Breastfeeding the infant/child with a cardiac defect: an informal survey.

Despite the well-established benefits of breastfeeding, there is little literature about breastfeeding the infant with a congenital cardiac defect. This paper describes the experience of 12 mothers of infants with cardiac defects. These mothers responded to an informal survey and described numerous obstacles to success such as maternal fatigue, anxiety, separation from infant, institutional policy, and lack of support from health care providers. Mothers compared sources of help and identified coping strategies. Perceived benefits of breastfeeding included decreased illness, decreased stress, feeling part of the infant's health care team, and maintaining a relationship with the infant. Recommendations for assisting the mother nursing an infant with congenital heart disease are included.

Two evaluations of combined mother-infant versus separate postnatal nursing care.

Combined mother-infant postnatal nursing care was compared with traditional, separate postpartum and newborn care in two studies. In Study I, self-administered questionnaires were completed by 408 mothers and 63 staff nurses. Data were collected both before and after mother-infant care was implemented. Benefits of the new system included increased maternal competence and satisfaction with parent education, parent-infant contact, and the nurse-client relationship, increased staff satisfaction, with no increase in operational cost. There were no breastfeeding differences, but ways to improve duration were implied by reasons for stopping. These findings were replicated in a separate setting with similar sample sizes. However, in the latter case, low staff ratios appeared to limit the benefits of mother-infant care to multiparas rather than primiparas.

The provision and evaluation of a neonatal resuscitation program.

The need to train perinatal staff in neonatal resuscitation is widely accepted; however, standardized educational programs have not been available. This study used a randomized control trial to evaluate a one-day neonatal resuscitation education program with 190 nurses. Experimental subjects receiving the program had significantly improved knowledge and skill performance. Knowledge, but not skill performance, was maintained at six months for the experimental group. There was a significant relationship between subjects' self-rating of knowledge and performance, suggesting that this method could be used to prioritize staff for basic or refresher training. An effective format and evaluation instruments for neonatal resuscitation training have been developed. Strategies to maintain skills should be addressed in future research.

Evaluating hospital postnatal nursing care: development of the instruments.

Measures of the quality of hospital postnatal nursing care were developed for an evaluative study of the benefits of combined mother-infant versus traditional separate staffing patterns. Two hundred mothers completed instruments designed to measure maternal competence, patient satisfaction, establishment of breast-feeding in hospital and breast-feeding success at 6 weeks, and 28 nursing staff completed measures of staff satisfaction. The internal consistency and test-retest reliability of scales were supported by alpha coefficients of .60 to .89 and correlation coefficients of .74 to .80. A 90% participation rate and a 97% completion rate were achieved for the maternal sample. Evidence is presented for instrument content, construct, and predictive validity.

Combined mother-infant nursing care.

A survey of five Canadian agencies where mother-infant nursing has been implemented found that there is a significant trend toward this concept of care. Agency characteristics, program operational details, the change process, and benefits are examined. Recommendations are made regarding program planning, and the need for more rigorous program evaluation is emphasized.