CHAPTER -VI

SUMMARY, CONCLUSION, RECOMMENDATIONS AND

IMPLICATIOS

6.1 Summary:

It includes systematic activities carried out throughout the study. The

particular study was done to “determine the effectiveness of Breastfeeding

Empowerment Programme (BEP) on triodomains and Breastfeeding outcome

among primigravidae”.

To achieve this the investigator formed the objectives as follows;

1. Evaluate the effectiveness of Breastfeeding Empowerment Programme

2. (BEP) on trio-domains and breastfeeding outcome among primigravidae

3. Correlate the trio-domains with breastfeeding outcome

4. Associate the selected background variables with trio-domains and

breastfeeding outcome among study group.

To answer the research questions hypotheses were formulated as follows:

1. There is a significant difference in the level of knowledge between primigravidae

who participate in the breastfeeding empowerment programme and those who do

not.

2. There is a significant difference in the level of skill between primigravidae who

participate in the breastfeeding empowerment programme and those who do not.

3. There is a significant difference in the level of self confidence between

primigravidae who participate in the breastfeeding empowerment programme and

those who do n

4.There is a significant difference in the breastfeeding outcome between

primigravidae who participate in the breastfeeding empowerment programme and

those who do not.

The investigator reviewed the literatures to support the study as well as the findings

of the study. It was in two parts . Part-A ; Related studies on breast preparation and

breastfeeding .Part-B; Conceptual framework based on Imogene. I. King’s Goal

attainment theory.

The research approach used for the study was evaluative approach and true

experimental design with two groups pre- posttest design was adopted.

The study included, the BEP (Breastfeeding Empowerment Programme) as an

intervention .The study setting was Sri Ramachandra Hospital at Porur, Chennai, in

Antenatal OPD, Labour room and postnatal wards. All antenatal women were served

as population, but whoever fulfilled the sampling criteria were samples.The samples

were allotted at random in both the groups by using simple random technique.

The prepared tool was in 3 sections.

Section 1: Background variables ( demographic, maternal and neonatal variables)

Section 2: Trio- Domain ( knowledge, skill and self confidence

Section 3: Breastfeeding Outcome ( LATCHES, breast engorgement and nipple pain)

Content validity was obtained from 9 experts. Reliability was checked using split half

and interrater method. Pilot study was done on 10% of the samples. The pilot study

showed feasibility in conducting the study. Few modifications were included in the

study with experts suggestions. The main study was conducted among primigravidae

to evaluate the effectiveness of BEP. The collected data were coded and analyzed

using descriptive and inferential statistics. The results of the study were ,

On comparison

• Among the Primigravidae 132(95.7%) had inadequate knowledge, 3(2.2%)

had moderately adequate and 3(2.2.%) had adequate knowledge in study group

and 121(91.%) had inadequate knowledge, 11(8.3%) had moderately adequate

knowledge and none of them had adequate knowledge in control group during

pretest. The posttest showed 5(3.6%) had inadequate knowledge, 119(86.2%)

had moderately adequate and 14(10%) had adequate knowledge in study group

and 121(91.7%) had inadequate knowledge, 10(7.6%) had moderately

adequate and 1(0.7% ) had adequate knowledge in control group.

• There’s statistically significant improvement in the overall level of knowledge

on antenatal and postnatal breast care among study group (64.51) when

compared to control group (42.75) at p<0.000*** level.

• Overall mean value of skill during posttest I (study group 62.41, control

group 59.18), posttest II (study group 70.10, control group 53.49) and posttest

III (study group 75.15 , 51.67) showed a statistically significant at the level

of p<0.05, p<0.001 level and p<0.001 level respectively.

• The mean difference of breastfeeding skill performance showed a statistically

significant level between posttest I - posttest II, posttest I - posttest III and

posttest II - posttest III at p<0.000***.

• There is improvement in the self confidence level during posttest I at the

level of p<0.000***.

• During posttest II there is no statistical difference in the self confidence

between the groups.

• There is statistically significant improvement in the self confidence during

posttest III at the level of p<0.000***.

• There’s statistically significant improvement in LATCHES (breastfeeding

pattern) during posttest I – posttest III and posttest II- posttest III which

showed a statistically significant value at the level of p<0.000***. During

posttest I posttest II there was no difference between the group.

• Presence of nipple pain level on the third postpartum day showed a significant

reduction t=15.660 at p< 0.000***which is a highly significant value among

study group compare to control group.

• The occurrence of breast engorgement was significantly reduced on the third

day of the postpartum period among study group, which is highly significant

at p<0.000*** level .The first and third day postnatal engorgement showed

p<0.05*and p<0.01** level respectively.

On correlation

• No correlation was found between knowledge and breastfeeding skill.

• Knowledge is not correlated with self confidence level.

• Breastfeeding skill performance and self confidence was positively correlated

with each other.

• There was a high correlation at p< 0.00l*** which was elicited between skill

and LATCHES on the third day of the postpartum period.

• There was a negative correlation between skill and pain during all the three

days of postpartum period.

• Skill and breast engorgement showed a negatively significant correlation at

p<0.05* level.

• Study group had a high level of positive correlation on the third day of the

skill with LATCHES score at the level of p<0.001***.

• Third postnatal day pain with posttest I, II, III self confidence level showed

perfect positive correlation at the level of p< 0.001***.

• Self-confidence and breast engorgement correlation revealed that on almost all

the days of posttest I, II, III breastfeeding engorgement with self-confidence

showed a negatively non significant correlation.

On Association

• Knowledge score with domicile was at p<0.05*, Knowledge score with

presence of social support during antenatal period was at p<0.05*. Association

of posttest skill score I (first postnatal day) and posttest skill score (second

postnatal day) with the weight of the mother showed at the level of

significance at p<0.01**. Posttest skill score II with occupation was at

p<0.05* and sex of the baby at p<0.05*. Posttest III skill score with education

of the mother was at p<0.05*, history of disease was at p< 0.05*.

• Posttest III skill score with education of the mother was at p<0.0.5* and

history of breast disease p< 0.05*. Posttest III (third postnatal day) self

confidence level with religion was at p<0.05* level.

• Posttest I pain with duration of labour and posttest II pain with age were

associated at the level p<0.05*. Posttest III engorgement with education of the

mothers was at p<0.05*. Sex of the baby is associated with posttest III breast

engorgement at p< 0.01** level.

On Regression

• Self-confidence is related with religion at the level of p<0.05 with the r-

value of 0.246.

• There was a significant relationship between sex of the baby and posttest -

II skill and sex of the baby at the level of p<0.05 with the r-value of 0.192.

• There was a significant relationship found between posttest - III skill with

education, social support during postnatal period, sex of the baby at the

level of p<0.05 with the r value of –0.209, -0.020 and 0.174 respectively.

• There was a significant relationship between occupation and posttest III

pain at the level of p<0.01 with the r-value of 0.195. And also there was

significant relationship between history of breast disease and posttest III

pain at the level of p<0.05 with the r-value of - 0.169.

• Breast engorgement is related with sex of the baby at the level of p<0.05

with the r - value of - 0.219.

6.2 CONCLUSIONS

The study conclusions are

• Immediate postpartum is crucial to initiate breastfeeding by most of the

primigravidae mothers and continue it for successful breastfeeding.

• It is mandatory to prepare primigravidae during antenatal period to have

adequate knowledge on breastfeeding as a basis to develop skill and self

confidence during postnatal period.

• Antenatal preparation of the mother especially on breast care and postnatal

breastfeeding is one of the best strategy to overcome the challenges and

complications during the postnatal period. Hence BEP is one of the best

strategy to prepare the primigravidae adequately during antenatal period to

have a successful breastfeeding postnatally.

6.3 RECOMMENDATIONS FOR FURTHER RESEARCH

• A comparative study can be done between normal vaginal delivery and

caesarean mothers for assessing the breastfeeding pattern.

• The same study can be replicated for a larger sample and in different settings

• The same study can be replicated for a longer duration in terms of posttest

assessment during 3rd month and 6th month.

• A comparative study can be done between urban and rural population.

6.4 IMPLICATIONS FOR NURSING PRACTICE

• Implementation and adherence to BFHI is one of the best strategies to have

a 100% successful breastfeeding.

• Midwives need to accept the responsibility of helping mothers to gain

knowledge and skills necessary to breast-feed successfully their newborns.

• Structured video assisted teaching and instructional materials, A.V. aids and

demonstrations are found to be effective among Primi mothers in improving

their knowledge and practice there by maternal confidence.

• The nurse midwives in the maternity wards, outpatient departments and also in

community midwifery practice can use the compact disc on breast care and

self-instructional module. It can be included as one of the teaching items in

mother’s craft courses.

• Midwives should provide sensitive and caring support for mothers who

desired to breastfeed but could not due to perceived inadequacy of milk

supply. If the mothers are prepared adequately during antenatal period, it may

ensure the exclusive breastfeeding.

• Each and every maternity nurse should join hands to promote and implement

100% of exclusive breastfeeding.

• Adherence to the policies & protocols implemented by the joint venture of

WHO& UNICEF’s Baby Friendly Hospital initiative (BFHI) is important.

Midwives should take part in implementing these policies wherever they

work.

6.5 IMPLICATIONS FOR NURSING ADMINISTRATION

• Nursing administrators should take steps to establish a separate lactation

consultation wing and appoint midwives as lactation consultant in Antenatal

Outpatient Department.

• Nursing leaders are challenged to undertake the health needs of most

vulnerable groups, especially maternal and child health by effective

organization and management.

• It is essential to promote hospital policies and procedures that facilitate

breastfeeding practices, to develop and maintain effective communications

and collaboration with other health care providers to ensure optimal

breastfeeding education and support for the mother and baby.

• The employers can be encouraged to provide appropriate facilities and

adequate time in the work place for feeding.

• Teaching session can be arranged in the antenatal ward to orient the new

mothers on breast preparation and breastfeeding techniques.

• Implementation of teaching can improve documentation and standard of

profession.

• Conducting In-service Education Programmes for the novice midwives on

these breast preparation and breastfeeding techniques aspects may be quite

useful.

• Nursing administrators should ensure that education should reach all

primigravidae mothers and safeguard them from the dangers of breastfeeding

complications.

• Promotion of breastfeeding and prevention of feeding problems should be a

combined effect of all health personnel working in the pediatrics and obstetric

department

6.6 IMPLICATIONS FOR NURSING RESEARCH:

• Nurse researchers should work on inventing different scales to measure the

breastfeeding pattern for the Indian standard.

6.7 IMPLICAITON FOR NURSING EDUCATION

• Student can be motivated in the antenatal OPD on breast care and breast hygiene

during antenatal period

• Nursing students can be instructed to practice the concept of breast self-

examination for the antenatal mothers in the antenatal OPD.

• Though breastfeeding techniques, advantages are included in the curriculum,

students should apply skills in assisting mothers, teaching them about

breastfeeding practices, becoming knowledgeable and skillful in both the

physiology and clinical management of breastfeeding. Promoting breastfeeding

must be a routine component in education. This compact disc and booklet can

serve as an educative tool for staff nurses working in maternity units by

continuous maternity nursing education.

• Nurse educators can plan the nursing programme to meet the challenging needs of

the antenatal mother.