Leading the Way: Promoting Breastfeeding Education and Integrating Best Practices for Nurses in the Paediatric Acute Care Setting.
Summary
The Canadian Pediatric Society (CPS), Health Canada (HC) and World Health Organization (WHO) recognize breastfeeding as the optimal method of feeding infants and recommend exclusive breastfeeding for the first six months and beyond two years of life (CPS, 2018; HC, 2020; WHO, 2018). Benefits of breastfeeding for infants include fewer visits to the doctor and decreased incidence of asthma, while benefits to mothers include decreased risk of type II diabetes and breast cancer. Breastfeeding enhances bonding with infant and offers an economical and environmentally conscientious approach to providing tailor-made nourishment for infants (HC, 2020). Based on a gap analysis of the breastfeeding best practice guideline (RNAO, 2018) and current practices at CHEO, staff reported a lack of confidence and self-reported knowledge about breastfeeding, families reported a lack of supportive attitudes toward breastfeeding from CHEO staff and CHEO did not have an International Board Certified Lactation Consultant (IBCLC) to mentor and support breastfeeding best practices. Additionally, before this RNAO fellowship began, CHEO staff did not receive breastfeeding education during the hiring process and no breastfeeding education was offered periodically during the year. CHEO is a specialized paediatric acute-care hospital in Ottawa. Every year CHEO helps more than 500,000 children and youth in eastern Ontario and surrounding areas. CHEO supports thousands of infants with feeding related issues annually. Based on this preliminary feedback there was a clear need for more breastfeeding support for staff and families at CHEO. This fellowship has provided staff with education, improved parental satisfaction with breastfeeding support received and staff are now offered education on hire and periodically throughout the year. Additionally, CHEO is working towards creating a permanent IBCLC role for ongoing breastfeeding support for staff and families.
The overall learning goal of this fellowship was to gain leadership skills by leading the breastfeeding best practice guideline (BPG) implementation at CHEO. I developed leadership skills related to project management by coordinating, teaching and evaluating breastfeeding education for inpatient nurses. Additionally, I developed leadership skills in the role of an International Board Certified Lactation Consultant (IBCLC) by mentoring and coaching nurses to support the integration of new breastfeeding knowledge into practice at CHEO.
Outcomes
Thanks to the funding from this RNAO fellowship, I was able to coordinate onboarding education for all new hires, create a partnership with CMNRP to offer a Breastfeeding Workshops for pediatric nurses 3x/ year and offer Lactation Consultant support to breastfeeding families and staff 2 days/ week from April- September 2021. (With support of two additional RN/ IBCLCs we formed a Lactation Support team to provide LC support 5 days/ week at CHEO on a trial basis). Additionally, resources were added to the CHEO website for staff and families to access and business cards and patient mediated posters were created to link families to these resources and also allow us to gather just in time feedback from families with the use if QR codes. To date the LC support team have supported 300+ families and CHEO is now working on creating a permanent LC role to sustain the efforts of the best practice guideline implementation.
Outcomes:
-Parents are now rating breastfeeding support received at CHEO 9.6/10
-Families are receiving more support for breastfeeding as evidenced by an increase in rates of breastfeeding assessments offered in nursing documentation
-Infant 0-6 mths are now receiving more human milk during their admission since the beginning of the fellowship
-We have strengthened the link to community supports for breastfeeding related issues by increasing access to online breastfeeding resources for staff and families, and also created a partnership with The Monarch Centre for transition infant care needs such as jaundice and weight checks with a family doctor and IBCLC following discharge home.
-Preliminary data is showing a decrease in length of stay as well as decrease in readmission rates amongst infants 0-6 mths who received any human milk during their hospital stay.
-As of August 2021 nurses are reported increased confidence to support breastfeeding families at CHEO
-As of July 2021 breastfeeding education is now being offered to all new nurses hired as part of their nursing orientation at CHEO
-We have strengthen the link to community supports for breastfeeding related issues by increasing access to online breastfeeding resources for staff and families, we also have these resources available on a business card we can share with families during our LC consults.
-Offer breastfeeding support two days/ week to all breastfed/ breast milk fed infants who visit CHEO during this fellowship
-Staff are showing uptake of education as evidenced by an increase in rates of breastfeeding assessments completed since the fellowship began
-Show evidence of breastfeeding BPG implementation and knowledge translation of breastfeeding education as evidenced by annual reported numbers of health care providers that received breastfeeding education (including interdisciplinary staff members such as OT, dieticians, and residents/ fellows)
-Lastly, in partnership with the Champlain Maternal Newborn Regional Program (CMNRP) all nurses at CHEO and nurses at other pediatric centres in the Champlain region will have an opportunity to attend an virtual 8 hour breastfeeding workshop targeting the education needs of the pediatric nurse population at no extra fee
-I attended the 40 hour virtual Gold Lactation conference and completed the “Essential Communication Skills for Lactation Professionals” and “Translating Knowledge into Practice: Creating effective lactation care plans” add on education sessions. In light of the limitations of offering education in person during Covid times, I created a monthly virtual “Breastfeeding Chat” where I invited experts in the area to share about different breastfeeding topics (ie: Breastfeeding and Cannabis with guest speaker Christina Cantin, Perinatal Consultant, CMNRP; Supporting feeding goals of our indigenous families, with nurse from Nunavut etc). We took a break from these offerings over the summer but we plan to continue this initiative again starting in September 2021.
Overall experience
My experience completing this RNAO fellowship has been my greatest source of joy during the pandemic and one of great personal and professional growth. I would highly recommend the Advanced Clinical Fellowship Program to any nurse with a keen interest in growing professionally and personally especially if you have a particular passion for advancing the nursing profession in a particular area.
I have learned so much! From caring for families with physical disabilities to families with minimal social supports to learning how to support complex infant feeding issues as well as working as a content expert in an interdisciplinary team and learning more about the professional role of the IBCLC at a pediatric centre; our LC team has been growing professionally in leaps and bounds and we have only scratched the surface.
I am thankful for my fellowship experience for the opportunities to grow my leadership skills in planning, developing, communicating and evaluating education for nurses. Additionally, my fellowship experience has provided growth both personally as a mother and as a nurse by journeying with families in crisis and finding ways to support great needs for bonding and infant development related to breastfeeding especially when families find themselves at CHEO.
My greatest accomplishment of this fellowship was working with a fantastic team and getting to know so many more partners and resources at CHEO and within our community. We had so much help from so many different teams at CHEO, the many successes of this fellowship are greatly attributed to the overwhelming support we received from CHEO and the community; it was such a joy to work with different teams towards a common goal.
One of the greatest challenges of this fellowship was balancing my project work with my other responsibilities at CHEO. During the third wave of Covid 19, my critical care nursing skills were often requested in the NICU, away from my fellowship work and it was sometimes hard to get momentum going again.
