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Am J Perinatol 2022; 39(04): 379-386
DOI: 10.1055/s-0040-1716489
Original Article

The Effect of a 20-Hour Baby-Friendly Hospital Initiative Training Program on Nurses’ Breastfeeding Knowledge, Attitudes and Confidence, in a Tertiary Hospital in Singapore

Doris Fok
1   Department of Obstetrics and Gynaecology, National University of Singapore, Yong Loo Lin School of Medicine, Singapore, Singapore
,
Hsin Fang Chang
2   Department of Obstetrics and Gynaecology, National University Hospital, Singapore, Singapore
,
Ling Yan Meng
3   Department of Surgery, National University of Singapore, Yong Loo Lin School of Medicine, Singapore, Singapore
,
Yvonne Peng Mei Ng
4   Department of Paediatrics, National University of Singapore, Yong Loo Lin School of Medicine, Singapore, Singapore
5   Department of Neonatology, Khoo Teck Puat-National University Children’s Medical Institute, National University Hospital, Singapore, Singapore
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Funding None.
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Abstract

Objective The Baby-Friendly Hospital Initiative (BFHI) enables maternity units to be centers of breastfeeding support to increase breastfeeding rates. This study evaluates the impact of the 20-hour BFHI training course on nurses' breastfeeding knowledge, attitude, and confidence in breastfeeding practice in a tertiary hospital in Singapore.

Study Design Seventeen sessions of the 20-hour BFHI training course were conducted by lactation consultants from 2010 to 2013 at the National University Hospital, Singapore. An anonymous self-administered survey on knowledge, attitude, and confidence in breastfeeding practices were distributed to nurses before (2009) and after (2014) the training courses to assess effectiveness of training.

Results One-hundred forty nurses and one hundred forty-eight nurses participated in the surveys in 2009 and 2014, respectively. Majority were registered nurses who worked in the postnatal wards and the neonatal intensive care unit. After training, there were significant improvements for five of eight items in infant feeding knowledge, including greater awareness of the International Code of Marketing of Breastmilk Substitutes and medical contraindication for breastfeeding. Participants reported more confidence in assisting mothers on breastfeeding, 77.1 to 88.5% (p = 0.019); advising hand expressing breast milk, 75.7 to 86.5% (p = 0.012); and advising attachment to the breast, 75.7 to 89.2% (p = 0.004) in 2014 compared with 2009. However, despite having high levels of confidence, only about half the nurses reported being able to assist mothers in breastfeeding, mainly due to time constraints.

Conclusion Implementation of the 20-hour BFHI training program positively influenced nurses' breastfeeding knowledge, attitude, and confidence in breastfeeding practices. Hospital procedures and manpower requirements should be re-examined to overcome nursing constraints in providing breastfeeding help to postpartum mothers.

Key Points

  • Nurses have low breastfeeding knowledge pretraining.

  • The 20-hour BFHI training course is effective.

  • Nurses have inadequate time to support breastfeeding.

Keywords

Baby-Friendly Hospital Initiative - nurses - education - breastfeeding - knowledge - attitude - confidence

Note

Staff Survey on Infant Feeding was approved by the National Health Group Domain Specific Review Board. Reference numbers: DSRB 2009/00401 and DSRB 2014/00931.


Supplementary Material



Publication History

Received: 16 April 2020

Accepted: 31 July 2020

Article published online:
10 September 2020

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