Breastfeeding Training Requires Creativity, Innovation

January 21, 2014
By Kristie Velarde

Stop watches and a two-minute warning may seem more common on a football field, but at the breastfeeding training for Methodist Charlton Medical Center in Dallas, they are just as much a staple as the hand expression doll and pumping station.

"Sometimes I feel like I have to speak as fast as an auctioneer to cover all of the material in my 20-minute module," says Reba Godfrey, RNC-MNN, IBCLC, LCCE, team leader for Methodist Charlton Medical Center. But we see that moving participants frequently around the room helps keep them focused."

Godfrey is part of a team participating in the Texas Ten Step Star Achiever Breastfeeding Learning Collaborative, a state-wide quality improvement project led by NICHQ and funded by the Texas Department of State Health Services that aims to help hospitals improve maternity care by following the evidence-based Ten Steps to Successful Breastfeeding, as established in the WHO/UNICEF Baby-Friendly Hospital Initiative.

Educating staff about breastfeeding best practices is one of the Ten Steps, but finding the time for the recommended training during busy work shifts can be challenging. Many hospitals are taking creative and innovative strategies to make trainings as non-intrusive and fun as possible.

Methodist Charlton Medical Center's approach to general staff training is three hour workshops with 20-minute, rotating, hands-on sessions designed to keep staff engaged. Topics, which range from role-playing to latch scores, address each of the major challenges that have been known to obstruct breastfeeding. The training is done jointly with the City of Dallas WIC Program; and the Methodist Dallas Medical Center and Parkland Health & Hospital System, two hospitals participating in Best Fed Beginnings. Best Fed Beginnings is a national improvement project led by NICHQ and the CDC to help hospitals achieve a "Baby-Friendly" designation, indicating adherence to the Ten Steps.

"It's so important for staff to feel comfortable," Godfrey says. "The hands-on training makes a tremendous difference in the care a mother receives at the bedside."

Godfrey adds that one of her nurses remarked that it was the "best breastfeeding training" she had ever attended. "It is truly making a difference at our hospital, as we've seen exclusive breastfeeding rates rise since the training started," says Godfrey.

The training launched in September 2013. Since then, approximately 600 nurses and lactation consultants have completed the training. That number is expected to reach 1,200-1,500 healthcare providers by the end of the summer. At that time, the three hospitals and WIC will re-evaluate the program and see how many more staff need to be trained, says Christine Wiseman, a training leader and manager of the City of Dallas Lactation Care Center.

"We have gotten excellent, informal feedback from the staff so far," Wiseman says.

Wellstar Cobb Hospital in Georgia, another facility participating in Best Fed Beginnings, needed to develop a staff training program that met both the needs of its 100 nurses and its limited budget so it had to get creative. Nurse Jacqueline Bempah says they took the show on the road, literally, creating a virtual classroom out of a cart packed with a video, model breast and pump. The cart and trainers announced visits to various nursing stations for a "limited showing" and rotated between four different topics—assessing a latch, how to express breast milk, alternative feeding methods and optimizing breastfeeding— to make it easy for nurses to attend one session at a time.

The flexible approach worked well for staff members who cover a variety of shifts, but Bempah and her team also noticed an opportunity to offer all four sessions at once. The team's "Breastfeeding Bootcamp" launched in September, and in just two months, 94 percent of nurses completed the bootcamp.

"One of the greatest benefits is that all of our nurses will have the same training and, as a result, they can provide the highest level of support possible to all of our moms," says Angela Morrison, a lactation consultant at Wellstar.

At Hennepin County Medical Center in Minneapolis, another facility participating in Best Fed Beginnings, a Skills Lab consisting of four hours of competency training provides nurses with hands-on experience. In addition to ensuring that clinicians provide the same care to all mothers, the Hennepin County team discovered an unexpected benefit.

"We found that getting people together who don't often have the opportunity to collaborate provided a platform for them to share best practices and tips," says Anna Mueller, nurse manager and team leader. "Sometimes this information is better absorbed coming from peers."

The Skills Lab training has been so successful that Hennepin County recently expanded the program to physicians. Mueller's advice for adding a physician track? Find a doctor who can champion the training with peers. Offering continuing education credits or using an existing staff meeting can also make training easier to implement.