Implementing an Evidence-Based Feeding Protocol: Impact on Nurses' Knowledge, Perceptions, and Feeding Culture in the NICU.

BACKGROUND: Evidence-based feeding practices are often variable among neonatal providers due to lack of knowledge and neonatal intensive care unit (NICU) feeding culture norms. PURPOSE: To evaluate changes in NICU nurses' knowledge, perceptions, feeding practices and culture following education about, and implementation of, an evidence-based Infant-Driven Feeding (IDF) protocol. METHODS: A pre-/postprospective comparative design was used to survey 120 registered nurses employed in a level 3 NICU about feeding practices, knowledge, and culture prior to IDF education and 1 to 2 months after IDF implementation. RESULTS: The preeducation survey yielded 59 respondents; of these, 30 responded to the same survey after IDF implementation. Postimplementation responses were significant for fewer nurses making decisions to begin oral feedings ( P = .035), greater use of gestational age to increase frequency of oral feeding attempts ( P = .03), less reliance on weight loss to decrease oral feeding attempts ( P = .018), an increase in use of combination interventions to prepare infants for oral feeding ( P = .001), and greater willingness to allow a rest period or stop the feeding if an infant falls asleep after completing 70% of the feeding ( P = .03). IMPLICATIONS FOR PRACTICE AND RESEARCH: Trends in several survey categories following the education program and implementation of IDF support the use of evidence-based practices (EBPs) such as IDF. Future research focused on nurses' perceptions of how education influences integration of specific EBPs into practice is needed. Evaluating EBP mentorship combined with education about EBPs can provide insights on how best to integrate EBPs into practice.

Impact of Maternal Severe Acute Respiratory Syndrome Coronavirus 2 Detection on Breastfeeding Due to Infant Separation at Birth.

OBJECTIVE: To assess the impact of separation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction (PCR)-positive mother-newborn dyads on breastfeeding outcomes. STUDY DESIGN: This observational longitudinal cohort study of mothers with SARS-CoV-2 PCR-and their infants at 3 NYU Langone Health hospitals was conducted between March 25, 2020, and May 30, 2020. Mothers were surveyed by telephone regarding predelivery feeding plans, in-hospital feeding, and home feeding of their neonates. Any change prompted an additional question to determine whether this change was due to coronavirus disease-2019 (COVID-19). RESULTS: Of the 160 mother-newborn dyads, 103 mothers were reached by telephone, and 85 consented to participate. There was no significant difference in the predelivery feeding plan between the separated and unseparated dyads (P = .268). Higher rates of breastfeeding were observed in the unseparated dyads compared with the separated dyads both in the hospital (P < .001) and at home (P = .012). Only 2 mothers in each group reported expressed breast milk as the hospital feeding source (5.6% of unseparated vs 4.1% of separated). COVID-19 was more commonly cited as the reason for change in the separated group (49.0% vs 16.7%; P < .001). When the dyads were further stratified by symptom status into 4 groups-asymptomatic separated, asymptomatic unseparated, symptomatic separated, and symptomatic unseparated-the results remained unchanged. CONCLUSIONS: In the setting of COVID-19, separation of mother-newborn dyads impacts breastfeeding outcomes, with lower rates of breastfeeding both during hospitalization and at home following discharge compared with unseparated mothers and infants. No evidence of vertical transmission was observed; 1 case of postnatal transmission occurred from an unmasked symptomatic mother who held her infant at birth.

Psychometric Validation of the Family Nurse Caring Belief Scale in a Neonatal Nursing Population.

PURPOSE: To psychometrically validate and strengthen the construct validity of the Family Nurse Caring Belief Scale (FNCBS) with a sample of neonatal nurses. DESIGN AND METHODS: Confirmatory factor analysis of the 25-item FNCBS, using the factor structure based on the original exploratory principal components analysis, was performed to evaluate the psychometric properties of the FNCBS with the neonatal nurse population. RESULTS: Confirmatory factor analysis (CFA) examined the factor structure of the FNCBS using the sample of neonatal nurses. The chi-square test determined overall model fit. Comparative fit index (CFI) and Tucker-Lewis index (TLI) were both <0.90 therefore, neither of these indices indicated good fit. The root mean square of error approximation (RMSEA) of the sample data was >0.06 and the standardized root mean square residual (SRMR) of the sample data is >0.08 and, therefore, the data did not demonstrate good fit. In addition, the factor correlations between the four latent variables were small. This suggests there is no parsimony and the sample data with neonatal nurses did not fit the model. CONCLUSION: The findings suggest the FNCBS was not psychometrically validated with the population of neonatal nurses and this study was unable to strengthen the construct validity of the FNCBS beyond the pediatric nurse sample in the original study. IMPLICATIONS FOR PRACTICE: This study highlighted the opportunity for continued research in the area of measuring nurses' beliefs regarding the provision of family-sensitive care to families in crisis and will generate a revision of the FNCBS to incorporate concepts which are important to care for a family unit.

Transforming a care delivery model to increase breastfeeding.

This article describes the process of changing the care delivery model for maternity practice in a New York State Regional Perinatal Center to support exclusive breastfeeding, defined as providing nothing other than human milk feedings. Barriers exist in hospitals that inhibit exclusive breastfeeding of newborns at the time of discharge and fail to meet the recommendations outlined by the World Health Organization and New York State Department of Health. All aspects of mother/baby care were evaluated to meet the recommendations and increase exclusive breastfeeding. Transforming the care delivery model for mothers and babies began in 2010 with an invitation to participate in the New York State Breastfeeding Quality Improvement in Hospitals Learning Collaborative. Twelve hospitals were selected to participate with the following objectives: increase exclusive breastfeeding; improve hospital breastfeeding policies, practices, and systems that are consistent with New York State hospital regulations, laws and recommended best practices; increase staff skills and knowledge of breastfeeding and lactation support through education; empower, educate, and support new mothers to successfully breastfeed and change the culture and social norm relative to breastfeeding. The transformation of the care delivery model resulted in an increase in exclusive breastfeeding from 6% to 44%.