1. 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

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

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

4. 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.

5. 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

6. 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?

7. 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.

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

9. 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.

10. Immunization Schedule http://www2.aap.org/immunization/izschedule.html#Birthon

11. Theories Gate Control Theory Theory of Comfort

12. Significance Ineffective coping Knowledge deficit QSEN competencies – http://qsen.org/competencies/ http://qsen.org/competencies/

13. Setting Outpatient clinics Post-partum units Acute care

14. Stakeholders Infants Parents Healthcare Providers – Nurses – Physicians Administrators

15. 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

16. Desired Outcomes Literature Review Effectiveness of breastfeeding Clinical recommendations

17. Search Plan

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

19. Levels of Hierarchy http://www.nap.edu/openbook.php?record_id=12444&page=23

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

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

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

23. New Understandings Overall Benefits of breastfeeding Additional findings

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

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

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