Assignment

Practice Issue Worksheet

List the topic and include the citation for the systematic review you have selected from our approved list (optional: an additional scholarly source of support):

What is the nursing practice issue you have identified related to the topic you have chosen?

Fully describe the scope of the practice issue:

What is the practice area?
___ Clinical
___ Education
___ Administration
___ Other (List):

How was the practice issue identified? (check all that apply)

___ Safety/risk management concerns
___ Unsatisfactory patient outcomes
___ Wide variations in practice
___ Significant financial concerns
___ Difference between hospital and community practice
___ Clinical practice issue is a concern
___ Procedure or process is a time waster
___ Clinical practice issue has no scientific base
__ Other:

Describe the rationale for your checked selections:

What evidence must be gathered? (check all that apply)
___ Literature search
___ Guidelines
___ Expert Opinion
___ Patient Preferences
___ Clinical Expertise
___ Financial Analysis
___ Standards (Regulatory, professional, community)
___ Other

Describe the rationale for your checked selections:

EVIDENCE SUMMARY WORKSHEET

Directions: Please type your answers directly into the worksheet.

Describe the practice problem in your own words with reference to the identified population, setting and magnitude of the problem in measurable terms:

Type the complete APA reference for the systematic review article you chose from the list provided.It must be relevant to the practice issue you described above. Include the APA reference for any additional optional supplemental scholarly source related to the review you wish to use.

Identify the objectives of the article:

Provide a statement of the questions being addressed in the work and how these relateto your practice issue:

Summarize (in your own words) the interventions the author(s) suggest to improve patient outcomes.

Summarize the main findings by the authors of your systematic review including the strength of evidence for each main outcome.  Consider the relevance to your project proposal for the Milestone 2 project paper.(If an optional supplemental source is also used, include a statement of relevance to it as well.)

Outline evidence-based solutions that you will consider for your project.

Discuss any limitations to the studies that you believe impacts your ability to utilize the research in your project.

THE CHOSEN REVIEW SYSTEM

Obstetrics/Delivery

McFadden, A., Gavine, A., Renfrew, M. J., Wade, A., Buchanan, P., Taylor, J. L., ... MacGillivray, S. (2017). Support for healthy breastfeeding mothers with healthy term babies. Cochrane Database of Systematic Reviews, Issue 2. Art. No.: CD001141. doi:10.1002/14651858.CD001141.pub5

Abstract

Background

There is extensive evidence of important health risks for infants and mothers related to not breastfeeding. In 2003, the World Health Organization recommended that infants be breastfed exclusively until six months of age, with breastfeeding continuing as an important part of the infant's diet until at least two years of age. However, current breastfeeding rates in many countries do not reflect this recommendation.

Objectives

To describe forms of breastfeeding support which have been evaluated in controlled studies, the timing of the interventions and the settings in which they have been used.

To examine the effectiveness of different modes of offering similar supportive interventions (for example, whether the support offered was proactive or reactive, face-to-face or over the telephone), and whether interventions containing both antenatal and postnatal elements were more effective than those taking place in the postnatal period alone.

To examine the effectiveness of different care providers and (where information was available) training.

To explore the interaction between background breastfeeding rates and effectiveness of support.

Search methods

We searched Cochrane Pregnancy and Childbirth's Trials Register (29 February 2016) and reference lists of retrieved studies.

Selection criteria

Randomised or quasi-randomised controlled trials comparing extra support for healthy breastfeeding mothers of healthy term babies with usual maternity care.

Data collection and analysis

Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. The quality of the evidence was assessed using the GRADE approach.

Main results

This updated review includes 100 trials involving more than 83,246 mother-infant pairs of which 73 studies contribute data (58 individually-randomised trials and 15 cluster-randomised trials). We considered that the overall risk of bias of trials included in the review was mixed. Of the 31 new studies included in this update, 21 provided data for one or more of the primary outcomes. The total number of mother-infant pairs in the 73 studies that contributed data to this review is 74,656 (this total was 56,451 in the previous version of this review). The 73 studies were conducted in 29 countries. Results of the analyses continue to confirm that all forms of extra support analyzed together showed a decrease in cessation of 'any breastfeeding', which includes partial and exclusive breastfeeding (average risk ratio (RR) for stopping any breastfeeding before six months 0.91, 95% confidence interval (CI) 0.88 to 0.95; moderate-quality evidence, 51 studies) and for stopping breastfeeding before four to six weeks (average RR 0.87, 95% CI 0.80 to 0.95; moderate-quality evidence, 33 studies). All forms of extra support together also showed a decrease in cessation of exclusive breastfeeding at six months (average RR 0.88, 95% CI 0.85 to 0.92; moderate-quality evidence, 46 studies) and at four to six weeks (average RR 0.79, 95% CI 0.71 to 0.89; moderate quality, 32 studies). We downgraded evidence to moderate-quality due to very high heterogeneity.

We investigated substantial heterogeneity for all four outcomes with subgroup analyses for the following covariates: who delivered care, type of support, timing of support, background breastfeeding rate and number of postnatal contacts. Covariates were not able to explain heterogeneity in general. Though the interaction tests were significant for some analyses, we advise caution in the interpretation of results for subgroups due to the heterogeneity. Extra support by both lay and professionals had a positive impact on breastfeeding outcomes. Several factors may have also improved results for women practising exclusive breastfeeding, such as interventions delivered with a face-to-face component, high background initiation rates of breastfeeding, lay support, and a specific schedule of four to eight contacts. However, because within-group heterogeneity remained high for all of these analyses, we advise caution when making specific conclusions based on subgroup results. We noted no evidence for subgroup differences for the any breastfeeding outcomes.

Authors' conclusions

When breastfeeding support is offered to women, the duration and exclusivity of breastfeeding is increased. Characteristics of effective support include: that it is offered as standard by trained personnel during antenatal or postnatal care, that it includes ongoing scheduled visits so that women can predict when support will be available, and that it is tailored to the setting and the needs of the population group. Support is likely to be more effective in settings with high initiation rates. Support may be offered either by professional or lay/peer supporters, or a combination of both. Strategies that rely mainly on face-to-face support are more likely to succeed with women practising exclusive breastfeeding.