> Date: Fri, 1 Jan 2010 10:13:01 -0500
> From: [log in to unmask]
> Subject: motivating recalcitrant nursing staff (long)
> To: [log in to unmask]
> 
> Dear Friends:
> 
> Mary Westra sends up a distress call.
> 
> I've been tackling this issue for years in the 18-hour Interdisciplinary
> Breastfeeding Management Course that I teach at the Health Department.
> 
> For one thing, it is a HUGE help to offer nursing contact hours. Nurses in
> my state must have a certain number of contact hours for relicensure.
> Because we are the Health Department, the course is offered for a very low
> cost, about one-third of the usual daily conference fee. This is a draw. I
> get people calling because they need the contact hours and don't care what
> the topic is....I aim my teaching to THEM, those with utterly no interest in
> the topic.
> 
> "Win-win with skin to skin" is the slogan. Boston Medical Center made a
> lovely video called "From Bottles to Breasts to Baby-Friendly" that is
> mostly nurse-centered. Audiences are drawn in, because it is nurses speaking
> to other nurses. The first segment of this fabulous film (and I have utterly
> no commercial or financial attachment to the film, and spent many dollars of
> my own money to transfer it to a DVD) shows a newly delivered baby on
> momma's bare chest, obviously in the delivery room. One hears staff talking
> and bustling around. Views of the dyad are interspersed with nurses speaking
> about the process of change. At one point, the mother's blood pressure is
> measured, without disturbing the skin to skin. Eventually the baby attaches.
> All by itself.
> 
> Carol Melcher RN, MSN (who developed the S.O.F.T. program) gave some
> wonderful advice in her recordings from the ILCA conference where she spoke.
> She is saying that 10-15% of staff will not change. So forget about
> them....and surround them with the 85% that do get it !!
> 
> Remind folks of the Healthy People 2020 goals for our nation, which are
> supported by the AAP and the CDC. I have a great cartoon of 7 women talking
> about the reasons that they didn't breastfeed. After talking about
> evidence-based practice, I ask my audiences what sort of advice those 7
> women would give to new mothers if the 7 were postpartum nurses. I suggest
> that the reason nurses discourage breastfeeding comes from a loving heart,
> that because the nurses themselves had trouble with breastfeeding, they want
> to save their clients any anguish and pain. Hence the "don't bother with
> that misery, honey" attitude. I am always looking for ways to praise and
> accept and embrace.
> 
> Talking about forgiveness is helpful. How awful a nurse could feel learning
> that the way she fed her precious baby was wrong, possibly disease-inducing!
> (And if her child is sick, she feels even worse!) And she was just following
> the medical recommendation. Kay Hoover talks about how many sad stories from
> staff that she would hear when she came to teach at a hospital; people have
> to tell their stories before they can move on. We have to listen and not
> take it personally.
> 
> Today, we learn from the past to make the future better.
> 
> In one class, I had to stop teaching because the audience of nurses was so
> vocally resistant that I had to sit down and listen. They ventilated for 45
> minutes about how they couldn't do this, about how their clients weren't
> interested, about how they had to get the L&D room empty quickly for the
> next client, about how hard it was and who gave a shit about all this
> breastfeeding stuff anyway? I was overwhelmed and felt terrible, like the
> world's worst teacher. I wrote to Dr. Barbara Philips about this class, and
> she responded with the most understanding and loving and supportive email
> that I will save forever. Here's the jist of what she said. "When the class
> shares their resistance with you, you are on the path to change. It is a
> good thing. Welcome their resistance because it means they are engaged with
> you. Listen and accept and validate. Meet them where they are."
> 
> The 3-day class is 3 days because of this. The resistance would emerge at
> Class 2, and then it would clear and folks could participate and learn and
> feel encouraged at Class 3. (I read this in some UNICEF publication.)
> 
> There's some fabulous nursing research to share that is very helpful. Nurses
> talking to nurses works. I get lots of positive feedback for using nursing
> research in the classes.
> 
> "Interruptions to breastfeeding dyads on postpartum Day 1 in a university
> hospital" by Morrison, Ludington-Hoe, and Cranston Anderson (JOGNN2006,
> 35(6):709-716 is a must for this type of work. Ask the class how many times
> from 8a to 8p a new dyad is interrupted. People *never* guess the average
> number (54). Then ask, "who interrupts the most?" It is medical and nursing
> staff. Then ask "Who is second?" The class usually responds 'visitors' but
> no, it is housekeeping and dietary. It is a shock for some nurses to realize
> that THEY are the cause of the interruptions. (I've gotten some nasty
> feedback about that!). Funny, because when I worked in L&D, and postpartum,
> I remember long complaint sessions about "all those visitors won't leave the
> new mother alone". It is US (the staff) making the problem....just as Dr.
> Philips says in the film. How in the world could a new mother feel safe
> exploring the use of her breasts when she is never alone with her baby for
> more than 9 minutes (for half their time alone together)?
> 
> Here's another good nursing research study: "Kangaroo Care at Birth for
> full-term infants November/December 2007Walters, Boggs, Ludington-Hoe et al
> MCH page 375" There is a lovely comment in the article about how nursing
> workload was not increased, and physicians found skin to skin to be
> analgesic for mothers during perineal repairs.
> *
> *
> All the S.O.F.T. stuff is another useful bit of nursing research. Do a
> google search for S.O.F.T and you'll get to where you want to go.
> 
> One more helpful piece of nursing research is:
> "Skin-to-skin care with the father after cesarean section and its effect on
> newborn crying and pre-feeding behavio*r" Birth 2007 Jun;34(2):105-14*
> Lovely for staff to see how dad can help with skin to skin after a cesarean
> section.
> 
> Biological Nurturing (Laid Back Breastfeeding) is a great, albeit expensive,
> DVD. Showing nurses how a baby can breastfeed while sleeping is a great
> stress reliever. How much effort have nurses spent trying to wake sleeping
> baby? I remember struggling with that. Well, you don't have to wake the baby
> to feed it. You can spoon feed newborn milk on a spoon. You can put the baby
> to breast and let its reflexes take over. Dr. Suzanne Colson's video clips
> are priceless for teaching. Another segment of her DVD that is helpful is
> the clips showing babies waving their arms and legs around while the mother
> is sitting in a fixed upright position, trying to breastfeed. Many nurses, I
> was one, have held infant arms and legs to help breastfeeding. Just having
> the mother lean back. so the baby stays on her chest without the mother
> having to hold it makes a HUGE difference. Audiences pay a lot of attention
> to these video clips because it gives them tools for their toolbox.
> 
> I think one reason nurses are resistant is because they lack the skills. Who
> wants to help someone do something if one has no clue how to help? It's so
> much easier to stick a bottle in baby's mouth.
> 
> When one nurse stands up in class and says "I used to hate breastfeeding"
> and then goes on to tell a story about how s2s made the difference, the
> tipping point occurs in that class. That is a miracle to witness; I wish I
> could bottle it!
> 
> Another great study is "A Pilot Study of a Nursing Intervention Protocol to
> Minimize Maternal-Infant Separation After Cesarean" JOGNN 2009;
> 38(4):430-442 Nolan and Lawrence. The creative folks in this institution
> rearranged their operating room so the infant warmer was aligned with the
> head of the operating table, so the mother could see her baby all the time.
> They did a bunch of other cool stuff too, to promote curiosity and
> attachment. Check it out.
> 
> I've spent a long time on this post.....it is what I have learned from the
> trenches, one nurse at a time.
> 
> warmly, and Happy New Year to us all!
> 
> Nikki Lee RN, BSN, Mother of 2, MS, IBCLC, CCE, CIMI
> craniosacral therapy practitioner
> www.breastfeedingalwaysbest.com
> 
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