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Background Several lactation assessment tools are available for in-hospital assessment of breastfeeding dyads, and their components vary widely. To date, no research has evaluated the perceptions of registered nurses (RNs) regarding the limitations and future improvements of these tools. Research Aim The aim was to describe RNs' perceptions of the limitations of currently used lactation assessment tools and how these tools could be enhanced. Methods Focus groups ( n = 7) were conducted with RNs ( N = 28) whose current responsibilities included in-hospital breastfeeding assessment. Recruitment occurred from April through July 2015 at regional and international lactation conferences. Focus groups were audiotaped and transcribed verbatim. Two lactation researchers analyzed the transcripts to identify emerging themes and subthemes. Results RNs identified three key limitations of the tools included being too subjective and time-consuming, difficulty in assessing audible swallows, and missing the big picture (e.g., overemphasizing numbers, being a snapshot in time). Suggested improvements focused on maternal characteristics (evolving breasts and nipples, holding it together, "got milk?," risk factors, embracing the role), infant characteristics (day of life, latch/suck/swallow, baby's "driving the bus," risk factors for supplemental feeding), their interaction (two to tango, positioning, better qualitative descriptors), and tool organization (formatting and multiple versions). Conclusions RNs suggested novel components for consideration when developing future lactation assessment scales, including removing audible swallowing, adding mother/infant interactions, infant output, and expressible colostrum, and developing criteria specific to infant age. Future research should translate these suggestions into evidence-based indicators and evaluate the resulting proposed tools for reliability and validity.

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Registered nurses found lactation assessment tool completion to be an essential part of their job and that it ensured infant safety, standardized care, maternal instruction, and lactation assessment. Differences in the lactation assessment tool completion process were described, based on staff expertise, workload, hospital policies, and varying degrees of compliance with established protocols. These findings provide critical insight for the development of future breastfeeding assessment tools.

The purpose of this pilot study was to determine the prevalence of sustained breastfeeding in late preterm and early term breastfeeding infants at 1 and 2 months of age and to identify the factors that were related to sustained breastfeeding. Subjects were identified through purposive sampling and completed the Breastfeeding Self-Efficacy Scale and data were collected on lactation support, hospital course details, and demographic factors. At 1 and 2 months of age, structured telephone interviews determined the current feeding status and postdischarge lactation support. Of 126 mothers, 82% sustained breastfeeding at 1 month and 71.2% at 2 months. Factors associated with sustained breastfeeding at 2 months included a college education (P = .014), higher day 1 breastfeeding scores (P = .007), higher Breastfeeding Self-Efficacy scores (P = .046), and continued maternal skin-to-skin contact (P = .007). High after day 1 breastfeeding scores were associated with sustained breastfeeding at 1 month (P = .000) and 2 months (P = .001). Unsustained breastfeeding at 1 and 2 months was associated with the occurrence of supplemental feedings (P = .001) and pumping at discharge (1 month, P = .002; 2 months, P = .015). Identifying the factors associated with the high-sustained breastfeeding rate in this population helps nurses focus on how to best support their breastfeeding experience.

Little research exists on secondary traumatic stress for obstetric nurses and best educational strategies. Mixed-methods analysis was conducted to evaluate use of interprofessional panel debriefing to prepare nursing students for trauma-informed care. A pretest and posttest paired-samples design evaluated student experience and internalization of communication techniques. Students (n = 54) gained communication techniques from the learning activity; they felt simulations were realistic and applicable and described the learning activity as emotional with support from faculty. This innovative learning activity is a valuable teaching method and may be applicable to clinical agencies for new staff.

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Preparing expectant parents of multiples required a unique prenatal education program. A thorough explanation of the course layout, curriculum, and content the faculty developed for this unique 9-hour program is presented. The unique implications for parenting multiples was highlighted throughout the program, which included expectations for late pregnancy, preparation for labor and birth, assuring infant safety, learning how to provide infant care, identifying sources of support, breastfeeding information and support, potential for neonatal intensive care, postpartum depression, and providing a multiple parent's personal perspective. All classes were interactive and used active learner-based teaching strategies.