I've been thinking about protocols. I think they exist for 3 purposes:
1) as a reminder to yourself
2) as a teaching tool for others
3) because you don't trust the other person to perform properly without it.
All three, really, are about trust. The protocol replaces reliance on trust
(in yourself, in someone else).
The simpler the event, the more it lends itself to distillation into a
protocol. The more complex the event, the more vague the protocol needs to
be and the more you have to rely on the judgment of the person doing the
work. If you persist in wanting a protocol for a complex event, you tie the
hands of the practitioner and are more likely to have a negative outcome.
There can be a detailed protocol for putting in an IV. There can't be a
very detailed one for doing an appendectomy. What we do for the
appendectomy is educate the person so he knows a whole lot more than he
needs to know for any specific case, and then we trust him to pick and
choose from his knowledge base according to circumstances. We trust him
because of his experience. He gains that experience step-wise, by
1) reading/hearing (books, lectures)
2) observing (assisting)
3) being observed
Hospitals are trying to come up with detailed protocols for the care of
breastfeeding dyads. Implied in that very effort is a belief that bfing is
simple. If they didn't think it was simple, they wouldn't try to distill it
into a protocol.
We fall into this simplistic thinking by trying to assist them in
formulating protocols. If only we can come up with a detailed enough
protocol... for positioning, for monitoring intake, for nipple shields,
whatever!
But the truly effective answer is to train the practitioner through
1) reading/hearing (books, lectures)
2) observing (assisting)
3) being observed
and use a practitioner who knows more than she needs to for any particular
situation.
And then just rely on the practitioner, not on a protocol. It's about
trust.
I'm not going anywhere in particular with this, but I'm *intrigued* with the
idea that complex events require simple protocols and only simple events can
be managed with complex protocols. And the more we know about
breastfeeding, the more we know it isn't simple...
--
Diane Wiessinger, MS, IBCLC Ithaca, NY
www.wiessinger.baka.com
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