Guidelines for the development of a training curriculum

Transcription

1 Guidelines for the development of a training curriculum

2 Guidelines for the development of a training curriculum Introduction Step 2 of the Ten Steps to Successful Breastfeeding, and Point 2 of the Seven Point Plan for the Promotion, Protection and Support of Breastfeeding in Community Health Care Settings, require that all staff be trained to implement the breastfeeding policy. The training progamme must ensure that staff are equipped with the skills and knowledge to implement the Baby Friendly best practice standards, and therefore the policy, within their own sphere of work. A good training programme is essential to the successful implementation of the Baby Friendly standards and the first step towards achieving a good training programme is the development of a written curriculum. This document is designed to help you write a curriculum and so plan your breastfeeding training programme effectively. Curricula for the education of all staff who provide care for breastfeeding mothers and babies is required as part of the implementation of Stage 1 of Baby Friendly accreditation. Copies of all curricula must be submitted to the Baby Friendly Initiative office as part of the evidence required for Stage 1 assessment. All curricula must demonstrate how the best practice standards, as outlined in the Ten Steps and Seven Point Plan, and the International Code of Marketing of Breastmilk Substitutes, are to be covered within the training programme. Once developed, the curriculum should be viewed as a working document to assist the trainer with the delivery and further development of the training programme. A detailed curriculum will also ensure that the prescribed training can be delivered by another suitable member of staff in the absence of the designated trainer. Many NHS breastfeeding trainers are midwives, health visitors or nurses who are not formally trained as teachers. For many, time is also at a premium with a limited number of opportunities to access staff for training. This can make providing the Baby Friendly training programme appear a daunting prospect. Spending time planning the training programme will help you to think about what and how to teach and how to use training time effectively. Beginning to visualise how the standards for staff education can be achieved within the reality of your NHS Trust will increase your confidence. Therefore, spending time writing the curriculum is much more than a paper exercise to help you pass a Baby Friendly assessment: It is a plan to help you achieve realistic goals. It is strongly recommended that all those responsible for providing staff education for the implementation of the Baby Friendly standards attend the Baby Friendly Initiative Train the Trainer course. Details of forthcoming courses can be found at materials provided as part of the programme can be used to support development of the written curriculum. 1

3 What is a curriculum? A curriculum is simply an outline of the content of a particular training programme. It provides an overall view of what is taught and how. An effective curriculum should generally include: An overall description of the structure of the programme The aims and learning outcomes for each session or part of the programme An outline lesson plan for each taught session, which demonstrates how the session is to be delivered Details of how individual sessions, such as practical skills reviews, are to be conducted This document provides guidance on how to set about planning a training programme and thus produce an effective curriculum. Writing the curriculum 1 Getting started The first step in planning a training programme is to decide what the overall purpose of that programme is. The main purpose in this case will be that staff will have the knowledge and skills to incorporate the Baby Friendly best practice standards into their daily practice. The Baby Friendly Initiative recommends a minimum of 18 hours for the training of staff such as midwives and health visitors, who have responsibility for the clinical care of breastfeeding mothers and babies. Other staff may require less than this. It is accepted that not all the training needs to take place in the classroom as it is recognised that this may be neither possible nor desirable. However, we would strongly recommend that at least one full study day away from the clinical area be provided, to build the foundation in staff knowledge. Other aspects of the training, such as practical skills reviews, are best delivered within the clinical area as they are an essential way of linking theory to practice. When planning a training programme, it is important to bear in mind that different staff groups may have different learning needs. For example, midwives do not require the same approach as doctors. You may therefore find that you need to produce more than one curriculum. These guidelines focus on the development of a curriculum for training staff who have a central role in the everyday clinical care of breastfeeding mothers and babies, such as midwives and health visitors. For the training of medical staff, please refer to the Baby Friendly Initiative website for information about the Baby Friendly Initiative s teaching packs for doctors. 2

4 2 The course content 2.1 Building the foundation It is the Baby Friendly Initiative s experience that, for staff who provide practical care for breastfeeding women, the following topics are essential for building a strong foundation of knowledge about breastfeeding. These should always be covered initially in a classroom environment. Why breastfeeding is important Evidence-based health benefits of breastfeeding Key differences between breastmilk and formula The value of colostrum The importance of exclusive breastfeeding How breastfeeding works Basic anatomy of the breast, focusing on key structures relevant to breastfeeding The action of prolactin and oxytocin The prolactin receptor theory The role of the Feedback Inhibitor of Lactation Skin-to-skin contact and care at birth Benefits of skin contact for mother, baby and, in particular, breastfeeding The importance of an early first feed The importance of early expression of breastmilk when mothers and babies are separated Practical skills The importance of effective attachment How a baby feeds at the breast How to recognise effective attachment and effective milk transfer Principles of positioning to enable effective attachment The technique of hand expression Effective teaching and communication of these skills to mothers The Baby Friendly initiative best practice standards and their purpose The Ten Steps and/or the Seven Point Plan and how they relate to practice The International Code of Marketing of Breastmilk Substitutes and how it relates to practice Helpful hint It is a good idea, as you teach these subjects, to begin to introduce their implications for practice as you go. For example, in anatomy and physiology, participants will learn the theory surrounding prolactin receptors; encouraging them to link this to practice (skin contact and an early feed) will make the theory more relevant. Similarly, encouraging participants to link practices such as rooming-in and demand feeding to physiology will help them to understand why these practices support breastfeeding. Note: This last section is best introduced towards the end of the foundation training, when participants are able to appreciate how the standards support good practice. The standards need to be linked to the physiology of lactation so that the reasoning behind them is clear. 3

5 2.2 Additional topics For some staff (for example, health care assistants), depending on the definition of their role within the health care facility, the foundation training together with practical skills reviews (see below) will be enough to equip them to practice in accordance with the breastfeeding policy. Staff who have overall clinical responsibility for decisions regarding the care of mothers and babies will need more in-depth training to enable them to fulfil their role. But: only when the foundation topics have been covered should you move on to addressing the more complex, related topics. This is because, whilst it is essential that these topics are covered in some detail, staff will only begin to grasp the importance of them when they have a solid knowledge base from which to work. Trying to cover these subjects earlier is likely to result in confusion for staff and, ultimately, in a lower level of compliance with the requirements of the breastfeeding policy. Note: Not all the additional topics listed below will be relevant to all disciplines you will need to select those which apply to the staff groups you are teaching. For example, hospital-based midwives do not normally require an in-depth knowledge of longer-term breastfeeding and weaning, while health visitors do not normally need in depth knowledge of hypoglycaemia. Possible additional topics The normal, healthy, term baby s ability to adapt to extra-uterine life, feed infrequently and utilise alternate fuel stores Recognition and management of the at-risk baby Recognition and management of the baby who is reluctant to breastfeed Specific breastfeeding support for mothers of preterm babies Alternative feeding methods (e.g. cup, syringe) Recognition, prevention and management of common breastfeeding complications (engorgement, mastitis, thrush) Recognition, prevention and management of common clinical situations (insufficient milk, breast refusal) Longer-term breastfeeding and complementary feeding The importance of enabling informed decision-making when mothers request care which does not reflect best practice These additional topics may be best covered in additional classroom time. Alternatively, they may be tackled effectively during workplace clinical update sessions. PLEASE NOTE THAT THE ABOVE LISTS ARE INTENDED AS GUIDANCE ONLY. YOU ARE ADVISED TO REFER TO THE CHECKLIST IN APPENDIX 1 FOR THE FULL LISTING OF TOPICS WHICH NEED TO BE COVERED. 4

6 2.3 Relating the course content to best practice It is essential that the training programme cover all Ten Steps and/or Seven Points and the International Code of Marketing of Breastmilk Substitutes (and subsequent relevant WHA resolutions). In order to check that this is the case, it is useful to compare your initial outline for the programme against the Ten Steps/Seven Point Plan and (where relevant) the International Code. The following is an example of how this might be done. Topic Steps / Points to which this topic relates Why breastfeeding is important How breastfeeding works Practical skills Step/Point 3 (antenatal information) and Step 6 / Point 5 (exclusive breastfeeding and the avoidance of supplements) Steps 4, 5, 6, 7 & 8 / Points 4 & 5 (the importance of an early feed, effective attachment, avoiding supplements, rooming-in and demand feeding) Steps 5, 6, 7, 8 & 9 / Points 4 & 5 (effective positioning and attachment and hand expressing, rooming-in, demand feeding and the avoidance of supplements, teats and dummies) Note: As shown in this grid, each Step/Point may be referred to during more than one session. This is useful to reinforce learning and to aid understanding of how the Steps/Points work together. 3 Aims, learning outcomes and lesson plans 3.1 Writing aims and learning outcomes Aims are simply broad statements which outline the overall purpose of the training. They could be seen as the point' of the session. There are normally only one or two aims for any training session. If they are to be used effectively, aims should usually be the first thing to be written. They can then be referred back to as the content of the session is being developed to ensure that the content is not getting away from the point. If the aim is viewed as the overall purpose or point of a teaching session, the learning outcomes are the stepping stones which enable the aims to be met. Learning outcomes break the aims down into smaller chunks and outline what it is you want the people who will attend the session to be able to do at the end of it. While each session will have only one or two aims, it may have several learning outcomes. 5

7 There is no need to be overly concerned with the precise wording of aims and learning outcomes. The important thing is to focus on why you are teaching the session and what you want the participants to have achieved in terms of learning by the end. For example if you are planning a training session on why breastfeeding is important, the aim of the session might be: Sample aim: To enable participants to deliver information about the health benefits of breastfeeding effectively to pregnant women. This identifies the general purpose of the session. It should be noted, when planning training for the achievement of Baby Friendly accreditation, that the aim of each session should be related to improving practice. For example, the purpose of a session on the health benefits of breastfeeding is not simply to improve staff understanding but also that to enable them to pass on this knowledge to the women and families in their care. The learning outcomes outline the skills and knowledge needed if the aim is to be met. You therefore you need to think about what you want the participants to be able to do by the end of the session. For example: Sample learning outcomes: At the end of this session, the participants will be able to: 1. List the evidence-based health benefits of breastfeeding for babies 2. List the evidence-based health benefits of breastfeeding for mothers 3. Outline the key differences between formula milk and breastmilk 4. Explain why all women need to be given information about the benefits and management of breastfeeding antenatally 5. Describe ways in which parents can be effectively informed about the health benefits of breastfeeding. Now check your list once more against the stated aim of the session. Will these learning outcomes ensure that the aim is met? Is there anything missing, which might mean that the aim can t be met? If so, you need to work out what must be added to the learning outcomes to plug the gap. When you are sure that, if the participants can fulfil all the outcomes you have listed, the aim will be have been met, your list of learning outcomes is complete. It is important to repeat this exercise for each session of your planned training programme, including practical sessions and workbooks, so that the curriculum is watertight. This may seem tedious but it will save you a great deal of time when you move on to planning the detail of each session and minimise the chances of there being gaps in the staff education you provide. The next step is to use the learning outcomes as the basis for your lesson plans. 6

8 3.2 Writing lesson plans There are many ways of writing effective lesson plans but the most important thing is that the plan should provide an overall outline of the lesson so that another trainer would be able to pick it up and use it to deliver a lesson of similar quality in your absence. A good lesson plan should include the following: The title of the session The length of the session The aim(s) of the lesson The learning outcomes for the lesson The content of the lesson The Steps and/or Points to which the lesson relates The timings within the lesson The teaching method(s) to be used The resources to be used It is important to keep referring to the learning outcomes as you develop the lesson plan, to ensure that all learning outcomes are being met within the lesson. Having developed the aims and learning outcomes for a session on the importance of breastfeeding, your subsequent lesson plan might look something like the grid on the next page. When you have developed all your lesson plans, use the checklist in Appendix 1 to confirm that your course will address all the knowledge and skills required of staff practising in a Baby Friendly facility. 7

9 Sample lesson plan: Title of lesson: The Importance of Breastfeeding (1hr 15 mins) Aim of lesson: To enable participants to deliver information about the health benefits of breastfeeding effectively to pregnant women Lesson relates to Step /Point(s): Steps 3 & 6; Points 3 & 5 Learning outcomes for lesson: At the end of the lesson the participants will be able to: 1. List the evidence-based health benefits of breastfeeding for babies 2. List the evidence-based health benefits of breastfeeding for mothers 3. Outline the key differences between formula milk and breastmilk 4. Explain why all women need to be given information about the benefits and management of breastfeeding antenatally 5. Describe ways in which parents can be effectively informed about the health benefits of breastfeeding. Time Content Method Resources (10 mins) Health benefits of breastfeeding for mothers, babies and society Group work. Each group focusing on one area Flipchart paper/ pens (20 mins) Feedback from group work linking to evidence Group involvement with tutor participation Flipchart, handouts (15 mins) Differences between formula and breastmilk Lecture OHT*s (30 mins) Supporting informed choice getting the information across to mothers Short lecture, followed by group work and sharing of ideas OHT*s, Flipchart paper / pens OHT = overhead transparency, or acetate. 8

10 4 Practical skills reviews Ensuring that relevant staff have the knowledge and skills to assist mothers with positioning and attachment and hand expression is crucial to the successful implementation of the Baby Friendly best practice standards. Experience has shown that supervised practical skills review sessions are a valuable way to review classroom learning within the clinical environment. They provide the learner with an opportunity to consolidate knowledge and relate theory to practice. Practical skills reviews can be carried out on a one-to-one basis or in small groups. Initially it is recommended that learners be asked to demonstrate how they would teach positioning and attachment and hand expressing using a doll and breast model. This allows the supervisor to address learning needs without undermining the trainee s confidence or exposing mothers and babies to poor practice. Whenever possible this should be followed up in the clinical environment, where trainees will be supervised teaching these skills to breastfeeding mothers. 4.1 Content of supervised practical skills reviews It is essential that practical skills review sessions cover not only the practical skills of positioning and attachment and hand expression of breastmilk but also the communication skills needed to pass these skills on to mothers. Clinical staff who take responsibility for teaching mothers these skills must have a sound understanding of the underlying physiology and the mechanics of the process, together with the ability to explain these effectively to mothers. The sample practical skills review feedback forms in Appendix 2 can be used to plan the content of the practical skills reviews. 4.2 Managing the implementation of supervised practical skills reviews Practical skills reviews should be viewed as a key part of the overall training programme. It is therefore essential that all staff attend them. A mechanism should be developed to ensure full attendance and records need to be maintained of this. The lead person responsible for training provision will have overall responsibility for the implementation of practical skills reviews and, unless the workforce is very small, it is recommended that s/he select key workers to support her/him in this role. These key workers will require additional training; acceptable standards should be agreed and guidelines produced to ensure ongoing competency and consistency. 4.3 Facilitating individual supervised practical skills reviews Once the key workers have been identified and trained as practical skills review facilitators, all remaining staff should be allocated to a named facilitator. Adequate time should be set aside to conduct each practical skills review and management support may be required to enable this to happen. 9

11 On completion of the practical skills review the facilitator should provide feedback, both written and verbal, to the staff member. A form may be devised for this purpose (see sample practical skills review forms, Appendix 2). As part of this feedback it is important to provide positive reinforcement of good practice as well as to identify areas which require improvement. A review date should be agreed with the learner to enable these areas to be revisited. When the facilitator is confident that the staff member has demonstrated adequate skills and knowledge in relation to positioning, attachment and hand expressing, that staff member can be signed off as competent. However, it is recommended that practical skills reviews be repeated at varying intervals according to the staff member s level of skill and their work role. This is particularly important for staff who may not have an opportunity regularly to consolidate practical skills, for example those working primarily in an antenatal setting. 5 Assessment and evaluation of the education programme Frequent evaluation allows the trainer to identify how well the training programme has worked. It also enables particular strengths and weaknesses of the programme to be identified. There is no point in continuing to deliver a programme without knowing whether or not it is effective. For an education programme to be deemed effective it is essential that the aims and learning outcomes are met. The first step in evaluating the programme is therefore to assess the amount of learning that has taken place. This can be done informally and formally, both during the training sessions and afterwards. For example, learning can be informally assessed through question and answer sessions and ad hoc feedback as the session progresses, while quizzes and written tests, administered before the course and then repeated afterwards, can provide a more formal assessment. The most effective way to assess the overall effectiveness of the training programme is through audit. Frequent audit of staff knowledge and skills and of the care mothers and babies receive will inform the facilitator of strengths and weaknesses within the education programme. This information can then be used as a basis for further training updates and for the development of future courses. The Baby Friendly Initiative audit tools are strongly recommended for this purpose. If the expected learning did not take place, an evaluation of the way the programme was delivered may identify why this was. Points to consider include: Was the venue easily accessible and did it provide an environment conducive for learning? Did the participants receive information and details of the programme in good time? Was the equipment available and working? Was the content clear, relevant and appropriate to the participants needs? 10

12 Were the methods and resources used appropriate to the content and did they enable learning to take place? Was the time allowed for each session appropriate to the content and the abilities of the participants? Did the participants appear to engage and contribute to discussions throughout the course? If not, why not? The answers to these questions may be gained using the assessment methods described above, through informal feedback from the participants, and via evaluation forms designed to elicit focused comments on both the content and the delivery of the course. Feedback from an experienced key worker or teacher who has observed the course is also valuable. If the programme failed to achieve its aims, an understanding of why this happened will enable the necessary improvements to be made. * * * * * * * * * * * Submission for Stage 1 assessment As part of your submission for assessment at Stage 1 you are required to provide written curricula for all your breastfeeding training programmes. This need not be overly detailed but you should ensure that your submission includes: An overall description of the structure of the programme Aims and learning outcomes for each element of the programme Lesson plans outlining how each session is to be taught Details of how practical skills reviews are to be conducted 11

13 Appendix 1 Curriculum checklist for the education of staff with responsibility for the clinical care of mothers and babies The curriculum should ensure that staff are able to implement the breastfeeding policy and thus practise in line with the Baby Friendly standards. Check your curriculum against the list below to ensure that it fulfils this requirement. It may be helpful to identify which element(s) of the training deal with each topic or skill, i.e. formal (classroom) teaching (FT), practical skills reviews (PSR), ad hoc teaching such as lunchtime workshops (AHT), or some other means, for example a memo to staff (Other). The training will enable staff to understand: FT PSR AHT Other The key known health benefits of breastfeeding Simple breast anatomy (i.e. in terms relevant to breastfeeding) The physiology of breastfeeding, i.e. the roles of: Prolactin Oxytocin The Feedback Inhibitor of Lactation The benefits to the baby of an unlimited, unhurried period of skin-to-skin contact at delivery The importance of skin-to-skin contact in the initiation of breastfeeding The importance of effective positioning and attachment for breastfeeding: To ensure a good milk supply In the avoidance of common problems What constitutes effective (and ineffective) attachment at the breast and how to recognise it Recognition of effective milk transfer The principles of effective positioning for breastfeeding How to help mothers to achieve effective positioning and attachment for breastfeeding Why breastfeeding mothers should be taught hand expression of breastmilk How to teach hand expression of breastmilk to mothers The importance of exclusive breastfeeding for the first six months 12

14 The training will enable staff to understand: FT PSR AHT Other Why supplements (including water) should not be given to breastfeeding babies: Risks to baby s health Effect on breastmilk supply Possible interference with later attachment at the breast Effect on mother s confidence The recommended age for the introduction of solid foods Why it is important for mothers and babies to stay together as far as possible: To enable mother and baby to get to know one another To enable mother to recognise early feeding cues and therefore enable demand feeding The meaning of demand feeding (frequency and length of feeds) Why demand feeding is important for both mother and baby The information that mothers who are separated from their babies need to enable them to initiate and maintain lactation (especially mothers with babies in the neonatal unit and those planning to return to work) Why the use of teats should be avoided during the establishment of breastfeeding Why dummies should be avoided for breastfeeding babies (potential interference with both attachment and demand feeding) The importance of giving pregnant women information on: The health benefits of breastfeeding The importance of exclusive breastfeeding Skin-to-skin contact Rooming-in Demand feeding The importance of avoiding teats and dummies The importance of effective positioning and attachment for breastfeeding How to provide information on breastfeeding antenatally, to enable women to make informed decisions Why pregnant and labouring women should not be asked their feeding intention 13

15 The training will enable staff to understand: FT PSR AHT Other How to facilitate skin contact on the labour ward while maintaining safety and appropriate care of mother and baby (if relevant to role) How skin contact may be used during the postnatal period as a means of addressing breastfeeding problems The importance and management of night feeds (including benefits and risks of, and contraindications to, bed sharing) The common complications of breastfeeding (engorgement, mastitis, thrush), and how they may be prevented and managed (if relevant to role) The normal, healthy term baby s ability to adapt to extrauterine life and utilise alternative fuel stores, even if feeding infrequently (if relevant to role) How to manage healthy, term babies who are reluctant to breastfeed, so as to avoid the need for supplementation (if relevant to role) How to manage at risk babies pro-actively, so that supplementation is avoided or minimised (if relevant to role) Recognition, prevention and management of common clinical situations (insufficient milk, breast refusal) What constitutes an acceptable clinical indication for supplementation What alternative methods of feeding are possible and how to use them safely Why mothers need to be informed about the support available to them for breastfeeding (both professional and voluntary) and how to access this How to ensure that mothers make informed choices about how they care for their babies The importance of following policies and guidelines and of documenting all care fully and accurately (including how to use and complete checklists appropriately) The Ten Steps to Successful Breastfeeding and/or the Seven Point Plan for the Protection, Promotion and Support of Breastfeeding in Community Health Care Settings The International Code of Marketing of Breastmilk Substitutes and its implications for practice 14

16 Appendix 2 Sample practical skills review feedback form Positioning and attachment Name Position... Supervisor Position. Date of practical skills review. Section A Underpinning knowledge Is the practitioner able to describe: or X Supervisor s comments Principles of positioning? Head and body in line Held close to mother Nose opposite nipple Head free to tilt back Position sustainable for both Enabling effective attachment? Wait for gape Tongue down Lead with chin (maintaining extension of the head) Effective attachment? Chin indenting breast Mouth open wide Lower lip turned back Cheeks full and rounded If visible, more areola seen above top lip Slow, rhythmic suckling with pauses Feeding is pain-free 15

17 Section B Information-giving and communication skills Did the practitioner: or X Supervisor s comments Explain why effective positioning and attachment are important? Establish what the mother already knew? Explain what constitutes effective positioning and attachment: Accurately? Using simple language? In a logical sequence? Using a hands-off approach? Make good use of leaflets / doll / model breast etc.? Check the mother s understanding? Use appropriate body language? Posture Eye contact and facial expressions Document the event appropriately? Additional comments by supervisor: Comments by practitioner: Signed: Supervisor..... Practitioner

18 Sample practical skills review feedback form Hand expression Name Position... Supervisor Position. Date of practical skills review. Section A Underpinning knowledge Is the practitioner able to describe: or X Supervisor s comments Relevant breast anatomy? Ways to stimulate the oxytocin reflex? e.g.: Having baby near Gentle breast massage Use of something to remind mother of baby Where the mother should place her fingers? Cup the breast in her hand Use her thumb to walk down the breast (or backwards from nipple) Stop when a difference in texture is detected How to express milk? Place finger(s) and thumb opposite each other Compress and release (+/- pressing back first) Repeat, maintaining a rhythm of press & release Avoid sliding fingers on skin If more than a few drops is required: Watch for drips to become squirts, then to subside Once flow has subsided, rotate fingers and thumb around breast and repeat press and release Move to other breast when rotation fails to bring renewed flow 17

19 Section B Information-giving and communication skills Did the practitioner: or X Supervisor s comments Explain why hand expression may be useful? Establish what the mother already knew? Explain the procedure: Accurately? Using simple language? In a logical sequence? Using a hands-off approach? Make good use of leaflets / model breast etc.? Check the mother s understanding? Use appropriate body language? Posture Eye contact and facial expressions Document the event appropriately? Additional comments by supervisor: Comments by practitioner: Signed: Supervisor..... Practitioner