The World Health Organization (2011) advocates exclusive breastfeeding for six months to provide nutritional, immunologic and other health benefits. Breastfeeding mothers stroke their babies more frequently which helps in mother-child interaction and baby’s physical and cognitive development (Field et al., 2010). In Singapore, however, a national survey demonstrated that only 21% of mothers were breastfeeding at six months postpartum when 95% attempted to breastfeed but most stopped due to feeding problems (Deurenberg-Yap, Foo, Lim, Ng, &Quek, 2005). Incorrect techniques causes complications like breast engorgement, sore nipples and low milk supply, which in turn leads to cessation of breastfeeding (Tully, & Payne, 2003). The purpose of learning of this teaching plan is to impart breastfeeding skills to new mothers to empower them to breastfeed correctly and prevent common feeding problems that lead to premature weaning.

First breastfeeding experience affects a mother’s breastfeeding outcomes for future children (Deurenberg-Yap et al., 2005). This finding emphasizes the importance in supporting breastfeeding in new mothers.

2. Target Learners

The teaching plan aims to teach a first-time mother in the hospital on the proper practical techniques of breastfeeding. Mothers, who do not breastfeed because they cannot, their baby cannot or they choose not to, are not selected as target learners. Contraindications of nursing include maternal use of certain drugs (Ito, Lee, & Moretti, 2000), untreated maternal tuberculosis, human immunodeficiency virus infection, herpes lesions on the breast (Eglash, Montgomery, &Wood, 2008) and galactosemic baby (Eglash et al., 2008).

3. Assessment of the Learner

a) Learning Needs

The nurse would assess the client’s learning needs by asking her questions that reflect her level of breastfeeding knowledge. London (2009) suggested that the nurse may appear disrespectful if she fails to acknowledge what the client knows and insists on teaching something she knows very well. The nurse will arrange another teaching session for the client to acquire breastfeeding knowledge if she lacks it. Deurenberg-Yap et al. (2005) demonstrated that awareness of the benefits of breastfeeding significantly prolong breastfeeding. In addition, theories on adult education consistently state that adults are more motivated to learn things they perceive as relevant and important (Wingard, 2005). Hoddinott and Pill (2000) supported that mothers prefer to be facilitated to make their own decision to breastfeed rather than being told to do it. Acquiring breastfeeding knowledge allows the client to make informed decision so she will be motivated to learn.

b) Educational Level

The nurse would evaluate the client’s literacy level to judge the literacy level of the teaching plan to ensure that she will be able to comprehend and apply what is taught.

c) Readiness to Learn

The client’s emotional state and physical comfort is assessed as an indicator of her readiness to learn. Kendall-Tackett (2004) stated that postpartum depression causes atrophy of hippocampus, leading to impact learning and memory and Spear (2008) indicated that mothers with negative childbirth experience and complications experienced difficulties in breastfeeding due to emotional distress and medication effects. For these mothers, the nurse will give extra support, administer prescribed pain medications or refer them to counselling service before the sessions.

d) Cultural Background

The nurse would factor in cultural considerations specific to the client so that she can interact with the client effectively without offending her. For example, shaking head can mean “yes” or “no” in different cultures (cited in Manson, Leavitt, & Chaffee, 2007). A mother is allowed to practice breastfeeding using a doll substitutes if she does not feel comfortable breastfeeding in front of the nurse.

e) Dominant Learning Style

The nurse will determine the client’s dominant learning style and teaches in a manner that favours the style. Vance (2003) stated the choice of teaching style would affect a learner’s learning outcome.

4. Planning

a) Time Management

A survey conducted revealed that 36.7% of nursing students identified lack of time as a barrier to patient education (Dal, Demir, & Bulut, 2009). To save time, the nurse has to be organized and prepared the teaching tools beforehand. The nurse should not delegate teaching to a healthcare assistant because of staff shortage. London (2009) contended that patient education should be done by healthcare professionals who are well-aware of the content and the rationales.

b) Time Frame

The teaching sessions will not be conducted in the first few hours following childbirth. A mother should start breastfeeding within an hour of birth to ensure successful breastfeeding and promote mother-infant relationship (Tully, & Payne, 2003). As such, the nurse’s priority in the first few hours is to assist client in initiating breastfeeding rather than teaching.

The teaching plan consists of 2 short sessions that take place over two days. Redman (2004) indicated that short teaching sessions are more constructive than one lengthy session. Moreover, labour is an energy-draining process, short sessions caters to the client’s fatigue and increased need for rest.

Postpartum perineal pain has been reported to affect 92% of mothers for the first 2 months of delivery (Andrews, Thakar, Sultan, & Jones, 2007). In view of that, teaching sessions will be scheduled after morning medicine round when the client experiences less pain and thus most receptive to learning.

c) Teaching Resources

The nurse will show two videos by Howcast (2009) and Parents (2008). The nurse will ensure that the information in the videos is accurate and reliable before showing to the client.

Lactessa doll which is specifically designed for breastfeeding education will be used for demonstration. The doll resembles a real newborn with realistic weight, flexible limbs and head as well as a three-dimensional mouth that allows realistic demonstration of positions, latch-on and feeling of the hard palate. If the doll is not available in the ward, the nurse can propose to purchase one or use a pillow as a substitute (Birth International).

d) Teaching Venue

In adult learning theories, teaching is not just about imparting knowledge and skills, it also involves setting the optimum environment for learning (Hutchinson, 2003).

Breastfeeding- friendly environment is required to promote breastfeeding (Mitra, 2003). The teaching sessions will be conducted in teaching room. The nurse will book the room after assessing the client. She will arrange the seats, prepare the resources required and ensure that the physical environment is not noisy, not cold or overheated. The factors that are beyond the nurse’s control are the size of the room and whether the room is well-equipped with the audiovisual equipment. If the equipment is not available, the nurse will borrow it from other wards before the session.

Hutchinson (2003) stated that it is necessary for the student to feel secure in order to experiment, verbalize concerns and raise questions. Mitra (2003) also identified embarrassment as one of the barriers to breastfeeding. To respect client’s dignity, the nurse will ensure that the door is locked during the sessions.

e) Method of implementation

The nurse would adjust the plan according the client’s characteristics identified in the assessment process. This is made possible by incorporating other teaching sessions into the teaching plan based on individual needs.

One-to-one teaching is used to provide the mother with a private space to breastfeed as many mothers feel uneasy breastfeeding in front of others (Johnson, Williamson, Lyttle, & Leeming, 2009).

Vance (2003) identified that people learn better and faster with their dominant learning style. As such, this teaching plan incorporates several ways of learning which include video watching, story sharing, demonstration with explanation and return demonstration

Visual learners need to see images in order to learn effectively (Vance, 2003). Hoddinott, Pill (2000) and Su et al., (2007) demonstrated that women preferred practical demonstrations of breastfeeding rather than being told how to. Therefore, the nurse ensures that the teaching sessions are not just facts but also action-orientated by showing videos and providing demonstration and describing each step as she performs it.

To get the attention of auditory learners, the nurse would repeat important points. After demonstration, the nurse would ask the client to repeat the explanation as Vance (2003) stated that auditory learners remember better when they verbalize it. Also, the nurse will share successful breastfeeding stories. Literature review has demonstrated that storytelling is increasingly used in patient education to transmit human experiences, knowledge and skills (Haigh, & Hardy, 2010). Storytelling is not only cost-effective (Silver, 2001), mothers have learned effectively from other mother’s experiences and challenges (Spear, 2008).

Kinesthetic learners have short attention span and learn best through hands-on practice (Vance, 2003). Therefore, the client will be encouraged to hold a doll and follow along nurse’s actions during demonstration to keep her engaged.

f) Expected Outcome

The primary expected outcome is that at the end of the 2 sessions, the client will be able to correctly demonstrate and describe a variety of breastfeeding positioning, latching-on and burping techniques.

The secondary expected outcome is that the client will not develop complications of breastfeeding and continue to breastfeed independently for 6 months and beyond as advocated by World Health Organization (2011). As a result, the baby achieves optimum health and client loses maternal weight (World Health Organization, 2011).

The nurse will clearly state the expected outcomes in the first session. Tully and Payne (2003) reported that mothers with goals tend to breastfeed for a longer duration of time. The nurse and the client will negotiate on common appropriate objectives as adult learners are motivated when they are involved in objective setting (Schwenk, 1987).

5. Implementation

Day 1: March 17, 2011 at 9:00am – 9:20am

Activity

Time Frame

Learning Content

Teacher’s Role

1. Introduction

5 minutes

Self introduction

Discuss expected outcomes.

Remember client’s name and address her by her name to build mutual trust (Hutchinson, 2003).

2.Video showing

10 minutes

Proper positioning, latching-on and burping

Start the video

Remain in the room to observe if the client is receptive.

3. Story sharing

5 minutes

Learn from other mother’s experience and challenges.

Narrate true breastfeeding stories

Day 2: March 18, 2011 at 9:00am – 9:30am

Activity

Time Frame

Learning Content

Teacher’s Role

1. Demonstration

10 minutes

Demonstration of skills with description of the steps while client follows along.

Demonstrate proper techniques and provide description.

2. Return demonstration

10 minutes

Patient performs return demonstration on her baby

Provide brief instant oral feedback

2. Debrief & feedback session

10 minutes

Evaluate progress

Provide feedback on client’s performance.

Determine if client is competent to breastfeed independently

6. Evaluation

During return demonstration, the nurse assess client’s proficiency of breastfeeding techniques and gives frequent brief instant feedback on the client’s performance so the client is aware of her progress and able to correct her mistakes on the spot.

During debrief and feedback session, the nurse provides summative feedback on the client’s overall performance. Adult learners appreciate feedbacks and use it to evaluate their progress (Schwenk, 1987). Descriptive feedback is more effective than evaluative feedback because it provides suggestions for improvement (Schwenk, 1987). For example, the client accidentally dropped the doll. An evaluative statement would be, “You’re really clumsy.” A better descriptive statement would be, “You were not positioning the baby correctly. You should support the head with your forearm.” The nurse should provide specific feedback (Schwenk, 1987). A general statement such as, “You’ve done well”, can be replaced with “I noticed that you’ve demonstrated the breastfeeding positions very well, especially for the cradle hold”, to reinforce the specific positive behaviour. Feedback is given immediately after client’s demonstration to allow her to remember her performance and adjust her behaviour accordingly.

2000 wordsEvaluation continues after the sessions ended. The baby may not be feeding whenever its mouth is at the breast so the nurse will assess the mother and her baby for signs of milk transfer during each feeding (Tully, & Payne, 2003). She will assess the client for breast softening and lightening and signs of oxytocins release during feeding. She will assess the baby for rhythmic suck and audible swallows during feeding, moist mouth after feeding, at least two stools and six wet diapers in a day as well as absence of hunger cries between feeds (Tully, & Payne, 2003).