Date Approved


Graduate Degree Type


Degree Name

Nursing (D.N.P.)

Degree Program

College of Nursing


The numerous health benefits of breastfeeding have been widely acknowledged. Evidence from the literature overwhelmingly indicates that breastfeeding is the optimal form of feeding and is globally accepted as the gold standard for infant nutrition. Focusing on efforts to support and promote breastfeeding through following recommendations of evidence-based practices such as the Baby-Friendly Hospital Initiative (BFHI) is an effective way to target the existing low breastfeeding rates and improve health outcomes.

The purpose of this practice dissertation project was to work in collaboration with a community hospital on the BFHI designation pathway by specifically implementing breastfeeding education (Step three of the guidelines). Program goals included improving breastfeeding knowledge, self-efficacy, and intent among the targeted population. Using the conceptual frameworks of both Donabedian and Breastfeeding Self-Efficacy Theory, a multi-faceted approach was implemented targeting all pregnant women in this organization‟s affiliated prenatal clinic. Helping to create transformational change in organizational culture at the system level resulted in the development of the prenatal educational program (PEP). Healthcare providers and office staff delivered breastfeeding education and support to patients as a component of their routine care.

Preliminary evaluation of the PEP did not indicate that there was a difference in the short-term outcomes of breastfeeding knowledge, self-efficacy, and intent. However, significant differences in breastfeeding knowledge and self-efficacy were found between women who planned to breastfeed when compared to women who were undecided or did not intend to breastfeed. These significant differences in breastfeeding knowledge and 7 self-efficacy were found in both the pre-intervention and post-intervention assessments. Practice implications exist related to implementation science, systems change and addressing breastfeeding barriers. Healthcare providers must have the necessary skills to provide breastfeeding education and support, and to improve health outcomes at the community level. A doctorally prepared nurse can have an integral role in achieving these outcomes.