Breastfeeding Behavior Research Articles

Factors Influencing Radiation Protection Behavior of Nurses in Intensive Care Units

Purpose : The purpose of this study was to identify the factors that influence the behavior of intensive care unit (ICU) nurses regarding radiation protection, and to provide basic data to improve radiation protection educational programs. Methods : This descriptive research study included 143 nurses working in ICUs. Data were collected through a self-reported structured questionnaire and analyzed using t-test, Pearson’s correlation coefficients, and hierarchical multiple regression analysis. Results : Radiation protection environment (<i>β</i>=.35, <i>p</i>=.001), radiation protection self-efficacy (<i>β</i>=.25, <i>p</i> =.002), type of hospital (<i>β</i>=-.25, <i>p</i>=.002) and experience in ICU (<i>β</i>=-.18, <i>p</i>= .022) affected the radiation protection behavior of ICU nurses. The total explanatory power of model was 60.0% (R<sup>2</sup>=.64, Adj. R<sub>2</sub>=.60, F=17.71, <i>p</i>＜.001). Conclusion : In order to enhance the standards of radiation protection behavior among intensive care unit nurses and improve radiation protection self-efficacy, educational and training programs should be developed. Additionally, administrative support should be considered to create environments with better radiation protection at the organizational level.

Do shift-working nurses’ work-life quality relate to their physical health and diet quality?

Abstract Background Shift work negatively affects work-related quality of life and this situation causes significant labour force losses and decreased productivity in the society, especially health problems in nurses. This study was conducted to determine the relationship between work-related quality of life, physical health level and nutritional behaviours of nurses working in shifts. Methods This descriptive and relationship-seeking study was conducted with 312 nurses selected by quota sampling in Istanbul. Data were collected between December 2022 to July 2023 using the The Professional Quality of Life Scale (ProQOL), Physical Health Questionnaire and Food Consumption Frequency Questionnaire. Descriptive statistics and Pearson correlation tests were conducted on IBM SPSS 25.0. BeBIS 7.1 software were used for calculation diet index. Results Compassion Satisfaction (CS), Burnout (B) and Compassion Fatigue (CF) scores of nurses was examined, a relationship was found between CS score and B score (r=-0.39 p < 0.05) and between B score and CF score (r = 0.58 p < 0.05). CS score correlated with Cardiovascular Risk Level score (r=-0.15 p < 0.05) and diet index score (r = 0.15 p < 0.05). B score correlated with Gastrointestinal Risk Level score (r = 0.27 p < 0.05) and Cardiovascular Risk Level score (r = 0.38 p < 0.05). There was a correlation between the score of CF and Gastrointestinal Risk Level score (r = 0.25 p < 0.05) and Cardiovascular Risk Level score (r = 0.31 p < 0.05). Daily energy, fibre, vitamin B1 and C, folate, calcium and magnesium intakes of nurses were lower than the recommended. Conclusions Research results support that the gastrointestinal and cardiovascular systems have a direct relationship with stress and emotional states. In the policies to be developed within the scope of occupational health nursing practices, it is recommended to carry out studies to improve the physical health and nutritional behaviours of nurses in order to improve their work-related quality of life. Key messages • Nurses are a risky occupational group in terms of burnout. Protection studies should be prioritised to prevent burnout. • Gastrointestinal and cardiovascular system complaints of nurses should be paid special attention during recruitment and periodic examinations.

How social and commercial determinants influence exclusive breastfeeding in the Philippines

Abstract Background The World Health Organization recommends exclusive breastfeeding (EBF) for the first six months after delivery. However, the EBF rate in the Philippines is only 29%. Existing literature suggests that the influence of infant formula marketing (IFM), communication channels, and traditional health beliefs are possible contributors to low EBF rates, but rare studies have been conducted in low-resource settings. Methods: To bridge the gap, 15 barangays in Palawan were selected; 97 interviews were conducted with lactating mothers (LM), health workers (HW), traditional healers, infant formula sellers, and community leaders (CL) to represent different perspectives. The results were coded and analyzed inductively. Results LM received EBF information through multiple resources. Poverty, lacking breast milk (BM), EBF education, and health benefits (HB) to infants are top contributors to EBF while maternal employment and no BM are top barriers to EBF. Elders, traditional health beliefs (THB), and the influence of COVID-19 can influence EBF in both directions. LM emphasized more on poverty and elders to EBF while HW and CL emphasized the role of EBF education and HB. Urban LM tend to have more regular EBF education, use pumps when going out, and are more influenced by IFM. LM in remote areas tend to have more THB, have more BM substitutes, and share BM. Social classes, locations, Indigeneity, migration, and poverty are intersectioned to influence EBF. Conclusions Multiple social and commercial determinants influenced EBF. LM is facing more challenges to EBF under globalization and capitalism. Remote LM are less benefited from new technologies and policies to promote EBF. Different stakeholders have echo chambers to perceive the determinants of EBF. To improve health equity and EBF, the situations of marginalized people in remote areas should be more considered in policy making. Community building should also be considered differently to assist in EBF. Key messages • The project focuses on social and commercial determinants of exclusive breastfeeding with people in extreme poverty. • The project includes plenty of Indigenous breastfeeding behavior that are underreported.

Information Needs and Seeking Behavior of Nurses for Effective Health Care Delivery: A Case Study of Federal Medical Center, Owerri.

Information Needs and Seeking Behavior of Nurses for Effective Health Care Delivery: A Case Study of Federal Medical Center, Owerri.

Organizational evidence-based practice culture, implementation leadership, and nurses: A bidirectional mediation model.

This study aimed to explore 1) factors that influenced the evidence-based practice competencies and behaviors of clinical nurses and 2) the interaction between the organizational evidence-based practice culture, head nurses' implementation leadership, and nurses' evidence-based practice competencies and behaviors. The significance of organizational evidence-based practice culture and head nurses' implementation leadership in enhancing nurses' evidence-based practice competencies and behavior is widely recognized in healthcare settings. However, there is limited knowledge of how these factors influence nurses' evidence-based practice competencies and behavior. A cross-sectional survey was conducted at 10 hospitals in China. Data were collected via online questionnaires from October to December 2020, utilizing social characteristic questionnaires, the Evidence-Based Practice Questionnaire, the Organizational Culture and Readiness Scale for System-wide Implementation ofEvidence-Based Practice, and the Implementation Leadership Scale. All data were imported into the IBM Statistical Program for the Social Sciences (SPSS) 27.0 and PROCESS version 4.1 macro on SPSS for statistical analysis. The design and reporting of our study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Checklist. We received 1047 (99.15%) valid questionnaires. The multiple linear regression analysis showed that significant factors were organizational evidence-based practice culture, implementation leadership, and years of experience in nursing. After controlling for the impact of the covariate (years of experience in nursing), it was found that organizational evidence-based practice culture partially mediated the relationship between head nurses' implementation leadership and nurses' evidence-based practice competencies and behaviors. Additionally, head nurses' implementation leadership partially mediated the relationship between organizational evidence-based practice culture and nurses' evidence-based practice competencies and behaviors. Organizational evidence-based practice culture, head nurses' implementation leadership, and years of experience in nursing significantly predict nurses' evidence-based practice competencies and behaviors. Organizational evidence-based practice culture and head nurses' implementation leadership mutually mediated their influence on nurses' implementation of evidence-based practice. Head nurses should proactively seek opportunities to enhance their implementation leadership, such as participating in training programs (e.g., mentoring and coaching programs) and attending conferences, workshops, or seminars on implementation leadership. Policymakers should also consider providing more policy support for implementing leadership development and cultivating a positive evidence-based practice culture.

The effect of end-of-life care awareness education on the knowledge, attitudes and behaviours of intensive care nurses: A randomized controlled trial.

Education in end-of-life care (EoLC) is essential for improving the knowledge, attitudes and behaviours of intensive care nurses. This study aimed to evaluate the effect of online awareness education, based on the End-of-Life Nursing Education Consortium, on the knowledge levels, attitudes and behaviours of intensive care nurses. This single-centre randomized controlled study. This study was performed in a tertiary intensive care unit in a university-affiliated hospital. Seventy-six intensive care nurses were selected and equally randomized. In the education, the group was given an EoLC awareness education programme on an online platform as 40-60-min sessions once a week for 4 weeks. The descriptive Information Form, EoLC Knowledge Test and the Nurses' Attitudes and Behaviours towards the EoLC Scale were used. In the study, intensive care nurses' knowledge, attitude and behaviour levels towards EoLC were evaluated before and after 4 weeks (±3 days) following the education. When the mean post-education scores of the nurses in the education group were compared with the control group, it was found that their mean scores on the EoLC Knowledge Test (p = .001, Cohen's d = 1.354, 95% CI = 3.240-6.549), the attitude sub-dimension (p = .001, Cohen's d = 1.520, 95% CI = 4.510-7.858), the behaviour sub-dimension (p = .001, Cohen's d = 1.425, 95% CI = 3.206-6.214) and the total attitude and behaviour (p = .001, Cohen's d = 1.927, 95% CI = 8.408-13.643) were statistically significantly higher than those of the control group. This study showed that EoLC awareness education positively affected nurses' knowledge, attitudes and behaviours. Accordingly, planning EoLC awareness education online at regular intervals may be recommended for intensive care nurses. Intensive care nurses may be given online EoLC awareness education to positively affect their knowledge, attitudes and behaviours about EoLC. Online EoLC education can be effective in terms of reaching a large number of nurses, time and cost.

Emergency nurses' attitude and related factors toward geriatric: A cross-sectional study

Aging and the consequent disabilities are major concerns in contemporary society. The last century has witnessed a significant increase in the elderly population, particularly in developing countries, thereby heightening the need to address the issues this demographic faces. Understanding nurses' attitudes towards geriatric and the factors influencing these attitudes is crucial for predicting and, if necessary, modifying the behavior of emergency department nurses. This study aims to determine the emergency nurses' attitudes and related factors toward geriatric. This cross-sectional analytical study targeted nurses working in the emergency departments of medical training centers in Rasht. A total of 190 nurses were selected using the census sampling method. Data collection involved a two-part questionnaire: one section capturing demographic characteristics and the other utilizing Kogan’s Attitudes Toward Old People scale. The study revealed that the average age of the nurses was 34.41 (standard deviation [SD]=6.37) years. Among the 190 nurses, 171 (90.0%) were women, 105 (70.0%) were married, and 178 (93.7%) held bachelor's degrees. The average length of professional experience among participants was 8.87 (SD=5.24) years, with 7.24 (SD=4.31) years spent in emergency departments. The mean attitude score towards geriatric was 136.24 (SD=10.47), indicating a generally unfavorable attitude. Supervisors exhibited a significantly more positive attitude toward geriatric than regular nurses (P=0.035). No statistically significant relationship was found between the nurses' attitudes and their personal or occupational variables (P<0.05). The findings indicate that nurses generally hold unfavorable attitudes toward geriatric. Given the critical importance of providing high-quality care to this population, developing strategies to improve nurses’ attitudes towards geriatrics is imperative.

Nurses' Perceptions and Behaviours Regarding Climate Change and Health: A Quantile Regression Analysis.

The aim of this study is to identify the factors associated with nurses' perceptions and behaviours related to climate change and health (PBCH) according to their PBCH levels. A cross-sectional study was used. This study included a sample of 499 Korean nurses and adhered to the STROBE checklist. Data were collected from March 23 to May 10, 2023. Quantile regression analysis was performed, and PBCH levels were measured using the Korean version of the Climate Health and Nursing Tool. Across all quantile groups, the experience of extreme weather events and awareness of climate change-coping facilitators were associated with PBCH. Differences were observed in factors associated with PBCH levels. Significant associations with PBCH were observed within the 75th percentile group, for having a religion, household income, and workplace climate friendliness. In the 25th percentile group, having a child, the number of sources for climate change-health-related information, and experience in setting climate change-health goals and strategies significantly influenced PBCH. We propose a differentiated strategy by elucidating the factors associated with high and low quantiles of PBCH levels. By verifying specific factors associated with PBCH levels, nurses can enhance their preparedness to respond to the health risks posed by climate change in their clients. Identifying common factors associated with all quantiles of nurses is important for establishing universal PBCH characteristics. Recognising the distinctions between high and low PBCH levels can aid in developing tailored nursing strategies to enhance PBCH among nurses. This study adhered to the STROBE guidelines. No Patient or Public Contribution.

Self-identity explains better breastfeeding intention of ethnic pregnant mothers of Western Nepal: Extending the theory of planned behavior.

Breastfeeding intention is one of the strongest predictors of breastfeeding behavior and practice. The Theory of Planned Behavior (TPB), with its main construct, behavioral intention, is useful to predict actual behavior. While the literature has examined the implications of other theoretical notions such as self-identity, moral norm, descriptive norm, and socio-demographic variables, their roles remain unclear. Similarly, research on ethnic and low-income mothers is even insufficient. Therefore, given the original TPB constructs, our goal was to examine the role of extra theoretical constructs and specific demographic variables, and observe whether the original model would alter. A cross-sectional analytical study was carried out among 325 pregnant mothers in six purposively selected health care facilities of Kaski and Tanahu districts, using structured pro forma, from December 2018 to November 2019. We developed stepwise multivariate logistic regression from the entered and cleaned data, observed the effects on breastfeeding intention (BFI), and checked against multiple parameters. We interpreted the model with adjusted odds ratios and β coefficients, along with the variance explained. Out of 325 pregnant women, more than half (54.8%) were primiparous, and the mean age was 25.1±5 years. All three theoretical constructs of TPB regressed the BFI significantly, with 10.7%, the breastfeeding attitude dominating (β = 0.734, p = .003), and the other two constructs-perceived breastfeeding control (β = 0.659, p = .011) and breastfeeding subjective norm (β = 0.504, p = .045). Interestingly, breastfeeding self-identity added further variance of 5.2% (β = 0.955, p < .001), followed by income, with 3.2% (β = 0.856, p = .001), both of which also tallied large effect sizes. The model parameters showed consistency and robustness. We discuss the variables of the theoretical and extended model for BFI as well as the arguments for the explained variance. Self-identity is a strong and independent predictor of breastfeeding intention and, therefore, should be considered to better prepare for breastfeeding, especially among ethnic pregnant mothers. The direct and intermediate effects of self-concept and income need further study with more robust designs.

Breastfeeding Behaviors by Race/Ethnicity and Foreign-Born Status in the United States: An Analysis of the U.S. National Survey of Children's Health.

Objective: The foreign-born population is growing in the United States, but no nationally representative statistics of breastfeeding behavior disaggregated by race/ethnicity and foreign-born status have been published in recent years. This study examines breastfeeding initiation, any breastfeeding, and exclusive breastfeeding at 3 and 6 months among foreign-born and U.S.-born Non-Hispanic (NH) Black, NH White, and Hispanic women in the United States. Methods: This is a cross-sectional study utilizing years 2021 and 2022 of the National Survey of Children's Health. Sample children identified as NH White, NH Black, and Hispanic who were 6 months to 5 years old and residing with their biological or adoptive mother were included (n = 27,818). Results: Foreign-born women in all racial/ethnic groups (NH Black, NH White, and Hispanic) had significantly higher odds of any breastfeeding at 6 months relative to U.S.-born NH White women. However, they did not have significantly different odds of exclusive breastfeeding for 6 months relative to U.S.-born NH White women. U.S.-born Hispanic women had rates of exclusive breastfeeding for 6 months (23.2%) that were much closer to U.S.-born NH Black women (23.4%) than to foreign-born Hispanic women (29.4%) or U.S.-born White women (32.1%). Conclusions: The large percentage of foreign-born women who reported some breastfeeding at 6 months indicates a strong commitment to breastfeeding and may be a leverage point for future exclusive breastfeeding interventions among this group. U.S.-born Hispanic women appear to be struggling with exclusive breastfeeding and may need additional interventions.

The effect of organizational silence on the relationship between workplace ostracism and nurses' procrastination behavior: A structural equation modeling.

This study aims to assess the relationship between workplace ostracism and the procrastination behavior of nurses, as well as examine the effect of organizational silence on this relationship. Controlling workplace ostracism and eradicating time wasters, especially procrastination behavior among nurses, are key strategies that add value to organizational effectiveness. In addition, remaining silent about significant issues facing nurses is a devastating approach to the success of both healthcare organizations and the nursing profession. A cross-sectional descriptive correlational exploratory research design was used to conduct the study. Data were collected from 352 nurses recruited from three large university hospitals in Alexandria, Egypt. Four instruments, namely, the Workplace Ostracism Questionnaire, the Organizational Silence Scale, the Active Procrastination Scale, and the Unintentional Procrastination Scale, were used. Structural equation modeling was used to test the hypothesized relationships among the variables. The findings demonstrated a significant positive and moderate association between workplace ostracism and both active and passive procrastination behaviors among nurses. Moreover, there was a strong positive and significant correlation between organizational silence and workplace ostracism. The results of mediation revealed that the indirect effect of workplace ostracism on both active and passive procrastination behavior through organizational silence was statistically significant, suggesting that organizational silence partially mediated this relationship. The study highlighted the ongoing challenges posed by toxic workplace issues, such as organizational ostracism and silence, as significant factors contributing to nurses' procrastination behaviors. Not only do these factors directly impact nurses' productivity, but they also interact to exacerbate negative outcomes in nursing care. Addressing these toxic dynamics is critical to improving nurse performance and ensuring quality care in healthcare settings. This study offers new insights for navigating toxicity and upgrading nursing productivity in healthcare organizations through fostering a more inclusive and communicative work environment. Promoting team cohesion and ensuring that all staff members feel valued and included can reduce feelings of isolation that may lead to procrastination. Also, creating safe spaces for nurses to voice concerns without fear of reprisal could significantly diminish passive procrastination, which ultimately enhances overall patient care quality and organizational efficiency.

Differences in Breastfeeding Initiation and Duration by Migration History in the Hispanic Community Health Study/Study of Latinos.

Objective: To estimate differences in breastfeeding initiation and duration across dimensions of migration history (migration to the U.S. 50 states/District of Columbia [DC] in childhood, adulthood, or not at all) in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Methods: We used data from HCHS/SOL on 520 individuals with a post-baseline live birth and information on breastfeeding collected at Visit 2 (2014-2017). We fit log binomial models adjusted for parity, age at pregnancy, education, income, and immigration history and incorporating sampling weights. Results: Overall, 84% of participants reported initiating breastfeeding and 30% reported breastfeeding for 6 or more months. On average, individuals reported breastfeeding for a median of 88 days (interquartile range: 156). Compared with those born in the U.S. 50 states/DC, individuals born in another country or U.S. territory who arrived in the U.S. 50 states/DC as children (<18 years old) were 2.7 times more likely to initiate breastfeeding (adjusted prevalence ratio 2.7, 95% confidence interval [CI]: 1.4, 4.9) and those who arrived as adults were 2 times more likely to initiate breastfeeding (adjusted prevalence ratio 2.0, 95% CI: 1.1, 3.6). We observed similar patterns for breastfeeding continuation. Conclusions: The timing and duration of life course experiences such as migration are key determinants of breastfeeding behavior among Hispanic/Latina postpartum persons.

Translating and validating the gay affirmative practice scale for nurses in mainland China.

The gay affirmative practice (GAP) scale is an effective tool for evaluating the beliefs and behaviors of health care professionals toward gay and lesbian clients. This study aimed to examine the reliability and validity of the GAP scale among Chinese nurses. A quantitative cross-sectional study was conducted to evaluate the Chinese version of the GAP (C-GAP) scale after translation and cross-cultural adaptation and to examine its psychometric characteristics. The reliability and validity of the C-GAP scale were determined by item analysis, factor analysis, internal consistency, test-retest reliability, and discriminant construct validity. The GAP scale was translated and adapted specifically for China. A total of 1440 participants completed the C-GAP scale, sociodemographic questionnaire, and Marlowe-Crowne social desirability scale. The C-GAP scale exhibited a Cronbach α of 0.95, with a high test-retest reliability coefficient of 0.92. Exploratory factor analysis identified 2 factors that accounted for 59.91% of the total variance. The results of the confirmatory factor analysis were as follows: χ2/df = 1.09, goodness-of-fit index = 0.98, adjusted goodness-of-fit index = 0.97, root mean square error of approximation = 0.01, Tucker-Lewis index = 1.00, comparative fit index = 1.00, incremental fit index = 1.00, parsimony goodness-of-fit index = 0.85, and parsimony normed fit index = 0.91. These findings confirm that all goodness-of-fit indices were satisfactory. The C-GAP scale can be an effective tool for health care professionals and managers and for education and research; it can also identify the beliefs and behaviors of health care professionals toward gay and lesbian clients, facilitating cultural competence development and enhancing care quality awareness and skills. The C-GAP scale demonstrates reliability and validity; however, because the sample consisted only of nurses, the findings may not be generalizable to other professional groups, such as counselors and therapists. Therefore, the occupational focus of the sample limited the broader applicability of the results. The C-GAP scale is a reliable and valid tool suitable for assessing the practice attitudes and behaviors of Chinese nurses toward gay and lesbian clients.

Dissatisfaction with working conditions associated with lower vaccine confidence, commitment and behaviors among nurses: A large scale cross-sectional survey in France

BackgroundBefore, during, and after the COVID-19 pandemic, doctor shortages led many countries to expand nurses' role in their mass vaccination programs. Nonetheless, nurses often express marked vaccine hesitancy. Simultaneously, their working conditions have been deteriorating. ObjectivesTo study 1) the association between nurses' perceptions of their working conditions and their vaccination-related behaviors (vaccination recommendations to their patients), and 2) the mediating role in this associations of their trust in health authorities, vaccine confidence, and vaccine proactive efficacy. DesignA cross-sectional survey. SettingsSalaried, community (self-employed) and mixed nurses in France. Participants18,888 nurses registered with the French national order of nurses (ONI, registration is mandatory) (N = 439,323). MethodsIn February 2023, this cross-sectional study used an online questionnaire to survey the nurses mandatorily registered with the French national order of nurses. Seven items adapted from models of psychosocial risk factors at work assessed their satisfaction with their working conditions. The international short version of the Pro-VC-Be (health professionals, vaccine confidence and behaviors) a validated instrument measuring psychosocial determinants of health-care professionals' vaccine behaviors) evaluated their vaccine-related attitudes and behaviors. Multiple group mediation analysis with structural equation modeling measured the associations between satisfaction at work, trust in health authorities, vaccine confidence, proactive efficacy (commitment and self-efficacy) in vaccination, and vaccination recommendations (against seasonal influenza for those with a chronic disease and against COVID-19 among adults). ResultsAmong the 18,888 participants, satisfaction at work had generally deteriorated, and only 47 % considered vaccines safe. Among salaried nurses (61 %), satisfaction at work was statistically significantly associated (p < 10−3) with trust in health authorities (β = 0.26 [0.24; 0.28]), vaccine confidence (total effect: β = 0.35 [0.31; 0.38]), proactive efficacy (total effect: β = 0.18 [0.16; 0.21]), and, to a smaller extent, with seasonal influenza and Covid-19 vaccine recommendations (total effect: β = 0.13 [0.09; 0.16]). Trust in health authorities played a statistically significant role (p < 10−3) mediating the associations of satisfaction at work with vaccine confidence and proactive efficacy. These three dimensions in turn mediated the relation between satisfaction at work and frequency of vaccination recommendations. These relations were similar among community nurses. ConclusionsSatisfaction at work appears to enhance nurses' vaccination attitudes and behaviors, which are likely to reinforce their capacity to promote their patients' vaccination. Significant improvement in their working conditions is needed to enable them to accomplish this role serenely.

Commercial milk formula marketing entry points: setting the course of infant and young child feeding trajectories

BackgroundThere is a limited understanding of the dynamic influences that shape infant and young child feeding (IYCF) decisions over time. We conducted an innovative qualitative study to reconstruct IYCF trajectories across early life course phases, in the context of the socioecological model (SEM) and the commercial determinants of IYCF.MethodsWomen of different socioeconomic status were interviewed in two large metropolitan areas in Mexico. Our specific goal was to allow us to better understand if and how the commercial milk formula (CMF) marketing influenced breastfeeding decisions in a complex dynamic way involving the individual, relational, community and societal levels.ResultsHospitals, health professionals, and interactions with social media were key category entry points throughout the prenatal, perinatal, early infancy period and beyond. The CMF industry interfered by engaging a wide array of actors across the different layers of the SEM, most prominently the health care system and the workplace. Through its marketing strategies the CMF operates subconsciously and its messages are most effective when health institutions, health care providers, workplace spaces and social norms are weak in their support for breastfeeding.ConclusionsThe cases in our study highlight how, together with a weak breastfeeding counseling system, and health professionals who lack training in breastfeeding and normal infant behavior, lead to the opportunity for CMF marketing to shape infant feeding, and ultimately to the decision to feed formulas that some mothers were not planning to use and cannot afford.

Forceful Milk Ejection Reflex and Tongue-Tied Neonates’ Breastfeeding Behaviour

Background: Forceful milk ejection reflex in mothers and tongue-tie in infants often cause breastfeeding difficulties. Our purpose was to observe the breastfeeding behavior of tongue-tied neonates, in the presence of forceful milk ejection of their mother versus tongue-tied infants without forceful milk ejection or in the presence of forceful milk ejection in non-tongue-tied infants. Methods: This is an observational, prospective, cohort study. The study was undertaken at the Lactation Institute, in Cluj-Napoca, Romania, between 2012 and 2018. We studied the breastfeeding behavior of neonates attending the Institute. The study includes 80 tongue-tied new-borns of mothers with forceful milk ejection (Group I), compared with the breastfeeding behavior of 40 tongue-tied neonates of mothers with normal let-down (Group II) and 29 neonates without tongue-tie in the presence of forceful let-down (Group III). Descriptive statistics, including numbers and percentages, and SAS software were utilized. Categorical data are presented as counts and percentages and analyzed with chi-square tests, utilizing R and Python software. Statistical significance was set at p-value ≤ 0.001, in some cases at p-value ≤ 0.05 using a chi-square test, sometimes validating the results with Fisher’s Exact Test. Proportional Analysis and Post-Hoc Analysis (pairwise Z-tests for proportions) were also carried out to demonstrate the frequency of cases. Results: From Group I, the majority (92.50%) were breastfed effectively in the first week, significantly different from infants in Group II (20%), where frenotomy was more frequent (92.50%) and performed mainly for suckling difficulties (86.48%). The difficult latch had a higher percentage in infants in Group II (92.50%). “Reflux-like syndrome” (93.10%), breast refusal (24.13%), and, choking (93.10%) were more frequent in infants in Group III. Conclusions: The majority of tongue-tied infants, whose mothers had early forceful milk ejection, were able to effectively breastfeed after birth. In this cohort, frenotomy might not be necessary or could be postponed. The presence of tongue-tie only, without fast milk flow, led to suckling difficulties and the need for frenotomy. Reflux-like syndrome, choking, and breast refusal were more present in infants without tongue-tie but with fast milk flow.

Effectiveness of the ‘SELF-program’ on nurses' activity encouragement behavior and nursing home resident's ADL self-reliance; a cluster-randomized trial

BackgroundNurses play a crucial role in encouraging nursing home resident's activity and independent functioning. However, nurses often take over tasks unnecessarily, which can deprive resident's remaining abilities. The Function-Focused Care philosophy offers guidance for developing programs that support nurses to optimize activity and independence of older people. However, such programs developed internationally have demonstrated inconsistent effects. Lessons have been gathered to improve future programs, which led to the development of the ‘SELF-program’: a holistic, interactive and theory-based program that aims to improve activity encouragement behavior of nurses and indirectly to optimize self-reliance of nursing home residents. ObjectiveThe aim of this study was to examine the effectiveness of the SELF-program on nurses' activity encouragement behavior and nursing home residents' self-reliance in activities of daily living. MethodThe program's effectiveness was examined in a two-arm (SELF-program vs Care as Usual) cluster-randomized trial in Dutch nursing homes. Wards were recruited as units of intervention. The MAINtAIN questionnaire was used to assess the primary outcome: nurses' activity encouragement behavior regarding self-reliance in activities of daily living. The GARS-4 questionnaire was used to assess the secondary outcome: residents' self-reliance in activities of daily living. Measurements were taken at: 1) baseline, 2) three months after baseline, and 3) six months (for residents) and nine months (for nurses) after baseline. The acquired data was analyzed using mixed linear regression. Both adjusted and unadjusted analyses are reported. ResultsTwenty-eight nursing home wards, with 287 nurses and 241 residents participated in the study. A statistically significant treatment by time interaction effect was observed in nurses' activity encouragement behavior at three months (d = 0.53; p = .003; 95 % CI 1.88–8.02) and at nine months (d = 0.38; p = .02; 95 % CI 0.67–7.27). No statistically significant treatment by time interaction effects were observed in residents' self-reliance in activities of daily living. However, a trend was observed towards a less pronounced decrease in self-reliance in those residents allocated to wards that exposed nurses to the SELF-program, reflected by small to medium negative effect sizes at three months (d = −0.25; p = .07; 95 % CI -2.21 – 0.09) and at six months (d = −0.29; p = .07; 95 % CI -3.22 – 0.11). ConclusionThe SELF-program was effective in improving nurses' activity encouragement behavior. The process evaluation conducted parallel to the trial could yield valuable lessons to further improve the SELF-program before widespread implementation. Trial-registrationThe study is registered in the Dutch Trial Register (NL9189), as of December 22 2020. Recruitment commenced in March 2021.

Analysis of the influential factors on innovative behaviors among ophthalmic specialty nurses in China: a cross-sectional study

ObjectiveTo investigate the current situation of innovative behavior and organizational structure authorization of ophthalmic specialty nurses in China, and analyze the influencing factors of innovative behavior.MethodsA cross-sectional survey was carried out among 301 ophthalmic specialty nurses in China, representing Representing 82 hospitals in 25 provinces, using a general data questionnaire, Innovative Behavior Scale(IBS), and conditions of work effectiveness questionnaire(CWEQ-II).ResultsThe mean total score for innovative behavior among Chinese ophthalmic specialty nurses was (4.73 ± 1.14), and the mean total score for organizational structure authorization was (61.65 ± 14.69). The logistic regression analysis revealed that organizational structure authorization, hospital grade, and ophthalmic specialty nurses primarily engaged in clinical care and clinical research had statistically significant impacts on the level of innovative behavior (P < 0.05). The higher the organizational structure authorization score, the higher the innovative behavior level of ophthalmic specialty nurses, the level of innovation behavior of grade-B tertiary hospitals is higher than that of grade-A tertiary hospitals. The main positions are low level of innovative behavior in clinical care and high level of innovative behavior in clinical research.ConclusionsThe innovative behavior and organizational structure authorization of Chinese ophthalmic specialty nurses are at a medium level, the innovative behavior of ophthalmic specialty nurses is influenced by factors such as organizational structure empowerment level, hospital grade, and main job position. Nursing managers are advised to develop tailored training programs based on the influencing factors of innovative behavior among Chinese ophthalmic specialty nurses, in order to enhance their level of innovation and improve the quality of nursing services provided by Chinese ophthalmic specialty nurses.

Development and psychometric evaluation of the catheter assessment, management and performance (CAMP) scale for nurses

AimTo develop and test the psychometric properties of a self-administered scale to assess the knowledge, skills, attitudes and behaviour of nurses to support the self-management of patients living with indwelling urinary catheters. BackgroundNurses are pivotal in supporting patients with urinary catheter self-management to prevent potentially avoidable hospital presentations. However, no validated scale is available to assess nurses’ attitudes and readiness for this task. DesignA quasi-experimental design was used to collect survey data both at baseline and after the completion of the intervention. A total of 128 participants were recruited from the Western Sydney region (New South Wales, Australia), who were working in community healthcare settings. Research Electronic Data Capture (REDCap™) database was used to manage the survey data collected for data analysis purposes. This study has been registered with the Australian New Zealand Clinical Trials Registry (ACTRN126210 0 0683831) MethodsUsing a three-stage process of concept identification, item construction and pilot testing to develop the Catheter Assessment, Management and Performance (CAMP) scale, followed by factorial and discriminant validity and reliability testing. This 23-item CAMP scale is theoretically informed by the COM-B (Capability, Opportunity, Motivation-Behaviour) model, recognised for its effectiveness in understanding and influencing behaviour change. The scale was distributed to nurses working in three community health care settings to assess their knowledge, attitude and behaviour regarding catheter management and performance. ResultsFour factors were identified using scree plot, accounting for 63.36 % of total explained variance, which reflected the four dimensions of the COM-B model. Cronbach's alpha of the overall CAMP scale (0.93) and subscales (0.92, 0.87, 0.85 and 0.86) indicate good internal consistencies. The CAMP scale was able to detect changes in nurses’ self-reported behaviour change following educational intervention (85.53 versus 95.98, p < 0.001). ConclusionThe CAMP scale is valid and reliable scale, capable of assessing nurses’ capability, opportunity and motivation to support patients, through delivery of catheter self-management education that can potentially prevent catheter-related complications and avoid hospital presentations. Future research could explore using CAMP scale among non-specialist nurses and in various clinical settings to enhance its effectiveness and generalisability.

Research Trends on Self-Efficacy in Breastfeeding Mothers During 2000-2023: A Bibliometric Analysis.

Self-efficacy is important in supporting breastfeeding behaviors and enhancing breastfeeding practices. This study aimed to explore research trends, identify knowledge gaps, and provide a comprehensive overview of breastfeeding self-efficacy. Data were retrieved from the Scopus online database on March 20, 2024, encompassing articles published in English between 2000 and 2023. The search strategy focused on articles containing the keywords "self-efficacy," "breastfeeding," and "mother." VOSviewer version 1.6.19 was then used to map the data and visually identify research clusters. The analysis yielded a significant increase in breastfeeding self-efficacy research over the past 2 decades. The United States led in publication numbers (117 documents), while Canada dominated citations (2792 citations). Furthermore, the analysis identified 8 critical themes in 8 different clusters, encompassing various aspects of breastfeeding, including determinants, behaviors, interventions, and mental health considerations during lactation, and employed research methodologies. One crucial gap identified in this study pertains to low breastfeeding social support. This includes a lack of support from peer groups, social networks, and social media platforms. Addressing this gap can be a valuable reference point for developing future interventions to bolster breastfeeding self-efficacy. Bibliometric analysis contributes to exploring research trends, identifying knowledge gaps, and providing a comprehensive overview of breastfeeding self-efficacy.