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Abstract
The significance of breastfeeding, as opposed to the use of the formula, is crucial to the further physiological development of a child. An increase in the levels of breastfeeding across the globe has set as one of the critical initiatives of Health People 2020, yet the results of the specified endeavor have been quite minuscule so far. Therefore, a strategy for increasing the exclusivity of breastfeeding rates among postpartum women is indispensable in the management of health issues among infants.
The goal of this project is to prove that the use of breastfeeding role-play exercises has a tremendously positive impact on the rates of exclusivity of breastfeeding in postpartum women. The study seeks to examine the current gap in knowledge concerning the use of role-playing strategies as a means of enhancing the rates of breastfeeding among postpartum women. The study represents quantitative research. The data for which has been gathered with the help of a questionnaire aimed at determining the frequency of breastfeeding in postpartum women before and after the implementation of the suggested intervention.
The results of the study show that the use of the proposed method leads to an increase in the rates of breastfeeding exclusivity in postpartum women. However, further qualitative analysis may be required to analyze the reasons for postpartum women to decline exclusive breastfeeding. Thus, the implementation of research recommendations and the proposed intervention is likely to yield the maximum result.
Introduction
The importance of breastfeeding has been severely underestimated within the global community, leading to multiple health complications in infants. The promotion of breastfeeding exclusivity as the idea of breastfeeding being the only source of nutrients for infants has been on the agenda of the Healthy People 2020 initiative, yet very few milestones have been achieved in this direction (Centers for Disease Control and Prevention, 2018; Breastfeeding report card, 2018; NDNQI: A Press Ganey solution, 2016). These reports indicate that the drop in breastfeeding rates has been quite noticeable over the past decade, with only half of infants being breastfed after three months, and only 25% receiving breastfeeding after six months (Centers for Disease Control and Prevention, 2018; Patterson, Keuler, & Olson, 2018). However, for different reasons, most mothers prefer other feeding options after their children reach the age of 3 or 6 months (Heidari, Keshvari, & Kohan, 2016). Therefore, an intervention allowing to address the problem at hand is needed drastically.
To obtain more precise results on the selected healthcare problem, the author altered the PICOT question from a foreground to a background one. Thus, the PICOT question is, In pregnant African American women (P), will an educational program (I) compared to no education (C) increase the rate of breastfeeding (O) over three months (T)? The best method for evaluating the effect of the intervention would be to utilize a t-test, which would enable the DNP student to compare and contrast the findings pertaining to the intervention and referent groups. Therefore, it will be necessary to recruit pregnant women in the study, using such eligibility criteria as second- or third-trimester singleton pregnancy and the absence of premature birth risks. Other factors to consider will be the absence of conditions excluding or complicating breastfeeding and belonging to the African American race.
Problem Description
The described issue has a direct and profound impact on childrens health. Specifically, studies indicate that children who do not receive breast milk since their birth are predisposed to the development of health issues such as the infant being susceptible to the development of an array of health concerns. For instance, breast milk has been proven to prevent health issues such as diabetes, cardiovascular diseases, obesity, and even cancer in children (Gao, Wang, Qin, Dong, & Liu, 2018, p. 1).
Moreover, there is evidence that breastfeeding leads to a reduced threat of gastrointestinal infections in infants (Romano et al., 2016; Dallazen & Vitolo, 2017). Moreover, research has shown that breastfeeding also has an appositive impact on mothers, preventing them from developing different types of cancers, as well as osteoporosis (Kamoun & Spatz, 2018; Davie et al., 2019). The current practices used in the Temple Hospital University are rooted in the traditional approach, which deprives them of the chance to be used to educate patients and allow them to learn the opportunities that exclusive breastfeeding provides to their children, as well as themselves (The Joint Commission, 2018). Therefore, a strategy based on education through role-playing and similar activities is needed.
Rationale
The reasons for bringing the issue of breastfeeding exclusivity into the light mostly include the drop in health rates among mothers and infants, as well as a rise in infant mortality, caused by the unwillingness of mothers to breastfeed their children, or ceasing to breastfeed them at a reasonably early stage. Reports indicate that a significant number of women refuse to breastfeed their children after the latter reach the age of 3 or, at best, six months (England, 2017). The specified strategy has a drastically adverse effect on children, leading to a rise in mortality rates among them (Johnson et al., 2015; de Jager et al., 2015). Therefore, the project variables include exclusive breastfeeding rates in patients (dependent variable), the use of role-playing, and the traditional practices (independent variables).
Although the practice of breastfeeding has not been entirely abandoned by women globally, the general tendency toward a drop in the age of children that are weaned by their mothers is somewhat troubling presently (Kamoun & Spatz, 2018; Habtewold, 2019). Therefore, creating the strategy that would help to change the behaviors of breastfeeding mothers and encourage them to continue the specified practice is due (Ismail, Alina, Wan Muda, & Bakar, 2016; Khresheh & Ahmed, 2018). The primary rationale for this paper to examine the effects of a nurse leader-directed improvement in the rates of exclusive breastfeeding lies in the drastic decrease in the number of women who decide to continue breastfeeding, as well as the negative health consequences that the specified population, as well as their children, face (Islam et al., 2019; Kanhadilok et al., 2016). Studying the specified issue has a massive relevance for the nursing practice since it will inform the decision-making when addressing the problem of refusal to breastfeed among mothers of infants in other communities.
Specific Aims
The goals of the project include the development of effective practice for maintaining the exclusivity of breastfeeding in young mothers and its comparison to that one used presently in the target hospital setting. In the course of this project, the strategy of using scripting and roleplaying will be compared to the traditional tools for improving the rates of breastfeeding among postpartum women. It is believed that the suggested method of using roleplaying will allow cementing the necessity to breastfeed among the postpartum women at the Temple University Hospital due to the personalized approach and the focus on improving patient education. The provision of the necessary instructions and resources is likely to have a tremendously positive outcome in terms of increasing the rates of breastfeeding exclusivity in the target demographic (Lau, Ho-Lim, Im Lim, & Chi, 2019; Saffari, Pakpour, & Chen, 2017; Howell, Bodnar-Deren, Balbierz, Parides, & Bickell, 2014).
Individually, the levels of health literacy and awareness, particularly regarding the importance of breastfeeding, will be tested among the participants. It will be necessary to gauge the extent of the lack of knowledge in postpartum women at Temple so that an appropriate strategy could be applied. Also, the objective of evaluating changes in womens perceptions of breastfeeding before and after the intervention should be seen as an essential part of the research. By considering the changes in womens attitudes, one will be able to determine the extent of the problem and the ability with which the proposed strategy of roleplaying should be applied to the chosen setting of the Temple University Hospital.
The PICOT question that this paper strives to answer is, in breastfeeding mothers located in the Temple Hospital University, does the application of an intervention based on role-playing and the associated tools help to improve the rates of breastfeeding compared to the traditional model? The central hypothesis of this research implies that the introduction of role-playing techniques as the basis for patient education and the provision of relevant information to mothers of infants leads to an improvement in exclusive breastfeeding rates.
The Evaluation Method and Its Meaning
The selected evaluation method is both the most suitable and reliable one. Such tests allow identifying the statistical significance (or the lack of it) in the data analyzed. Statistical Package for the Social Sciences (SPSS) will be utilized to run the test and assess the results received. Scholars employ this approach is frequently both in general and specifically in studying breastfeeding intervention effects. Overall, researchers commonly use statistical tests to evaluate the effect of breastfeeding education effects. Bonuck et al. (2014) have employed a statistical test to check the impact of an intervention on breastfeeding intensity and duration. Giglia, Cox, Zhao, and Binns (2015) have investigated the influence of an Internet intervention on the breastfeeding rate increase with the help of the chi-squared test. The study by Wu, Hu, McCoy, and Efird (2014) has involved the analysis of variance (ANOVA) F-test to analyze the effect of a breastfeeding self-efficacy intervention on womens decisions regarding the issue. Thus, one can justify the use of a t-test by positive examples from other studies since scholars report statistical tests to offer the most accurate results on the evidence-based problem.
The numbers in the test will mean the rate of change in womens attitudes toward breastfeeding after the intervention. The author expects that in the intervention group, the rate will be higher than in the referent group. The minimal significance level of the test will be 0.05. If the difference between the two groups is 0.05 or higher, the intervention will be considered as successful. Following the study by Howell, Bodnar-Deren, Balbierz, Parides, and Bickell (2014), the independent variable of the present paper will be the intervention status (positive or negative). The dependent variable will be the educational intervention.
The Significance of the Result
The result will matter because the current level of breastfeeding among the target population group is too low to be sufficient. As Jones, Power, Queenan, and Schulkin (2015) have found, minority women, face more barriers to breastfeeding than the general population. The lack of proper education on the matter is one of such obstacles, so the results of an educational intervention will indicate whether and to what extent such approaches can help mitigate the problem.
Benchmarks, NDNQI Data, and KPI Metrics
The Centers for Disease Control and Prevention have set the benchmarks for breastfeeding. Specifically, the American Academy of Pediatrics advises breastfeeding as the exclusive approach to feeding infants for the first six months ( Breastfeeding report card, 2018). Another benchmark is the combination of breastfeeding with complementary foods from the sixth to the twelfth month. The National Database for Nursing Quality Indicators (NDNQI) views education on and assistance with breastfeeding as one of the core nursing competencies ( NDNQI: A Press Ganey solution, 2016). Also, the NDNQI data indicate that breastfeeding is one of the risk factors for newborn falls and drops (The Joint Commission, 2018). Thus, these data show that some of the most esteemed healthcare institutions evaluate the significance of breastfeeding highly.
To evaluate the clinical practice change, the author will utilize several KPI metrics. First of all, the study will evaluate patient satisfaction and patient experience rates. These measures will help to assess the effectiveness of the intervention. Additionally, they will promote the understanding of patients satisfaction levels. The researcher (DNP student) will exploit the first metric chosen for evaluation only once, after the intervention. It is possible to make use of a questionnaire at this point to find out patients perceptions about their participation in the project. Those content with the results will constitute the high-satisfied group, whereas those not content with the outcomes will form the low-satisfied group. The overall state of wellbeing, as well as the physical and mental health of participants and their newborn children, will serve as an indicator of patient satisfaction. The more patients report positive effects of the intervention, the more useful the project will be. This KPI metric is rather crucial since the very essence of any healthcare-related process is the improvement of peoples health.
Secondly, the study will compare operation costs before and after the intervention. It is no secret that hospitals sometimes have to spend too much money on longer patient stays or readmissions. The lack of breastfeeding leads to the deterioration of childrens health. As a result, much financial support at the moment applies to deal with the health problems of newborns from African American families (Johnson, Kirk, Rosenblum, & Muzik, 2015). To evaluate the effectiveness of the intervention, the (researcher (DNP student) will record operation costs related to healthcare programs involving newborns before and after the project. The author expects that after the intervention, operation costs of the hospital will become lower, and the healthcare facility will be able to save money on some urgent needs.
Finally, it will be necessary to evaluate the operational workload to assess whether it has decreased after the intervention. As well as the previous measure, operation costs, the operational workload is a crucial factor impacting the functioning of the hospital. The fewer women choose to adhere to breastfeeding practices, the worse immune systems their babies have. The more babies become ill, the more personnel are required to look after them. Frequently, hospitals experience nursing shortages, which affects the operations in the facility badly. The evaluation of operational workload before and after the intervention will allow tracing whether the project has enhanced the workload and alleviated the healthcare professionals burnout. The identified KPI measures will make it possible to assess whether the project has been successful.
Definition of Terms
Before proceeding to the further examination of the problem, one will need to pinpoint some of the most common terms to be used in this paper later. Exclusive breastfeeding is the strategy of breastfeeding that implies no other food or drink, not even water, except breast milk (including milk expressed or from a wet nurse) for six months of life, but allows the infant to receive ORS, drops, and syrups (vitamins, minerals, and medicines), according to the World Health Organization (2020, para. 8).
Chapter Summary
The critical areas presented in this chapter are the problem of the lack of willingness to breastfeed among the mothers of infants and the resulting increase in the infants susceptibility toward various health issues, including the threat of diabetes, CVD issues, respiratory concerns, and many other health problems. The chapter also outlines briefly the rationale for this study to take place, namely, the fact that the current state of research on the effects of low rates of exclusive breastfeeding on infants could use additional data. Moreover, the lack of information about the reasons for mothers to refuse to breastfeed, as well as the strategies for encouraging mothers to resume breastfeeding or to start it in its particular form, indicates that further research is needed (Jones, Power, Queenan, & Schulkin, 2015).
The PICOT question that this paper strives to answer is, in breastfeeding mothers located in the Temple Hospital University, does the application of an intervention based on role-playing and the associated tools help to improve the rates of breastfeeding compared to the traditional model? The leading theory of this study implies that the introduction of role-playing and scripting techniques as the basis for patient education and the provision of relevant information to mothers of infants leads to an improvement in exclusive breastfeeding rates.
Search Strategy
The process of locating the necessary resources to review the recent studies in breastfeeding and the associated concerns required using scholarly databases such as Google Scholar, CINAHL, PubMed, and Medline. In the course of the search, the following keywords were used: breastfeeding exclusivity, breastfeeding postpartum women, exclusive breastfeeding rates drop, and exclusive breastfeeding strategies encourage mothers. The specified keywords have helped to identify the primary sources of information concerning the scope of the problems, the existing frameworks for promoting exclusive breastfeeding, the outcomes of the failure to implement exclusive breastfeeding, and the current gaps in the literature.
The main inclusion criteria were the topic matching the required one, the publishing date, the source (only peer-reviewed journals were used), and the credentials of the authors. Thus, the relevance, credibility, and reliability of the articles found in the process were maintained. The exclusion criteria, in turn, were limited to the materials in non-peer-reviewed journals and the studies that were published in 2015 and earlier.
In the course of the search, 48 articles were located and incorporated into the list of references to be used in this study. The reasons for selecting the specified materials over the rest of the search results included the extent to which they addressed the issue of breastfeeding, as well as their characteristics such as the publishing date and the usefulness for the research. For instance, the papers by Giglia, Cox, Zhao, and Binns (2015) and Srinivas, Benson, Worley, and Schulte (2015) were exclusively selected due to their focus on the existing options for encouraging breastfeeding in mothers of infants, as well as their attention on the effects that the absence or lack of breastfeeding entails for children.
EBP Model
Implementing a useful EBP model is a critical step in introducing change to the nursing environment. For this study, the Johns Hopkins EBP Model was chosen due to the options for patient education that it provides, along with the opportunities for improving EBP-based research. The model incorporates three foundational concepts of practice, research, and culture, with the emphasis on the assessment and understanding of the internal and external factors affecting the efficacy and integrity of research results (see Fig. 1). Namely, the issues such as culture and environment, as well as the concerns related to supplies, staffing, and standards are defined as internal factors shaping practice, education, ad research (Linares, Rayens, Gomez, Gokun, & Dignan, 2015; Thomson, Tussing-Humphreys, Goodman, Landry, & Olender, 2016). Alongside the specified issues, the phenomena of accreditation, legislation, quality measures, regulations, and standards are identified as external factors affecting research, education, and healthcare practice (Johnson et al., 2015; Bai, Fong, & Tarrant, 2015). The model provides the pillars to support the current research since it helps to delve into the problem of the refusal of breastfeeding using study and considering the impact of external factors through patient education (England, 2017; Linares et al., 2017; Wallwiener et al., 2016). Overall, the model fully supports the project and allows implementing it properly in the target nursing setting of the Temple University Hospital.
Available Knowledge
A brief look at the existing state of research on the subject matter indicates that there is sufficient information on the changes in the rates of breastfeeding across the U.S. The drastic effects of failing to provide infants with actual breast milk instead of the formula are also covered extensively in the existing studies. For instance, the NOVITA Study Group (2016) mentions the critical health concerns that children are likely to develop unless provided with breast milk, including the propensity toward diabetes and CVD. Likewise, Horie et al. (2017) mention that the levels of hemoglobin are likely to be drastically low in children hat do not receive breastfeeding as infants. Therefore, the existing evidence points to the necessity to resolve the problem raised in the PICOT question of this paper.
Furthermore, the effects of traditional strategies for managing the evident reluctance toward breastfeeding in mothers of infants have been studied in depth. For example, the paper by England (2017) analyzes the efficacy of the strategies deployed in the Indian healthcare context to prompt breastfeeding practices among Indian mothers. Concerning the PICOT question of this paper, the specified information indicates that there are quite a several approaches toward encouraging mothers to breastfed. Yet, the presence of inhibiting factors, of which there is a large variety, including cultural, socioeconomic, financial, technological, and many other ones, prevents mothers from exclusivity breastfeeding practices (Ball et al., 2016; Castro et al., 2017).
The specified evidence magnifies the importance of the PICOT question that this paper strives to answer; namely, the advantages of the role-playing approach compared to the traditional set of techniques used to convince women to perform breastfeeding until the child reaches the age of six months. Therefore, the studies in question have a direct relation to the problem at hand and are indispensable for its resolution.
Finally, the reasoning that mothers typically use when refraining from breastfeeding practices has been examined thoroughly. For example, the paper by Kamoun and Spatz (2018) mentions sociocultural factors, primarily, cultural beliefs, lying at the basis of the decision to wean an infant at a very young age (Chipojola et al., 2019). Individually, Kamoun and Spatz (2018) examine the traditional practices in the African American Muslim culture to investigate the underlying causes of women refusing to breastfeed in the conditions that do not imply any other restraints otherwise.
Besides, barriers to proper health must be acknowledged and recognized by other parties as well. Namely, the awareness issues and the phenomenon of maternal knowledge need to be studied in greater depth, as the paper by Thomas et al. (2015) suggests. It is crucial to ensure that vulnerable groups, which are represented the mothers of infant children in a case in point, are provided with access to the relevant literature and databases of knowledge. However, in the described situation, young mothers have minimal opportunity to seek additional information unless approached by nurses and provided with encouragement in their pursuit of further awareness. Therefore, it is critical to ensure that the promotion of awareness becomes an essential part of the described challenge (Moudi, Tafazoli, Boskabadi, Ebrahimzadeh, & Salehiniya, 2016). Without the support of the critical information about the health concerns that infants and their mothers may face unless breastfeeding is promoted as an essential practice, further improvements in the rise in breastfeeding rates are highly questionable.
However, there is also a noticeable gap in knowledge of the subject matter. Namely, very few of the related studies seek to explore the opportunities for promoting breastfeeding to patients beyond the traditional framework (Bonuck et al., 2014; Ravishankar, Joseph, & Shashidhara, 2019). As a result, the effects of the current strategy for managing the problem of health issues in infants that do not receive enough breastfeeding remain minuscule (Johnson, Kirk, Rosenblum, & Muzik, 2015).
Chapter Summary
This chapter provides an overview of critical information about the current state of research concerning the problem of breastfeeding. The available knowledge indicates that mothers of infants typically lack the knowledge and awareness needed to encourage them to offer their children breastfeeding until the age of six months (Jin, Wang, Wang, Qiao, & Nan, 2020; Ware, Webb, & Levy, 2014). Therefore, the Johns Hopkins EBP Model is expected to assist in changing the perspective of the target demographic and creating the environment in which young mothers of infant children will be willing to breastfeed and, thus, help their children to avoid drastic health consequences.
Conclusion
Overall, the assessment of the latest data on the problem of breastfeeding indicates that an introduction of an innovative strategy for handling the situation observed currently is needed. Individually, none of the papers addresses the importance of role-playing as a potential strategy for convincing mothers to breastfeed their children until six months so that infants could receive the nutrients that would allow them to develop immunity toward a range of health issues, as well as resilience toward a variety of health concerns. Therefore, further study of the problem needs to be continued so that strategies for addressing the issue of breastfeeding could be proposed.
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