Research on the effect of evidence-based practice based on core competencies on improving breastfeeding counseling skills of obstetric nurses.

BACKGROUND: Although breastfeeding is widely encouraged, there are gaps between the knowledge and practice of good breastfeeding outcomes. Specifically, nurses' breastfeeding knowledge, skills and communication competency may be suboptimal. Competency-based, evidence-based interventions may address this issue; but their effectiveness is poorly understood. OBJECTIVE: To examine whether implementation of an evidence-based, core competency program was associated with changes in breastfeeding counselling practices among obstetric nurses and selected maternal breastfeeding outcomes. METHODS: This was a pre- and post-intervention study in a tertiary hospital. Evidence was searched from global guidelines and the literature, rated using tools, and translated into a competency framework based on the Knowledge-to-Action model. Nursing staff were provided with a tailored intervention program involving theoretical training, simulated skill practice, adoption of a standardized protocol and ongoing supervision. Practitioner, patient and system-level outcome indicators, including breastfeeding counseling skills, knowledge, skills, mother's breastfeeding ability and exclusive breastfeeding rates, were measured pre and post-intervention. The assessment was done through observation and checklists and descriptive and comparative statistics were used to analyse the data. RESULTS: During the post-intervention assessment period, higher values were observed for all predefined practice indicators. Mothers receiving ≥6 counselling sessions increased from 22.0% to 88.0%, nurse training participation increased from 45.5% to 100.0%, effective breast-problem management increased from 70.0% to 100.0%, and exclusive breastfeeding during hospitalization increased from 26.0% to 50.0%. Maternal breastfeeding ability was reported as an ordinal outcome, with high ability increasing from 38.0% to 88.0%. Nurses' counselling competence scores increased descriptively from 102.09 ± 10.25 to 117.91 ± 8.62. These findings indicated that the implementation period was associated with higher observed knowledge, skills, and protocol-compliance indicators. CONCLUSION: The findings suggested that a structured, competency-based, evidence-informed intervention may improve breastfeeding counselling competence among obstetric nurses and may support better maternal breastfeeding outcomes during hospitalization. However, because this was a single-center pre- and post-intervention study with a small sample and short follow-up, further controlled multicenter studies are needed to confirm the effectiveness and sustainability of the intervention.