Using Simulation to Teach Breastfeeding Management Skills and Improve Breastfeeding Self-Efficacy (2024)

Table of Contents
Abstract LITERATURE REVIEW PURPOSE METHODS TABLE 1. INACSL Criteria. TABLE 2. Qualitative Questions. Simulation Activity RESULTS Data Analysis IMPLICATIONS FOR PRACTICE STUDY LIMITATIONS AND FUTURE RECOMMENDATIONS TABLE 4. Implications for Practice. ACKNOWLEDGMENTS Biographies DISCLOSURE FUNDING REFERENCES References

Abstract

Breastfeeding rates in the United States continue to be variable and are not meeting benchmarks established by Healthy People 2020. The literature indicates that although breastfeeding knowledge of providers is paramount in the success of breastfeeding mothers, most receive minimal education regarding breastfeeding management. Recognizing a lack of opportunities for nursing students to practice breastfeeding management during clinical rotations, a breastfeeding simulation program was implemented for students prior to beginning Maternal Child Health clinicals. Students reported increased confidence in caring for breastfeeding dyads and enhanced comfort when providing care to a breastfeeding mother (breastfeeding self-efficacy). This hands-on educational approach can be utilized for any provider working with breastfeeding dyads.

Keywords: simulation, nursing education, breastfeeding, lactation support skills

The benefits of breastfeeding are well documented; extensive research has shown breastfeeding to be protective against a host of adverse health outcomes for both mother and infant (Binns et al., 2016; ). Despite these benefits, breastfeeding rates in the United States continue to be variable, with fewer than 50% of infants exclusively breastfed through the first 3 months of life (). This data may be reflective of the lack of support nursing mothers receive from their health-care providers (CDC, 2018).

LITERATURE REVIEW

The literature indicates that although breastfeeding knowledge of health-care providers is paramount in the long-term success of breastfeeding mothers, most nurses, and other health-care providers receive minimal education regarding management of breastfeeding (; ; Yang et al., 2018). Conflicting information provided by health-care providers, potentially due to a lack of education, has also been cited as a factor in early breastfeeding weaning (Bäckström et al., 2010; ) and this lack of education may extend to lay health-care providers as well. Wilson-Clay (2015), when discussing doula support for breastfeeding, stated, “The role of the doula in early breastfeeding support can also help women reach their goals… [however] many doulas may not be aware of new and important research into risk assessment for mothers and babies for whom early breastfeeding does not go smoothly” (para 1). The lack of education, and in particular, hands-on experience can undermine support for breastfeeding parents.

A variety of methods including lecture, online modules, discussion, and instruction in the clinical setting, have been used to incorporate lactation content in educational curricula (Ben Natan et al., 2018; ; Cianelli et al., 2015; Delonia et al., 2015; Folker-Maglaya et al., 2018; Gary et al., 2017). Within nursing programs, these methods have demonstrated improved scores among students regarding breastfeeding knowledge. However, it is unknown if this knowledge translates into enhanced provider breastfeeding self-efficacy and improved ability to care for the breastfeeding mother/infant dyad.

Nursing students rarely have the opportunity to practice hands-on lactation management skills prior to beginning their Maternal Child Health (MCH) rotation and may be uncomfortable assisting a new mother to breastfeed her newborn. In addition, students' opportunities for learning and practicing breastfeeding skills during a clinical rotation, are directly related to their clinical setting, availability of appropriate patients, as well as, supportive, knowledgeable nursing staff. Simulation is one avenue that has been used to improve clinical learning (Brown et al., 2019; Kim et al., 2012; Riley-Baker et al., 2020).

To assist with the clinical learning, faculty must assist students with assessment skills, prioritization of the patient problems, and treatment of the patients' conditions in an environment where safety is not compromised. Consequently, the pedagogical simulation approach has been a successful method to promote clinical development and reasoning (Eysenbach et al., 2019). The safe learning environment demonstrated in simulation allows for the enhancement of students' knowledge and understanding of related concepts (Sundler et al., 2015).

Pedagogically, technologies with simulation have been developed and vary with their ability to simulate reality, ranging, on a continuum, from low to high fidelity. Faculty utilizing low-fidelity simulation models construct a “hands-on” learning activity that resembles a clinical environment using static mannequins, creating minimal physiological responses, yet enhances a learning experience that is valuable at improving clinical skills (Basak et al., 2016). In contrast, high-fidelity simulation employs physiological responses that replicate a broad spectrum of detailed clinical experiences (Basak et al., 2016). According to the literature, high-fidelity simulation technology has advanced significantly as a “state of the art” teaching approach and could be a mechanism for nursing students to transfer competency to the live clinical environment (Cason et al., 2017). With the use of true-to-life patient characteristics, high-fidelity simulation enhances students' knowledge of human anatomy, pathophysiology, and pharmacology reactions, along with high-tech efficiency ().

When using low or high fidelity, the emphasis of problem-solving, decision-making, and teamwork should be at the forefront of any learning activity. Faculty should strive for patient realism, in a professional manner so that the students recognize the learning activity is congruent with the clinical environment (Tun et al., 2015). Nursing students who experience any well thought out simulation, have the chance to develop a more profound knowledge base, producing high-value competencies, thus improving student and patient outcomes.

Simulation, as an educational method, creates transformational learning experiences and provides contextualized learning, combining didactic knowledge with clinical skills practice. Shin et al. (2015) conducted a meta-analysis of the effectiveness of simulation in nursing education. Their findings supported the effectiveness of simulation education, providing students with authentic clinical situations, and allowing them to practice psychomotor skills in safe environments. Aebersold (2018), in an educational commentary regarding the use of simulation in nursing education, stated: “Simulation-based education today has matured to the point where we have good evidence to demonstrate effectiveness.” Rhodes and Burgess (2018) describe a modified breastfeeding simulation activity with students taking turns playing the role of nurse and the patient, enacting common breastfeeding scenarios. Vignettes using voice over PowerPoints were used to outline clinical scenarios and provide visual clues for the simulation. The authors found the use of clinical simulations to help reinforce the didactic knowledge gained in the workshop. Lactation simulation models, however, were not utilized in this study, potentially hindering realism of the experience.

A consideration when using simulation in nursing education is the type of simulation model used. There is limited research evidence on the differences between the use of low-fidelity and high-fidelity simulation models on a student's ability to acquire clinical skills. One study found that students perceived the use of high-fidelity models to be more beneficial in their simulation experience as compared with using a low-fidelity model, however, knowledge achievement in this study was not evaluated (Basak et al., 2016). In a review of the simulation literature, Hallenbeck (2012) found that although high-simulation models are used widely in nursing education, there was no clear evidence their use translated to better patient outcomes. Kim et al. (2016) conducted a meta-analysis of the effectiveness of simulation-based learning depending on fidelity. Study results indicated strong educational effects using simulators with significant effects on the psychomotor domain. The researchers concluded, since the effects were not proportional to a specific fidelity level, it was important for educators to use a variety of interventions in meeting the educational needs of students. Given the price differential between high- and low-fidelity models, it is important to consider students' perceptions of the simulation experience when using both types of products.

PURPOSE

Nursing faculty at a small mid-western university recognized a lack of opportunities for students to practice breastfeeding support and management skills during their MCH clinical rotation. Faculty postulated providing hands-on educational experiences using lactation simulation models prior to their clinical rotation would allow students to gain confidence in lactation management in a nonthreatening environment, minimizing risk, and harm to the breastfeeding dyad. The purpose of this study was to:

  1. Explore through qualitative investigation the impact of a lactation simulation experience on the breastfeeding self-efficacy of undergraduate nursing students.

  2. Identify qualitative differences between the use of a low-fidelity or high-fidelity breastfeeding simulation model.

METHODS

Faculty developed a structured breastfeeding simulation program expanding on the Rhodes and Burgess (2018) approach, utilizing both low- and high-fidelity simulation products. An expected outcome of the program was to improve student communication skills when interacting with breastfeeding families, increase student breastfeeding knowledge, and increase student confidence in caring for breastfeeding dyads (breastfeeding self-efficacy). Criteria developed by the International Nursing Association for Clinical Simulation and Learning (INACSL Standards Committee, 2017) were utilized in the development of the simulation program. Application of the INACSL criteria (Table 1) is “best practice” in meeting objectives of a simulation program and optimizing achievement of expected outcomes. Utilizing INACSL criteria, this initial program was considered a pilot study.

TABLE 1. INACSL Criteria.

  1. Perform a needs assessment

  2. Construct measurable objectives

  3. Structure the format of a simulation based on the purpose, theory, and modality for the simulation-based experience

  4. Design a scenario or case to provide the context for the experience

  5. Use various types of fidelity to create the required perception of realism

  6. Maintain a facilitative approach that is participant centered and driven by the objectives, participant's knowledge or level of experience

  7. Begin simulation-based experiences with a prebriefing

  8. Follow simulation-based experiences with a debriefing and/or feedback session

  9. Include an evaluation of the participant(s), facilitator(s), and the simulation-based experience

  10. Provide preparation materials and resources to promote participants' ability to meet identified objectives and achieve expected outcomes

  11. Pilot test simulation-based experiences before full implementation

Source. INACSL Standards Committee (2017).

Institutional Review Board (IRB) approval was obtained for this study. All students who were enrolled in the MCH rotation in the fall and winter terms participated in the simulation activity, which took place prior to the students' clinical rotations. While students were required to participate in the simulations, they were not required to participate in data collection and were assured the decision to decline participation would not affect their grade. Demographic data was collected prior to the simulation. Qualitative data was gathered via open-ended questions at two-time points: (a) immediately following the simulation experience and (b) at the end of the students' clinical rotation (Table 2). A total of 77 students participated in the simulation, and 76 completed both study questionnaires. The majority of students (87%) self-identified as female and 13% male, with an average age of 22.83 (min. 20; max. 49).

TABLE 2. Qualitative Questions.

  1. What did you learn from the breastfeeding simulation?

  2. How did this simulation impact your confidence in working with a breastfeeding dyad?

  3. How do you feel about being a breastfeeding advocate after the simulation experience?

  4. What do you think would improve the simulation experience?

  5. aDid the simulation help prepare you for working with breastfeeding dyads during your clinical experience?

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Note. Additional question added for questionnaire following clinical OB rotation.

Simulation Activity

Prior to the simulation, students were assigned prework, providing them with an overview of basic lactation management strategies including, therapeutic communication, positioning, latch techniques, and milk expression. In addition, a 1-hour breastfeeding lecture was presented by an International Board-Certified Lactation Consultant (IBCLC), connecting didactic theory with clinical skills information. The lecture included information related to breastfeeding benefits, public health implications of breastfeeding, Healthy People 2020 goals, and the impact of nurses' attitudes on parental breastfeeding success.

Two simulation scenarios were developed utilizing the framework developed by Campbell and Daley (2017). Students were provided with objectives and a description for each scenario prior to the actual simulation (Table 3). Objectives focused on basic breastfeeding skills most often utilized by novice practitioners working with breastfeeding dyads. Two wearable breastfeeding simulation models were available at the university; a low-fidelity cloth covered burgundy colored breast model, and a silicone covered high-fidelity model, in various skin tones. Students were randomly assigned to use a low- or high-fidelity model during their simulation experience. Prior to the simulation, students were blinded from viewing the other model.

TABLE 3. Clinical Scenarios (Abbreviated) With Objectives.

Scenario 1
You are caring for a first-time mother that has had a successful breastfeeding session immediately postbirth on the birth bed. The baby was born full term … complicated … normal spontaneous vaginal birth. Apgar scores were 9 and 9. Initial BF session, the L&D nurse assisted mom with latch. Mom did not receive any breastfeeding education at that time. The infant fed for about 5 minutes and then fell asleep. Mom is now on postpartum and the infant is showing signs of hunger; awake, alert, and rooting. The nurse is to provide assistance with positioning, latch, and breastfeeding education.
Objectives

  • Effectively communicate with client throughout the breastfeeding session

  • Perform breast and nipple assessment prior to feed

  • Provide instruction and assistance as needed with positioning and latch

  • Evaluate feeding adequacy and educate client

  • Appropriately and accurately answer the client's questions

Scenario 2
36-week infant, vaginal birth, was born to a first-time parent. Infant weighed 5# 12 oz with Apgar's of 4 and 7. Following birth, once stable, the infant was placed at the breast in the birth room but did not latch. The L&D nurse evaluating the client noted that the client had flat nipples. The infant was fed 5 mL of breastmilk substitutes via syringe and was taken to the nursery for further evaluation. The parent was transferred to PP and the infant was brought in 2 hours later. It is now 6 hours postbirth and after repeated attempts, the infant has not latched to the breast. The infant was fed 10 mL breastmilk substitutes via spoon. The client states they very much want to breastfeed. The nurse is to provide assistance to the client with expression of breastmilk and appropriate education regarding feeding the infant.
Objectives

  • Demonstrate effective and supportive communication with mother regarding infant's inability to breastfeed

  • Provide instruction regarding hand expression to establish and maintain milk supply

  • Demonstrate hand expression to the client and instruct client to return demonstration

  • Discuss methods to provide infant with expressed colostrum

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During the simulation experience, students worked in pairs; each had the opportunity to wear the breast model and play both the role of “parent” during one scenario and “nurse” during the second scenario. Throughout the simulation, students were expected to apply knowledge gained from the prework and lactation lecture as well as therapeutic communication skills learned during previous clinical rotations. Faculty observing the simulation utilized a checklist to record student performance during each scenario. Following the simulation experiences, a debriefing session was conducted in small group sessions utilizing INACSL Standards Committee (2017) guidelines, and faculty used the performance checklist to guide the debriefing sessions. Debriefing is considered an essential component of simulation to provide students with immediate feedback on their clinical performance, allowing real-time evaluation and assessment of the experience. Debriefing also allows students an opportunity to reflect critically on their experiences and is considered to be essential in transforming student perspectives of a clinical experience (Decker et al., 2013).

Nursing students often verbalize some degree of apprehension prior to their clinical rotations and this may be amplified when beginning a specialty clinical since students may not have prior knowledge or experience in the area. The use of simulation can assist in decreasing students' anxiety while increasing overall learning and engagement with clinical content. Simulation experiences can also assist in achieving course objectives, increase self-confidence, and have an overall positive impact on the student and their ability to deliver care (Khalaila, 2014).

A component of the exercise was to assess the impact simulation could have on the students' comfort levels when providing care to a breastfeeding mother and also identify if the simulation was an effective means of integrating didactic lactation education with clinical breastfeeding skills (breastfeeding self-efficacy). Throughout the simulation, students were observed, and careful notes of the activity were recorded by faculty. Given the unfamiliarity with the clinical subject matter, numerous students struggled initially with the simulation (e.g., when handling the infant or providing appropriate coaching cues to the mother). At that time, faculty provided brief verbal cues to students, redirecting the scenario, thus guiding the students down the path of discovery. In addition, the cues allowed students to become more confident in their nurse/patient interaction, decreasing self-consciousness, and nervousness. Students demonstrated increased engagement with the simulation activity as their anxiety decreased.

Learning is dependent on the integration of experiences and reflection, which was achieved during the debriefing. In addition to providing feedback to students on their performance during the simulation exercise, faculty donned the breastfeeding simulation models during the debriefing and demonstrated a “best practice” approach in managing care of the breastfeeding dyad. With faculty role-playing a scenario, the nonjudgmental environment allowed students to learn and apply best practices for lactation management. By promoting a positive learning atmosphere, students had the opportunity to verbalize how they felt during the simulation, critique their personal performance, and reflect on the overall experience. During the debriefing, students voiced several illuminating comments, including: “This will help me so much with what to say to a mom!; I will know what to say if asked; I feel so much more comfortable with breastfeeding; That wasn't so bad!” It was clear to faculty that students' self-analysis was an essential component of their learning process, enhancing the continuum of knowledge acquisition.

RESULTS

Data Analysis

Narrative responses to the research questions were reviewed independently by each faculty researcher, looking for specific themes. After the initial review, researchers met to compare their findings, and four major interrelated themes emerged:

  • Student comfort using Breastfeeding Techniques (improved hands-on skills)

  • Student Confidence in overall care and education of patients

  • Breastfeeding Advocacy regarding the importance of breastfeeding

  • Simulation Experience responses

Breastfeeding Techniques

Students overwhelmingly reported they felt more comfortable in the routine management of breastfeeding skills. For most students this was their first experience assisting a mother with breastfeeding techniques. Students were able to apply the knowledge that they gained from the prework to the simulation activity. Many participants reported increased knowledge regarding how to position an infant at the breast for successful feeding. Specifically, students commented that they learned how to massage breasts and manage engorgement; conduct hand expression of milk; use pillows for different breastfeeding positions, and how to approach a mother who may not be confident in her breastfeeding skills. Student comments included:

“I learned how to properly hand express milk, treat mastitis, identify correct latch position”; “I learned how to teach new mothers about different positions and how to assess that breastfeeding is going well”; “I learned about various positions, how to help with engorgement and alternatives for a poor latch.”

Student Confidence in the Education of Patients

An essential component of nursing care is patient education, however, there is little literature available on how to teach students to teach their patients. Following the simulation, students commented that the experience provided them with the opportunity to practice teaching about breastfeeding, which in turn improved their overall confidence in patient education. As a result of the simulation activity, the students' overall breastfeeding confidence increased. Students were able to accurately verbalize breastfeeding education, techniques, and demonstrate to the patient in the scenario. This teaching included, not only the “how to” of breastfeeding, but extended to teaching about how to evaluate breastfeeding adequacy and important discharge information. Student comments included the following:

“I learned a lot of information from the breastfeeding simulation on how to teach a mother how to breastfeed … and how to properly talk to patients who are having difficulty breastfeeding”; “How to communicate with a breastfeeding mother and give her discharge instructions”; “I felt better prepared to educate my patient about breastfeeding.” “I learned a lot about how to teach the patient how to latch on baby and to always give the mother encouragement (that they are doing well).”

Breastfeeding Advocacy

Increased breastfeeding initiation rates and success is associated with the support of health-care providers who believe in the importance of breastfeeding. According to the American Academy of Pediatrics (AAP) statement on breastfeeding (Gartner et al., 2012), pediatricians, who showed an interest in feeding plans, had a positive impact on breastfeeding outcomes. Labbok (2013) described the need for unequivocal support of breastfeeding by all providers and found that women expressed greater satisfaction with their hospital breastfeeding experiences if they received support for their breastfeeding intentions. Therefore, student advocacy of breastfeeding support is an important outcome of the simulation experience and may correlate with increased breastfeeding success. Students initially approached the simulation with trepidation and some commented they were not sure why they “had to learn this”; by the end of the simulation and debriefing, most students appeared to convey a sense of accomplishment with an increased awareness of the importance of breastfeeding. Most students expressed they had a more positive view of breastfeeding and recognition of the importance of breastfeeding support. Some students still expressed reservations about their advocacy role, stating they needed further education and clinical practice time. Student comments supporting an advocacy role included the following:

“I feel I would really encourage a mother to work on breastfeeding v. going straight to formula if she were having trouble”; “I feel am more of an advocate because I now understand why this is so important”; “I felt great, even though I did not think BF was important, I now understand the benefits of doing so”; “I wholeheartedly believe in being a breastfeeding advocate”; “I am a 100% supporter of breastfeeding now and feel more confident in my skills explaining benefits.”

Comments indicating the need for additional knowledge to take on an advocacy role included the following:

“I feel like I need to learn more and practice more before I can be an advocate”; “I know more [about breastfeeding], but I don't know if I know enough to be an advocate … I need more clinical practice”; “I feel somewhat confident. However, I feel like I'd be more confident if I actually experienced breastfeeding and birth.”

Simulation Experience Feedback

Students were overwhelmingly positive in their feedback regarding the simulation experience, which corresponds with prior research regarding the use of simulation for clinical education (; Germain et al., 2018). Students provided specific comments which supported the overall experience, such as: I think it was definitely beneficial for a student who has never seen breastfeeding. Students also provided recommendations to improve the simulation. In particular, students wished the simulation experience had been longer, provided more review of the scenarios prior to the actual simulation, and had included information related to milk expression and pumping. Student comments for improvement included the following:

“Teach students how to perform breast exams”; “I think the simulation being longer and teaching how to use and assemble a breast pump would be helpful”; “Maybe going through different scenarios with more time to practice would be beneficial”; “The simulations were great although I feel like if the nipple expression was easier it would better.”

Qualitative Differences Between Low- and High-Fidelity Models

A stated purpose of this study was to identify if there were any qualitative differences in students' responses based on the type of breast model used in the simulation experience. Thematic responses were grouped by simulator used (high-fidelity and low-fidelity groups). Students in both groups had similar responses to the overall simulation experiences: 11 students using the low-fidelity model and 13 students using the high-fidelity model provided highly positive responses about the simulation experience without suggesting any areas of improvement. Similarly, 20 students using the low-fidelity models and 18 students using high-fidelity models expressed greater confidence in their breastfeeding skills and knowledge. Overall, based on these responses, it appears for the novice, undergraduate students, the use of low-fidelity breastfeeding simulation models was adequate to achieve positive responses. Repeating this study with advance practice nursing students or practitioners working to achieve a higher level of lactation support expertise may show a greater preference for the high-fidelity simulation model.

IMPLICATIONS FOR PRACTICE

This was a pilot project using lactation simulation to support competent breastfeeding care, and faculty viewed the experience as a pedagogical success. The simulation proved to be an engaging method by which to educate undergraduate nursing students about breastfeeding support and management and provide them with the fundamental of breastfeeding skills. Students' reflections following the workshop revealed an increase not only in breastfeeding self-efficacy but a heightened awareness of the health implications of breastfeeding as well. Students gained an understanding of Healthy People 2020 breastfeeding goals and expressed positive attitudes regarding the importance of breastfeeding. Following simulation, students appeared eager to engage with patients, voicing an increased willingness to support breastfeeding mothers during their upcoming clinical rotation. This feedback indicates quality lactation education for nursing students, which incorporates clinical simulation opportunities, is a vital component of improving care of breastfeeding mothers.

STUDY LIMITATIONS AND FUTURE RECOMMENDATIONS

Limitations of the study include the fact that data were based on anecdotal, qualitative reporting, and clinical practice outcomes were not measured. In addition, the number of participants who completed the study was low (N = 38 for low fidelity and N = 38 high fidelity) making the findings difficulty to generalize. Expanding the number of study participants would provide more robust data for statistical analysis. Future studies collecting quantitative data, including pre- and postclinical practice outcomes (were participants able to confidently apply their learned skills in the clinical setting) would be helpful in measuring the clinical significance of using simulation for teaching lactation skills. Assessing participants' perceptions of “realism of experience” between low-fidelity and high-fidelity simulation and analyzing data related to clinical outcomes could provide valuable information when choosing simulation products. Lastly, it would be helpful to collect data from novice as well as advance care practitioners to identify whether low- or high-fidelity products would be most useful for learning specific skills. Given the cost difference in the two types of products, it is important to identify when a low-simulation product may be adequate to achieve desired clinical practice outcomes.

This study was conducted with undergraduate nursing students but may be applicable to any providers working with breastfeeding dyads during the antenatal, perinatal, and postpartum periods. Implications for practice are summarized in Table 4. Given that accurate breastfeeding knowledge, clinical skills, and advocacy are related to positive breastfeeding outcomes, the use of breastfeeding simulation can be applied across disciplines as an educational approach for clinical support of the breastfeeding dyad.

TABLE 4. Implications for Practice.

  • Use of breastfeeding simulation can:

    • Improve breastfeeding self-efficacy of practitioners who have contact with breastfeeding dyads

    • Apply knowledge and improve clinical skills of practitioners working with breastfeeding dyads

    • Increase breastfeeding advocacy

    • Provide practice opportunities for breastfeeding management and support

  • Clinicians and educators should consider options of breastfeeding simulation models depending on the level of skill needed by practitioners

    • Low-fidelity models may be sufficient for novice and lay practitioners

    • High-fidelity models may be needed for advanced practitioners

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ACKNOWLEDGMENTS

The authors wish to acknowledge the assistance of Sherry McConnell MS, RN for her assistance in planning and participating in the clinical simulations scenarios. This research was supported by an internal University of Detroit Mercy research grant.

Biographies

ELAINE WEBBER is a Certified Pediatric Nurse Practitioner and an International Board-Certified Lactation Consultant. She is a clinical Associate Professor at the University of Detroit Mercy McAuley School of Nursing, teaching primarily pediatric nursing and professional/leadership courses and maintains a clinical practice in pediatrics and lactation. She has published on topics related to pediatric and breastfeeding and has presented at numerous regional, national, and international conferences.

NADINE WODWASKI is a Certified Adult Clinical Nurse Specialist and a tenure track Assistant Professor at the University of Detroit Mercy, McAuley School of Nursing. Her clinical practice spans maternal-child, adult, emergency, and medical surgical nursing. As an academician, she has elected to focus on caring behaviors, breastfeeding, simulation, intact care, and emotional intelligence.

RENEE COURTNEY is a Certified Family Nurse Practitioner and a Certified Transcultural Nurse. She is a tenure track Clinical Assistant Professor at the University of Detroit Mercy, McAuley School of Nursing and teaches in the graduate nursing program. Her areas of interest include transcultural healthcare, simulation, integrative health and interprofessional education & collaboration. She maintains a clinical practice as an adult care hospitalist.

DISCLOSURE

The authors have no relevant financial interest or affiliations with any commercial interests related to the subjects discussed within this article.

FUNDING

The author(s) received no specific grant or financial support for the research, authorship, and/or publication of this article.

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Using Simulation to Teach Breastfeeding Management Skills and Improve Breastfeeding Self-Efficacy (2024)

References

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