Digital Repository Masters Theses Spring 2026 Breastfeeding Education to Increase Knowledge and Improve Skills for Nurses Chellene Hogge Weber State University Follow this and additional works at: https://dc.weber.edu/collection/wsudoctoral Hogge, C. 2026. Breastfeeding Education to Increase Knowledge and Improve Skills for Nurses. 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 Breastfeeding Education to Increase Knowledge and Improve Skills for Nurses Project Title by Chellene Hogge 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 4/25/2026 Ogden, UT Date 4/25/2026 Student Name, Credentials (electronic signature) Date 5/28/26 MSN Project Faculty (electronic signature) Date 6/9/26 Anne Kendrick (electronic signature) DNP, RN, CNE MSN Program Director Note: The program director must submit this form and paper. Date 1 Breastfeeding Education to Increase Knowledge and Improve Skills for Nurses Chellene Hogge Annie Taylor Dee School of Nursing Weber State University Amber L. Fowler, DNP, MSN-Ed, RN MSN Project March 29, 2026 2 Abstract Purposes/Aims: The purpose of this project is to provide education to postpartum nurses to improve their confidence and skills in breastfeeding support. Rationale/Background: Nurses are key to early breastfeeding success, yet many feel unprepared for supporting mothers when they enter practice. Using a multimodal approach to education can help promote stronger knowledge, competence, and self-efficacy among nurses. These interventions enhance maternal outcomes, including reduced anxiety, higher breastfeeding self-efficacy, and higher exclusive breastfeeding rates. Methods: For this project, a structured, multimodal breastfeeding education program for postpartum nurses will be implemented. Improvement and impact will be measured using preand post-education surveys of nurses' self-efficacy and maternal outcomes, and by tracking exclusive breastfeeding rates. Standardization, consistency, and cross-checking of data will ensure accuracy and completeness. Ethical considerations, voluntary participation, and privacy of all involved parties align with Rosswurm and Larrabee’s Evidence-Based Practice model to guide design, implementation, and evaluation. Results: This project is expected to increase the postpartum nurses' confidence and competence in providing breastfeeding support, as reflected in higher self-efficacy scores and improved skill performance. It is also anticipated to increase exclusive breastfeeding rates and improve maternal outcomes through lower anxiety levels and higher breastfeeding self-efficacy. Conclusions: This project has the potential to strengthen breastfeeding support practices, reduce reliance on lactation consultants, and enhance maternal outcomes through a sustainable, multimodal education model. Keywords: breastfeeding education, nurse confidence, postpartum care, self-efficacy 3 Breastfeeding Education to Increase Knowledge and Improve Skills for Nurses Global health organizations widely endorse exclusive breastfeeding (World Health Organization, 2017). Bedside nurses, who are the key facilitators of early breastfeeding, often lack time and structured training to provide adequate support, contributing to maternal uncertainty and lower breastfeeding rates. Recent literature reveals that structured, theory-based education programs, particularly mobile health tools and experiential learning, can significantly enhance nurses’ confidence and improve maternal outcomes (Blixt et al., 2023; Clark et al., 2024; Madayag et al., 2025). When nursing staff receive appropriate education and support tools, outcomes include enhanced infant growth, increased maternal breastfeeding self-efficacy, and reduced maternal anxiety (Celik & Toruner, 2024). These findings highlight the importance of comprehensive, technology-enhanced education in empowering nurses and improving exclusive breastfeeding outcomes (Hartney et al., 2021). Statement of Problem Nursing students receive limited classroom instruction that prepares them to support breastfeeding. Most programs offer limited basic knowledge about breastfeeding, and students often enter the workforce inadequately prepared with the practical skills necessary. Nursing schools generally lack a standardized, competency-based curriculum for teaching breastfeeding skills (Bowdler et al., 2022). The Baby-Friendly Hospital Initiatives (BFHI) offer clear guidelines; however, many programs do not integrate these guidelines into their curricula (Mulcahy et al., 2022). There are significant inconsistencies and varied internalization of breastfeeding support principles related to culture, personal experience, and timing of maternalchild health coursework (Yang et al., 2018). 4 Because maternity units are only one part of a hospital system, continuing education to support breastfeeding is often limited and infrequently established in clinical practice. Many mothers leave the hospital not feeling confident in their ability to breastfeed their infants. This leads to lower rates of exclusive breastfeeding. The postpartum nurse plays an important role in establishing breastfeeding, yet often feels inadequate in their ability to support breastfeeding mothers at the bedside. Providing nurses with this education through ongoing learning opportunities helps them build confidence and competence through experiential learning (Prokop et al., 2021). This education must go beyond what nursing school coursework or new hire orientation to a unit can offer. This project aims to provide postpartum nurses with resources on breastfeeding support options, enabling them to confidently educate their patients and help them feel more confident in their ability to breastfeed exclusively during their hospital stay and after discharge. This problem is not unique to individual facilities but is a worldwide concern. The World Health Organization, Department of Health and Human Services, American College of Obstetricians and Gynecologists, and the American Academy of Pediatrics all promote the importance of exclusive breastfeeding in the first six months of life and beyond (Partnership for Quality Measurement, n.d). Significance of the Project Providing improved education and training to nurses will enhance their ability to support and educate breastfeeding mothers, thereby increasing the percentage of mothers who feel confident in their self-efficacy regarding breastfeeding and promoting exclusive breastfeeding rates (Celik & Toruner, 2024). Often, lactation consultants have limited hours to see patients, many times across multiple units, including outpatient consultations. They often do not have 5 adequate time to teach and support all breastfeeding mothers through varying census levels. Therefore, additional education and support tasks fall to the postpartum nurse; however, their training is much less than that of a lactation consultant, and their confidence and ability to help are much lower. Additional training gives nurses greater satisfaction and confidence in assisting patients with breastfeeding (Blixt et al., 2023). Review of the Literature This literature review was conducted to identify effective education and engagement techniques that can enhance a nurse’s confidence in providing breastfeeding education and support. Confident nurses are more likely to initiate timely conversations, address concerns effectively, and empower parents with evidence-based guidance. This enhances breastfeeding rates and strengthens trust between families and healthcare providers. In nurses working with postpartum mothers who want to exclusively breastfeed (P), how do best practices and strategies for educating nurses about breastfeeding support options (I), compared to current practice (C), affect the nurse's confidence to provide education and support about breastfeeding options (O), over one month (T)? The themes revealed in this review suggest that increased education and support for nurses result in improved outcomes for mothers and infants. Ongoing learning opportunities help nurses build confidence and competence, and programs that utilize technology, artificial intelligence, and virtual or face-to-face mentorship increase breastfeeding knowledge and improve clinical competence. Framework Rosswurm and Larrabee’s Evidence-Based Practice (EBP) model outlines an approach that can be utilized to help postpartum nurses translate research into useful ways of supporting breastfeeding. The model structure includes six steps (1) assess the need for change in practice, 6 (2) link the problem with interventions and outcomes using standardized classifications and language, (3) synthesize best evidence, (4) design change(s) in practice, (5) implement and evaluate the change, and (6) integrate and maintain the practice change (Thurston & King, 2004). These steps emphasize the importance of utilizing data from multiple sources and the need to test and evaluate data-driven changes throughout the implementation process (Rosswurm & Larabee, 1999). The first step in this model is to assess the need for change. During patient and caregiver rounding, nurses were found to lack confidence in their ability to support breastfeeding mothers. This gap in confidence directly affected maternal self-efficacy and contributed to lower satisfaction among both patients and caregivers. The second step in the process involves establishing a connection between reduced nurse confidence in supporting breastfeeding mothers and the observed rates of exclusive breastfeeding. This link highlights how provider self-efficacy can directly influence maternal outcomes and feeding practices. During step three of Rosswurm and Larrabee’s model, a literature search was conducted to compile current evidence on strategies for enhancing nurses’ confidence in supporting breastfeeding mothers. This evidence provided a foundation for identifying effective interventions to enhance clinical support and maternal outcomes (Thurston & King, 2004). Step four of the model involves designing a change and planning its implementation. Evidence indicated that nurses who received targeted education, hands-on training, and practical experience in breastfeeding support demonstrated increased confidence in assisting mothers. Based on these findings, an educational program was developed for both new and existing nurses, with the goal of enhancing their competence and comfort in providing breastfeeding assistance. Once the change is designed, step five involves implementation and evaluation to determine whether the intervention should be adapted, 7 adopted, or rejected (Rosswurm & Larrabee, 1999). A pre- and post-education poll will be administered to the team to assess the program's impact on nurse confidence and determine whether modifications are needed or if the initiative should be sustained. Finally, step six occurs when a change is adopted; it must be integrated and maintained through ongoing education and stakeholder support (Rosswurm & Larrabee, 1999). Strengths and Limitations According to Rosswurm and Larrabee (1999), this evidence-based practice model derives its strength from its structure and sequence of steps, the inclusion of stakeholders, feasibility, and relevance. Connecting the need for change related to this project with the gaps identified in the nurses' knowledge and confidence guides the development and accomplishment of effective and crucial educational interventions, including hands-on training and simulation. Evaluating how these interventions correlate with outcomes, such as improved nurse and patient self-efficacy and increased exclusive breastfeeding rates, can ensure that breastfeeding education is relevant to the real-world barriers faced by postpartum nurses while still being evidence-informed. The use of Rosswurm and Larabees' model also presents limitations. Its linear design may not fully accommodate the iterative nature of practice change, where feedback loops and ongoing adjustments are often necessary. Additionally, the model provides limited guidance on sustaining change over time, which can be a critical gap when aiming for long-term improvements in clinical practice and workforce development. Recognizing these limitations allows supplementation of strategies for ongoing evaluation and reinforcement within the evidence-based practice model (Thurston & King, 2004). This will ensure that training efforts remain responsive to evolving needs, sustain improvements in nurse confidence, and continuously align with breastfeeding best practices and patient outcomes. 8 Search Strategies A literature search was conducted to identify current evidence using Google Scholar, Weber State University’s Stewart Library’s OneSearch and Advanced Search (which span multiple databases), Ovid, PubMed, and CINAHL to direct initial exploration. Articles published from 2020 through 2025 were included in this literature review to ensure the information remains current. The search included keywords such as breastfeeding, exclusive, support, education, nursing, self-efficacy, technology, qualitative, quantitative, knowledge, and nursing curricula. Various Boolean combinations were created with the above-mentioned keywords to create a broad search. Synthesis of the Literature Results of a literature review suggest that breastfeeding education is most effective when healthcare professionals receive hands-on training, rather than relying solely on classroom instruction (Mulcahy et al., 2022). Healthcare providers have greater confidence when offered techniques such as simulation, mentoring, and observational practice sessions (Blixt et al., 2023). The analysis of the literature identified various themes: a) increased education and support for nurses improves patient outcomes when related to breastfeeding, b) comprehensive education and support for patients improves exclusive breastfeeding rates, c) the use of technology increases nurses' confidence in assisting with breastfeeding, and d) organizational and environmental factors impact quality of care. Mulcahy et al. (2022) highlight that although healthcare professionals possess knowledge, they often lack the skill and competence to provide practical hands-on support. Improved nursing curriculum, as well as continued education in practice, must be prioritized to assist nurses in developing practical skills, such as positioning, 9 latch, problem-solving routine concerns, and overcoming barriers (Mulcahy et al., 2022). A multi-modal approach to educating nurses is practical and offers flexibility and accessibility (Kevenjan et al., 2024). Increased Education and Support Improve Outcomes The literature reveals that structured education has a significant positive impact on nurses' confidence and competence in supporting breastfeeding, resulting in improved outcomes. In both quantitative and qualitative research, mothers who received various forms of support and education from their nurses experienced improved infant growth, increased breastfeeding success, and higher self-efficacy ratings, as well as decreased anxiety levels (Wong et al., 2020). Multiple studies found that nurses who received breastfeeding education through theory-based programs, including those that integrated mobile health tools, experienced a significant boost in confidence when supporting mothers with exclusive breastfeeding, especially in more complex cases like painful feeding or poor infant growth (Blixt et al., 2023; Clark et al., 2024; Madayag et al., 2025). Structured breastfeeding education programs also led to measurable improvements in participants' understanding, perceptions, and practices regarding breastfeeding, resulting in significantly enhanced maternal breastfeeding outcomes (Blixt et al., 2023). In a study by Madayag et al. (2025), nursing students who completed a breastfeeding training program consistently showed a significant improvement in their self-efficacy in supporting mothers. This program incorporated the use of mobile technology, which resulted in statistically significant improvements in nursing students' knowledge, attitudes, and practices regarding breastfeeding (Madayag et al., 2025). Additionally, a study by Clark et al. (2024) demonstrated that when nurses are confident in their ability to support mothers, exclusive breastfeeding rates are significantly improved at ≤2 months (p < 0.001) and at 6 months (p = 10 0.02), partial breastfeeding rates at ≤2 months (p = 0.04), breastfeeding self-efficacy at ≤2 months (p = 0.03), and self-efficacy and partial breastfeeding rates in early postpartum stages. However, it's important to note that these results may not be generalizable to all healthcare settings, and further research is needed to understand the specific factors that contribute to these outcomes. Comprehensive Education Supports Exclusive Breastfeeding Providing nurses with breastfeeding education through hands-on practical learning experiences fosters assurance and proficiency (Prokop et al., 2021). The Registered Nurses' Association of Ontario (RNAO) (2018) highlights how targeted training and system-level integration can enhance exclusive breastfeeding practices. The RNAO (2018) also emphasizes the need for practical and emotional support for nurses, who often feel underprepared to assist with breastfeeding, despite their frontline role. Mastrup et al. (2020) conducted a qualitative descriptive study of new neonatal nurses to examine the impact of a multifaceted intervention that included a structured training program, weekly breastfeeding meetings, and the distribution of educational materials. The findings revealed a statistically significant increase in exclusive breastfeeding rates at discharge following implementation of these strategies (Mastrup et al., 2020). When nurses are equipped with structured protocols and best-practice training, their confidence and capability to deliver effective education and support are improved, thereby improving breastfeeding rates (Swanson et al., 2023). This was demonstrated by an increase from 22% to 54% in direct breastfeeding (DBF) for the first oral meal, an average rise from 13.3 to 20.3 in DBF meals per hospitalization, and a surge in test weights by 166% (Swanson et al., 2023). 11 The Role of Technology in Nurse and Patient Education Technology and digital tools are playing an increasingly important role in nursing education, offering a flexible and effective alternative to traditional methods. Research has shown that these tools enhance knowledge and provide remote support, thereby improving evidence-based breastfeeding education in nursing curricula (Kejenjan et al., 2025). Nursing students demonstrated significant improvements in breastfeeding knowledge and educational practices following the intervention of mobile health tools (Madayag et al., 2025). A replicated trend across multiple studies demonstrates the promising potential of digital tools to strengthen clinical confidence and advocacy for breastfeeding support (Celik & Toruner, 2024; Hartney et al., 2021; Madayag et al., 2025). Technology-supported breastfeeding interventions, comprising e-booklets, motivational SMS, phone consultations, and education, had a positive impact on infant growth, maternal breastfeeding self-efficacy, success, and anxiety levels among mothers (Celik & Toruner, 2024). Focusing on reducing early formula use and improving health outcomes, those who received tech-based support reported higher breastfeeding self-efficacy, greater success, and lower anxiety levels, underscoring the value of digital tools in postpartum care. Celik and Toruner (2024) found significant differences between the intervention group (IG) and the control group (CG) for infant growth metrics and maternal self-efficacy, success, and anxiety. Specifically, IG infants had higher weight and height z-scores (P < 0.05), significantly higher maternal self-efficacy and success at follow-ups (P = 0.001), and reduced maternal anxiety (P = 0.001). Hartney et al. (2021) evaluated the use of instructional animation to teach breastfeeding physiology to students 12 and practicing midwives. They found it an engaging and effective teaching resource, especially for complex concepts. Artificial intelligence (AI) tools, such as generative AI (e.g., ChatGPT), chatbots, and integrated virtual reality (VR), are also being explored in nursing education. These tools have demonstrated a positive impact on learning attitudes, self-confidence, and knowledge acquisition (Ma et al., 2025). The implementation of AI can present challenges, particularly in enhancing higher-order cognitive tasks like critical thinking and clinical understanding. AI often performs worse than traditional learning methods in these areas. Overall, the use of AI enhances knowledge and skills, promoting self-directed learning among nurses and student nurses (Ma et al., 2025). Organization and Environmental Factors Impact Quality of Care Clark et al. (2024) found that organizational structure and the culture surrounding education have a profound influence on the success of healthcare providers in delivering evidence-based care. Nurse-patient ratios and the quality of the working environment are factors that can directly affect the ability of nurses to provide comprehensive breastfeeding support. While this factor is modifiable, the work environment is even more crucial to successful breastfeeding care. In units with a healthy work environment, staffing levels had a minimal impact on missed opportunities for breastfeeding support (Clark et al., 2024). A successful work environment is enhanced through organizational changes. These changes include fostering collaborative relationships, providing supportive nurse managers, and promoting the development of professional practice among nurses (Clark et al., 2024). In guidelines established by the World Health Organization (WHO) (2017), institutional policies should support evidence-based practice. Leaders must ensure that clearly written policies 13 on breastfeeding are regularly disseminated to healthcare providers and coordinated across all services. Gaps across the care continuum present a persistent challenge in effectively integrating compassionate and meaningful support (WHO, 2017). Education and interventions delivered across both the antenatal and postnatal periods demonstrate much better effects on exclusive breastfeeding rates and maternal self-efficacy, especially up to six months postpartum (Wong et al., 2021). Summary of Literature Review Findings and Application to the Project Global health organizations widely endorse exclusive breastfeeding; however, bedside nurses, who are the key facilitators of early breastfeeding, often lack time and structured training to provide adequate support, contributing to maternal uncertainty and lower breastfeeding rates. Recent literature reveals that structured, theory-based education programs, especially those incorporating mobile health tools and experiential learning, can significantly enhance nurses' confidence and, in turn, improve maternal outcomes (Blixt et al., 2023; Clark et al., 2024; Madayag et al., 2025). When nursing staff receive appropriate education and support tools, outcomes include enhanced infant growth, increased maternal breastfeeding self-efficacy, and reduced maternal anxiety (Celik & Toruner, 2024). Hartney et al. (2021) further demonstrated that animation can be an engaging and effective tool for teaching complex breastfeeding physiology, enhancing comprehension among midwifery students and professionals. These findings demonstrate the importance of comprehensive, technology-enhanced education in empowering nurses and improving exclusive breastfeeding outcomes. The literature comprehensively addresses the multifaceted nature of protecting, promoting, and supporting breastfeeding, spanning individual competency, organizational management, and technological implementation. Healthcare providers, particularly nurses and 14 midwives, bear primary responsibility for hands-on support. Despite this, widespread gaps in practical knowledge persist, even among experienced staff. To address these gaps, targeted training for nurses has been found to be highly effective, especially when delivered through multi-component, experiential methods including simulation and clinical coaching. The enhancement of healthcare providers' self-efficacy is a crucial predictor of breastfeeding success. Project Plan and Implementation This section outlines the strategic project plan and implementation process that bridges the gap between nursing knowledge and clinical application. As was highlighted in the literature review, structured, technology-enhanced education and experiential learning work together to improve nurse confidence and maternal breastfeeding outcomes. Building on that evidence, this plan provides a specific roadmap that translates these findings into the postpartum setting. The implementation will utilize Rosswurm and Larabee’s Evidence-Based Practice (EBP) model as a framework to guide the transition from theoretical concepts to practical, hands-on competency. The following paragraphs will describe the development of a multi-modal curriculum that incorporates simulation, digital tools, and mentorship. These strategies will secure organizational support and evaluate the program’s impact on nurse self-efficacy and exclusive breastfeeding rates. Plan and Implementation Process The first phase of the project begins with program design and resource development. To address the identified gap in nurse confidence and practical skills, an educational curriculum will be developed, integrated with Baby-Friendly Hospital Initiative (BFH) guidelines, which will ensure a standardized, competency-based approach. The program will be established in a 16-bed postpartum unit at a community hospital and will include approximately 35 nurses. The material 15 will incorporate instructional animations and engaging written material that clarifies complex concepts and simplifies breastfeeding physiology. Including digital tools, such as mobile health applications and e-booklets, this program will promote relevancy with a younger nurse workforce while also providing flexible and, at times, remote support. In the next phase of this plan, flexibility and accessibility are offered through a multimodal approach. Nurses will participate in a theory-based education program that offers structured training in practical skills, including positioning, latch techniques, and problemsolving strategies. This training will go beyond traditional classroom methods, incorporating experiential learning, mentorship, and technological integration. Nurses will engage in hands-on simulation, observational practice sessions, and clinical coaching to build proficiency. Weekly breastfeeding huddles will provide ongoing support and mentorship to discuss challenges and share best practice tips. Mobile health tools and motivational text messages will be implemented to reinforce knowledge and support nurses in caring for mothers through complex cases. To ensure the plan's success, we will involve organizational stakeholders who can help foster a healthy work environment. Leaders will disseminate clear breastfeeding policies and ensure those policies are coordinated across all services. By improving collaborative relationships and ensuring managers are supportive, nurses can have greater confidence in providing education at the bedside. This will empower postpartum nurses to handle more breastfeeding tasks and reduce reliance on the lactation consultants. Finally, establishing the sustainability of the plan will involve evaluating its effectiveness through a pre- and post-education poll. Additionally, collecting data on maternal outcomes, including breastfeeding self-efficacy and anxiety levels, and exclusive breastfeeding rates will demonstrate the impact of the program. The results of these evaluations will determine whether 16 to adapt or adopt the program. The sustainability of the program will be achieved through ongoing education and the integration of these practices into the unit’s workflow, ensuring it remains relevant and evolves to meet changing clinical needs. Interdisciplinary Team The success of this project will depend on contributions and collaboration from an interdisciplinary team composed of patients, clinicians, and leadership. The program aims to create an environment where breastfeeding support is a coordinated effort rather than an isolated task, and where maternal needs are addressed more consistently. Through coordinated efforts both during the antepartum and postpartum periods, this team will ensure that support efforts are not fragmented. Postpartum Nurses. As the primary facilitators of early breastfeeding, postpartum nurses need improved education; this program focuses on that. Their current roles are often complicated by feelings of inadequacy or a lack of time. It is anticipated that, following this program, they will develop confidence and competence. Participants in this program will complete computer-based training modules and a breastfeeding support class, where they will enhance and strengthen their skills through hands-on training from lactation consultants, including latch techniques, positioning, and real-time problem-solving. To complete the program, they will be “passed off” by their mentor after observing 5 breastfeeding interactions within 2-3 months of completing the training. Lactation Consultants. Bearing much of the burden of educating patients, lactation consultants often have limited hours and are spread across multiple units. In this program, they will serve as mentors, empowering postpartum nurses to handle many basic breastfeeding education tasks. This will be accomplished through teaching a breastfeeding support class for 17 nurses and observing postpartum nurses as they assist their patients with breastfeeding. The mentors will provide real-time feedback and in-the-moment suggestions to optimize postpartum nurses' patient support. This will allow the lactation consultant to be more available to assist with complex cases, NICU parents, and outpatient needs. Nurse Managers and Healthcare Leaders. The primary responsibility of leadership in this program is to foster a healthy work environment. They will participate in system-level meetings to advocate for clearly written breastfeeding policies and consistency across healthcare sites. They will disseminate applicable policy information to their team and help coordinate consistency across all services. Another vital role of leadership will be to provide administrative support for nurses, using acuity-based tools in the EMR to assign patients appropriately, enabling them to dedicate sufficient time to bedside breastfeeding education. Patients and Support Person(s). The program's success will depend heavily on patient participation and their support person(s). Families must feel confident in their feeding plan and be active participants in the program to achieve the anticipated results of improved self-efficacy and decreased anxiety. Confident and well-trained nurses will build and strengthen trust among patients, support persons, and the healthcare team. Description and Development of Project Deliverables This program will use a variety of deliverables to support the project. These deliverables will increase confidence and competence in breastfeeding support through structured, evidencebased education. The participating nurses will be given access to a webpage that links to various educational videos as part of computer-based training. They can refer to this webpage and the educational videos for support during and after completing the program. Upon completion of the web-based training, they will participate in an in-person class. This will be taught by a lactation 18 consultant and will include a PowerPoint presentation with practice scenarios and hands-on training. Surveys will be conducted at the beginning and at the end of the program. These deliverables support a multimodal approach that combines theory, hands-on practice, and digital reinforcement, thereby improving both caregiver and patient experience and outcomes (Prokop et al., 2021). Digital Breastfeeding Education Hub. The Adobe webpage will be a digital hub where nurses can access breastfeeding resources, videos, quick reference guides, and links to evidencebased materials. The content will be visually engaging and centrally located for technologyenhanced learning. Digital platforms make education accessible, flexible, and engaging (Madayag et al., 2025). The webpage introduces breastfeeding concepts and allows learning to extend beyond the classroom, enabling learners to prepare for patient interactions and reinforce skills. Technology-friendly educational platforms have been shown to significantly improve clinical decision-making, breastfeeding knowledge, and nurses' self-efficacy (Kevenjan et al., 2024). A blended learning approach has been shown to result in better outcomes than lectureonly classes (Mulcahy et al., 2022). Updates and accessibility for the webpage will be maintained by the unit educator, with the service line practice council's approval, supporting the program's sustainability through a central location for ongoing education, updates, and future training. (see Appendix A) Enhancing Breastfeeding Support PowerPoint Lesson. The PowerPoint lesson plan will serve as the core instruction tool for the program. This presentation will serve as the basis for an in-person training class taught by certified lactation consultants. The class will incorporate formal, structured education to improve nurses' knowledge, confidence, and clinical competence in breastfeeding (Blixt et al., 2023). The plan incorporates key concepts for latch assessment, 19 positioning, troubleshooting common problems, and understanding lactation physiology. Its visual format supports cognitive processing and retention, as reported by Hartney et al. (2021), and is highly effective for teaching complex breastfeeding concepts, preparing nurses for the hands-on, experiential aspects of the training. (see Appendix B) LATCH Breastfeeding Education Brochure. This brochure serves as a teaching aid and evaluation tool for nurses to use when supporting patients. The use of standardized skillbased tools can improve clinical consistency and reduce variability in breastfeeding support techniques (Bowdler et al., 2022). The LATCH framework provides a method for nurses to assess the quality of the infant’s latch and can help nurses teach and support their patients. This tool aligns with evidence indicating that nurses lack confidence in hands-on breastfeeding assessments without structured tools (Blixt et al., 2023). The availability of quick-reference materials can reduce cognitive load during busy shifts. (see Appendix C) Pre- and Post-Surveys. The survey will be administered to participants before and after the program. They are designed to measure nurses' confidence, skills, and ability to support breastfeeding patients. The surveys tie directly to the Rosswurm and Larrabee model (step 5) to implement and evaluate the program. Research demonstrates that structured feedback loops and self-efficacy scales improve learning outcomes and long-term retention (Celik & Turuner, 2024). (see Appendix D) Timeline During the initial phase of the program, which is approximately 4 weeks, the materials will be finalized and prepared for use. The pre-survey will be available to participants during the first 2 weeks to establish baseline confidence and skill level. During weeks 3 and 4, refinements to the educational materials will be made based on survey feedback to address specific 20 knowledge gaps, followed by publication of the Adobe webpage. This learning link will be shared with participants to begin reviewing these centralized digital resources. Leadership approval will also be obtained during these first 4 weeks, and lactation consultants will collaborate on their mentorship role to link education with evidence-based interventions. The next phase, weeks 5-8, will begin with introducing the project timeline to the postpartum team, outlining expectations, and scheduling their in-person training sessions. The inperson training sessions will accommodate 4 to 6 nurses. This period allows logistical planning, coordinating classroom and simulation space, scheduling the appropriate mentor hours, and confirmation of the nurse’s access to the digital materials. This ensures readiness and supports exploration and curiosity. Education delivery begins during weeks 7 and 8, followed by hands-on simulation and experiential learning with bedside coaching and observation of real breastfeeding interactions during weeks 9-12. Discussions incorporated into daily unit huddles will reinforce learning and offer opportunities to troubleshoot issues or concerns. The final phase of the program begins at week 13, during which the nurses will begin to implement newly acquired skills and build confidence. Ongoing support for education refreshment will be provided through the continuing availability of the LATCH brochure, Adobe webpage, and corresponding video links. During this time, managers will monitor workflow and promote staffing models that support breastfeeding. Nurses will complete the post-education survey during weeks 13-14, allowing a comparison with the baseline data. The results will be analyzed to determine the program's effectiveness and identify opportunities for improvement. These results will be shared with leadership and the team during weeks 15-16, and the program will be refined, adopted, or expanded to ensure the change is maintained and embedded into 21 sustainable workflows, maintained by the unit manager and Nurse Clinical Leaders. (see Appendix E) This plan is a multimodal education program designed to enhance postpartum nurses' breastfeeding support capabilities. It begins with the development of digital training materials, followed by in-person and hands-on instruction, simulation, and mentored clinical practice. Throughout this project timeline, nurses will progress from foundational learning to real-time application at the bedside, culminating in an evaluation of changes in nurse confidence and their ability to incorporate the learning into routine practice. Project Evaluation Evaluating the effectiveness of this project will be conducted through formative and summative strategies, including pre- and post-education knowledge checks, real-time feedback during simulation sessions, and chart audits to track changes in documentation. The use of preand post-intervention assessments is well supported in the literature as an effective method for evaluating changes in healthcare professionals’ knowledge, skills, and confidence following breastfeeding education initiatives (Mulcahy et al., 2022; Jonas et al., 2021). Using a validated survey, as demonstrated in Blixt et al. (2023), to compile pre- and post-education results will provide insight into the areas where nurses are gaining knowledge and increasing their selfefficacy. Self-efficacy is a critical determinant of healthcare professionals’ ability to deliver consistent, evidence-based breastfeeding support and has been shown to improve following structured breastfeeding education and training (Blixt et al., 2023; Wong et al., 2021). The nurses currently participate in monthly chart audits; a random selection of charts is reviewed to ensure they include required components. A review of breastfeeding documentation will be incorporated into these existing audits, allowing evaluation of impact before and after the 22 intervention to assess changes in the consistency and accuracy of documentation, which provides evidence of the education's effectiveness and aligns with evidence-based practice and quality improvement frameworks (Rosswurm & Larrabee, 1999; Jonas et al., 2021). Examples of this documentation include LATCH scores, breastfeeding support interventions, and exclusive breastfeeding rates at discharge, which are commonly used indicators in breastfeeding-focused quality improvement initiatives (Swanson et al., 2022). Further evaluation will be conducted by recording the number of nurses who complete the modules, attend the class, and pass off breastfeeding interactions with the lactation consultant, providing a measurable indicator of program adoption. Participation in the program will not be mandated but will be strongly encouraged. Monitoring participation and competency validation is supported as an essential process measure in educational and practice-change initiatives aimed at improving breastfeeding outcomes (Mulcahy et al., 2022; Rosswurm & Larrabee, 1999). Unit-level exclusive breastfeeding rates will be compared for 3 months preintervention and 3 months post-intervention as a summative method to determine clinical impact. Changes in exclusive breastfeeding rates are widely accepted as an outcome measure and have been linked to improved nursing education, work environments, and standardized breastfeeding support practices (Mason et al., 2025; Wong et al., 2021). Together, these evaluation methods will provide comprehensive data on the program's effectiveness in strengthening nurses' competence and confidence, improving breastfeeding outcomes, and guiding future refinements for long-term sustainability (Mulcahy et al., 2022; Wong et al., 2021). Ethical Considerations Interventions for this project will be socially responsible, reflecting equity and respect for all participants. The training materials and implementation promote non-discriminatory practices 23 and ensure that education is accessible and inclusive. Culturally sensitive breastfeeding education is strongly supported in the literature as essential to improving both staff confidence and patient outcomes, particularly when caring for diverse populations (Mulcahy et al., 2022; Bowdler et al., 2022). To support this practice, the educational content will acknowledge that breastfeeding beliefs, practices, and challenges vary widely across cultural, social, and family contexts. Instruction will emphasize respectful, nonjudgmental support for all infant feeding decisions and encourage nurses to provide patient-centered education that aligns with individual values, language preferences, and health literacy levels. Educational strategies that acknowledge diverse learning styles and professional backgrounds have been shown to enhance engagement and reduce disparities in the delivery of breastfeeding support (Hartney et al., 2021; Jonas et al., 2021). All survey responses will remain confidential, and identifying information will not be shared to protect privacy and psychological safety, which is consistent with ethical standards for nursing education research and quality improvement initiatives (Rosswurm & Larrabee, 1999; Jonas et al., 2021). Participation in the project will be voluntary, and all nurses working in the unit will be treated respectfully, without penalty or pressure, regardless of their participation. Voluntary participation and protection from coercion are foundational ethical principles in nursing-led education and quality improvement projects (Rosswurm & Larrabee, 1999). Ethical implementation will include clear communication that participation or nonparticipation will not affect performance evaluations, scheduling, or professional standing. This project will rely on validated tools, objective data, and transparent evaluations rather than subjective impressions to minimize bias and enhance credibility. The use of validated instruments, such as breastfeeding self-efficacy scales, and objective measures, including chart audits and breastfeeding rates, is 24 widely supported to reduce evaluator bias and strengthen the integrity of findings (Blixt et al., 2023; Wong et al., 2021). Deliberate efforts will be made to avoid influence from personal background, prior breastfeeding experience, or individual commitment to breastfeeding, acknowledging that such factors can unintentionally shape attitudes and evaluations if not addressed (Bowdler et al., 2022; Mulcahy et al., 2022). Collectively, these initiatives support nurses' professional growth through ethical principles and evidence-based practice while safeguarding participants' autonomy, confidentiality, cultural respect, and fairness across diverse populations and needs. Ethical and culturally responsive educational practices are essential because nurses’ confidence, attitudes, and competencies directly influence the quality and consistency of breastfeeding support provided to families (Mulcahy et al., 2022; Blixt et al., 2023). When education is grounded in ethical standards, it creates a psychologically safe learning environment that encourages honest self-reflection, skill development, and sustained practice change rather than superficial compliance (Rosswurm & Larrabee, 1999). Cultural respect and fairness are equally vital, as breastfeeding experiences and expectations differ widely across populations based on culture, language, socioeconomic status, family structure, and access to resources. Research consistently demonstrates that culturally insensitive or judgment-based breastfeeding support contributes to disparities in breastfeeding outcomes and undermines maternal confidence (Wong et al., 2021). Education that explicitly prepares nurses to provide respectful, individualized, and nonjudgmental support improves nurses’ self-efficacy and enhances their ability to meet the needs of diverse patient populations (Blixt et al., 2023; Bowdler et al., 2022). By emphasizing inclusivity and cultural humility, the 25 program supports equitable care delivery and aligns with professional nursing standards for patient-centered care. Discussion This section synthesizes the literature review findings with the proposed project and highlights the evidence-based strategies used. This project is significant to the advancement of nursing practice and incorporates research recommendations for implication in future practice. The evidence consistently demonstrates that structured breastfeeding education offered through a multimodal approach improves nurses' confidence, competence, and ability to provide adequate breastfeeding support (Blixt et al., 2023). The project addresses a critical gap by translating these findings into a practical education program that supports postpartum nurses in their clinical practice. This discussion examines how the project’s impact can extend beyond a single unit to advance nursing knowledge, support equitable care delivery, and inform future quality improvement initiatives. Evidence-Based Solutions for Dissemination Dissemination of project findings is essential to ensure that the knowledge gained contributes to practice improvement and professional learning, extending beyond a single unit. This project will be disseminated through multiple evidence-based strategies aligned with academic and clinical practice standards. A poster presentation will be shared with peers and faculty during the NRSG 6802 program, allowing for scholarly dialogue, feedback, and knowledge exchange. Poster presentations are a recognized method for disseminating evidencebased practice and quality improvement initiatives, particularly within nursing education and clinical leadership contexts (Rosswurm & Larrabee, 1999). 26 In addition to academic dissemination, findings will be shared within the clinical organization through staff meetings, unit-based councils, and interdisciplinary forums. Sharing outcomes such as changes in nurse self-efficacy, participation rates, and exclusive breastfeeding trends supports transparency and reinforces a culture of evidence-based practice (Clark et al., 2024). Digital dissemination strategies, including sharing educational materials and summary findings through internal huddle platforms and unit newsletters, further enhance accessibility and sustainability. These approaches align with evidence demonstrating that ongoing exposure to educational content and outcomes promotes adoption and long-term integration of practice change (Mulcahy et al., 2022; Wong et al., 2021). Significance to the Advancement of Nursing Practice This project holds significant implications for advancing nursing practice by addressing a well-documented gap in breastfeeding education and bedside support. Nurses play a central role in establishing breastfeeding during the immediate postpartum period, yet many report limited confidence and preparation to provide adequate support (Bowdler et al., 2022; Prokop et al., 2021). By implementing a structured, evidence-based education program, this project directly supports professional development and strengthens nurses’ clinical competence. The literature consistently demonstrates that increased nurse self-efficacy is associated with improved breastfeeding outcomes, including higher exclusive breastfeeding rates and enhanced maternal confidence (Blixt et al., 2023; Wong et al., 2021). This project contributes to nursing knowledge by operationalizing these findings into a practical intervention that emphasizes experiential learning, mentorship, and technology-enhanced education. Furthermore, the project aligns with professional nursing standards that emphasize patient-centered care, 27 ethical practice, and lifelong learning (Registered Nurses’ Association of Ontario [RNAO], 2018). From a leadership and systems perspective, this initiative supports the advancement of nursing practice by promoting role clarity and shared responsibility for breastfeeding support. By empowering postpartum nurses to provide consistent, evidence-based education, the project reduces reliance on limited lactation consultant resources and improves continuity of care (Clark et al., 2024). This approach strengthens interdisciplinary collaboration and enhances the overall quality of maternity care. Implications The primary strength of this project lies in its grounding in current evidence and its use of a multimodal educational approach. Incorporating digital resources, hands-on training, and mentorship aligns with best practices shown to improve nurse confidence and skill acquisition (Mulcahy et al., 2022; Madayag et al., 2025). The use of pre- and post-surveys and objective outcome measures strengthens evaluation and reduces bias (Blixt et al., 2023). However, several limitations must be acknowledged. The project is implemented within a single postpartum unit, which may limit generalizability to other settings. Variability in staffing levels, workload, and organizational culture may also influence participation and outcomes (Clark et al., 2024). To mitigate these barriers, leadership engagement and flexible scheduling are essential to support nurse participation. Additionally, offering education in multiple formats allows nurses to engage with content despite time constraints. Another potential limitation is reliance on self-reported confidence measures, which may be influenced by social desirability bias. This limitation is partially addressed by including objective data, such as chart audits and breastfeeding rates (Rosswurm & Larrabee, 1999; Wong 28 et al., 2021). Recognizing these limitations provides opportunities for refinement and strengthens the project's credibility. Recommendations Several recommendations come from this project. First, future iterations could expand implementation to additional units or facilities to evaluate scalability and broader impact. Integrating breastfeeding education into orientation and annual competency validation may further support sustainability (Mulcahy et al., 2022). Second, continued evaluation beyond the initial post-intervention period would provide insight into long-term skill retention and sustained changes in practice. Future research should also explore the impact of culturally tailored breastfeeding education on diverse patient populations, as disparities in breastfeeding outcomes remain a significant concern (Wong et al., 2021). Additionally, examining the role of emerging technologies, such as artificial intelligence–supported learning tools, may further enhance personalized education and clinical decision-making (Ma et al., 2025). Addressing these gaps will strengthen the evidence base and inform future nursing-led interventions. Conclusions This project addressed a well-documented gap in postpartum nursing practice: inadequate preparation and confidence among nurses to provide practical, consistent, and culturally responsive breastfeeding support at the bedside. The literature consistently demonstrates that while nurses are central to early breastfeeding success, many lack the practical skills, selfefficacy, and structured educational support necessary to meet mothers’ needs during the critical postpartum period (Bowdler et al., 2022; Prokop et al., 2021). Findings from the literature review highlight that structured, theory-based, and experiential education, particularly when delivered 29 through multimodal approaches that include hands-on practice, mentorship, and technologyenhanced learning, significantly improves nurses’ breastfeeding knowledge, confidence, and clinical competence (Blixt et al., 2023; Mulcahy et al., 2022). These improvements are strongly associated with enhanced maternal self-efficacy, reduced anxiety, and higher exclusive breastfeeding rates, especially when education is delivered across the care continuum and grounded in evidence-based frameworks (Wong et al., 2021; Clark et al., 2024). Guided by Rosswurm and Larrabee’s Evidence-Based Practice model, this project translates these findings into a practical implementation plan that integrates digital education resources, in-person instruction, simulation, and mentored clinical practice within a postpartum unit. The project’s key findings underscore the importance of empowering nurses through ethical, culturally sensitive education that emphasizes patient-centered care, equity, and professional accountability. Collectively, these outcomes are particularly significant for postpartum populations, where early breastfeeding experiences shape long-term maternal confidence and infant health. 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Guideline: Protecting, promoting and supporting breastfeeding in facilities providing maternity and newborn services. https://apps.who.int/iris/handle/10665/259386 Yang, S.-F., Salamonson, Y., Burns, E., & Schmied, V. (2018). Breastfeeding knowledge and attitudes of health professional students: A systematic review. International Breastfeeding Journal, 13(8). https://internationalbreastfeedingjournal.biomedcentral.com/articles/10.1186/s13006018-0153-1 34 Appendix A Digital Breastfeeding Education Hub (Adobe Webpage) https://new.express.adobe.com/webpage/HLeCN9di7DrJa 35 Appendix B Enhancing Breastfeeding Support PowerPoint 36 37 38 39 40 41 Appendix C LATCH Brochure 42 Appendix D Pre and Post-Surveys 43 44 45 46 47 48 Appendix E Timeline