COMPETENCY ITEMS AND VALIDATION TECHNIQUES

COMPETENCY: BREASTFEEDING

STANDARD: Breastfeeding education and counseling are integral components of maternal and child health home visiting nursing care. Breastfeeding provides immunologic, nutritional and psychosocial benefits to the breastfed newborn.

I. MCH HV nurse demonstrates knowledge of and ability to determine, with client, her goals and plan of care

 

Technical Skills

Interpersonal Skills

Critical Thinking Skills

Validation

1. Lists 5 benefits of breastfeeding to mother and/or newborn

2. Identifies community breastfeeding support sources

Written Test:

q Validate technical skills items #1 and #2 by written test

3. Describes impact of breastfeeding on family relationships

4. Elicits mother's feelings and concerns about breastfeeding

5. Determines and supports maternal breastfeeding goals

6. Involves mother in identifying breastfeeding support system

9. Individualizes care based on cultural influences

10. Prioritizes breastfeeding concerns for each mother baby couple

11. Recognizes own knowledge, limitations, and consults other sources as needed

Demonstration:

q Validate interpersonal skills items #4 to #8 and two of the three critical thinking items (#9 to #11) through observation of nurse/client interaction on a home visit. If a home visit is not feasible, validate using the role-play below. Discuss with the nurse, after the home visit, or role-play following questions listed on the next page.

 

 

 

 

 

 

 

 

 

 

 

I. MCH HV nurse demonstrates knowledge of and ability to determine, with client, her goals and plan of care

 

Technical Skills

Interpersonal Skills

Critical Thinking Skills

Validation

 

 

 

7. Involves the mother in developing and implementing a plan for priority concerns

8. Recognizes cues of maternal fatigue and avoids overwhelming mother with information

 

 

 

 

 

 

 

q Role Play:

You visit a 35-year-old Hispanic (or other ethnic group relevant to your population) mother, G2P2, who is breastfeeding her 4-day-old son. Although she breastfed her first child three years ago this child’s nursing behavior is frustrating. While her first child readily went to the breast, this infant is sleepy, jaundiced and not interested in nursing. Mother must return to work in 4 months.

q Discussion questions with the nurse after home visit or role play:

a. What techniques (i.e. body language, tone of voice) did you use to convey support?

b. What questioning techniques did you use to elicit mother’s breastfeeding goals?

c. How did you assist mother to identify her priorities?

d. Discuss 2 (your choice) critical thinking skills that were applied.

e. How were cultural issues addressed?

f. Describe any situations when a referral for this mother would be appropriate

g. What is the follow up plan for this family?

 

 

 

II. MCH HV nurse demonstrates knowledge and ability to assess and educate Mom selcare related to breastfeeding

 

Technical Skills

Interpersonal Skills

Critical Thinking Skills

Validation

1. Describes signs and symptoms of mastitis and yeast infection of the breast

2. Lists 2 factors that contribute to sore nipples for the mother

3. Lists 3 s/s letdown

4. Lists 3 nursing interventions to treat: engorgement, nipple pain, and plugged ducts or mastitis

5. Describes adequate nutrition and fluids for breastfeeding (refer to postpartum maternal and newborn nursing care for validation)

 

 

    

Written Test:

q Validate technical skills items #1 to #5 by written test.

 

 

 

 

II. MCH HV nurse demonstrates knowledge and ability to assess and educate Mom self care related to breastfeeding (continued)

 

Error! Bookmark not defined.Technical Skills

Interpersonal Skills

Critical Thinking Skills

Validation
 

6. Involves mother in planning to promote relaxation and enjoyment of breastfeeding

7. Prioritizes breastfeeding concerns for each mother- baby couple

8. Recognizes own knowledge limitations and consults other sources as needed

Demonstration:

Validate interpersonal /critical thinking skills item #6 through #8 through observation of nurse/client interaction on a home visit. If a home visit is not feasible validate using the role-play below. Discuss with the nurse, after the home visit or role-play, the questions listed below.

q Role Play:

You visit a G1P1 who is upset when you arrive. Her baby is 3 days old. He nurses frequently and her nipples are red and sore. She is frustrated and crying. She wants to give up nursing.

q Discussion questions with nurse after home visit or role play:

a. How did you assess whether the baby is latched on correctly?

b. How did you evaluate the success of breastfeeding?

c. What suggestions did you have for mother to enhance physical comfort and relaxation?

d. What questions were asked to elicit information regarding relaxation techniques that were useful to mother?

e. How did you incorporate mother’s suggestions into a plan?

f. How did you respond to the mother who wishes to stop breastfeeding?

g. Describe any situations when a referral for this mother would be appropriate.

h. What was your follow up plan?

III. MCH HV Nurse demonstrates knowledge of and ability to assess newborn feeding

 

Technical Skills

Interpersonal Skills

Critical Thinking Skills

Validation

1. Lists 3 signs of effective latch

2. Lists 3 characteristics of effective suck/swallow pattern

3. Lists 4 feeding readiness or early hunger cues

4. Lists 3 signs and symptoms of newborn satiety

5. Describes normal newborn feeding frequency during the first few weeks of breastfeeding

6. Identifies when the first growth spurt usually occurs and describes how it affects the baby’s feeding pattern.

Lists 3 signs and symptoms of dehydration in newborn

 

 

 

7. Identifies adequate weight gain for newborn

8. Describes at least 2 possible effects of formula supplementation on newborn health and maternal milk supply

9. Lists signs and symptoms of increased billirubin in the newborn-jaundice.

Describes the difference between primary newborn jaundice and elevated billirubin related to feeding.

Describes breastfeeding strategies for infants with elevated billirubin.

10. Demonstrates cradle hold, football hold, side lying positions for breastfeeding

11. Demonstrates 1 or more techniques for detaching newborn from breast

12. Demonstrates 1 or 2 techniques for burping baby

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

13. Creates an environment of privacy for communication and/ or physical assessment

 

14. Obtains consent before touching patient

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

15. Considers the effects of medications mother is using on breastfeeding and newborn health

Written Test:

q Validate technical skills items #1 to #9 by written test.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Demonstration:

· Validate technical skills items #10, #11, and #12 through demonstration using a doll.

a. 3 positions for breastfeeding (cradle hold, football hold and side lying.)

b. 1 or more techniques for detaching the newborn from the breast.

c. 1 or more techniques for burping the baby.

Validate interpersonal skills items #13 and #14 and critical thinking item #15 through observation of nurse/client interaction on a home visit. If a home visit is not feasible validate using the role-play below. Discuss with the nurse, after the home visit or role-play, the questions listed below.

q Role play:

You are visiting a 26 year old G3P3 who is first time nursing mom. Several visitors and children are present in a small apartment. The baby is 2 days old. Mom relates that the baby was disinterested in nursing initially but did latch on and nurse prior to hospital discharge. She thinks that the baby latches on after she attempts to initiate nursing for a few minutes. She asks if you think the baby is getting enough. Your assessment indicates that mom gets migraine headaches and has a prescribed pain relief medication.

 

Discussion questions with the nurse after home visit or role play:

a. How did you create an environment conducive to communication and/or physical assessment?

b. How did you assess for proper latch and effective suck

c. How did you respond to the mother asking if her baby is getting enough?

d. What did you consider in your discussion with mom re. her pain medication and breastfeeding?

e. Describe when you would refer this mother for lactation consultation.

f. What are/were your follow up plans for this mother?

 

IV. MCH HV nurse demonstrates knowledge of and ability to teach re. methods of expressing, storing, and feeding breast milk

 

Technical Skills

Interpersonal Skills

Critical Thinking Skills

Validation

1. Describes safe storage for expressed milk at refrigeration 32-39 F

2. List at least 3 alternative feeding methods of expressed milk

Written Test:

q Validate technical skills items #1 and #2 by written test.

3. Demonstrates correct use of breast pumps available in area

 

 

 

 

 

 

 

 

 

 

4. Explores ways with client to continue breastfeeding while separated from baby

 

 

Demonstration:

q Validate technical skill item #3 by.

Demonstrating correct use of a breast pump. Look for:

a. Good hygiene - hand washing, cleaning pump and pump collection items

b. Stimulating let-down reflex

c. Following pump directions - proper size nipple adapter, centering nipple in

breast flange, breast seal, & pressure setting

q Validate interpersonal skills #4 through observation of nurse/client interaction on a home visit. If a home visit is not feasible validate using the role-play below. Discuss with the nurse, after the home visit or role-play, the questions listed below.

q Role play:

A nursing mom is planning to return to work in three weeks. Her infant is 3 months old and has been breast fed exclusively. She would like her son to receive breast milk or stored milk. She has not developed a plan but has many questions for you. She will be unable to come home to nurse the baby during her workday.

q Discussion questions with nurse after home visit or role play:

a. What information did you use to assist mother in developing a plan for expressing milk when she and the baby are to be separated (i.e., length and frequency of separation; storage options; time to pump or hand express)?

i. What plan was developed?

 

 

 

 

 

 

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