Exclusive breastfeeding, breastfeeding self-efficacy and perception of milk supply among mothers in Singapore: A longitudinal study.

AIM: This study aimed to examine the factors that affect exclusive breastfeeding among mothers in Singapore. DESIGN & PARTICIPANTS: This was a longitudinal study over 6 months. Data was collected on 400 mothers with breastfed infants who attended at primary care clinics. METHOD: Mothers completed self-administered questionnaires on breastfeeding practices, demographic factors, breastfeeding self-efficacy and perception of milk supply at three time points: baseline and follow up visits at infant age 3 months and 6 months. The tools used were the Breastfeeding Self-Efficacy Scale (Short form) (BSES-SF) and Perception of Insufficient Milk (PIM) questionnaire. FINDINGS: Exclusive breastfeeding rate was 38.2% at infant age 6 months. Baseline breastfeeding self-efficacy and perception of milk supply scores were significantly higher for mothers who continued exclusive breastfeeding up to 6 months compared to those who had stopped exclusive breastfeeding (p < .01). Generalized Estimating Equation model (GEE) showed that mothers who had tertiary education (OR 2.65, 95% CI 1.24-5.66), planned to breastfeed for at least 6 months (OR 6.81, 95% CI 2.15-21.57), had baseline BSES-SF above 50 (OR 1.95, 95% CI 1.07-3.54) and PIM scores above 20 (OR 4.05, 95% CI 2.35-6.97) were significantly more likely to be exclusively breastfeeding at 6 months.

One size fits all? Challenges faced by physicians during shift handovers in a hospital with high sender/recipient ratio.

INTRODUCTION: The aim of the present study was to investigate the challenges faced by physicians during shift handovers in a university hospital that has a high handover sender/recipient ratio. METHODS: A multifaceted approach was adopted, comprising recording and analysis of handover information, rating of handover quality, and shadowing of handover recipients. Data was collected at the general medical ward of a university hospital in Singapore for a period of three months. Handover information transfer (i.e. senders' and recipients' verbal communication, and recipients' handwritten notes) and handover environmental factors were analysed. The relationship between 'to-do' tasks, and information transfer, handover quality and handover duration, were examined using analysis of variance. RESULTS: Verbal handovers for 152 patients were observed; handwritten notes on 102 (67.1%) patients and handover quality ratings for the handovers of 98 (64.5%) patients were collected. Although there was good task prioritisation (information transfer: p < 0.005, handover duration: p < 0.01), incomplete information transfer and poor implementation of nonmodifiable identifiers were observed. The high sender/recipient ratio of the hospital made face-to-face and/or bedside handover difficult to implement. Although the current handover method (i.e. use of telephone communication), allowed interactive communication, it resulted in systemic information loss due to the lack of written information. The handover environment was chaotic in the high sender/recipient ratio setting, and the physicians had no designated handover time or location. CONCLUSION: Handovers in high sender/recipient ratio settings are challenging. Efforts should be made to improve the handover processes in such situations, so that patient care is not compromised.