Evaluation of Evidence - Essay Example

Literature review Literature Review Evaluation of Evidence PICO Question: (P), does a pre-natal breastfeeding education program (I) impact the period of absolute and proper breastfeeding (O) for pregnant women contemplating breastfeeding, as compared to not taking part in a prenatal breastfeeding education program (C)? Part I: Identification of Research Evidence Found in Appendix 1 Part II: Appraisal of Evidence Article 1 Keresztes and Schmidt (2012) conducted a study to establish whether a pre-natal nursing class can advance breastfeeding self-efficiency and exclusive breastfeeding for expectant mothers. The study adopted a quasi-experimental design, using the same group for both pre-test and post-test. The researchers narrowed down to a sample of 162 mothers and 100 partners/coaches from 22 breastfeeding workshops that were conducted for a period of one year. This entailed a breastfeeding education programme and at home over the phone. Every participant was requested to sign the consent form at the start of the programme stipulating their readiness to take part in the assessment. The study established that the participants scored evidently higher for breastfeeding knowledge, rated breastfeeding as more essential, and mentioned significantly higher confidence levels in breastfeeding than in pre-class questionnaires. In particular, in the 6-week postpartum interview, 70 of the original 153 mothers were interviewed. 91% were still breastfeeding, and 59% were breastfeeding exclusively. 77% pointed out that the workshop had advanced their confidence in breastfeeding. The study proved that nurses have a significant role to play in educating the expectant mothers in the case the prenatal education did not take place. However, this study had a significant weakness that entails lack of comparison group, high attrition rate, probably Hawthorne impact, selection unfairness, and inadequate generalizability. As a result of the increased rate of attrition and inability to depict correct correlation with the entire public, the findings fail to offer sufficient backup for the execution of the prenatal breastfeeding education programme for expectant mothers. Article 2 Mei Zen, Su-Chen, Avery, Wei, Kuan-Chia, and Meei-Ling (2007) conducted a study to assess an internet based breastfeeding training program offered to primigravidas in the 3rd trimester of pregnancy with the intention of intensifying breastfeeding understanding and boosting capabilities. The design entailed a sample of 120 women, at 29 to 36 weeks gestation, and showing the wish to take part in the breastfeeding education program. The participants were allowed to sign the consent forms that indicated their willful intentions of taking part in the study. The study established evident advancement in breastfeeding knowledge and perception on the posttest by the trial cohort compared with the controlled cohort. At 2, 4 and 6 weeks postpartum, the experimental group had evidently greater exclusive breastfeeding rates than the controlled cohort. It is evident from the study that nurses must strive to remain informed and techno-savvy. This entailed being prepared to provide answers to questions in the hospital settings, in the case online backup is not available. However, this paper encountered some weaknesses. The researchers chose a small population of a similar location, impacts of choosing and lack of generalization, Hawthorne effect, convenience sample applied to the study, repeated testing. Finally, founded on the reduced attrition rate, randomization of participants, and accomplishment of the program, this study may have substantial significance for putting into practice. However, due to the impacts of choosing and lack of generalizability, the study must be replicated in a larger population ahead of implementation occurring widely. Article 3 Rosen, Krueger, Carney and Graham (2008) carried out a research to assess the effects of many breastfeeding results of 3 groups getting various ways of pre-natal breastfeeding training. The study adopted a non-experimental design and a retrospective cohort design. The researchers gathered a sample of 194 expectant mothers who showed their interest in taking part in breastfeeding in the prenatal period. The study fails to indicate whether the IRB standards were addressed. However, data was acquired from hospital records via a chart audit. The study found out that statistically variance was lacking in the start of breastfeeding rates between the three groups. The women who took part in any of the breastfeeding programmes had evidently intensified exclusive breastfeeding rates at 6 months as measured up to the controlled cohort. Also, there was no evident variance in rates between the two varying kinds of class. On this account, the authors found out that the training offered only in the physician’s office without attending class led to reduced breastfeeding retention rate. In this regard, education must be boosted in the prenatal care setting. Additionally, patients must be persuaded by nurses in the office setting to take part in the breastfeeding training programmes (Rosen et al., 2008). However, this study encountered many weaknesses/limitations. In particular, uneven cohort sizes retrospective chart review cannot establish comparison but causality. Over and above, the findings of the study showed a lack of generalizability. On the other hand, it showed evident rates that imply that the breastfeeding course, in the prenatal period, boost rates of ongoing breastfeeding at six months postpartum and offer support for execution in the clinical setting. Article 4 Shu-Shan, Li-Yin, Chen-Jei and Ching-Fang (2008) conducted a scientific study by designing a prenatal training program to impart knowledge on breastfeeding and evaluated the usefulness of the programme founded on the contentment with the programme, breastfeeding knowledge, perception, contentment, challenges, and period of absolute breastfeeding. In an educational classroom, the study formed a sample of 92 pregnant women, with the aim of breastfeeding, and surveys were conducted at home. Written consent was acquired, and all the participants were guaranteed of confidentiality of their responses to questionnaires. The study proved that women in a trial cohort had considerably greater posttest scores for nursing understanding as compared to the control group. At 3 days and 1 month postpartum, the experimental group had considerably superior perceptions about breastfeeding and contentment with breastfeeding. The period of absolute breastfeeding was greater in the experimental group, however, this variance reduced by 1 month postpartum. No evident variances existed in breastfeeding challenges between the 2 groups at 3 days postpartum or 1 month postpartum. This study focuses on the value of prenatal breastfeeding. However, this study posed some weaknesses that entail lack of randomization of trial and restricted cohort status, no placebo-like intervention, possible Hawthorne effect, small sample size, and limited generalizability. As a result of the limited sample size and lack of evident increase in exclusive breastfeeding, the results of this research do not backup execution of this prenatal breastfeeding education programme for expectant mothers. Synthesis of the findings I managed to find sufficient study papers related to my PICO question. I strived to find recent research articles that had been published in the United States. For example, three of the articles I found were from Taiwan and Canada. These countries are developmentally similar to the United States. In this regard, the findings could still be applied in America. I employed the Boolean operators on the Weber State University and Utah State University library websites to solicit sources. I attempted using a Google search to find articles. However, many articles I found required a subscription to access the full articles. Whenever I did found a preferable article, I searched for it specifically on the Weber and Utah State databases. I found the article by Rosen, Krueger, Carney and Graham (2008), through this method. Overall, the assignment would have been easier if I would have a subscription to websites, such as PubMed, particularly when it came to finding articles about the United States. Overall findings The general findings of the four articles revolved around attending some form of prenatal breastfeeding courses or programs will improve an expectant mother’s knowledge, attitude, and rate of exclusive and successful breastfeeding. The articles examined in this literature review integrated participants who expressed a desire to breastfeed in both the control and experimental groups. In particular, Article 1 found evident improvements in breastfeeding understanding, perception, contentment, and period of absolute breastfeeding in the trial cohort that received a prenatal education by using tests and questionnaires. Article 2 used a one cohort pre-test and post-test design and was the most inconsistent of the four studies because of the high attrition rate. Nonetheless, the study still found significantly higher rates of breastfeeding knowledge, ratings of importance, and confidence levels in breastfeeding in participants in the posttest period. The study also found much higher continued breastfeeding levels in the participants as compared to the general public. Article 3 applied a retrospective cohort design, and found women who attended either a two-hour one-time breastfeeding course or weekly two-hour courses had evidently advanced continual breastfeeding rates at six months as measured against those who only received education during standard prenatal care. Article 4 used an internet-based education program to teach women about breastfeeding and achieved significant improvements in breastfeeding knowledge and attitude on posttests when measured against the control cohort. The study also found that the women in the trial cohort had significantly greater exclusive breastfeeding rates than the controlled cohort during the postpartum period. Answering the PICO Question The research articles I found are comparatively effective at answering my PICO question. All four articles I examined proved that prenatal education programs significantly improved a mother’s overall knowledge, attitudes, and rate of exclusive breastfeeding. As mentioned earlier in question one, I wish I had a chance to find evidence more closely linked with the population of the United States. However, I believe the findings in the articles can be applied here as well. It is apparent that the entire study had some weaknesses in proving that the prenatal courses specifically improved the length of successful and exclusive breastfeeding, but the evidence combined seems to present valid cases. Implementation in Practice I believe the evidence is sufficient to prove that prenatal breastfeeding courses improve outcomes of successful and exclusive breastfeeding. All of these articles support that the more education a woman receives in the prenatal period, the more successful and knowledgeable she will be in breastfeeding. Therefore, I believe that clinical practice should be changed to improve prenatal breastfeeding teaching in the standard care setting, or patients should be better educated on the importance of attending breastfeeding classes/education programs and made aware of the classes available to them. However, the articles did not determine whether a two-hour class, weekly meetings or online class is the most effective method of education. In this regard, I believe that further studies should be conducted to determine which methods are highly effective and to prove further the correlation between education and successful breastfeeding. References Keresztes, C., & Schmidt, M. (2012). Prenatal breastfeeding class evaluation. Kingston, Ontario: Kingston, Frontenac, and Lennox & Addington Public Health. Mei Zen, H., Su-Chen, K., Avery, M. D., Wei, C., Kuan-Chia, L., & Meei-Ling, G. (2007). Evaluating effects of a prenatal web-based breastfeeding education programme in Taiwan. Journal Of Clinical Nursing, 16(8), 1571-1579. Rosen, I., Krueger, M., Carney, L., & Graham, J. (2008). Prenatal breastfeeding education and Breastfeeding outcomes. MCN: The American Journal Of Maternal Child Nursing, 33(5), 315-319. Shu-Shan, L., Li-Yin, C., Chen-Jei, T., & Ching-Fang, L. (2008). Effectiveness of a prenatal education programme on breastfeeding outcomes in Taiwan. Journal Of Clinical Nursing, 17(3), 296-303. Appendix 1 Part I: Identification of Research Evidence Article 1 Keresztes, C., & Schmidt, M. (2012). Prenatal breastfeeding class evaluation. Kingston, Ontario: Kingston, Frontenac, and Lennox & Addington Public Health. Article 2 Mei Zen, H., Su-Chen, K., Avery, M. D., Wei, C., Kuan-Chia, L., & Meei-Ling, G. (2007). Evaluating effects of a prenatal web-based breastfeeding education programme in Taiwan. Journal Of Clinical Nursing, 16(8), 1571-1579. Article 3 Rosen, I., Krueger, M., Carney, L., & Graham, J. (2008). Prenatal breastfeeding education and breastfeeding outcomes. MCN: The American Journal Of Maternal Child Nursing, 33(5), 315-319. Article 4 Shu-Shan, L., Li-Yin, C., Chen-Jei, T., & Ching-Fang, L. (2008). Effectiveness of a prenatal education programme on breastfeeding outcomes in Taiwan. Journal Of Clinical Nursing, 17(3), 296-303. Read More