Introduction
The study involved 68 neonatal staff members. The questionnaire gauged their knowledge using a 40-item multiple-choice knowledge test and assessed their confidence in their knowledge of neonatal-related information and practices. There were six neonatal-related practices tested: positive touch, kangaroo care, breastfeeding support, the benefits of breastfeeding, breast milk expression, and the physiology of lactation.
The study aimed to compare training and experience as determinants of the confidence level among the staff that worked in the neonatal unit. Training in this study included a Master’s, Ph.D., and any specialization in neonatal care. The training was determined by the number of years that have passed since the completion of training. Experience refers to repeatedly performing a task for a long time and was measured by the number of years worked.
According to Brodsky (2008), the use of positive touch is vital in caring for infants. Hence, the neonatal staff needs to possess the skill since its proper application leads to a reduced period in the hospital for patients, especially infants.
The positive touch has also been shown to increase the well being of infants who had low weight at birth or those who were born before term. It has been shown to improve their growth and development. The questionnaire tested the knowledge that neonatal staff had about positive touch. It also assessed the confidence they had with this information and whether the confidence was as a result of training or experience they had had working in the unit.
Kangaroo care is the skin to skin contact between a neonate and the parent; mother or father. It has several benefits to the infant, parents, and even the hospital. Kenner & Lott (2007) argue that the proper application of this practice ensures that their temperature is within the normal range as they get warmth from the caregiver providing the care; the practice also regulates the heart rate and the respiratory rate. It has been known to reduce the incidences of infections acquired in the hospital and to improve growth and development in preterm babies. Another argument advanced by Kenner & Lott is that the practice benefits not only the infant but also parents as it enhances bonding, and specifically to mother, it improves lactation as it has been known to increase milk production.
Kangaroo care decreases the length of hospital stay and therefore saves the health care personnel from overworking and reduces the money spent on treating the neonates. The knowledge of neonatal personnel on Kangaroo care is important as, after realizing its benefits, they can educate parents about Kangaroo care. Previous studies on Kangaroo care have shown that the staffs in neonatal units that practice Kangaroo care have positive perceptions about Kangaroo care, unlike those staff in NICUs that do not practice kangaroo care. This brings out experience as an important factor in gaining confidence in something.
Breastfeeding has a lot of benefits for both the infant and the mother in neonatal care since it enhances bonding, and they can, therefore, develop a better relationship with both of them. It also ensures the contraction of the uterus to the mother. It, therefore, reduces the risk of postpartum hemorrhage while, at the same time, it has an economic advantage as the mother does not have to spend money on buying breast milk formula. As for the infant, breast milk has an important nutritional value for the age, especially for up to 6 months. It provides enough protein, water, and enhances immunity as, through breast milk, the infant gets antibodies. It is also safe and uncontaminated and therefore reduces the risks of getting food-related infections. Most babies are also able to tolerate breast milk, so it reduces further the incidences of food-related adverse reactions. Breastfed children are less likely to develop obesity in adulthood and have better cognitive development. The knowledge of the neonatal staff on the benefits of breastfeeding is important as they are the ones who give health education on the benefits of breastfeeding (Miracle & Fredland 2007).
Their confidence level will affect the likelihood that the clients will do as they have been advised to do. According to the World Health Organization, exclusive breastfeeding for the first six months is vital for the infant as it enables them to grow healthy and also gain enough antibodies to fight diseases hence boosting their immune system (World Health Organization, 2013). The American Association of Pediatrics estimates that many mothers work during the day or the night and leave their infants in the care of other people. In the hospital setting, some infants are not able to feed and have to be fed breast milk via a nasogastric tube, which involves the removal of milk from a woman’s breast without the baby suckling; it can be done manually using hands or by using breast pumps. The expressed breast milk can be stored for future use. Breast milk expression is necessary. Thus the need for exclusive breastfeeding demonstration is necessary to ensure the process is successful.
The physiology of lactation is important, and the neonatal staff has to have this knowledge to ensure that the mothers have a maximum production of breast milk. The physiology will also guide the approach to be used when the mother is unable to produce or produces little breast milk. It will also, guide the way of expressing the milk; breast milk expression may be difficult, and the care provider must understand the physiology of lactation. It will guide the contraceptive advice that will be given to the mother as some contraceptives lower the production of breast milk. Neonatal staff must have an all-round knowledge of the physiology of lactation as it will guide the kind of care given to the mother. They may be required to allow some more time between the mother and the infant amid medical procedures.
The study hypothesized that the staff is more confident and knowledgeable when they have worked longer in the neonatal unit. Some of the professionals that work in the neonatal care unit are nurses. Studies have shown that the confidence to take up professional responsibility among final year nursing students is very low. Despite going through training, the students do not have the confidence to take up the responsibility (Drexler, 2009).
The experience has been recognized as one of the major ways of promoting confidence among nursing students. The cognitive-gestalt theory of learning recognizes experience as a major factor in facilitating the learning process. Another study showed that students are more anxious when they get their first experience in the clinical areas but develop confidence after they have been there for a while. Previous studies have shown that even after the staff does not perform well on a knowledge study, it does not affect their confidence in performing the tasks (Wallace, 2013).
Results
The study showed that the confidence level of positive touch is more related to experience than it is related to training. The correlation coefficient for years worked and that for years since training is 0.568 and 0.379, respectively. It also showed that confidence in Kangaroo care is a result of experience rather than training. The correlation coefficients for worked years are 0.379 and 0.198, respectively. The confidence level of breastfeeding support, breast milk expression, physiology of breastfeeding, and breastfeeding benefits were attributed to experience, which was shown by years worked rather than training.
The correlation between correct knowledge on neonatal practices and years worked was positive for breastfeeding benefits, physiology of breastfeeding, and breast milk expression only. However, it indicates a weak correlation as the value is closer to 0 than it is close to 1. The correlation was negative for positive touch, Kangaroo care, and breastfeeding support.
The relationship between the years since training and the knowledge on breastfeeding practices is weak. The correlation coefficient was negative for the benefits of breastfeeding, breast milk expression, and breastfeeding support. It was positive for the Physiology of lactation, positive touch, and Kangaroo care, though the relationship was weak as the correlation was closer to 0.
The total correlation for confidence level and years worked was 0.053 and the total correlation between years since training and the confidence level was -0.053
Discussion
The results achieved show that the confidence level is more due to experience rather than training. The correctness of the knowledge achieved, however, is not necessarily due to experience as the more the years worked, the less correct the knowledge relating to neonatal practices is. The correlation coefficient for knowledge is close to zero, implying that the correlation between knowledge and years worked is weak.
Based on the results of the study conducted in the years that have passed since training, more consideration should be paid to short courses related to neonatal nursing, and they may contribute to training as a source of confidence. These include continuous medical education. They should have been factored into the study.
The results of this study can be used in institutions for training staff to work in neonatal care. They may want to increase their practice sessions to improve their confidence in their students (Shariff and Masoumi, 2005). To policymakers, experience may not necessarily mean that one has the correct knowledge required for the job. When employing staff, as much as they should consider experience, training is also important to ensure the correctness of knowledge. For those already employed, the policymakers must consider and implement continuous medical education in such aspects as positive touch, kangaroo care, and breastfeeding support to ensure that the practice is correct and that the kind of health education given to caregivers of children is based on the facts. According to Wallace et al. (2013), e-learning and workbooks may also be used to ensure that knowledge gaps identified are filled.
I would recommend that further research be done on the correctness of knowledge and the confidence levels between the different caregivers in the neonatal unit, for instance, nurses, nurse assistants, medical practitioners, and other staff who work at medical centers. This will give a clear and precise view of what profession needs, which kind of assistance should be provided, and it will guide their policymaking process to suit each of the staff in the different units at the medical center.
Reference List
Brodsky, D 2008, Primary care of the premature infant. Elsevier Health Services, Melville, New York.
Drexler, L. et al 2009, Strategies to improve final year nursing students confidence. Web.
Kenner C & Lott W J 2007. Comprehensive Neonatal Approach: An interdisciplinary approach. Saunders: St Louis Missouri.
Miracle, D & Fredland, D 2007, ‘Provider encouragement of breastfeeding: Efficacy and ethics’. Journal of Midwifery and womens Health, vol.52, no. 6, pp. 545-548.
Shariff, F& Masoumi, S 2005, ‘A qualitative study of nursing student experiences of clinical practice’, BMC Nursing. Web.
Wallace, L, Higman, W, Blake, K, Law, S and Anwar, K 2013, ‘Assessing the knowledge and confidence to perform breastfeeding practices in the neonatal unit –A case study of the use of the Neonatal Unit Clinician Assessment Tool (NUCAT) in Coventry, England’, Journal of Neonatal Nursing, vol. 7, no. 4. Web.
World Health Organization 2013, Breastfeeding-exclusive breastfeeding. Web.