The Effect of an Antenatal Breastfeeding Intervention on Breastfeeding Self-Efficacy and Intention Among Inner City Adolescents

According to Healthy People 2020, infants who are breastfed have improved nutritional, immunological, developmental, and social outcomes (USDHHS, 2014). Despite the benefits of breastfeeding and the focused international efforts to increase levels of breastfeeding, adolescents remain largely unaware and continue to have among the lowest levels of breastfeeding initiation (CDC, 2013; Spear, 2006). The purpose of this EBP project was to reduce the disparities of breastfeeding initiation by increasing breastfeeding self-efficacy and intention in an inner city specialty high school. Synthesis of the evidence demonstrated that needs-based, repeated antenatal education delivered by a lactation expert including breastfeeding peer counselor supports was best practice for engaging the adolescent population. Utilizing Social Cognitive Theory as the theoretical framework and the Stetler Model for Evidence-Based Practice as a model for practice change, an educational intervention was implemented incorporating an Internationally Board Certified Lactation Consultant (IBCLC), peer counselors, and breastfeeding support. Pre- and post-intervention breastfeeding selfefficacy and intended infant feeding preference were collected utilizing the Prenatal Breastfeeding Self-Efficacy Scale (BSES). Non-parametric statistical testing did not reveal any significant differences between mean self-efficacy scores (81.2 and 83.4 respectively, p = .500). Linear regression was performed on pre and post- intervention breastfeeding intention revealing that, while the intervention did positively impact intention, results were not statistically significant (p = .133)

“All Bundled Out” - Application of Lean Six Sigma techniques to reduce workload impact during implementation of patient care bundles within critical care – A case study

Within healthcare, clinical practice bundles have been used to implement standardized, nursing driven protocols resulting in standardized patient care and improved patient outcomes. Examples of these types of bundles include clinical practices shown through evidence based medicine to reduce occurrences of Ventilator Associated Pneumonia – VAP bundle; those shown to reduce the occurrences of central line infections – CL bundle; and those shown to significantly improve the outcomes of patients presenting with sepsis – Sepsis Bundle. Unfortunately, as critical care units cycle through the implementation of multiple bundles without adjustment in workflow practices the result is often increased staff fatigue and a more stressful work environment – a phenomenon appropriately termed by critical care staff members as being ‘All Bundled Out’. This paper will describe the partnership between IUPUI faculty and Sisters of St. Francis Health Services (SSFHS) in application of Lean Six Sigma techniques. These techniques were adapted for use within healthcare and were applied to reduce the workflow impact and optimize implementation of nursing driven, clinical protocols used to implement intensive glucose control for ventilator patients within two critical care units. Additionally, this paper will discuss the strategies and methodologies used to sustain initial results during the 9 months following the initial protocol implementation