Breastfeeding Education for Nurses in Rural Rwanda

Background:An infant's survival is highly dependent on their ability to effectively breastfeed. Effective breastfeeding and expression of breastmilk require the foundational efforts of mother, infant, and supportive nursing staff. Ineffective breastfeeding leads to undernutrition, increases the infant's risk for infection, and delays their recovery from illness. Infants in the neonatal unit face increased mortality and morbidity risk from inadequate breastfeeding due to low birth weight or illness. Nurses in the neonatal unit at a district hospital in Rwanda do not teach mothers how to breastfeed and have never received breastfeeding education. Training nurses to help mothers effectively express milk and breastfeed their infants while in the hospital can mitigate this risk. Methods:Nurses (6) completed a needs assessment that verified their desire to learn about breastfeeding and their preferred learning methods. A five-question pre-test identified their baseline knowledge and directed teaching objectives. Educational materials were developed in coordination with local advice and included handouts, a breast simulator, and a simulation checklist. Nurses received instruction and training in small groups over several sessions. Content included basic breast anatomy, instruction on how to express breastmilk, and steps to successful breastfeeding. Following the training, all nurses completed a matched five-question post-test to determine the effectiveness of the education and to assess their knowledge. After the training, nurses recorded the number of mothers they taught with their new skills for three months. They also viewed two breastfeeding skills videos to reinforce the training and answered questions upon completion. Four months after the initial training, nurses completed the same post-test to evaluate their retained knowledge. In addition, a focus group was held with the nurses to explore their perspectives of the training. Results: Pre-intervention, participants answered 34.7% of pre-test questions correctly. Post-intervention, 81.9% of questions were answered correctly for a 47.2% increase in knowledge. In the final post-test, participants answered 75% of the questions correctly; a 40.3% increase from the pre-test and 6.9% decrease in knowledge from the initial post-test. Nurses recorded teaching forms for all 132 patients admitted to the unit over a three-month period. Thirty-one mothers (23%) received breastfeeding education, four (3%) received education on expression of breastmilk, 60 mothers (45%) received both breastfeeding and breastmilk expression education, and 37 mothers (28%) did not receive any education on these topics. From focus group data, nurses commented that the education was beneficial and enhanced their ability to teach mothers. They felt motivated to continue teaching mothers because the mothers appreciated the teaching although they noted that some mothers were resistant to using alternative feeding positions. Participants identified time as the greatest barrier to teaching mothers. Conclusions: Training designed according to learner identified needs and methods was well- received. Nurses' knowledge increased and was retained through practice and reinforcement of concepts. Future projects at this site using these teaching methods are recommended to reinforce and develop breastfeeding skills and to improve other nursing skills that nurses identify