Breastfeeding as an effective pain-relieving intervention in infants receiving injectable immunizations: An evidence-based project Nebraska Methodist College MSN Program Capstone Project Jennifer Renken, BSN, RN Jillian Sisson, BSN, RN Kristen Villarreal, RN

Author Introductions Jennifer Renken, BSN, RN Jillian Sisson, BSN, RN Kristen Villarreal, RN

Introduction to Capstone This presentation was prepared for Nebraska Methodist College Master’s of Science in Nursing Capstone Course.

Participant Outcomes As a participant of this webinar, you will be able to: - Describe the impact of painful procedures on infants. - Explain the benefits of mothers’ breastfeeding infants during painful procedures, specifically injectable immunizations. - Discuss appropriate evidence-based interventions to reduce infant pain during painful procedures.

Continuing Education Credits In order to obtain contact hours or CEU's for a continuing education event, participants are required to attend the entire event, take the post test and return a completed evaluation

PICOT In infants receiving injectable immunizations, how does infant breastfeeding during injection administration, compared to no intervention, affect pain level as evidenced by the FLACC score within one minute of injection?

Problem The problem is that pain experienced due to injectable immunizations as infants can potentially affect the way people react to painful stimuli in healthcare settings as older children and eventually adults.

Purpose The purpose of this program is to explore breastfeeding as a pain relief measure during painful procedures.

Background The first year of life for an infant is the time when the majority of vaccinations are given. Coping skills are limited at this young age. Infant pain assessments may be neglected, due to lack of knowledge or understanding. Interventions may be known, but may not be used due to varying factors.

Immunization Schedule

Theories Gate Control Theory Theory of Comfort

Significance Ineffective coping Knowledge deficit QSEN competencies –

Setting Outpatient clinics Post-partum units Acute care

Stakeholders Infants Parents Healthcare Providers – Nurses – Physicians Administrators

Cost - Benefit Analysis Benefits: FREE! Promotes mother/infant bonding Encourages exclusive breastfeeding Increases patient satisfaction scores Costs: Workflow delays Possible safety issues Potential expense to add/remodel space

Desired Outcomes Literature Review Effectiveness of breastfeeding Clinical recommendations

Search Plan

Analyzing Literature Search Plan Results Critical appraisals – Validity, Reliability and Applicability Levels of Hierarchy of Evidence

Levels of Hierarchy

Critical Appraisal Thomas, T., Shetty, A.P., & Bagali, P. (2011). Role of breastfeeding in pain response during injectable immunisation among infants. Purpose Findings

Critical Appraisal Razek, A. & El-Dein, N. (2008). Effect of breast- feeding on pain relief during infant immunization injections. Purpose Findings

Critical Appraisal Tansky, C., & Lindberg, C. E. (2010). Breastfeeding as a pain intervention when immunizing infants. Purpose Findings

New Understandings Overall Benefits of breastfeeding Additional findings

Recommendations for Practice Encourage breastfeeding during injectable immunizations Workflow adjustments Feasibility/Availability

Suggestions for Practice Outpatient Clinic – Task Force – Workflow adjustments – In-services, training – Space redesign – Routine evaluation and feedback

Conclusion Understanding infant pain Infant pain management is important Use of breastfeeding in pain control Time for change