title: Preventing nipple trauma in lactating women in the University Hospital of the University of Sao Paulo: a best practice implementation project.
abstract: BACKGROUND
  Nipple trauma in lactating women is an important issue in facilitating successful breastfeeding. Evidence suggests that early postnatal education on the positioning and attachment technique, early observation of mothers and correcting breastfeeding techniques at an early stage may reduce nipple trauma.
  
  
  OBJECTIVE
  The aim of this project was to improve breastfeeding practice and thereby reduce nipple trauma in lactating women in a public hospital in Sao Paulo. More specifically the objectives of this project were: firstly, to assess the current practice in nurses' assistance concerning the prevention of nipple trauma; secondly, to adapt and trial a Breastfeeding Assessment Form to observe and educate the lactating mother during the early post-natal period; and thirdly, to assess the impact of introducing the assessment strategy on breastfeeding and nipple trauma rates.
  
  
  METHODS
  The Joanna Briggs Institute Practical Application of Clinical Evidence System online tool was utilized for this project. A clinical audit was conducted to assess compliance with best practice in nursing assistance concerning the prevention of nipple trauma. The project concluded with a second audit, which assessed the change in practice following the implementation of strategies to improve practice.
  
  
  RESULTS
  The project was successful in that there was an improvement across all of the audit criteria following the introduction of the strategy to promote best practice. Criterion 1, concerning nursing staff knowledge, improved in compliance by 73%. Criterion 2 and 4, concerning women's knowledge about prevention and management of nipple trauma, improved by 53% and 55% respectively. Breastfeeding assessment improved by 26% from baseline to follow-up audit. Moreover, an improvement in women's satisfaction and exclusive breastfeeding rates was observed; however, nipple trauma rates did not decrease.
  
  
  CONCLUSIONS
  This implementation project had great impact on both nursing staff as well as lactating women's knowledge of preventing and managing nipple trauma. It also enhanced women's satisfaction with breastfeeding and exclusive breastfeeding rates. Further research is required into other aspects involved with the onset of nipple trauma.
authors.affiliation: 1.Department of Nursing,University Hospital,.|University of Sao Paulo, Sao Paulo.|2.The Brazilian Centre for Evidence-based Healthcare: an Affiliate centre of The Joanna Briggs Institute.
authors.forename: Gilcéria Tochika
authors.initials: GT
authors.lastname: Shimoda
authors.affiliation: Department of Nursing, University Hospital, University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Alda Valeria Neves
authors.initials: AV
authors.lastname: Soares
authors.affiliation: Department of Nursing, University Hospital, University of Sao Paulo, Sao Paulo, Brazil.
authors.forename: Ilva Marico Mizumoto
authors.initials: IM
authors.lastname: Aragaki
authors.affiliation: Joanna Briggs Institute, University of Adelaide, South Australia, Australia.
authors.forename: Alexa
authors.initials: A
authors.lastname: McArthur
mesh_terms: D001938:Brazil; D001942:Breast Feeding / Q000379:methods*; D002983:Clinical Competence; D055318:Evidence-Based Nursing; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007774:Lactation / Q000523:psychology; D009558:Nipples / Q000293:injuries*; D009741:Nursing Staff, Hospital / Q000193:education
keywords: benchmarking; breastfeeding; clinical audit; evidence-based nursing; implementation project; nipple trauma