Julie;
I just finished a major project of inservicing all our LDRP staff.
Here are some thoughts for you to consider.
  1. I did a pretest to determine where the areas of greatest need
were.
  2. Based on the results from the pretest, I felt it was necessary
to spend some time on the basic anatomy of the breast and the
elements of milk transfer so that there could be an understanding of
the basis for positioning, latch, determining effectiveness, hand
expression, etc.
  3. My presentation was 2 hours long, but to get everything in I
had to move along a lot faster than I would have liked.  It could
easily have gone four hours.
  4. I did include 2 videos: the self-attachment one that is
available from Kitty Franz and the most recent one on positioning
and latch from the midwives group in England.  (I believe the title
is "Breastfeeding: A Guide to Positioning".  It's at work, so I
can't check for the exact wording. I got my copy from Linda Smith at
Bright Future-I'm sure it is available from other sources as well.)
  5. We already had in place a teaching flow sheet with an extensive
list of items about breastfeeding.  I tailored my presentation both
content and order presented to follow that checklist.
  6.  One of the biggest stumbling blocks is the attitude "But we've
always done it this way" and "I did it such and such a way and it
was fine for me".  In presenting info to staff, mothers, MDs etc. I
find it helpful to preface my remarks with a statement something
like this: "Breastfeeding doesn't change.  However, our
understanding of how it works and how to make it work more
effectively does change."  I also freely point out areas where I
used to think or practice differently than what I now recommend.  I
think this approach puts the listener at ease and assures them that
different recommendations now don't necessarily mean they were
"wrong" before.
  7.  Posttest after the presentation (same questions as the
pretest) will show how much the knowledge/attitudes of the listeners
has changed.  Pretest scores I got ranged from 31%-81% while
posttest scores ranged from 79%-96%.
  8.  If you have limited time, I would suggest covering the basics
of latch and milk transfer (including the related anatomy).  Then
cover what can interfere with those and how to know if baby is
nursing effectively.  Have other resources such at videos could be
available for staff to view on their own time.  If you are having
staff complete a competency, it could include attending the
inservice (or viewing a video of it if you can arrange one),
completing the test, & viewing suggested videos.  Our competency
also includes being checked off on knowledge of breastfeeding
equipment used on the unit (pumps, Haberman feeders, etc.) and being
observed helping with or at least assessing a baby's latch.
  9. If you have Power Point available on your computer, it is
excellent for making slides or overheads.  In addition, you can
print up copies of the key slides in a handout. It's a wonderful
tool!

Good luck to you.  If you can change or even "tweak" in the right
direction the practice of even one staff member, it will in turn
help every mother/baby that person works with.  Don't get
discouraged if it takes time to make changes.  I have found that
change came slowly the first years I worked in my present position.
In time change took place faster and more widely spread.  We could
see improvement even the next day after our inservice!

Winnie Mading RNC, IBCLC

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