Digital Repository Masters Theses Spring 2026 Neonatal Intensive Care Unit Nurse Breast Pump Education Kat Tice Weber State University Follow this and additional works at: https://dc.weber.edu/collection/wsudoctoral Tice, K. 2026. Neonatal Intensive Care Unit Nurse Breast Pump Education. Weber State University Doctoral Projects. https://cdm.weber.edu/digital/collection/WSUDoctoral This Project is brought to you for free and open access by the Weber State University Archives Digital Repository. For more information, please contact archives@weber.edu. WSU REPOSITORY MSN/DNP Neonatal Intensive Care Unit Nurse Breast Pump Education Project Title by Kat Tice Student’s Name A project submitted in partial fulfillment of the requirements for the degree of MASTERS OF NURSING Annie Taylor Dee School of Nursing Dumke College of Health Professions WEBER STATE UNIVERSITY Ogden, UT 04/24/2026 Date Kat Tice, BSN, RN, MSN Student 04/24/2026 Student Name, Credentials (electronic signature) Date Jamie Wankier Randles EdD, MSN, RN 04/24/2026 MSN Project Faculty Date (electronic signature) Anne Kendrick, DNP, RN, CNE 04/25/2026 Anne Kendrick Date (electronic signature) DNP, RN, CNE MSN Program Director Note: The program director must submit this form and paper. 1 Neonatal Intensive Care Unit Nurse Breast Pump Education Kat Tice Annie Taylor Dee School of Nursing Weber State University Dr. Jamie Wankier MSN Project March 29, 2026 2 Abstract Purposes/Aims: This project was designed to deliver educational content and clear guidelines to NICU nurses to increase their confidence in supporting mothers with breast pumping. Rationale/Background: Early breast pump education is necessary to help establish milk supply. It was identified that breast pump education was sometimes overlooked or that some nursingrelated barriers were preventing its completion. Recognizing knowledge gaps in breast pump use and implementing clear nursing guidelines are needed to address these challenges. Methods: Multiple tools were created throughout the MSN project implementation process. A pre-survey was designed to identify educational needs. Educational resources, including a presentation, skills pass-off, simulation scenario, and practice guideline posters, were developed. Chart auditing and a post-survey were created to evaluate the project's effectiveness and provide insight into the development of new nurse training. Results: Three themes were identified from the literature: 1) The importance of nurse-led interventions and support in the NICU, 2) Breast pumping in establishing and maintaining breast milk for NICU infants, and 3) The importance of nurse training and guidelines Conclusions: Equipping NICU nurses with clear guidelines and education fosters enhanced interdisciplinary communication and ensures that mothers receive the support and instruction necessary to encourage milk production and increase the likelihood that their infants are discharged receiving breast milk. Keywords: early breast pump education, nursing guidelines, nurse-led interventions 3 Neonatal Intensive Care Unit Nurse Breast Pump Education The American Academy of Pediatrics (AAP) recommends feeding mothers' own milk (MOM) to infants for at least six months after birth (Meek & Noble, 2022). Breast milk provides the most complete form of nutrition for babies in the first six months of life (De Boer et al., 2023). Admission to the neonatal intensive care unit (NICU) means separation of mother and baby for medical stabilization (Rosner et al., 2025). Separation of the infant and mother delays initiation of breastfeeding. If the infant cannot eat right away, to continue breastmilk production, mothers must use a breast pump to collect milk within six hours of delivery, at least eight times a day, every three hours (Pados & Camp, 2024; Rosner et al., 2025; Scholten et al., 2022). Mothers are typically the primary source of breast milk. However, a NICU stay often means the infant is too sick to initiate breastfeeding. A breast pump provides an efficient way to stimulate the hormones needed for breastfeeding (Pados & Camp, 2024). Mothers and their support systems require education on breast pumping in the NICU to establish and maintain milk supply throughout the infants’ stay. Breast pumping is timeintensive, requires extensive planning, and many mothers report not receiving enough education (Bigalky et al., 2021). Mothers need guidance on selecting the correct-fitting pump flanges and recommendations for hospital-grade pumps (Anders et al., 2024; Torres, 2019). Education must occur soon after admission to the NICU. NICU nurses spend a significant amount of time at the bedside with mothers and are in a crucial position to support them with early lactation (Blatz et al., 2020). In the midwestern hospital where the MSN project study is being conducted, there are no specific guidelines to support and educate mothers on the use of breast pumps. Often, education for breast pumping is missed during the admission process. NICU nurses must be educated about the importance of 4 breast milk pumping and the hospital resources available to support mothers in the NICU setting. Siva et al. (2026) demonstrated that nurse-led interventions, including involving mothers in neonatal care and providing health education on breast pumps, were effective in increasing breastfeeding rates at discharge. Nurses should have a clear understanding of breast pumping and the reasons behind following breast pump guidelines. A standardized process is necessary to ensure that all healthcare providers and mothers receive the same education and follow the same guidelines. Interdisciplinary collaboration and consistent information from the healthcare team are needed to improve breast pumping outcomes (Guo et al., 2025). This MSN project aims to provide breast pump education and guidelines for nurses in the NICU. Statement of Problem Breast milk is essential for the health of both neonates and mothers (George et al., 2023). Some known benefits of breast milk include reducing the risk of necrotizing enterocolitis (NEC), sudden infant death syndrome, and otitis media, as well as improving bone health and immune function (De Boer et al., 2023). For mothers, the benefits include a lower risk of breast and ovarian cancer, and type 2 diabetes mellitus (George et al., 2023). According to the 2022 Centers for Disease Control and Prevention (CDC) Breastfeeding Report Card, in 2019, 83.2% of infants received some breast milk; at one month, 78.6% received any breast milk; and at six months, 55.8% received any breast milk. Receiving some breast milk remains beneficial to neonates, but many mothers discontinue breastfeeding sooner than they would like (Centers for Disease Control and Prevention, 2024). Admission to the NICU will disrupt breastfeeding. The infant and mother are separated for medical stabilization (Rosner et al., 2023). A way to combat this is to provide mothers with a hospital-grade breast pump and the education to use the pump. Prolactin and oxytocin are 5 hormones that signal the body to produce milk, and a way to signal these hormones is released by nipple stimulation by an infant or breast pump (Pados & Camp, 2024). To establish a supply, it is recommended to initiate pumping within six hours of delivery and to pump both breasts for 15 minutes every three hours (Pados & Camp, 2024; Rosner et al., 2025; Scholten et al., 2022). Early milk expression has been shown to establish a long-term milk supply (Rosner et al., 2025). Ensuring mothers have privacy to pump milk encourages initiation of breast pump usage (Kim et al., 2023; Guo et al., 2025). When infants are admitted, a breast pump should be set up in the mother’s room and the NICU infants’ room, and education should be provided. The support from nurses who assist in caring for the baby has a significant influence on a mother's decision to breastfeed (Kim et al., 2023). NICU nurses spend several weeks with infants and their mothers, significantly impacting lactation outcomes (Blatz et al., 2020). Although lactation support is critical for these mothers, there have been barriers for NICU nurses to provide adequate education. Barriers included inconsistent milk measurements, excessive workload, insufficient time for education, and limited personal knowledge of breast pumps (Kim et al., 2023). When there is an excessive workload, nurses may opt to give infant formula rather than educating mothers on pumping or breastfeeding, due to the ease of use of formula (Guo et al., 2025). Other barriers at the local midwestern hospital under study indicated that nurses are not receiving adequate education in supporting new mothers in providing breast milk effectively for the newborn. Significance of the Project This MSN project focuses on educating NICU nurses to support mothers using electric breast pumps at a midwestern hospital. Breast milk contains human milk oligosaccharides, hormones, lipids, and microbes, which help reduce the risk of infections, metabolic diseases, and 6 autoimmune diseases (Witte Castro et al., 2025). The AAP noted that for infants born at 34-36 weeks, inadequate human milk intake in the first days after delivery can lead to a longer hospital stay and increased readmissions (Meek & Noble, 2022). Infants born under 37 weeks are often directly admitted to the NICU for stabilization and medical management (Rosner et al, 2023). However, skin-to-skin contact and breastfeeding within the first hour of delivery are recommended, as they have been shown to enhance patient outcomes (Meek & Noble, 2022). Skin-to-skin contact and breastfeeding typically do not occur within the first hour of admission to the NICU. A breast pump helps with early initiation and maintenance of a mother’s milk supply until the baby is old enough or well enough to be breastfed. For milk expression, the hospital standard is to provide mothers with a hospital-grade electric pump. D’Ambrosio et al. (2022) reported that only 47% of patients in the NICU received MOM by discharge without lactation support, and with support, the rate increased to 59%. NICU nurses need to recognize that receiving early education on breast pumps can help mothers initiate and establish a milk supply to breastfeed when their infant is ready to orally feed (Rosner et al., 2025). Many women are first-time mothers and appreciate guidance from health care providers (Bilgalky et al., 2021). In the local midwestern hospital where the MSN project is being conducted, there is no standardized workflow and process for establishing breast pump education. According to the MSN project study lead, breast pump usage is inconsistently discussed when the NICU nurse receives a transfer report from the maternity nurse. Additionally, it is not standard practice to ask the mother if she has received breast pump education or if a breast pump has been set up in an infant's room at admission. 7 This project aims to fill the knowledge gaps regarding breast pump usage and education in the NICU setting. NICU nurses have extensive experience but may not feel confident or comfortable with their knowledge (Blatz et al., 2020). Providing education will bolster nurses’ confidence in assisting mothers who are expressing breast milk, thereby improving patient outcomes. Blatz et al. (2020) found that nurses felt more prepared to support lactating mothers after an educational module on hands-on pumping (Blatz et al., 2020). Providing clear guidelines will standardize the care process in the NICU environment. Additionally, providing early nursing education on breast pump usage ensures that the baby receives MOM early and establishes a supply, so they will be successful when they are medically ready to breastfeed (Rosner et al., 2025). Review of the Literature A literature review was conducted to evaluate the impact of breast pump education on nurses' confidence in supporting NICU mothers. The PICOT question to guide the literature review was: In NICU nurses, how does implementing education and clear guidelines, compared to nurses who do not receive education and clear guidelines, affect their confidence to educate mothers with electric breast pump usage within six months? The literature review aimed to assess the current state of research on evidence-based best practices for educating NICU nurses on breast pumps and to identify what should be included in clear guidelines for this purpose. The literature review will explore three themes: education and support in the NICU, breast pump usage in the NICU, and the importance of nurse training and guidelines. Framework In the MSN Project area, there is currently no standardized workflow or process for breast pump education in the NICU. This MSN project aims to address knowledge gaps 8 regarding breast pump usage and education for nurses in NICU settings, to improve patient outcomes. The theoretical framework guiding this project is the Iowa Model of Evidence-Based Practice (EBP). The model's guidelines involve identifying and prioritizing an issue, forming a team, identifying relevant research, developing a plan, implementing the change, evaluating the outcome, and sharing the results (Melnyk & Fineout-Overhold, 2023). There are seven steps in the Iowa Model of EBP. The first step in the process is to identify a problem (Chiwaula et al., 2021). Identifying the problem involves brainstorming and prioritizing the issue in the area where the project will be implemented (Chiwaula et al., 2021). The MSN project aligned with the Iowa EBP model by identifying a problem in the study hospital. For the MSN project, the lead has identified a lack of standardized workflow and a specific process for breast pump education. PICOT questions are also developed in the first step. A PICOT question identifies the population, the intervention, the comparison, the outcome, and a timeline to help guide research (Feldner & Dutka, 2024). The PICOT question developed for the MSN project was: In NICU nurses, how does implementing education and clear guidelines, compared with nurses who do not receive education and clear guidelines, affect their confidence in educating mothers about electric breast pump use within six months? The second step of the model involves forming a team (Chiwaula et al., 2021). Identifying key stakeholders who will be important in implementing the project. Ensuring buy-in from administration is vital (Cullen et al., 2022). For the MSN project, the identified team of stakeholders included the unit manager, unit leadership, lactation nurse, NICU nurses, social work staff, and the project lead. Administration buy-in was ensured by creating a presentation that explained why the project was needed, its timeline, and the expected outcomes. 9 The third step of the model includes gathering research (Chiwaula et al., 2021). Research helps determine whether there is sufficient evidence to adopt a change in practice. Reliable research articles and levels of research are identified in this step of the model (Cullen et al., 2022). For the MSN project, research was conducted and compiled into an evidence table to assess the level of evidence. The articles will be evaluated in the literature review portion of the project. The fourth step in the Iowa EBP model is to develop a plan based on the body of evidence (Chiwaula et al., 2021). After conducting a literature review, a plan for implementing the MSN project was developed, which included a presentation and guidelines for establishing and maintaining breast pump education. The fifth step in the Iowa EBP model is implementation (Chiwaula et al., 2021). Implementation includes education about the change, resources to support it, details on how data will be collected, and procedures for reporting progress (Cullen et al., 2022). Implementation included conducting a pre-survey with the nurses and distributing an education module on breast pump usage and the new guidelines. The sixth step of the Iowa EBP model is evaluation (Chiwaula et al., 2021). Evaluation is conducted to determine whether the project met expectations or if any aspects require modification (Cullen et al., 2022). Evaluation will include post-surveys with the nurses to assess whether the education was understood and if they were using the guidelines. The final step of the Iowa EBP model involves sharing the results (Chiwaula et al., 2021). Results for the project will be communicated through progress reporting in the unit's quarterly newsletter. The Iowa EBP model is ideal for this MSN project, as its steps are straightforward and there are multiple feedback loops to guide the project's direction. 10 Strengths and Limitations There are various strengths and limitations in using the Iowa EBP model for an MSN project focused on nursing education. One strength of the model is its simplicity. The Iowa EBP model is easy to understand, with its steps organized and concise (Howe et al., 2022). Another strength of the model is that the process is not linear. There are frequent feedback loops that enable the process to change and improve without requiring a restart (Cohen et al., 2022). Additionally, the model enables flexibility in adjusting the plan as more information becomes available (Cohen et al., 2022). Limitations of the Iowa EBP model include the potential for failure due to teams' limited knowledge of the process, difficulty understanding how to evaluate research, and inadequate support (Pitsillidou et al., 2021). The Iowa EPB model takes time to train and educate the team. To address this, there should be proper leadership that demonstrates the EBP process (Chiwaula et al., 2021). Buy-in from key stakeholders must be ensured. Nurses should be encouraged to actively participate in the EBP process (Chiwaula et al., 2021). Despite some limitations of the Iowa EBP model, it remains an effective framework for implementing unit hospital projects, helping to simplify and clarify the project process. Search Strategies A literature search was conducted by Weber State University Stewart Library’s OneSearch to access research databases. Databases used in the literature search included CINAHL, PubMed, and Ovid. Research articles were limited to those published between 2018 and 2025 for current information. Key words included: “nursing”, “education”, breastfeeding”, “NICU nurse”, “lactation risk”, “mothers' own milk”, “importance of breast milk”, “electric breast pump”, “human milk expression”, “barriers”, “facilitators”, “attitudes”, “communication”, 11 and “guidelines”. Various Boolean combinations of the previously mentioned words were used. Search terms were broadened to include breastfeeding and all healthcare providers' education, as breast pump education is often embedded in breastfeeding education. Synthesis of the Literature Three themes were identified in the literature research regarding NICU nurse education and breast pump guidelines. The first theme is education and support in the NICU. NICU nurses have the influence to empower parents to become more involved in their infants’ care (Saltzmann et al., 2021). The second theme concerns breast pump usage. Breast pumping is a crucial tool for establishing and maintaining breast milk for NICU infants (Blatz et al., 2020; Maastrup et al., 2021; Rosner et al., 2025). The third theme is the importance of nurse training and guidelines. Breast pump education helps increase nurses' confidence in providing support to mothers (Blatz et al., 2020; Folker-Maglaya et al., 2018; Maastrup et al., 2021; Marhefka et al., 2021; Mulcahy et al., 2022). Breast pump education is also associated with a higher proportion of infants receiving mothers' milk at discharge (Marhefka et al., 2021). These themes align with the MSN project plan to provide breast pump education and guidelines to NICU nurses, thereby supporting mothers. Education and Support in the NICU In the United States, NICU admissions are increasing annually (Mazur et al., 2021). Common reasons for a NICU admission include prematurity, respiratory distress syndrome, infection, hypoglycemia, and feeding difficulties (Mazur et al., 2021). When their baby is admitted to the NICU, parents experience loss of control and helplessness (Yu et al., 2021). Parents require more education and guidance than those who have a mother-baby term admission (Yu et al., 2021). 12 Nurse-led interventions have been shown to increase maternal involvement in infant care (Chen & Chen, 2025; Siva et al., 2026). Parental engagement in the NICU contributes to better neurodevelopmental outcomes and fosters bonding (Saltzmann et al., 2021). Nurses can empower parents by helping them perform hands-on care with their infant (Saltzmann et al., 2021). An example of this is skin-to-skin care. Skin-to-skin care is associated with earlier attempts at breastfeeding in preterm infants (Heller et al., 2021). A common reason for not establishing skin-to-skin care in the NICU setting is that mothers often express fear of hurting their baby (Saltzmann et al., 2021; Schwab et al., 2024). Encouraging mothers by helping them initiate skin-to-skin care can enhance their confidence and infant bonding (Heller et al., 2021; Saltzmann et al., 2021; Schwab et al., 2024). Nurses spend a significant amount of time with parents at the bedside and have multiple opportunities to discuss different educational topics, such as breastfeeding (Blatz et al., 2020; Mulcahy et al., 2022; Pados & Camp, 2024). Education should occur at multiple points during an infant’s stay, as parents often feel overwhelmed when all education is presented at once and may struggle to retain the information (Mazur et al., 2021). Providing education to parents throughout their stay increased confidence upon discharge and helped prevent emergency department visits and readmissions (Mazur et al., 2021). Nurses provide vital support to mothers in the NICU setting. Mothers in the NICU are under much stress because of unexpected diagnosis, separation from their infant, and lack of skin-to-skin contact (Kim et al., 2024). Due to emotional stress, education should occur more frequently (Mazur et al., 2021; Nardella et al., 2024; Yu et al., 2021). Mothers were often left wanting more information because education was frequently limited to a single session or assumed they already possessed the necessary knowledge, given that they had other children 13 (Nardella et al., 2024; Yu et al., 2021). Frequent follow-up would help address mothers’ concerns and provide consistent guidance for breast milk pumping (Guo et al., 2025). Mothers described a desire to anticipate what breastfeeding would entail and to be supported in their goals by healthcare providers (Nardella et al., 2024). Mothers also described a need for non-judgmental communication from healthcare providers (Bigalky et al., 2021). They sought healthcare providers for support to reassure themselves that they were doing okay (Bigalky et al., 2021). To develop the necessary skills and knowledge, NICU parents require a family-centered care approach (Mazur et al., 2021; Saltzmann et al., 2021; Yu et al., 2021). Breast Pump Usage in the NICU Breast milk is associated with numerous positive health outcomes for infants (Rosner et al., 2025). Breast milk is associated with a healthy microbiome, supports growth and development, and reduces the risk of infection in newborns (Rosner et al., 2025). Prolactin and oxytocin are hormones that assist with milk production, and stimulation of the nipple is required to release prolactin and oxytocin (Pados & Camp, 2024). Stimulation of the nipple occurs by an infant or a breast pump (Folker-Maglaya et al., 2018; Pados & Camp, 2024). Breast milk is crucial for infants in the NICU, as it helps prevent NEC and sepsis, and is associated with improved neurodevelopmental outcomes (Cartagena et al., 2021; Heller et al., 2021). The World Health Organization recommends breastfeeding within the first hour after delivery (Rosner et al., 2025). In the NICU setting, infants are often separated from their mothers (Heller et al., 2021; Rosner et al., 2025). A breast pump helps increase and maintain milk production until the infant is ready to attempt breastfeeding (Blatz et al., 2020; Rosner et al., 2025). A sufficient milk supply is a crucial factor in establishing breastfeeding (Heller et al., 2021; Parker et al., 2018). Mothers expressed feeling little control over many aspects of the 14 NICU stay, and providing breast milk by pumping was a way for them to feel that they were helping their baby (Li et al., 2024; Torres, 2019). Mothers also expressed that pumping milk helped with infant bonding because it allowed them to be actively involved with their baby, even when they could not always be at the bedside (Li et al., 2024; Torres, 2019). Additionally, NICU infants should be considered to have an increased risk of lactation problems and will require additional education (Hoban et al., 2022). Insufficient milk supply is one of the primary reasons for early breastfeeding cessation (Maastrup et al., 2021; Parker et al., 2018). Early initiation of breast milk expression is crucial for establishing and maintaining an adequate breast milk supply (Maastrup et al., 2021). When an infant and mother are separated, breast pumping should be initiated within the first six hours of delivery (Heller et al., 2021; Rosner et al., 2025). NICU nurses should provide information on pumping and expressing colostrum upon admission (Crump et al., 2025). However, Heller et al. (2021) suggested providing education to mothers even earlier, upon admission to Labor and Delivery for preterm labor. When providing education, it was found that asking open-ended questions without assumptions about mothers’ feeding goals fostered greater trust between providers and mothers (Nardella et al., 2024). NICU nurses can support breast pumping by scheduling a lactation consultation within 24 hours of a newborn's admission to the NICU (Hoban et al., 2022). Lactation nurses can help ensure the right flange fit on a mother’s home pump before a mother's hospital discharge (Bigalky et al., 2021). Ensuring a proper flange fit reduces pain and improves milk removal efficiency (Anders et al., 2024). Education on breast pumping should include instructing mothers on how to properly clean their breast pump accessories (Leiter et al., 2021). Proper cleaning of breast pump accessories reduces the risk of mastitis and infant infections (Leiter et al., 2021). 15 Nurses encourage mothers by communicating that any pumped colostrum will be given to their infant orally by swab (Crump et al., 2025). Nurses providing support and education to mothers in breast pumping is crucial for establishing a milk supply (Blatz et al., 2020). Importance of Nurse Training and Guidelines A common barrier for nurses in helping mothers establish a breastmilk supply is the nurse's own experiences and preparedness with breast milk pumps (Blatz et al., 2020). Nurses have some knowledge of breast pumps, but do not feel confident in teaching mothers (Kim et al., 2024). Nurses' attitudes contribute to the lack of education on breast pumps for mothers (Blatz et al., 2020; Kim et al., 2024). Some NICU nurses have used a breast pump or breastfed, but did not have a positive experience (Blatz et al., 2020). In other cases, NICU nurses are in their 20s and have not yet had children, which contributes to their lack of confidence in assisting mothers due to their limited experience in this area (Guo et al., 2025; Kim et al., 2024). Mothers noticed that some nurses did not consider breastfeeding conversations to be part of their job but rather reserved them for lactation specialists or the mothers’ obstetricians (Guo et al., 2025; Nardella et al., 2024). Interprofessional collaboration and continuity of care are important in establishing guidelines (Crump et al., 2025). A lack of interdisciplinary collaboration and clear protocols resulted in fragmented breastmilk feeding support (Guo et al., 2025). Information on breast pumping should be consistent between nurses. Collaboration with NICU and lactation nurses would provide consistent care (Guo et al., 2025). Mothers expressed confusion and frustration when presented with contradictory information on breastfeeding with multiple providers (Nardella et al., 2024; Schwab et al., 2024). According to Nardella et al. (2024), conflicting information from different nurses can erode trust in healthcare providers. Schwab et al. (2024) 16 noted that there was some miscommunication among healthcare workers from different units regarding who completed the breast pump education. Clear guidelines for breastfeeding and pump use in the NICU would specify the type of education provided and who is responsible for delivering it. Furthermore, a process would ensure consistency and create greater trust with the new mother. Structural barriers have been identified as hindrances to supporting mothers (Crump et al., 2025). Guo et al. (2025) highlighted institutional barriers, such as hospital policies that limited parents’ access to their infants, decreased interactions between parents and their infants, and decreased interactions between parents and the healthcare team. Other institutional barriers included the availability of lactation nurses, nurse staffing, and the lack of continuity of care (Crump et al., 2025; Guo et al., 2025). A shortage of nursing staff may encourage formula feeding, as nurses perceive they do not have sufficient time to teach mothers about milk pumping or breastfeeding (Guo et al., 2025). Kim et al. (2024) noted that a lack of education and private spaces for mothers to pump milk are additional problems; therefore, hospital policies should be in place to support nurses. Education enhances healthcare workers' knowledge and skills related to breastfeeding (Folker-Maglaya et al., 2018). A study review conducted by Mulcahy et al. (2022) examined research that employed various forms of breastfeeding education, including classroom-based training, hands-on practice, simulations, and web-based training. The review revealed that having any educational component increased post-test knowledge scores (Mulcahy et al., 2022). Maastrup et al. (2021) noted that educational components helped establish guidelines for early milk expression. Guo et al. (2025) emphasized that breastfeeding education should encompass practical skills, health education, and communication techniques. 17 Education enhanced nurses' confidence in helping mothers with breast pumping and breastfeeding (Blatz et al., 2020; Folker-Maglaya et al., 2018; Maastrup et al., 2021; Marhefka et al., 2021; Mulcahy et al., 2022). Following an educational intervention on breast pump usage, nurses’ confidence scores in providing mom education were reported to be higher (Blatz et al., 2020). Blatz et al. (2020) noted that the educational module for the nurses helped increase their intention and renewed their commitment to helping mothers with breast pumps (Blatz et al., 2020). To improve the rate of infants receiving MOM, Marhefka et al. (2021) sent nurses to attend the Breastfeeding Resource Nurse Master (BRNM) training sessions. Following the educational sessions, Marhefka et al. (2021) reported an increase in NICU nurses' confidence in providing breastfeeding support. Nursing education can influence patient outcomes. Maastrup et al. (2021) and Mulcahy et al. (2022) reported that after educational component interventions, the number of mothers who breastfed at any time increased. Infants receiving any mother's milk by discharge increased with the Breastfeeding Resource Nurse Master training sessions (Marhefka et al., 2021). Providing an educational component on the importance of early breast pumping at staff meetings and shift huddles decreased the time to first milk expression and increased the percentage of mothers who initiated their first milk expression within six hours (Rosner et al., 2025). Evidence suggested that incorporating an educational component for breast pumps and providing clear guidelines enhanced nurses’ knowledge and confidence, ultimately improving patient outcomes (Blatz et al., 2020; Marhefka et al., 2021; Mulcahy et al., 2022; Rosner et al., 2025). Summary of Literature Review Findings and Application to the Project The literature review highlighted the key support role that NICU nurses played in educating mothers (Blatz et al., 2020; Mulcahy et al., 2022; Pados & Camp, 2024). Nurses 18 spending time educating mothers increased parental involvement, which is associated with increased infant bonding and better neurodevelopmental outcomes (Saltzmann et al., 2021). Mothers are seeking guidance from healthcare providers and need support (Bigalky et al., 2021). The literature review identified the importance of breast pumps in the NICU setting (Blatz et al., 2020; Rosner et al., 2025). Breast pumps are an essential tool in establishing and maintaining a milk supply until the infant is ready to learn to breastfeed (Blatz et al., 2020; Maastrup et al., 2021; Rosner et al., 2025). Breast pumping education should occur as soon as admission to the NICU and, in some instances, when the mother is admitted to the Labor and Delivery department for preterm labor (Crump et al., 2025; Heller et al., 2021). The literature review emphasized the importance of breast pump education for nurses and the need for specific guidelines (Maastrup et al., 2021). Research showed that education increased nurses' knowledge and confidence in assisting mothers with breast pumping (Blatz et al., 2020; Folker-Maglaya et al., 2018; Maastrup et al., 2021; Marhefka et al., 2021; Mulcahy et al., 2022). Additionally, education improved breastfeeding outcomes and was associated with a greater number of infants receiving breast milk at discharge (Marhefka et al., 2021). Providing education to nurses is also associated with a decrease in time to first milk expression and an increase in the percentage of mothers who initiate their first milk expression within six hours (Rosner et al., 2025). This MSN project aims to implement the findings of this literature review by creating an educational presentation module and a process for NICU nurses. Education will cover the importance of early breast pump usage, demonstrate how to use the breast pump, identify the barriers and facilitators that mothers face in breast pump usage, and introduce specific guidelines to ensure correct timing and frequent evaluation of education. 19 Project Plan and Implementation The MSN project aims to provide nurses with education on breast pump use and to introduce new practice guidelines based on evidence from the literature review. A pre-survey will be developed to evaluate nurses' knowledge and confidence in providing breast pump education. After the pre-survey, a presentation regarding breast pump usage will be developed. The presentation will provide nurses with education on breast pump use and the new practice guidelines. The presentation will be administered before the unit’s skills day for the nurses to review. The unit conducts review sessions twice a year to reinforce and practice skills. One skill will be dedicated to breast pumps. During the skills day, time is dedicated to simulations. There will be one simulation focused on assisting a mother with problem-solving a breast pump issue. There will be two forms of evaluation. One evaluation measure will be chart auditing. After skills day, the project lead will conduct chart audits to monitor if the new guidelines are being followed. The other method of project evaluation will be a post-survey. The post-survey will be developed and administered to nurses one month after the skills day to assess their knowledge and confidence in assisting mothers with breast pump usage. The post-survey will be readministered three months later to compare results with those of other surveys. The surveys will be used to identify further gaps in nurses' knowledge and inform necessary curriculum changes. The curriculum will be incorporated into new-hire training after the changes have been made. Plan and Implementation Process The education is intended for nurses at a local midwestern hospital's NICU. This section will discuss implementation steps, including project approval, pre-survey, meeting with the NICU education team, administering the breast pump presentation, a skills day session, and preand post-evaluation methods. 20 Establishing project approval is required for the successful implementation of this MSN project. The project lead will meet with the NICU manager and unit educator to present the project. After project approval, a pre-survey will be administered to the unit nurses through an emailed link. The pre-survey contains questions on nurses' current knowledge and confidence in providing breast pump education to mothers in the NICU. The pre-survey will be administered two months before the unit’s scheduled skills day. The pre-survey will be used to establish the nurses' current baseline knowledge. After the pre-survey results are available, there will be an initial meeting with the NICU educator and education team. The meeting will discuss the nurses' baseline knowledge on breast pumping based on the pre-survey results. Baseline knowledge will guide educational content. A second meeting with the education team will be held one week prior, and the nursing unit will be provided with the project presentation. before providing unit access to the presentation. The focus of the meeting will be to finalize educational content. An educational presentation will be developed following an assessment of nurses' knowledge gaps in breast pump education. The presentation will include education on the importance of early NICU education to establish a breast milk supply; nurse-led interventions helpful to mothers; instructions on using a breast pump; an overview of the new guidelines; and expectations for how progress will be measured and reported. An email will be sent to the unit one month prior to the unit skills day, providing instructions on how to access the presentation and ensuring they sign off that they have reviewed the education. The presentation will be available on the unit’s Teams channel. A sign-off sheet will be included in the Teams channel to ensure the nurses have reviewed the information prior to attending skills day. 21 The presentation that the nurses reviewed prior to the skills day session will help them demonstrate their learning through a skill pass-off and a simulation. The education content will be delivered during the NICU unit’s fall skills day sessions. There will be a breast pump skill pass-off. The nurses will identify the breast pump parts and demonstrate how to assemble them. While the pump parts are assembled, the nurses will explain pump settings and practice inspecting the parts for loss of suction. The nurses will also verbalize sanitation procedures, the milk storage process, and how to identify the correct flange fit on the breast. The nurse education team will conduct the breast pump skill pass-off for all nurses in the NICU. During the skills day sessions, some time is dedicated to simulation. Simulation will be used to replicate the breast pump assembly process in a controlled setting. During the skills day simulation session, there will be one situation involving helping a mother assemble a breast pump. There will be an issue with the breast pump, and the nurse will need to assist the mother in checking the equipment and resolving the problem. After the scenario, there will be time for debriefing to discuss what went well and what changes could be made. The project lead will start conducting chart audits after the skills session. The project lead will assign an additional member of the education team to assist. Mothers admitted to Labor and Delivery for preterm admission will be expected to have a nursing care coordination note from the NICU nurse. Chart auditing for infant admission to the NICU will be expected to include nursing communication stating that a pump has been set up in the mother’s room and that she has been added to the lactation consult list. The infant’s chart should include documentation of a lactation consultant note within 24 hours of NICU admission and of breast pump education conducted within three days of admission. 22 A post-survey will be administered twice during project implementation. Once, immediately after the skills session. The second post-survey will be administered three months after the skills session. The survey will include the same questions as the pre-survey to assess knowledge and nurses’ confidence in helping mothers with breast pump usage after education. The questions will be a mix of open-ended and Likert-scale questions. A unit-wide email will be sent out with a link to the survey. The post-survey will guide any changes to the breast pump education curriculum. After the second post-survey results are available, the project lead will meet with the NICU education team. The project lead will present results from chart auditing. Results from the pre-survey and post-surveys will also be compared and discussed. The team will discuss the changes needed with education and plan to reconvene in a month to finalize them and have the content ready for new-hire education. Interdisciplinary Team Teamwork is essential for NICU healthcare team members to ensure comprehensive education on breast pump usage, that hospital policies are followed correctly, and that patients and mothers are supported effectively. Teamwork in the NICU is crucial for improving communication and trust among team members and with parents. The implementation of the MSN project will require collaboration from the MSN project lead, NICU Manager, NICU Educator, nurse education team, the lactation nurses, and mothers and patients. The result of an interdisciplinary team delivering breast pump education and support to NICU nurses will increase breast pump use among NICU mothers. The various team members are highlighted below. 23 Project Lead. The MSN project lead will assume responsibility for managing and directing the project. The lead will oversee all aspects of the plan, including seeking project approval, developing educational content, and implementing, delivering, and evaluating the project results. The project lead will seek approval from the NICU Manager and NICU Educator to launch the project. After approval, the project lead will lead meetings to plan education and implementation. The project lead will attend educational sessions and serve as a point of contact for any questions the unit may have. Finally, the project lead will also oversee evaluation and any changes to educational content. NICU Manager. NICU Manager involvement is required as they need to provide approval for the project. The manager will be involved in ensuring collaboration between the women’s service units. The NICU unit needs to work with the Labor and Delivery unit to provide early education to mothers admitted for preterm birth. Additionally, the NICU Manager will help coordinate communication with the maternity unit to ensure breast pumps are set up in the mother’s hospital room. NICU Educator. The NICU Educator leads the education team for all women’s services at the hospital where the project will be implemented. The educator will also ensure collaboration between the women’s service units. The educator is certified in simulation training and can assist the project lead in ensuring that all needed elements are included in the provided situation. The NICU educator can help manage the simulation session provided to nurses during the skills session. In addition, the NICU Educator will act as a resource for the MSN project lead in developing appropriate guidelines. NICU Education Team. The NICU education team is needed to assist the project lead with education and the skills session. The education team will ensure all elements are covered in 24 the breast pump education presentation and will assist with the breast pump pass-off skills to the nurses. The education team is experienced in assisting with simulations. They will act as the mother in the simulation scenario. The education team will work closely with the NICU Educator and the MSN project lead in the breast pump guideline development. One member of the education team will be designated to assist the project lead with chart auditing. Lactation Nurses. The Lactation Nurses are needed for the MSN project by providing relevant information and helpful resources to support the educational presentation. One of the key points of education is to ensure that a lactation nurse consultant is present to see the mothers within the first 24 hours of admission. Lactation nurses can reinforce the initial education provided by NICU nurses and offer additional support to mothers in the NICU with breastfeeding. Mothers and Babies. Mothers and babies are the beneficiaries of the nurses receiving breast pump education. The mothers help the nurses gain more experience and identify any situation that the education did not cover. The nurses can share their experiences and suggest additional education needed through the post-survey. Description and Development of Project Deliverables To support the implementation of the MSN project, several tools were developed as project deliverables. The project deliverables include pre- and post-surveys to assess knowledge and perceptions, an educational presentation to support learning, a skills pass-off to evaluate competency, a simulation scenario to practice clinical application, practice guideline posters to ensure consistency, and a chart audit form to track data collection. This section provides a detailed description of each deliverable and how these tools will be used in the project. 25 Pre-Survey. The first deliverable is a pre-survey (Appendix A) assessing nurses' baseline knowledge. The questions are designed to assess nurses' confidence in providing breast pump assistance to mothers in the NICU, assessing barriers to breast pumping, and knowledge of lactation consultation hours. There are six questions. Three of the questions are Likert-scale questions, and the other three are open-ended. An email will go out to the unit with a link to the survey Google Form. The responses will be anonymous. The survey will be conducted two months before the skills session. The pre-survey results will help guide initial education. Educational Presentation. The second deliverable is a PowerPoint presentation (Appendix B) designed to educate NICU nurses on breast pumps. Mulcahy et al. (2021) found that including an educational presentation on breastfeeding showed significant increases in nurses' knowledge between pre- and post-surveys. The presentation is narrated by the MSN project lead. The presentation goes into detail on how to assemble a breast pump, identifies barriers to nurses and mothers, and discusses the importance of early initiation of breast pumping. The presentation is designed to provide a demonstration and visuals to educate the nurses. An email with instructions for accessing the educational presentation will be sent a month before the skills sessions. The presentation will be distributed via the unit's Teams channel a month in advance and will include a sign-off indicating that the nurses have reviewed the information. Skill Pass-Off. A skill pass-off (Appendix D) was designed to outline the specific skills and knowledge that the nurses need to demonstrate for breast pumps. These skills include identifying and assembling breast pump parts, verbalizing milk storage, following cleaning procedures, and adjusting pump settings. The tool will be used during the skills day session to guide education nurses in assessing nurses' knowledge. The skill pass-off sheet will serve as 26 documentation of skill completion and will be recorded on the hospital’s learning program for tracking purposes. Simulation Scenario. The simulation scenario (Appendix E) was designed to help nurses practice assisting a mother in identifying the problem with the breast pump. A simulation scenario is helpful for practicing communication skills in a safe place before going out into the unit and performing the real-life scenario. Webber et al. (2021) reported nursing students having increased confidence and comfort in caring for breastfeeding mothers after a simulation scenario. The scenario outlines the materials and actors needed, the situation and background, the goal, and a debriefing opportunity. The simulation scenario will be used after the skill pass-off portion of the education session. Post-Survey. The post-survey (Appendix C) was designed to assess nurses' knowledge after training. The survey will be distributed twice. The survey will be administered immediately after the skills day session and again three months later. A link to the Google Form will be distributed via email. The responses will be anonymous. The survey will assess nurses' knowledge and confidence, using three Likert-style questions and four open-ended questions. The responses will be compared to the pre-survey. The information will be used to assist with project evaluation. Chart Audit. A Google Form will be used to keep track of chart audit information (Appendix G). There are six questions. The questions are about nursing communication in preterm admission to Labor and Delivery and upon NICU admission. The charting audit will also evaluate if education has been recorded within three days of infant admission. The data collected will serve as a measure of success. A link will be available to the project lead and the chosen member of the education team who assists in charting audits. 27 Practice Guideline Posters. New practice guidelines (Appendix F) are highlighted by posters that will be displayed in the unit. The posters are included in the educational presentation and will be posted in the breakroom. The three posters cover different scenarios, highlighting different aspects of breast pump usage. The posters are visually engaging and designed to enhance visibility to support nurses in recalling the updated guidelines. The posters will be displayed concurrently with the debut of the educational presentation. Timeline The MSN implementation plan will run for approximately eight months. The following section outlines the project’s timeline, including all necessary steps. An infographic of the timeline (Appendix H) provides a clear visual of the implementation process. The first step for implementation is project approval from unit leadership. The project lead will meet with the NICU manager and educator a month before project plan implementation. Once the project is approved, the lead will administer the pre-survey to the unit two months before the planned skills session. The unit will have one week to provide answers. The project lead will gather the results and share them with the NICU educator and education team to discuss the results. The meeting will take place seven weeks before the project's skills session. The project lead and the educational team will meet a second time before sending out the educational presentation to finalize educational content. The meeting will take place a week before emailing the educational presentation to the unit. An email with instructions for accessing the educational presentation and the sign-off sheet will be sent to the NICU nurses. The email will be sent out a month before the skills session. The skills session will take place a month after the educational presentation is sent out. The skills session will be divided into two parts. The first part of the skills session will be when 28 the educational team assists with the breast pump skill pass-off. The second part of the skills session is conducting a simulation. Upon completion of the skills day, a post-survey will be administered. The staff nurses will have one week to complete the post-survey. An email will be sent with a Google Forms link for access. The same post-survey will be sent three months after the skills session. The unit will have one week to complete the second post-survey. The day after the skills sessions, the project lead and one additional member from the education team will begin performing chart audits. The chart audits will continue for three months. Three months after the skills session, the second post-survey will be administered. After the second post-survey is completed, the project lead will meet with the NICU educator and education team to evaluate gaps in education and identify necessary changes. Changes will be made and ready in one month. Once the changes are made, the educational material will be incorporated into new-hire training. The timeline provides a structured framework for education, evaluation, and practice improvement. Project Evaluation The goal of the MSN project is to increase nursing confidence by providing formal breast pump education and guidelines. The pre-survey tool (Appendix A) will serve as a baseline assessment in assessing gaps in breast pump knowledge and nursing confidence. The answers from the pre-survey will be compared with those from the post-survey (Appendix C). There will be two measures of success. The first measure is that 90% of post-survey respondents select “strongly agree” to confidence in both assembling a breast pump and troubleshooting breast pump issues with mothers. The post-survey will also serve as a tool to gather feedback from 29 participants who still have knowledge gaps and would like additional education or support added to the curriculum. The second measure of success involves chart auditing. Chart auditing will start after the unit’s skill session. Chart auditing will serve as a method to assess whether the new guidelines are being followed. The project lead and an education team member will collect data on four charting metrics: 1) A nursing care coordination note in the mother’s chart for preterm admission to Labor and Delivery, 2) Upon infant admission to the NICU, nursing communication addressing a pump is set up in the mother's room, and adding mom to the lactation list, 3) Lactation consultant note within 24 hours of infant NICU admission. 4) Breast pump education within three days of admission. The project will be considered effective if, within three months of project implementation, these metrics are documented in 75% of cases. Ethical Considerations Specific ethical considerations must be addressed when conducting the project. The following section will address the social responsibility and ethical considerations. When conducting a project in the clinical setting, it is important to assess how the study will benefit society without harming the subjects. The project promotes social responsibility by supporting improved clinical outcomes in the NICU by helping nurses gain confidence in assisting mothers with breast pumping. Providing education and guidelines aims to support NICU nurses in ensuring that mothers receive appropriate education and that nurses are building their confidence in their breast-pumping knowledge. The MSN project will be conducted in an equitable environment. Non-discriminatory practices are mandatory. All NICU nurses on the unit will be invited to participate. The nurses will be informed that participation in the project is voluntary and that no retribution will be made 30 against those who opt out. Nurses can withdraw participation at any time. Data collection will remain confidential throughout project implementation. Pre- and post-surveys will be anonymous. Chart audits will not contain any patient or nurse information. The project lead will ensure that the data being collected is secured and that access is granted only to those involved in project implementation when needed. Upon completion of data collection, outcomes will be reported. The skill pass-off and simulation sessions are designed to provide a safe environment for skill development and learning. The skill pass-off will offer nurses the opportunity to receive constructive feedback and ask questions about the breast pump. The nurse conducting the passoff will be nonjudgmental and will encourage clarifying questions. The simulation scenario will give the nurses a chance to practice the skill in a controlled environment before clinical application. Before participating in the simulation, nurses will be informed that discussions of individual performance and scenarios should not occur outside the learning environment. An informed discussion will ensure that participants maintain psychological safety throughout the educational process. Psychological safety is a critical component of an effective learning environment, enabling nurses to practice their skills without fear of ridicule. After the scenario is conducted, time will be allotted for debriefing. Debriefing is an opportunity to discuss the scenario and identify knowledge gaps in nursing. Debriefing promotes open dialogue. Nurses will have an opportunity to speak up and ask any clarifying questions. As the project is conducted in the MSN project lead’s place of employment, it is important to acknowledge and address the potential for personal bias. Personal bias may manifest as preferential treatment toward some participants while being overly critical of others. To minimize preferential treatment, members of the NICU education team will support the project 31 lead in facilitating both the skill pass-off and the simulation. The project lead will emphasize the importance of avoiding personal bias during instruction to promote a fair and equitable environment. The way data is collected can influence a project's results. There is potential to favor data that aligns with goals and ignore contradictory data. The project lead acknowledges this potential problem and will ensure integrity and complete data collection by adding an education team member to help complete chart audits. Surveys will maintain neutral language to ensure participant responses are not steered in a particular direction. Peer review will be conducted to ensure results are not skewed. Together, these actions will help minimize bias and ensure the validity of the project’s results. Discussion Nurse-led interventions serve to foster parental involvement in infant care and are associated with increased parental confidence and infant bonding (Saltzmann et al., 2021; Yu et al., 2021). After conducting nursing educational interventions, the percentage of infants receiving any mother’s milk by discharge increased (Marhefka et al., 2021). Nurses are readily available at the bedside to help with problems that may arise with breast pumping. Clear protocols are needed to ensure that mothers receive the support they need. The MSN project includes multiple modalities of breast pump education and practice guidelines in education documentation and communication. In the NICU setting, practice guidelines are needed to ensure that nurses know what is expected of them. The MSN project aims to add to nursing practice by providing comprehensive education and establishing guidelines. The following sections will cover evidence-based dissemination solutions, the project's significance to nursing practice, its implications, and recommendations for future research. 32 Evidence-Based Solutions for Dissemination Consistent communication during the implementation of new projects improves nurse engagement. Sharing information on the progress and results of the MSN project is vital. Updates on the project as data is gathered will be disseminated through the unit’s quarterly NICU newsletter. Progress will be reported, including pre- and post-survey results and audit findings from nursing charting. Staff meetings are another mode that will be used in communicating project results. Time will be allotted at staff meetings to review the data, answer questions, and gather feedback. Finally, the project lead will develop a poster and present the information to peers and faculty at the Weber State University Annie Taylor Dee School of Nursing. Significance to the Advancement of Nursing Practice A breast pump is a way for mothers to maintain milk supply until infants are ready to orally feed (Blatz et al., 2020; Rosner et al., 2025). Mothers cite low milk supply as the reason for early cessation of breastfeeding (Maastrup et al., 2021). The MSN project advances nursing practice by providing education for NICU nurses on breast pumps, thereby improving nurses' confidence in assisting mothers with them. The MSN project provides multiple instructional formats to ensure comprehensive education. Developing guidelines promotes consistency and standardization. A lack of clear protocols results in fragmented support (Guo et al., 2025). Standardization is needed so that all involved can understand the gaps in education that still need to be addressed. The MSN project provides NICU nurses with practice guidelines, including standardization for documenting pump education and communication. Implications 33 The project's implications are highly relevant to the nursing profession and contribute valuable knowledge that can enhance clinical practice. The MSN project offers several strengths. One strength is that the project incorporates multiple educational modes for nurses with various learning styles. The educational presentation (Appendix B) narrated by the project lead serves as a first point of education and includes video links for review. A component of hands-on training is added by a skill pass-off. Practicing a scenario before applying it in clinical practice enables nurses to refine their skills and identify problems that may not have been addressed in prior educational experiences. Another strength of the project is that every stage of the process is clearly outlined. The framework covers the progression from initial brainstorming through final project evaluation. The project gathers participant feedback to identify knowledge gaps and make necessary project changes. Feedback mechanisms are necessary to support continuous improvement and to evaluate project effectiveness. A potential limitation of the project is participants' resistance to change. For successful project implementation, nurse engagement and support are essential. Nursing engagement can be achieved by involving unit members in planning and implementation. The project coordinator will demonstrate that feedback is valued and that the project will be changed based on the nurses’ input. If the suggested changes cannot be incorporated into the project, the project lead will inform the appropriate parties. An additional limitation of the project is the sample size. The project uses a small convenience sample size. A small sample size may skew results, leading to false-positive findings. Potential strategies for increasing the sample size may include expanding participation 34 to include the nurses from the Labor and Delivery and Maternity units. Expanding participation to include other comparable NICUs in the geographical area would also increase the sample size. Recommendations This MSN project is not exhaustive, and additional information could strengthen its effectiveness. Project participation could be extended to other women’s services units in the hospital or similar NICUs in the area to increase the sample size. Certain components could be added to nursing education. Including additional information about emerging technologies, such as wearable pumps or specific evidence-based breast pump mobile applications, would be beneficial. Additional strategies for discussing breast pumping with mothers who have limited or no English fluency to ensure equitable access to information would be beneficial. Further research is needed to fill knowledge gaps. The project is being implemented in a hospital that operates a level two NICU. Additional research is needed to identify any unknown factors in higher-level NICUs that affect outcomes. Labor and Delivery and Maternity nurses also play a key role in providing maternal education, and further research should seek to include them in the project. Another area where the project has knowledge gaps is regarding patient feedback. To enhance the project’s efficacy, it would be essential to gather and incorporate patient feedback into the project evaluation. Conclusions Educational interventions enhance nurses' confidence in assisting mothers with breast pumping (Blatz et al., 2020; Folker-Maglaya et al., 2018; Maastrup et al., 2021; Marhefka et al., 2021; Mulcahy et al., 2022). The goal of the MSN project is to increase nurses’ confidence in providing pump education to mothers in the NICU by using multiple learning formats. An educational presentation on breast pumping was developed for NICU nurses, including a skill 35 pass-off and a simulation scenario. Multiple learning formats are needed to provide a wellrounded educational experience and to ensure that the mother receives comprehensive, consistent information. An additional goal of the MSN project was to develop practice guidelines to ensure education is completed and documented. It is essential that NICU nurses receive breast pump guidelines to enhance the patient experience. The evaluation plan involves incorporating feedback to revise breast pump education for implementation in the new nurse orientation. While this project focuses on nurse confidence and the development of guidelines, further research is needed to gather and incorporate patient feedback. Further research will also be needed to expand applicability across various NICUs and in other women’s services units in the hospital setting. Overall, the MSN project aims to strengthen the quality and consistency of breast pump education for NICU nurses, thereby improving clinical outcomes for mothers and infants. 36 References Anders, L. A., Mesite Frem, J., & McCoy, T. P. (2024). 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Children, 8(9), 795. https://doi.org/10.3390/children8090795 43 Appendix A Pre-Survey Assessment The link provided is to the pre-survey assessment Google Form that the nurses will be emailed prior to education implementation. https://docs.google.com/forms/d/e/1FAIpQLSdALZdcIAPh3ia5mcr9pYc00X0ycU7I9PhZ9MZS iKEllVkbng/viewform?usp=dialog 44 Appendix B Employee Education Presentation The link provided is the educational presentation that the NICU nurses will review before the skills session. https://youtu.be/wHTkdZsMt6A 45 Appendix C Post-Survey Assessment The link provided is to the post-survey assessment Google Form that the nurses will be emailed after education implementation. https://docs.google.com/forms/d/e/1FAIpQLSdP5tTpd5ql-CpN4loY7nl_CpiebLvDAj2h5fG1FfwdVvsPg/viewform?usp=dialog 46 Appendix D Skill Pass Off 47 48 Appendix E Simulation Scenario 49 50 Appendix F Practice Guideline Posters 51 52 53 Appendix G Breast Pump Communication Chart Audit The link provided is to the Google Form that the project lead and an education team member will use to conduct chart audits. https://docs.google.com/forms/d/e/1FAIpQLSf7_D3_7asqJOIp1ad9rePgNtO7yx18jU5x2ZUno2BOlNqow/viewform?usp=dialog 54 Appendix H NICU Breast Pump Education Timeline Infographic 55