Key con ecpt s :Nur ses ' P r actices an d Kn ow ledg e of Br eastfeedin g
N u rs e s 'P rac tic e s an d K n o w le dg e of B re a s t f e e din g
in K ore a an d T h ailan d
H aeky u n g L ee・W ann ee Deoisr es・
Chin t an a W a ch ar a sin
H aekyun g Lee :P r ofes sor of th e Depar tm ent of Nur sin g , Kan g w on N at ion al Univ er sity . W ann ee Deoisr es :A s sist ant pr ofes sor of t he Departm ent of M at ern al- Child H ealth Nur sin g , F acult y of Nur sin g at Bur aph a Univ er sity .
Chint an a W ach ar a sin :In st ru ct or of th e Departm ent M at er n al- Child H ealth Nur sin g , F aculty of Nur sdin g at Bur apha Univ er sit y in T h ailan d.
Br ea st feedin g is str on gly r ecom m en ded for full- t erm infant s . Ideally , br easr m ilk sh ould b e pr actically th e only sour ce of nutr ient s for th e fir st four t o six m onth s for m ost infant s (E v an s , Ly on s an d Killien , 1986 ). T he nutr ition al, im m un ological, psy ch ological an d econ om ical adv ant ag es of br ea stfeedin g ar e w ell docum ent ed in our lit er atur e. Y et , th e in ciden ce of br ea stfeedin g h as v ar ied con sider ably ov er tim e (Besk e an d Garv is , 1982).
F r om 1955 t o 1971, th er e w as pr ogr es siv e declin e in br ea st feedin g in Am erica . But , 33.4%
of all infant s in 1975 an d 45.1% of all infant s in 1978 w er e br est - fed in A m er ica. S o th er e w as a r esur g en ce in it s in ciden ce thr ou gh 1978(M ar tin ez an d N aleezien ski, 1979). M or eov er , m any h ealth car e pr ofes sion als h av e tr ied t o en cour ag e m oth er s t o m aint ain br eastfeedin g at lea st unt il 4 m onth s of ag e, an d m u ch lit er at ur e r epor t s h ow t o in cr ease an d m aint ain br ea stfeedin g (Jenn er , 1988 ; H olt , 1983).
H ow ev er , in Kor ea, th er e w a s a pr ogr essiv e declin e in br ea stfeedin g aft er 1970 an d only 20- 30% of infant s w er e br ea st - fed in 1990 (T h e Kor ean Nur ses ' A s sociation New s , 1992).
A lso, t her e w er e n osign s t o in dicat e an in cr ease in th e in ciden ce of br eastfeedin g . S o th e K or ea Gov ernm ent al an d th e n on - g ov er m ent al or g anizat ion s , in cludin g th e K or ean Nur ses ' A s sociation , initiat ed t he "Br eastfeedin g P r om otion M ov em ent ". T hey h av e begun t o pr ov ide in - ser v ice pr ogr am s for nur ses an d t o ch an g e h ospit al r outin es (T h e K or ea Nur ses ' A s sociation N ew s, 1992).
Both t he succes ses an d failur es of br ea srfeedin g h av e been stu died an d m any fact or s for b oth h av e been cit ed. Besk e an d Gr av is (1982) r epor t ed t hat w om en w h o br ea stfeed fr equently ex pr es sed disappoint m ent t ow ar d t he h ospit al nur ses . H art , Bax , an d Jenkin s (1980 ) r epor t ed t hat h ealth car e pr ofes sion als sh ould h av e an im port ant r ole t o play in th e m an ag em ent of
br est feedin g .
An d y et , m any nur ses still h av e n ot intr odu ced th e pr actices t hat ar e kn ow n t o b e h elpful in th e est ablishm ent of br ea st feedin g (H ou st on an d F ield, 1988; A ber m an an d kir chh off , 1985 ).
M any stu dies r epor t ed t hat h ealth pr ofes sion als h av e r ar ely b een m ention ed a s influ en cin g m ot her ' s infant - feedin g decision s (Beske an d Gr avis , 1982; M ullett , 1982; W iles , 1984 ). A m aj ourity of w om en ev en r eport ed th at nur ses did nit discu s s about infant feedin g w it h t hem (Kirk e, 1980 ). Yet , sev er al inv estig at or s hav e foun d t hat postpartum w om en w ould h av e pr efer r ed m or e t echnical a s sist an ce w ith w ould feedin g an d m or e suppor t for m h ospit al nur ses (Besk e an d Gr avis, 1982; H all, 1978). An ex am in ation of th e r elev ant lit er atur es in dicat es th e hospit als sh ould pr ov ide opport unities for su cces sful lact ation , an d th at h ealth pr ofession als sh ould in str uct nur sin g m oth er s about th e t echniqu es of br ea stfeedin g durin g t heir h ospit al st ay . S o, it is v ery im por t ant t o identify nur ses ' pr actices pr actices th at m ay enh an ce or hin der th e est ablishm ent of br ea stfeedin g an d t o ex am in e nur ses ' kn ow ledg e r eg ar din g br eastfeedin g .
T he aim of this st udy is t o com par e th e ex istin g nur se s ' pr actice s w ith th e actu al nur s e s ' kn ow ledg e of br ea stfeedin g in th e t w o count rie s . It is h oped th at this st udy w ill pr ov ide em pirical ev iden ce a s t o h ow differ ent h ospit als ' con dition s ar e t o pr ov ide oppor tunitie s for su cce s sful br ea st feedin g durin g h ospit alization an d h ow nur s e s ' kn ow ledg e of br ea stfeedin g is differ ent in th e t w o count rie s .
D e f in it i o n T e rm
T er m u s ed in this stu dy is defin ed a s follow s : Nur s es ' pr a ctice of br ea stfeedin g : R out in e nur sin g car e r eg ar din g infant feedin g h av e b een im plem ent ed by nur s e s w h o w or k in th e m at ern al an d n eon at al unit at a h ospit al.
L i t e r at u re R e v i e w
A v ar iety of fa ct or s h av e b een identified t o b e influ ential in br ea stfeedin g su cce s s . M u ch lit er atur e h a s r epor t ed th at a g e, edu cation lev el, socioecon om ic st atu s , m at er n al h ealth st atu s , s ocial suppor t , an d pr ofe s sion al suppor t h av e a significant effect on br ea stfeedin g su cce s s (Bais ch , F oc , W hitt en , an d P aj ew ski, 1989; Be sk e an d Gr av is , 1982; Gulick , 1982;
K ear n ey , 1987 ; M an st ed, Pr offitt , an d Sm art , 1993; M ullett , 1982; Robbin s , 1992; Y oos , 1982).
R eiff an d E s s ock - V it ale (1985) r epor t ed t hat h ospit al st aff an d r outin es sh ould ex er t a str on g influ en ce on m ot her s ' infant - feedin g pr actice s . A dm itt edly , h ealth car e pr ofes sion als an d t he h ospit al con dition s of br ea st - feedin g pr a ctice s h av e litt le influ en ce on m ot her s ' dem ogr aphic an d env ir onm ent al v ariables . H ow ev er , s cer t ain pr opor tion of su cce s sful br ea stfeedin g out com e s r e sult fr om h ospit al- b a sed pr actice s su ch a s h ow soon sft er bir th a w ell b aby can st art br ea st feedin g for th e fir st tim e (S alar y a , E a st on an d Cat er 1978 ; D e Chat eau an d W inber g , 1978), w h eth er br ea st fed b abie s n or m ally ar e giv en any kim d of supplem ent s or m ot (Ev an at al, 1986; Du s diek er , Boot h , S tum bo, an d Eich enber g er , 1985;
Gr ay - D on al, Kr am er , M un day , an d Ledu c, 1985 ), h ow fr equ ently a m oth er giv es br ea stm ilk t o h er b aby at th e h ospit al(H ou st on an d F ield, 1988 ), w h eth er a m oth er w h o w ant s can feed w ith out a fix ed s ch edule or n ot (L ' e sper an ce, F r an z, 1985; S alar iy a , E a st on an d Cat er , 1978), w heth er a m oth er h a s an opportunit y r oom or n ot (Cor eil an d M urphy , 1988 ), th e pr e s en ce or ab s en ce of r oom in g - in for m oth er s an d babie s (K eefe , 1988; T an , 1992), an d th e pr e s en ce or ab s en ce of support an d education for m hospit al st aff (R eiff, E s s ock - Vit al, 1985).
T he A m er ican A ca dem y of P ediatric s (1980, 1982)h a s st at ed th at h ealt h pr ofe s sion als sh ould en cour a g e m oth er s t o br ea stfeed th eir full- t er m infant s . M any r e s ear ch er s r eport ed th e im por t an ce of pr ovidin g ex pect ant par ent s w hit en ou gh infor m ation for th em t o m ake inform ed decision s ab out infant feedin g . B e ske an d Gr avis (1982) stu died 94 br ea st feedin g m ot her s in 1982, an d foun d in th eir de s cr iptiv e stu dy th at m oth er s did n ot r at e th eir phy sician , or th e b aby ' s phy sician , or th e nur s e a s a continuin g significant s our ce for en cour a gin g br ea sr feedin g , an d th at th e la ck of infor m ation w a s r elat ed t o pr em atur e dis continuation . In an oth er stu dy , W ile s (1984) ex perim ent ed w ith 40 pr im ipar ou s w om en an d a s s es s ed t heir th echnical kn ow ledg e r eg ar din g br ea stfeedin g . W om en w h o w er e b et t er inform ed show ed a significantly high er fr equen cy of su cce s s in br ea stfeedin g th an th os e w h o did n ot (p =.01). A b er m an an d Kir chh off (1985) ex am in ed 51 pr im arily low - in com e, sin gle , bla ck m ot her s . T h ey foun d t hat m or e t han on e - half of th e s am ple population r epor t ed th at a nur s e n ev er dis cu es s ed infant feedin g w ith t hem an d n on e of th e m oth er s cit ed nur s e s or doct or s a s an influ en cin g fa ct or . T h ey su g g e st ed th at th e r ole of nur sin g in infant feedin g decision s an d patient t eachin g n eed t o b e r e - ev alu at ed. A n der s on an d Geden (1990) ex am in ed nur se s in Can a da t o dat erm in e w h eth er education , clinical ex per ien ce , or per s on al ex per ien ce pr edict ed m at ern al- n eon at al nur s es ' kn ow ledg e of br ea stfeedin g . T도 finding , coupled with the similar fin din g s of Cr ow der (1981) an d H at es (1981), su g g est ed t hat kn ow ledg e of br ea stfeedin g by m at ernity nur ses h a s n ot in cr ea sed sin ce 1981, an d nur ses h av e lim it ed kn ow ledg e of br ea stfeedin g . In addition m any h ospit als still h av e n ot im plem ent ed th e pr actices th at ar e kn ow n t o b e h elpful in th e est ablishm ent of br ea st feedint (H ou st on et al, 1988 ).
M e t h o d s
S u bj e c t s
Dat a w a s select ed fr om 1 h ospit al in S eoul. Kor ea , 1 h ospit al in Chun gju , Kor ea an d 3 h ospit al in T aejon , Kor ea an d 2 h ospit al in Ch onbur i, T h ailan d, 1 h ospit al in Ch achoen g so, T ailan d an d 1 h ospit al in Ray oun g , T h ailan d th at h av e 200 or m or e liv e bir th each y ear . T h e collectin g per iods of t he dat a w er e fr om J anuar y t o F ebr uar y , 1994 in T h ailan d an d fr om July t o A u gu st , 1994 in K or ea . A ft er r eceiv in g a n otice of agr eem ent fr om each h ospit al ' s nur sin g dir ect or , th e r e sear ch er s s ent t he h ead nur s es of t he m at ern al- child nur sin g w ar d in ea ch in st itution th e qu estionn air es t o th em t o distribut e t o st aff nur s e w orkin g in m at er - n eon at al unit s .
S o, a s elf - adm inist er d qu e stionn air w a s distribut ed t o about 140 nur s e s inv olv ed w ith
m at ern al an d n eon at al car e.
Of appr ox im at ely 114 nur s e s sur v ey ed, com plet e dat a w er e av ailable on 110 ca s e s . In s t ru m e n t s
N ur s e s ' pr actice s w er e a s s e s s ed u sin g a 39 - it er m qu e stionn air e , m odified fr om H ou st on et al.' s S cale (1988 ). T h e s cale r eflect ed th e follow in g ar ea s :(1) w hen an d w h at w a s giv en t o an infant aft er bir th .(2) feedin g s ch edules ,(3) supplem ent ation an d com plem ent ation ,(4) policy for r oom in g - in ,(5) t ea chin g br ea stfeedin g t echnique s , an d (6) in ciden ce of br ea stfeedin g .
N ur s e s ' kn ow ledg e of br ea srfeedin g w a s m ea sur ed u sin g A n der s on an d Geden ' s br ea srfeedin g kn ow ledg e qu estionn air e (1990 ) w ith 20 it em s th at r eflect ed m an a g em ent ,(2) br ea stfeedin g m an a g em ent w h en a h ealth pr oblem is pr e sent ,(3) post part um anticipat or y guidan ce ,(4) an at om y an d phy siology , an d (5 ) nutr ition . T h e num b er of corr ect an s w er s w er e sum m ed an d t he t ot al s cor e s r an g ed fr om 1 t o 20.
In a ddit ion t o g ath er in g m or e inform ation , dem ogr aphic an d per s on al que stion s w er e pos ed t o elicit dat a t o de scr ibe th e s am ple an d t o ex plicat e th e fin din g s .
D at a A n a ly s i s
R espon s e cat eg orie s w er e coded ent er ed int o a com put er , w h er e th ey w er e an aly zed u sin g t he St atist ical P a ck a g e for S ocial S cien ces pr ogr am (S P S Sx ). F r equ en cy w a s u s ed t o com par e t he nur s e s ' pr a ctices in th e t w o countr ie s . T he nur s e s ' kn ow ledg e of br ea stfeedin g w a s inv e stig at ed u sin g th e t - t e st .
R e s u lt s
1) Char act eristics of R espon dent s
T he dem ogr aphic ch ar act erist ics r elat ed t o t he t w o gr oup s of r epon dent s w er e pr e s ent ed in T able 1. Out of t he t ot al 110 nur s e s w h o par ticipat ed in this stu dy , 50 w er e T hais , an d 60 w er e K or ean s . 5 nur s es in th e T hailan d sam ple h ad LP N s ; 45 of th em h a d A s s ociat e RN s . 4 of th e K or ean s am ple w er e A s s ociat e RN s ; 47 w er e B accalaur eat e RN s ; an d 9 h a d M a st er ' s degr ee s . T he T h ai nur s e s h ad an av er a g e a g e of 28.5 y ear s . T h e K or ean sam ple w a s y oun g er t han th e T h ailan d s am ple. T h e m ean y ear s w orkin g w ith n ew b orn s an d/ or n ew m oth er s w a s 4.8 y ear s in th e T h ailan d s am ple an d th e m ean y ear s w orkin g w a s 2.5 y ear s in K or ea s am ple.
< T able 1> D em ogr aphic Ch ar a ct r er ist ic s of S am ple
Ch ar a ct er ist ic T ailan d K or ea
N % N %
L e v e l o f n u r s i n g p r o g r a m
LP N/ LV N 5 (10.0% ) —
A s s ociat e 45 (90.0% ) 4 ( 6.7% )
Baccalau r eat e — 47 (78.3% )
M a st er — 9 (15.0% )
P o s t i on at th e h o s p ot al
LP N/ LV N 5 (10.0% ) —
RN st aff 39 (78.0% ) 52 (86.6% )
RN ch ar g e n ur s e 4 ( 8.0% ) 4 ( 6.7% )
H e a d n ur s e 3 ( 4.0% ) 4 ( 6.7% )
A g e
20- 25 17 (34.0% ) 24 (40.0% )
26- 30 13 (26.0% ) 24 (40.0% )
31- 35 10 (20.0% ) 7 (11.7% )
36- 40 8 (16.0% ) 4 ( 6.7% )
ov er 41 2 ( 4.0% ) 1 ( 1.6% )
W o rk i n g y e a r s w i t h n e w b o rn s a n d/ o r n e w m o t h e r s
le s s t h an 1 y ear 6 (12.0% ) 16 (26.7% )
1- 5 y ear s 19 (38.0% ) 35 (58.3% )
ov er 5 y ear s 25 (50.0% ) 9 (15.0% )
2) F ir st br ea stfeedin g
43 nur s e s (86% ) of th e T hailan d sam ple an sw er ed th at infant s in th eir h ospit al st ar t ed t o br ea stfeed for th e fir st tim e w ithin t w o h our s aft er bir th , w hile only 1 nur s e (2.0% ) of t he K or ean s am ple r e spon ded only 1 nur s e (2.0% ) of th e K or ean s am ple r e spon ded th at th ey st ar t ed t o br ea stfeed w ithin t w o h our s aft er birt h (T able 2).
< T able 2> F ir st Br ea s tfeedin g
N ot e : P er c ent s w er e e st im at ed b a s ed on t h e n um b er of nu r s e s w h o a n s w er e d t h e qu e st ion
Ch ar a ct er is tic T ailan d K or ea
N % N %
W h e n d o e s a w e l l b a b y s t a rt t o b r e a s t f e e di n g f o r f i r s t t i m e
im m e diat ely follow in g bir th 27 (54.0% ) —
w ith in on e h ou r of bir t h 15 (30.0% ) 1 (2.0% ) w ith in t w o h ou r s of birt h 1 ( 2.0% ) —
2- 4 h ou r s aft er bir th — —
fr om 4 - 8 h ou r s aft er birt h 6 (12.0% ) 25 (49.0% )
v aries 1 ( 2.0% ) 25 (49.0% )
N o r esp on es — 9
W h a t w a s a b re a s t f e e din g b ab y g iv e n a s a f ir s t f e e din g .
br ea st : alw ay s 47 (100.0% ) 3 ( 9.1% )
s om et im es — 27 (81.9% )
n ev er — 3 ( 9.1% )
N o r esp on se 3 27
P ro v i de f o r a m ot h e r f o r h a v e s k in c o n t a c t w it h h e r b a b y in t h e d e iv e ry ro om
A ll m oth er s 27 (54.0% ) 13 (22.8% )
s om e m ot h er s 13 (26.0% ) 16 (28.1% )
N ev er en cou r a g er 10 (20.0% ) 28 (49.1% )
N o r esp on se — 3
All(N =47) for th e T h ailan d nur ses an sw er ed t hat br east - fed infant s alw ay s h ad t heir fir st feed fr om th e br ea st , w hile only 3 nur s e s (9.1% ) of K or ea an s w er ed th at br ea st - fed infant s alw ay s h a d th eir fir st feed fr om th e br ea st . 27 nur s e s (81.8% ) of K or ea r espon ded th at fir st
feed, w hile 3 nur s es (9.1% ) of K or ea an s w er ed th at m oth er s n ev er offer ed br ea st m ilk a s th e fir st feed. 5 of t he 23 T hailan d r e spon dent s an s w er ed th at th ey alw ay s offer ed w at er a s th e fir st feed an d 7 of th em s om etim e s offer ed w at er a s th e fir st feed . In contr a st , 21 of th e 42 K or ean r e spon dent s an s w er ed th at th ey alw ay s g av e w at er a s infant s ' fir st feed. Only 1 of t he 18 T h ailan d r e spon dent s an s w er ed th ey alw ay s g av e glu cos e t o infant s a s th eir fir st feed an d only 1 of th e T h ailan d s am ple s om etim e s g av e glu cos e t o infant s a s th eir fir st feed. But all th e 42 K or ean nur se s an s w er ed th at th ey g av e glu cos e t o infant s a s th eir fir st feed.
40 nur s e s (80% ) of th e T hailan d sam ple an d 29 nur s e s (50.9% ) of th e k or ean s am ple an s w er ed th at th ey pr ov ided for m oth er s t o h av e skin cont a ct w hit th eir b aby an s w er ed t hat doct or s n ev er en cour ag ed m oth er s t o cut th e babie s ' um bilical cor d .
3) F eedin g S chedule s
W hile th e m ajor ity (80% ) of th e 45 T h ailan d r e spon dent s an s w er ed th at br ea stfeedin g m ot her s could giv e br ea st m ilk a ccor din g t o th e baby ' s dem an d, only 21 nur s e s (47.7% ) of th e 44 K or ean r espon dent s an s w er ed t hat br ea stfeedin g m oth er s could giv e br ea st m ilk accor din g t o th e b aby ' s dem an d (T able 3 ). A ll of th e 45 T hailan d r espodent s an s w er ed t hat a br ea stfeedin g m oth er could feed h er baby h er s elf at night , an d 38 of t he 53 K or ean r e spon dent s an s w er ed th at a br ea stfeedin g m oth er could n ot feed h er b aby h er s elf st night .
< T able 3> F eedin g S ch edu le s
N ot e : P er cent s w er e e st im at ed b a s ed on th e n um b er of nu r s e s w h o an s w er ed t h e qu e s tion
T ailan d K or ea
N % N %
A p p i c a t i o n o f f e e di n g s c h e d u l e s w it h a b r e a s t f e e d i n g b a b y
a fix ed s ch e du le 9 (20.0% ) 23 (52.3% )
a cc or din g t o a b aby ' s dem a n 36 (80.0% ) 21 (47.7% )
N o r e spon s e 5 16
C a n a m o t h e r f e e d h e r b r e a s t f e e d in g b a b y h e r s e l f a t n i g h t ?
y e s 45 (100.0% ) 15 (28.3% )
N o — 38 (71,7% )
N o r espon s e 5 7
4) S upplem ent ation an d com plem ent ation
W h en ask ed if supplem ent s w er e giv en t o br ea stfeedin g infant s bet w een br ea stfeedin g , t he m aj orit y (73.5% ) of th e T h ailan d sam ple an sw er ed n o, w hile only 6(13,3% ) of th e Kor ean sam ple an sw er ed n o an d th e m aj or ity (86.7% ) of th em an sw er ed y es (T able 4)
< T able 4> S u pplem en t ation an d Com plem ent at ion
T ailan d K or ea
N % N %
S u pp le m e n t s b e t w e e n b re a s t f e e din g
N ot e : P er cent s w er e estim at ed b a s ed on t h e n um b er of n ur ses w h o an sw er ed th e qu estion
Y es alw ay s 2 ( 4.1% ) 11 (24.4% )
Y es occa sion ally 11 (22.4% ) 28 (62.2% )
N o n ev er 36 (73.5% ) 6 (13.3% )
N o r e spon s e 1 15
C o m ple m e n t s w it h b re a s t f e e din g
Y es alw ay s 3 ( 6.3% ) 10 (23.8% )
Y es occa sion ally 7 (14.6% ) 28 (62.2% )
N o n ev er 38 (73.5% ) 4 (13.3% )
N o r e spon s e 2 18
W h en supplem ent s w er e giv en t o br ea st feedin g infant s , 11 of th e 18 T h ailan d r espon dent s g av e w at er t o br ea stfeedin g infant s an d 7 of th e 18 T h ailan d r espon dent s g av e form ula a s a supplem ent . H ow ev er , th e m aj ority (N =37) of th e 45 Kor ean r espodent s an sw er ed th at infant s w er e supplem ent ed w ith form ula . A n sw er s t o th e qu estion s on com plem ent ar y feedin g of br ea st - fed infant s w er e sim ilar t o th ose of supplem ent ary feedin g . T h e m ajor ity (N =38) of th e T h ailan d sam ple an sw er ed n o, w hile only 4 of th e Kor ean sam ple an sw er ed n o. Als o an sw er s t o t he type s of com plem ent s w er e sim ilar t o t he type s of supplem ent s w er e sim ilar t o th e t ypes of supplem ent s . M ost of th em g av e for m ula t o br ea stfed infant s a s a com plem ent (9 out of th e 17 T h ailan d sam ple an d 35 out of th e 38 K or ean sam ple ).
5) P olicy for r oom in g - in
W h en th e nur se s w er e a sk ed w heth er th e hospit al h a s fa cilities for r oom in g - in or n ot , 46 nur s es in th e T h ailan d s am ple an sw er ed th at th ey h av e fa cilitie s for r oom in g - in an d 4 of t hem an sw er ed n o(T able 5). H ow ev er , 13 nur s es in th e K or ean sam ple h av e fa cilities for r oom in g - in an d 33 of t hem do n ot h av e th e r oom in g - in sy st em . T h e m aj or ity (N =45 )of th e T h ailan d w a s kept w ith t he m oth er in th e fir st 12 h our s aft er bir th an d only 1 of th em an s w er ed th at th e b aby w a s s epar at ed fr om th e m oth er an d pla ced in th e nur s er y , ex cept for feeds . In contr a st t o an s w er s of th e T h ailan d s am ple, th e m ajor ity (79.6% ) of th e K or ean s am ple an s w er ed t hat th e br ea st - feedin g baby w a s s epar at ed fr om th e m oth er an d placed in t he nur s ery an d n o on e an s w er ed th at baby w a s r outin ely k ept w ith th e m oth er . R e spon s e s t o th e que stion s on h ow m uch t im e m oth er an d b aby spen d t og et her each day w hile st ay in g at th e hospit al w er e sim ilar t o th os e an sw er s about w h er e th e br ea st - fed b aby st ay s aft er bir th .
< T able 5> P olicy for R oom in g - in
T ailan d K or ea
N % N %
P r e s e n c e o f t h e r o o m o n g - i n s y s t e m
Y e s 46 (92.0% ) 13 (24.5% )
N o 4 ( 8.0% ) 33 (62.2% )
in m odified r oom — 7 (13.3% )
N o r esp on se — 7
N ot e : P er cen t s w er e estim at ed b a sed on t h e nu m b er of n ur ses w h o an sw er ed t h e qu e st ion
W h e re i s a b ab y a f t e r b irt h ?
R ou tin ely k ept t h e m ot h er 45 (90.0% ) — S ep ar at ed fr om t h e m ot h er an d
placed in th e nu r s er y 1 ( 2.0% ) 43 (79.6% )
Ot h er 4 ( 8.0% ) 11 (20.4% )
N o r esp on se — 6
6) T eachin g br eastfeedin g t echniqu es
T he stu dy also ex am in ed w h o h as th e r espon sibility for t eachin g ab out br ea stfeedin g kn ow ledg e (T able 6). Alm ost all t he nur se in th e t w o countr ies (39 of t he T h ailan d nur ses an d 37 of th e kor ean nur ses )an sw er ed th at a nur se h ad a r espon sibility for t eachin g ab out br ea stfeedin g pr oblem s w hile t heir patient s w er e in h ospit al. H ow ev er , w hile m or e th an 90% (N =48) of T h ailan d sam ple an sw er ed th at all m oth er s w er e t au ght br ea stfeedin g t echniqu e, only on e- thir d (31.5% ) of t he Kor ean sam ple an sw er ed th at th ey t aught br ea stfeedin g t echniqu e t o th e m oth er s . M or eov er , alm ost 70% of th e K or ean sam ple an sw er ed th at th ey did n ot t each br ea stfeedin g t echnique. T h e dat a also r ev ealed th at all r espon dent s in T h ailan d sam ple an sw er ed th at th ey h ad postpartum clas ses for m oth er s dur in g h ospit alization an d only 1(1.9% ) of th e Kor ean sam ple an sw er ed th at th ey had postpar tum cla s sed for m oth er s . H ow ev er , 13 out of t he 42 K or ean r espon dent s an sw er ed th at m ot her s ar e giv e any on e - on - on e post part um t eachin g .
< T able 6> T each in g Br ea stfeedin g T echn iqu es
N ot e : P er cen t s w er e e st im a t ed b a s ed on th e nu m b er of nu r s e s w h o an s w er ed t h e qu e s tion
T ailan d K or ea
N % N %
A r e m o t h e r s r o u t i n e ly t a u g h t t h e t e c h n i q u e s o f b r e a s rf e e d in g ?
Y e s 48 (96.0% ) 17 (31.5% )
N o 2 ( 4.0% ) 37 (68.5% )
N o r e spon s e — 6
P re s e n c e o f p o s t p art u m c la s s e s f o r m ot h e r s
Y es 50 (100.0% ) 1 ( 1.9% )
N o — 52 (98.1% )
N o r espon s e — 7
7) In ciden ce of br ea st feedin g
Nur ses w er e a sk ed about h ow m any m oth er s ch oose t o st ar t br ea stfeedin g in th e h ospit al(T able 7). 33 of th e T h ailan d r espon dent s an sw er ed th ar 51- 75% of th e m oth er s st ar t ed br ea st feedin g in th e h ospit al an d 14 of th em an sw er ed th at 26 - 50% of m ot her s st art ed br ea stfeedin g an sw er ed th at 26 - 50% of m oth er s st art ed br eastfeedin g w hile in h ospit al. 15 of
t he Kor ean r espon dent s an sw er ed t hat 51- 75% of th e m ot her s st ar t ed br ea stfeedin g in th e h ospit al an d 2 of t hem an sw er ed th at 76- 100% of m ot her s st ar t ed br ea stfeedin g w hile in h ospit al. T he an aly sis of th e fr equ en cy of br ea stfeedin g w h en th e m oth er s w er e fin ally disch ar g ed fr om th e hospit al w a s th e sim ilar t o t hose per cent ag es of br eastfeedin g w hile st ayin g in t he h ospit al.
< T able 7> In ciden ce of Br ea st feedin g
N ot e : P er cen t s w er e est im at ed b a sed on t h e nu m b er of nu r ses w h o an sw er ed th e qu estion
T ailan d K or ea
N % N %
H o w m a n y m o th e r s c h o o s e t o s t art b re a s t f e e din g in th e h o s p it al ?
Un der 10 p er cent 1 ( 2.0% ) 21 (42.9% )
10- 25 per cen t — 4 ( 8.1% )
26 - 50 per cen t 14 (29.2% ) 7 (14.3% )
51- 75 per cen t 33 (68.8% ) 15 (30.6% )
76 - 100 p er cen t — 2 ( 4.1% )
N o r espon se 2 11
H o w m a n y m o th e r s are di s c h arg e d w it h b re a s rf e e din g f rom t h e h o s pit a l ?
U n der 10 p er cent — 20 (40.8% )
10- 25 per cen t 1 ( 2.3% ) 6 (12.2% )
26 - 50 per cen t 16 (61.4% ) 7 (14.3% )
51- 70 per cen t 27 (36.3% ) 14 (28.6% )
71- 100 p er cen t — 2 ( 4.1% )
N o r espon se 6 11
8) Nur ses ' Kn ow ledg e of br ea stfeeding
Sim ilarities an d differ en ce on br ea stfeedin g kn ow ledg e b et w een th e t w o gr oup s w er e inv e stig at ed u sin g a pooled, t w o- t ailed t - t e st (T able 8). T h er e w a s a significant differ en ce b et w een t he t w o gr oups (t =- 7.44, p =.000). Br ea stfeedin g kn ow ledg e s cor e s for th e T h ailan d s am ples w er e m ean =5.1000, SD =1.146: an d for th e K or ean s am ples ' s cor e s w er e m ean =7.8667, S D =2.411 (T able 8). T he m ean s cor e of th e T h ailan d s am ple w a s low er th an th e m ean s cor e of th e K or ean s am ple .
< T able 8> Com par is on of Br ea st feedin g K n ow ledg e B et w een th e T w o Gr oup s T ailan d K or e a
(N =50) (N =60)
X S D X S D t - v alu e p
kn ow ledg e of
b er a st feedin g 5.1000 1.147 7.8667 2.411 - 7.44 .000
D i s u s s in
T his stu dy com par ed nur s e s ' pr actice s an d kn ow ledg e of br ea st feedin g in K or ea an d T h ailan d . T h e degr ee of nur s e s ' pr a ct ice s of br ea stfeedin g in T h ailan d w a s high er th an th at
in K or ea . H ow ev er , th e m ean s cor e of nur s e s ' kn ow ledg e of br ea stfeedin g in T h ailan d w a s significant ly low er th an th at in K or ea .
In this stu dy , infant s in t he hospit als of T h ailan d st art ed t o h ospit als of K or ea . A lth ou ch m u ch lit er atur e (A m erican A ca dem y of P ediatr ic s , 1980, 1982; R eiff an d E s sock - V it al, 1985 ; T h ornt on , 1987 ) su g g est s th ar ear ly initial br ea stfeedin g is th e be st w ay for su cce s sful br ea stfeedin g , only 2% of th e K or ean s am ple r eport ed th at infant s st art ed t o br ea stfeed w ithin r epor t ed th at . W h en com par ed w ith w h at w a s giv en t o infant s a s th e fir st r eed, infanrt in th e T h ailan d s am ple w er e giv en br ea st m ilk m uch m or e a s th e fir st feed th an infant s in th e K or ean s am ple , an d all of th e K or ean sam ple r eport ed th at th ey g av e glu cos e t o infant s a s t he fir st food. A n an aly sis of th e dat a show ed th at alm ost all nur s es in th e K or ean s am ple still g av e glu cos e w ith a b ottle t o infant s a s th e fir st food. M or eov er , m or e th an half (52.3% ) of t he K or ean sam ple in dicat ed th at th ey g ot a fix ed s chedule w ith a br ea st - fed baby an d th e m aj orit y of th e K or ean r espon dent s an s w er ed th at a m oth er could n ot feed h er b aby h er s elf at night . T h e s e r e sult s in dicat ed th at b abies of th e T hailan d sam ple could feed on dem an d an d T h ailan d m oth er s t ook car e of th eir babies a s m u ch a s pos sible in th e hospit als , an d th e r ecom m en dation s of th e W or ld H ealth Or g anization w er e im plem ent ed pr ett y w ell in T h ailan d . T his suppor t s our con clu sion th at th e policy of h ospit als in K or ea sh ould ch an g e t o suppor t br ea stfeedin g m oth er s .
Com parin g th e fr equ en cy on supplem ent s an d com plem ent s w e foun d th at m or e th an 80%
of th e K or ean s am ple g av e supplem ent s an d/ or com plem ent s t o br ea st - fed infant s an d 26% of t he T h ailan d sam ple g av e supplem ent s . W h en t he dat a of th e T h ailan d s am ple on supplem ent s w a s com par ed w ith th e r e sult s of H ou st on an d F ield ' s st udy (1988), th e pr opor tion of th os e givin g supplem ent s w a s high er in th e dat a (32 out of 46 st aff nur se s ) of H ou st on an d F ield ' s stu dy t hos e (13 out of 49 nur se s )in t he T h ailan d sam ple . T h e dat a su g g e st ed t hat th e hospit al in th e T h ailan d ' s s am ple kept w ell th e r ecom m en dation s of th e W orld H ealth Or g anization . M uch lit er at ur e br ea stfeedin g (A m er ican A cadem y of P ediat ric s , 1980, 1982; E v ent s , Ly on s an d Killien , 1986 ) an d th e W orld H ealth Or g anizat ion guidelin e s dem an d th at n o w at er b e giv w an d th at infant s only r eceiv e m ilk aft er birth .
T he r oom in g - in policy in sur es t hat a m oth er w ill b e able w ith h er n ew b orn im m ediat ely . A ls o, nur s es can a s s e s s an d pr ovide car e t o a m ot her an d n ew - b orn sim ult an eou sly . M or eov er , this policy h elped t o r edu ce h ospit al cost s (Lev in e, 1980; M an s ell. 1984). W h en k eefe (1988 ) stu died ab out th e im pa ct of r oom in g - in on m at ern al sleep at night , m oth er s int t he r oom - in gr oup r epor t ed a slightly high er Qu ality of sleep a s com par ed a slight ly high er qu ality of sleep a s com par ed w ith th e m oth er s w h os e n ew bor n s slept in nur ser y . T his r e sult in dicat ed th e m ajor ity of m oth er s w er e s atisfied w ith th e r oom in g - in policy . H ow ev er , th e r e sult s of out K or ean cur r ent stu dy sh ow ed th at only on e - fourth of th e K or ean curr ent stu dy sh ow ed th at r oom in g - in sy st em an d th e m aj orit y of th e s am ple r epor t ed th at th e b aby st ay ed in t he nur s ery .
On e of th e m ost im port ant fa ct or s t o en cour a g e br ea stfeedin g is h ealt h edu cation for pr egn ant an d n ew m oth er s . M any stu die s r epor t ed th at m any m ot her s did n ot h av e any
h ealth edu cat ion t alk s , an d A b er m an an d Kir chh off (1985) r eport ed th at m or e th an on e - h alf of t he s am ple population n ev er discu s s ed infant feedin g w ith nur s es . H ow ev er , alm ost all of t he w heth er nur s e s r outin ely t au ght m oth er s th e t echniqu es of br ea stfeedin g an d h a d postpartum cla s s es for m oth er s . In contr a st t o th e r esult s of m any st udies , m ost nur s e s in T h ailan d w er e a ctiv ely inv olv ed in t ea chin g ab out br ea stfeedin g t echniqu e s an d postpartum car e . But , only on e - t hir d of th e kor ean s am ple an sw er ed y es r eg ar din g w h eth er nur se s r outin ely t au ght m ot her s th e t echniqu e s of br ea stfeedin g an d only 1.9% of th e K or ean s am ple ha d post part um cla s s es for m oth er s .
T o t e st th e differ en ce of kn ow ledg e about br ea stfeedin g b et w een t he t w o gr oup s , r e spon dent s in ea ch gr oup w er e com par ed u sin g th e t - t est . A signigicant differ en ce occur r ed b et w een th e t w o gr oup s on kn ow ledg e of br ea stfeedin g (t =- 7.44, p =.000). T h e r esult sh ow ed t hat th e T h ailan d s am ple did n ot h av e m or e kn ow ledg e ab out br ea stfeedin g t han th e K or ean s am ple did , ev en t hou gh th e T hailan d s am ple part icipat ed in t ea chin g br ea stfeedin g t echniqu e s an d postpar tum car t w ell. On e of th e r ea son s w hy th e T h ailan d s am ple did n ot h av e m or e r ecently about br ea stfeedin g th an th e K or ean s am ple m ay be th at th e K or ean s am ple gr aduat ed m or e r ecent ly th an t he T h ailan d s am ple . Cr ow der (1981) r eport ed th at subject s w ith 0- 5 y ear s of ex per ien ce h a d high er kn ow ledg e ab out br ea stfeedin g th an subj ect w ith 5- 15 y ear s of ex per ien ce in h er stu dy . A n oth er r ea s on m ay be r elat ed t o th e num ber of it em s on th e A n der s on an d Geden ' s qu estionn air es . A n der s on an d Geden (1990) su g g e st ed t hat th eir que stionn air es sh ould in cr ea s e th e num b er of qu e st ion s t o in cr ea s e th e lik elih ood of a m or e r eliable m ea sur e w h en th ey stu died nur s e s ' kn ow ledg e of br ea stfeedin g . A n der s on an d Geden (1990) in sist ed th at con sist ent an d accur at e br ea stfeedin g , e specially durin g t he h ospit alization . H ow ev er , th e m ean s cor es in our s am ples w er e low er th an th e m ean s cor e of A n der s on an d Geden ' s stu dy (th e m ean s cor e of th e T h ailan d sam ple =5.1; th e m ean of t he K or ean s am ple =7.866, th e m ean of t he A n der s on an d Geden stu dy =12.2). T he s e r e sult s su g g e st ed th at nur s es in th e t w o countries hav e lim it ed kn ow ledg e of br ea stfeedin g an d th ey did n ot giv e con sist ent an d a ccur at e infor m at ion , alth ou gh m ost of th e T hailan d s am ple t au ght t echniqu es of br ea sr feedin g . T h e lim it ed kn ow ledg e of br ea stfeedin g m ay influ en ce th e su cce s s in br ea stfeedin g . A ls o this r esult sug g e st ed th at nur s es in th e t w o countr ie s n eed t o r eceiv e in - s er vice pr ogr am s or t o w or k on s elf - in st ru ction
L i m i at i o n s a n d Im p li c at i o n s
T he im plication s an d con clu sion s dr aw n fr om this stu dy m u st b e int erpr et ed in light of t he lim it ation s inh er ent w ithin th e stu dy .
Lim it ation s of t his st udy w er e ob s er v ed. T h e r e spon dent s of th e t재 countries w er e only 110 nur ses in lim it ed ar ea s in th e t w o count ries . In addition , th e subject s w er e b a sed on th e num b er of r espon dent s w ho an sw er ed t he question . S o, th e r espon dent s could n or describ ex act ly th e con dition s in th e t w o countries . If th e collection of dat a h ad b een m or e accur at e an d con sist an d. An oth er lim it at ion w as th e a sequacy an d th e num b er of it eam s on th e th e
A n der son an d Geden ' s qu estionn air e. S om e r espon dent s said th at th ey could n ot un der st an d s om e of th e kn ow ledg e qu e st ion s b ecau s e th ey w er e t oo up - t o- dat a qu e st ion s . S o, futur e r e sear ch sh ould, th e que stionn air e r eg ar din g kn ow ledg e pr ocedur e r eg ar din g kn ow ledg e sh ould b e m odified, an d th e num b er of qu e stion s should b e in cr ea s ed.
T o in cr ea s e nur s e s ' kn ow ledg e of br ea stfeedin g , nur s e s sh ould h av e s elf - st udy an d r eceiv e in - s er v ice tr ainin g . T h er e is als o n ece s sit y t o dev elope a sy st em for a cert ified la ct ation nur s e t o acces s an d int er v en e in th e n eeds of br ea stfeedin g m oth er s . E ach of th e h ospit als in t he t w o countrie s sh ould r ecognize th at it s pr actice s m u st b e cleary ex am in ed in th e light of curr ent kn ow ledg e , an d w rit t en w ar d pr ot ocols n eed t o b e dev eloped t o en cour a g e con sist ent t ea chin g an d pr a ctices , particulary in th e ar ea of infant feedin g .
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-국 문 초 록 -
한 국 과 태 국 의 일 부 간 호 사 의 모 유 수 유 에 관 한 지 식 및 실 천 정 도
이혜경・W annee Deoisr es・Chintana W achar asin
이혜경:강원대학교 간호학과
W ann ee Deoisr e s :브라파대학 간호대학 Ch in t an a W ach ar a sin :브라파대학 간호대학
모유가 인공유보다 아기에게 신체적, 정신적으로 바람직하다는 것은 강조할 필요가 없다. 모유수유 율을 증가시키기 위하여는 간호사들이 아기어머니에게 모유수유와 관련된 지식을 전달하여, 모유수유를 실천할 수 있게 적극적으로 도와주어야 한다.
이 연구는 신생아나 산모와 함께 일하는 한국의 간호사 60명, 태국의 간호사 50명을 대상으로 모유수 유에 관한 지식과 이 지식을 얼마나 어머니에게 전달하는지를 비교 조사한 것이다.
연구결과 한국 간호사보다 태국 간호사가 모유수유에 관한 정보를 어머니에게 더 적극적으로 모유수 유를 할 수 있게 도와주고 있었다. 또한 태국병원의 체계도 모자동실을 실시하는 등 어머니가 아기를 낳은 직후부터 모유수유를 할 수 있게 되어 있는 것으로 나타났다.
그러나 모유수유에 관한 지식정도를 비교한 결과 한국의 간호사가 태국의 간호사보다 더 정확한 지식 을 갖고 있는 것으로 나타났다.
이 연구 결과는 한국의 모성간호사들이 좀 더 적극적으로 어머니가 모유를 할 수 있도록 도와야 하 며, 한국병원의 체계도 모유를 수유하기 쉽고 편안한 환경을 제공하여야 함을 나타내고 있었다. 또한 태국의 간호사와 한국의 모성간호사는 모유수유에 관한 최근의 지식을 정확하게 알아야 할 필요성을 제 시하고 있었다.