Consultant’s Corner: Recurrent Plugged Ducts

Scenario: Elizabeth, a lactation consultant in private practice, is frustrated when a woman returns with persistent plugged ducts. She often sees women around 3 to 6 weeks and again around 4 months postpartum, with a combination of symptoms including white blebs at the tip of the nipple and abundant milk supplies. Often she works with them to clear up the plugged ducts, only to find them back under times of stress, when other children are sick or during the holidays, on the brink of mastitis. Elizabeth would like better indicators to help identify the risk factors for recurrent plugged ducts and suggestions for ways to work with women in their treatment to avoid other complications. She has heard about the use of alternative therapies, possibly even ultrasound, but is unsure of the scientific efficacy of these treatments. – [An invited response follows]

Challenges of breastfeeding preterm infants: A case study. What goes right, what goes wrong, and what can nurses do?

Promoting breastfeeding of preterm infants offers clinical challenges for maternal-child nurses, and requires understanding the experience of the mother. Maternal-child nurses, in collaboration with hospital- and community-based lactation specialists, can meet the unique needs of preterm infants and their mothers. There are several opportunities for nurses to educate other health care professionals in the care of preterm infants and their mothers. The case study in this article presents one mother’s experience of delivering a preterm infant and the many obstacles to breastfeeding that she encountered, and it also offers suggestions for what nurses and other health care professionals can do to make sure other mothers have a more positive experience

TEACHING ADVANCED PRACTICE NURSE ROLE DEVELOPMENT USING STUDENT DEVELOPED CASES

Abstract A paradigm shift is occurring in graduate education for nurses in the United States. The developing roles for nurses are a result of many factors, challenging how nurses are prepared in an evolving system. Case study writing was used as an innovative method of teaching at the graduate level to assist professionals new to a role to articulate their vision and develop concrete plans for role enactment. The focus will be on masters prepared advanced practice nurses, but discussion will include the Doctorate of Nursing Practice and will allow for meaningful dialogue internationally

Hyperlactation - How left-brained \u27rules\u27 for breastfeeding wreak havoc with a natural process

A variety of arbitrary and often unphysiological rules for breastfeeding are frequently suggested to breastfeeding mothers. Many of these rules duplicate strategies commonly used to increase milk supply, and thus, when undertaken by the many women who already have a generous milk supply, can lead to overproduction. Oversupply, or hyperlactation, is a frequent yet often unrecognized problem that can present with a variety of distressing symptoms for the breastfeeding mother and her infant. Infants may present with symptoms suggesting colic, milk protein allergies, or gastroesophageal reflux, or may present with unusually rapid or slow growth. Mothers may present with tender leaking breasts, sore infected nipples, plugged ducts or mastitis, or even the perception of insufficient milk supply. With an understanding of the pathophysiology of these symptoms, proper diagnosis and breastfeeding management can allow milk production to return to homeostatic levels and provide dramatic symptom relief. March 23, 2012: Author’s note 7 years after publication: Over the 7 years since we wrote this manuscript, we continue to see mothers and babies with these same clinical problems, and we are still learning. Here’s a quick look from 2012 at what we wrote in 2005. Specifics can be found in a link at this site soon. During the last 7 years our treatment strategies have become much more simple and flexible since our earlier strategies encouraged too much of the rigid and rule-based left-brained thinking that often causes or contributes to hyperlactation. In this manuscript, we never once mentioned using hands on the breasts as a strategy for preventing or resolving the problems of hyperlactation, and yet in recent years we’ve found this has revolutionized our management approach. We’ve found that when dealing with hyperlactation, pumping can often be counterproductive. Underweight slow weight gain babies are in a category of their own. Regardless of their symptoms, by definition the underweight baby is NOT drinking too much, and in our experience, typical strategies for addressing hyperlactation can be counterproductive or even dangerous. In particular, staying on one side “to get to the hindmilk” doesn’t work with these sleepy, flow-dependent babies. Side switching may be helpful, but is rarely sufficient, and medical attention is critical. While hyperlactation appears to be increasingly recognized by lactation professionals, left-brained strategies abound, and resolution is often elusive, even by those who correctly identify it. Much more research is needed in all of these areas, as well as in several interesting and related areas discussed in our longer note. Finally, the thoughts and suggestions given here cannot replace appropriate medical attention by a physician or other medical provider. We do not encourage self-treatment, particularly when symptoms are severe. Readers seeking lactation support can locate an International Board Certified Lactation Consultant (IBCLC) in their geographic area at www.ilca.org “Find a Lactation Consultant” http://www.ilca.org/i4a/pages/index.cfm?pageid=343

Impact of the COVID-19 Pandemic on Nursing Students’ Clinical Learning Experiences in British Columbia: The student perspective

The clinical learning environment is where nursing students gain knowledge, practice skills and become socialized into the nursing profession. Traditionally, in Canada, the clinical learning environment takes place hospital and community settings. The COVID-19 pandemic required quick thinking by nursing faculty to replace on-site clinical hours. Given the quick change-over, there was minimal consideration given to nursing students\u27 perspectives in the planning stages. This study aimed to investigate nursing students\u27 experience in the clinical learning environment before and during the COVID-19 pandemic. The perceived quality of students\u27 learning experiences was assessed using the Clinical Learning Environment, Supervision and Nurse Teacher (CLES+T) Scale (Saarikoski et al., 2008) and open-ended questions to corroborate quantitative findings. Undergraduate baccalaureate nursing students from nine schools of nursing in British Columbia, Canada, completed an online validated survey about their different clinical learning experiences. Paired t-tests were conducted, revealing no statistically significant difference in nursing students\u27 perceived quality of their experiences before and at the height of the COVID-19 pandemic in March 2020. Quantitative and qualitative findings highlight the importance of the clinical instructor in nursing students’ clinical experiences. Our findings are valuable as nursing faculty continue to navigate opportunities for learning in the clinical learning environment as COVID-19 continues to evolve. Résumé L’environnement d’apprentissage clinique est l’endroit où les membres du corps étudiant en sciences infirmières acquièrent des connaissances, pratiquent des habiletés et se socialisent dans la profession infirmière. Au Canada, ces environnements d’apprentissage clinique sont habituellement des milieux hospitaliers et communautaires. La pandémie de COVID-19 a nécessité une réflexion rapide de la part du corps professoral en sciences infirmières pour remplacer les heures cliniques en présence. Compte tenu du changement rapide, peu de considération a été accordée aux perspectives des membres du corps étudiant en sciences infirmières lors des étapes de planification. Cette étude visait à enquêter sur l’expérience étudiante dans l’environnement d’apprentissage clinique avant et pendant la pandémie de COVID-19. La qualité perçue de leurs expériences d’apprentissage a été évaluée à l’aide de l’échelle Clinical Learning Environment, Supervision and Nurse Teacher (environnement d’apprentissage clinique, supervision et enseignement infirmier; Saarikoski et al., 2008) et de questions ouvertes pour corroborer les résultats quantitatifs. Des membres du corps étudiant du premier cycle du baccalauréat de neuf écoles de sciences infirmières de la Colombie-Britannique, au Canada, ont répondu à un sondage en ligne validé sur leurs différentes expériences d’apprentissage clinique. Des tests t pour données appariées ont été effectués, ne révélant aucune différence statistiquement significative dans la qualité perçue de leurs expériences avant et au plus fort de la pandémie de COVID-19 en mars 2020. Les résultats quantitatifs et qualitatifs soulignent l’importance des formatrices ou formateurs cliniques lors des expériences cliniques du corps étudiant en sciences infirmières. Nos résultats sont importants, car le corps professoral en sciences infirmières continue de chercher des occasions d’apprentissage dans l’environnement d’apprentissage clinique à mesure que la COVID-19 continue d’évoluer

Cultural adaptation of the health communication assessment tool to portuguese language, Brazil

This study aims to describe the process of cultural adaptation of the Health Communication Assessment Tool (HCAT) to Brazil. The HCAT is a scale that evaluates communication behaviors in clinical simulation. We developed a methodological research in an institution of higher education through the following stages: translation of the tool from English into Portuguese; evaluation by a committee of judges; back-translation; and semantic evaluation. All stages of the cultural adaptation process were rigorously developed ensuring semantic, idiomatic, cultural and conceptual equivalence between the original and the Brazilian version, in addition to a concordance of more than 70% of the nursing teachers who were invited to collaborate in evaluation. They are from three Brazilian regions – Northeast, Southeast and South – and participated in the last stage, namely semantic evaluation. It was concluded that the Brazilian version of the HCAT was culturally adapted and it will be a good tool to assess the communication skills of nursing students in a scenario of clinical simulation

Simulation Scenarios for Nurse Educators: Making It Real

Computerized patient simulation is an exciting and innovative pedagogical method that allows overburdened faculty members to prepare student nurses for clinical practice prior to working with patients. Technology, however, must combine available technical capacities and pedagogical expertise. This book provides a step-by-step process by which to develop, incorporate, and integrate simulated scenarios into the nursing curriculum, while enabling faculty to shape content or create new content for specific needs.It presents a 'how-to' for implementing the simulation environment; provides the conceptual and theoretical foundations of simulation in nursing education; and includes CD-ROM with faculty instructions for preparation (suggested assignments, skills to review, websites to examine, etc.

Simulation Scenarios for Nurse Educators: Making it REAL

Book description: Computerized patient simulation is an exciting and innovative pedagogical method that allows nurse educators to prepare student nurses for the challenges of clinical practice. This book serves as a step-by-step guide to designing and developing simulated scenarios, and integrating them into nursing curriculums. The authors provide concrete information about the use of simulation in a variety of programs, courses, and schools with flexible simulator uses, including live actors and static mannequins. This book also provides options for building a learning resource center, and offers guidance on faculty development. Additionally, the contributors present 17 exemplars of actual scenarios in multiple clinical areas, as well as testimonies of practicing faculty. – Publisher descriptionhttps://digitalcommons.fairfield.edu/nursing-books/1000/thumbnail.jp