalized Older Adult: A Scoping Review.

Objectives: This scoping review (a) describes programs to improve mobility in hospitalized adults and (b) determines the methods used to measure mobility. Method: The Joanna Briggs Institute Methodology for Scoping Reviews was used to conduct this review. Results: Our findings suggest that using a multidisciplinary approach may be the most effective way to promote mobility in hospitalized older adults. Most studies did not articulate how physical activity was measured, indicating that more research is needed. Discussion: The literature shows that implementation of protocols designed to improve the early and regular implementation of physical mobility activities improves the health outcomes of hospitalized older people. Costs associated with healthcare utilization are also reduced, including hospital length of stay. Mobility programs that quantified mobility through validated measurement tools or accelerometers are the most promising as they provide feedback that reinforces progress of the patient and the expected benefits of early mobility.

Training for the Air Force fitness assessment: the experience of postpartum women.

Active duty personnel in the U.S. Air Force (USAF) are required to pass periodic fitness assessments in order to facilitate and evaluate physical readiness. Pregnant women are exempt from testing but must take the fitness test 6 months after childbirth. However, evidence from prior research indicates that in the first 6 months postpartum, women may not achieve prepregnancy fitness levels and may be more vulnerable to mental and physical health problems. It is important for health care clinicians to understand how training for the USAF fitness test after childbirth may impact health and well-being. The purpose of this study was to develop a deep understanding of the experiences of postpartum USAF women as they train for their fitness assessment. Understanding was sought through a phenomenological study by interpreting the meaning of the lived experiences of 17 active duty women at two USAF bases. Two overarching patterns emerged from this analysis: "Striving to Perform under Pressure through Profound Life Transitions of Childbirth" and "Seeking Understanding from Others." These results provide insight into the challenges postpartum women encounter while training for their fitness assessments, and they can inform practices that facilitate efforts of women in returning to optimal fitness and well-being.

The value of community-focused interprofessional care in peru for developing cultural competency in health professions students.

International immersion experiences for health-care students have increased over the past 10 years. Students and faculty expect these experiences to increase cultural competency; however, research on outcomes of these programs has lacked rigor. Over a 4-year period, groups of nursing and other health professions students spent 3 weeks in Peru providing primary care and health education. Students attended pre-departure seminars addressing personal travel health and safety, culture and health care in Peru, working with interpreters, and ethics of international health care. Student participants (N=77) completed an instrument assessing self-perceived cultural competency before and after the experience. Results of pre- and post-immersion scores showed significant increases in perceived cultural competency and increased self-efficacy in cultural knowledge, skills, and attitudes for four groups of students. Implications and future directions are discussed and recommended.

Changes in Air Force fitness measurements pre- and post-childbirth.

U.S. Air Force (USAF) personnel are required to take periodic fitness assessments with minimum requirements to earn satisfactory performance evaluations. Active duty women are exempt from fitness testing during pregnancy and until 6 months postpartum. Although there is evidence that many women do not achieve prepregnancy fitness levels by 6 months postpartum, no published studies were found that evaluated changes in fitness measurements and assessment pass rates in active duty USAF women after childbirth. The purpose of this study was to compare USAF fitness assessment component measurements and overall pass rates at 6 months postpartum to prepregnancy measurements. A paired t-test analysis of fitness component measurements of 107 active duty women showed significantly larger abdominal circumferences, fewer push-up repetitions, and longer run times at 6 months postpartum when compared to prepregnancy assessments. No significant difference was found in sit-up measurements. Secondly, there was a significantly lower pass rate at 6-months postpartum compared to the prepregnancy time frame. Results from this study indicate that women may struggle to achieve prepregnant fitness levels and pass their fitness test by 6 months postpartum. More research is needed to discover which factors impact women's ability to successfully meet fitness standards postpartum.

Deliberate practice of motor skills in nursing education: CPR as exemplar.

Our study explored the effects of deliberate practice on the retention ofcardiopulmonary resuscitation (CPR) psychomotor skills among nursing students. The practice sessions were short, six minutes a session one time a month. Differences in performance between students who had deliberate practice and a control group, with no practice beyond the initial training, were compared every three months for one year. The intervention group performed better than the control over the 12 months. There is a need in nursing education for deliberate practice of relevant and high-use skills for students to improve their performance and gradually develop their expertise.

HeartCode BLS with voice assisted manikin for teaching nursing students: preliminary results.

The purpose of this study was to evaluate the effectiveness of HeartCode BLS, a self-directed, computer-based course for obtaining basic life support (BLS) certification. For part 2 of the course, students learned and practiced their cardiopulmonary resuscitation (CPR) psychomotor skills on a voice assisted manikin (VAM). Students from 10 schools of nursing were randomly assigned to two types of CPR training: HeartCode BLS with VAM or the standard, instructor-led (IL) course with manikins that were not voice assisted; 264 students trained using HeartCode BLS and 339 had an IL course. When students passed their respective courses and were certified in BLS, their CPR skills were tested using the Laerdal PC SkillReporting System. Students who trained using HeartCode BLS and practiced their CPR skills on VAMs were significantly more accurate in their ventilations, compressions, and single-rescuer CPR than students who had the standard, IL course with regular manikins.

Outcomes of teaching baccalaureate nursing students about mastitis utilizing a multimodal teaching tool.

Annually, 10-33% of U.S. lactating women develop mastitis. Often underreported, mastitis has acute and chronic sequelae with rare documented cases of invasive breast surgery due to pervasive infection. Evidenced-based prevention, early recognition, and treatment of mastitis are not emphasized in the undergraduate nursing profession textbooks or academic settings. Using current evidence-based research on postpartum mastitis, and concepts of maximizing cognition, this pre and post test study examines the knowledge acquired and retained utilizing traditional teaching methods compared to a multimodal teaching video on mastitis with a baccalaureate nursing student population. A significant difference in knowledge acquisition was noted between pre and post tests results. Furthermore, using Benner's novice to expert criteria, baccalaureate student nurses improved their ability to articulate lay and professional descriptions of and treatment for mastitis. These results emphasize the significance of lactation curricula in undergraduate nursing programs and the importance of utilizing multimodal delivery methods.