الفهرس 
Review of LiteratureOnly 14 pages are availabe for public view
Abstract
Every year more than 10 million children under the age of 5 years die, mainly from causes which can prevented by successful exclusive BF. Highly motivated and knowledgeable professional nursing intervention is an effective way to prevent the exclusive BFD which helps in reduction of infants’ morbidity and mortality (Cesar et al., 2016). Nurses play a vital role in preparing, educating and encouraging mothers to breastfeed so the nursing intervention is the cornerstone in the initiation and continuation of exclusive BF (El-Houfey et al., 2017). Therefore, the present study was aimed at study the effect of nursing intervention on prevention of exclusive BFD.
Aim of the study:
The aim was study the effect of nursing intervention for prevention of exclusive breastfeeding discontinuation. This aim was attainted through the following objectives:
Assessment of knowledge, practice and attitude of mothers toward exclusive breastfeeding.
Assessment of factors affecting exclusive breastfeeding continuation.
Planing, implementing and evaluating the effectiveness of nursing intervention.
Research Hypothesis:
Effect of nursing intervention on prevention of exclusive breastfeeding discontinuation had a positive effect on contiuation of breastfeeding.
I. Technical design
1- Research design:
A quasi-experimental design was utilized in the current study.
2- Research setting:
This study was conducted at Obstetric Outpatient Clinic, Breast Feeding room in NICU of Children’s Hospital affiliated to Ain Shams University and MCH center in Abassia sector/ Cairo.
3-Research Subject:
A purposive sample composed of 100 mothers, (24) were primipara women at the third trimester who attended the mentioned setting for follow up and (76) of them were lactating mothers with infants aged from birth up to 6 months regardless their characteristics.
Inclusion criteria:
- Primipara women at third trimester.
- Infants aged from birth up to 6 months.
4- Tools of data collection:
Data was collected through using the following tools:
I- A pre-designed Interviewing Questionnaire: Appendix II (Tool I) (pre/ post nursing intervention implementation) it was prepared by the researcher in an Arabic language after reviewing the related literature to assess the studied mothers’ and infants’ characteristics, mothers’ knowledge regarding exclusive BF, factors affecting exclusive BFD and its prevention. It consisted of the following parts:
Part 1: characteristics of the studied mothers as age, educational level and employment status.
Part 2: characteristics of infants as age, gender and birth order.
Part 3: Mothers’ knowledge regarding exclusive BF, factors affecting exclusive BFD and its prevention (pre/post nursing intervention).
Scoring system:
Items of mothers’ knowledge regarding exclusive BF consisted of closed ended questions. According to mothers’ responses, each question is checked either correct (1 score) or incorrect (zero). The score of (>75%) referred to good, average (65≤75%) and poor (< 65%) knowledge. Content validity:
The predesigned interviewing questionnaire was assessed and ascertained by a panel of five experts in pediatric nursing field to validate its format, layout, consistency, accuracy and relevancy.
The reliability of each tool was confirmed by using Cronbach’s alpha test and it was 0.77 for knowledge questionnaire tool I. The reliability of the attitude tool II and practice tool III were 0.80 and 0.85 respectively.
II. Iowa Infant Feeding Attitude Scale (IIFAS) (Tool II):
The Iowa Infant Feeding Attitude Scale (IIFAS) was adapted from Mora, Russell, Dungy, Losch and Dusdieker, (1999) to assess attitude of the studied mothers’ towards prevention of EBF discontinuation. The IIFAS contained 17 questions. Participants responded to a 5-point- rating scale where one was “strong agreement”, two “agreement”, three “neutral”, four “disagreement” and five “strong disagreement”. Half of the questions are worded favorably towards breastfeeding and the remaining is worded favorably towards formula feeding. Score of (≤65%), (65<75%) and (≥75%) revealed negative, neutral and positive attitude of the studied mothers towards prevention of exclusive BFD respectively.
III- Observational checklists that was adapted from Verma et al., (2015) (Tool III):
To assess the studied mothers practice regarding breast feeding (pre and post nursing intervention). Each step was checked either done correctly (1 score) or not done (zero). Then the total practice of breast feeding was scored either competent (≥85%) or incompetent (<85%).
II- Operational Design:
1- Preparatory phase:
Tools of data collection were designed (Tool I: Pre-designed interviewing questionnaire) and adapted (Tool II &III: IIFAS&observational checklists) by the researcher. A review of local and international related literature covering all aspects of exclusive BF, factors leading to early BFD and nursing intervention for prevention of exclusive BFD using available books, journals, articles, magazines and internet was done to be acquainted with the various aspects of research problem to develop the study tools and nursing intervention for prevention of exclusive BFdiscontinuation.
2- Pilot study:
A pilot study was carried out, involving 10% (10) of pregnant women at the third trimester and the lactating mothers with their infants aged from birth up to 6 months and they were excluded from the study sample later. The result of the data obtained from the pilot study helped in modification of the study tools, where some items were corrected, omitted and added as necessary.
3- Field of the work:
The actual field work was carried out for 6 months from the first of January 2019 to the end of June 2019. The researcher was available in the study setting by rotation during morning shift three days per week to assess mothers’ knowledge, attitude and practice of the studied mothers towards prevention of exclusive BF discontinuation. The average time needed for the completion of the study tools was approximately 30-40 minutes. The studied mothers filled the study tools by themselves with the aid of the researcher if mother need help or illetrate.
The nursing intervention for prevention of exclusive BFD was developed by the researcher in the form of the educational program, based on the actual needs assessment of the studied mothers, in the light of different national and international references and was written in simple Arabic language.
The nursing intervention was implemented for 4 weeks, 3 days per week. The subject content has been sequenced through 10 sessions to be covered as 8 hours (5 hours for theoretical and 3 hours for practical part), the duration at each session ranged from 30-50 minutes including periods of discussion. At the beginning of the first session, an introduction about educational program of prevention of exclusive BFD was given by the researcher, each session started with summary, feedback about previous session, simple words were used to suit the mothers’ level of understanding. Different methods of teaching were used as lectures, small group, discussion; demonstration, redemonstration and real situation. Suitable teaching aids were prepared and used during the educational program implementation such as handout, posters and pictures. Methods of evaluation used in the nursing intervention were as feedback, pre and post test.
The implementation of nursing intervention was carried out at previously mentioned settings where mothers’ knowledge, attitude and practice were assessed pre nursing intervention to get a baseline assessment of mothers prior to the development of the nursing intervention and immediately post nursing intervention by using the same tools to determine the effect of implemented nursing intervention. The researcher had met the pregnant women at Obstetric Outpatient Clinic and lactating mothers at Breast Feeding Room in NICU of Children’s Hospital and MCH center with the infants. Each mother was assessed individually to assess knowledge, practice and attitude towards prevention of exclusive BFD. Then nursing intervention implemented on the studied mothers who divided into groups at the mentioned settings based on the mothers’ needs assessment. Each group was composed of 15-20 mothers to implement the nursing intervention easily.
Nursing intervention appraisal was done by comparing the mothers’ knowledge and practice and attitude, using the same preassessment study tools.
III- Administrative Design:
An official permission was obtained from administrators of the study settings through a formal letter that was issued from the Dean of the Faculty of Nursing, Ain Shams University.
Ethical consideration
The research approval was obtained from the Scientific Ethical Research Committee, Faculty of Nursing/ Ain Shams University. An oral approval to carry out the study was taken from each mother in the study sample. Mothers were assured that all the gathered data will be treated confidentially. Mothers were also informed about their right to withdraw from the study at any time without giving any reason.
IV- Statistical Design:
Data collected were organized, revised, coded, tabulated and statistically analyzed by using computer program (SPSS) version 20. Data were presented using descriptive statistics in the form of numbers and percentage, Mean and Standard Deviation (¯(×)±SD) and chi-square test (2) were used to estimate the statistical significant difference between variables of the study. Proportion probability of error (P value) was used. Significance of the results was considered at p- value < 0.05.
Results:
The findings of the current study can be summarized as:
The mean age of the studied mothers was (27.45±5.62 years). Nearly two thirds (63%) of the studied mothers were working where (33%) out of (63%) were working for 6 hours.
Most of the studied mothers (84%) had not received health education about prevention of exclusive BFD during antenatal care.
More than one half of the studied mothers (52%) had breast and nipple problems during the current pregnancy which may lead to exclusive BFD.
The mean age of the studied infants was (3.43±1.08 months). Only less than one fifth (17.1%) of the studied infants were fed exclusive BF.
Two thirds of the studied mothers (66%) had good knowledge regarding exclusive BF post compared to only less than one third (32%) of them pre implementation of nursing intervention for prevention of exclusive BFD.
Factors affecting exclusive BFD were problems during pregnancy (46%), cracked nipple (58%), breast engorgement (82%), congenital anomalies (38%), poor sucking (32%), employment (43%) and not receiving health teaching support (84%) from health care team.
Nearly two fifths (37%) of the exclusive BF barriers were deprivation due to return of mothers to work and nearly one third (29%) were due to insufficient of breast milk.
Nearly two thirds (62%) of the studied mothers had good total knowledge regarding exclusive BF, factors affecting exclusive BFD and its prevention post implementation of nursing intervention.
More than three fifths of the studied mothers (61%) had positive attitude towards prevention of exclusive BFD post implementation of nursing intervention.
More than three fourths (78%) of the studied mothers performed competent breast feeding practice post nursing intervention compared to only two fifths (41%) of them pre nursing intervention of prevention exclusive BF discontinuation.
There was a statistical significant difference between total knowledge of the studied mothers regarding exclusive BF, factors affecting exclusive BFD and its prevention and mothers’ age (in years), level of education and employment status pre/post nursing intervention (P-value=<0.040*, 0.008* and 0.011*).
There was highly statistical significant difference between breastfeeding total practice of the studied mothers and their total knowledge regarding exclusive BF, factors affecting exclusive BFD and its prevention pre/ post implementation of nursing intervention about prevention of EBF discontinuation (P-value=<0.001**).
Conclusion
The current study concluded that, mothers had good knowledge regarding exclusive BF, factors affecting exclusive BFD and its prevention, had a positive attitude towards prevention of exclusive BFD and performed competent practices of breast feeding post implementing of nursing intervention about prevention of exclusive BFD. So, nursing intervention had a positive effect on prevention of exclusive BF discontinuation.
Recommendations
In the light of the study findings, the following recommendations are suggested:
Assess the pregnant women and lactating mothers to determine warning factors and barriers which may lead to exclusive BF discontinuation.
Adopt proper nursing intervention to satisfy health educational needs of mothers regarding prevention of exclusive BF discontinuation.
Comply with antenatal care to prevent problems that may hinder the prevention of exclusive BF discontinuation.
Developing pre and postnatal nursing intervention for protecting, promoting and supporting breastfeeding which aid in the prevention of exclusive BF discontinuation.