Running head: PICOT PROPOSAL

PICOT Proposal
Samantha Visser
University of South Florida

PICOT PROPOSAL

University of South Florida College of Nursing

NUR 4169C EBP for Baccalaureate Nurses
PICOT Proposal Form
Type Information/Response in this Column
Briefly describe the
Breastfeeding is the most natural and beneficial method of feeding
opportunity for clinical
an infant, yet rates are still significantly lower than desired by
improvement.
obstetricians and pediatricians. Babies who are breastfed receive
antibodies from their mothers that can defend against a long list of
illnesses. Infants who are fed with formula are at an increased risk
for many diseases that breast fed babies are not.
Why is this issue
important for your clinical
setting or organization?

List 1-2 background

pertinent questions.
State the PICOT question.

Also write out complete

PICOT statement in
complete sentence:
Describe the ideas you
have for solving the
problem.
What do you hope to
achieve?
How will you measure the
outcome of your practice
improvement?
Identify the members of
your proposed project
team by position or job
title and their roles.
Institution where the
project might be
implemented in the future.

Increasing the rates of breast feeding will decrease the cost of

infants readmitted for health related reasons that could be caused
from lack of breast feeding and natural antibodies. St. Josephs
Hospital has a separate building specialized for womens health,
including labor and delivery, that would put an emphasis on the
health of newborns as well.
What are the health benefits of breastfeeding for both the mother
and baby?
How long should a baby be breastfed?
P: Hospitalized postpartum mothers
I: Lactation nurse consults postpartum
C: No lactation nurse consult
O: Increased rates of breast feeding
T: 12 months
In hospitalized postpartum mothers, does a consult with the
lactation nurse postpartum, compared to no consult with the
lactation nurse, increase the rates of breastfeeding?
If the evidence states that breastfeeding rates increased with the
intervention of a lactation nurse consult postnatal, hospitals should
implement a policy change such as, core measures for a postpartum
mother.
Increased rates of breast feeding
We propose to evaluate the breastfeeding in both the consulted
group and non-consulted group by reviewing the self-reported
information from the mothers.
Lactation nurses will educate the mothers on breastfeeding the
newborns. The labor and delivery nurses will have to put in the
consults for the lactation nurses to see the mother and baby.
Hospitals, birthing centers, midwifery units

PICOT PROPOSAL
List 3 peer reviewed
research papers that will
provide the evidence for
the PICOT

3
See reference list below.

PICOT PROPOSAL

4
Annotated Bibliography

Bonuck, K., Stuebe, A., Barnett, J., Labbok, M. H., Fletcher, J., & Bernstein, P. S. (2014). Effect
of primary care intervention on breastfeeding duration and intensity. American Journal
Of Public Health, 104(S1), S119-27. doi:10.2105/AJPH.2013.301360
This study was conducted to determine the effectiveness of pre- and postnatal
interventions to increase breastfeeding. The study was completed as a two-arm study, Best Infant
Nutrition for Good Outcomes (BINGO) arm and Provider Approaches to Improved Rates of
Infant Nutrition and Growth Study (PAIRINGS) arm. There was a total of 666 participants in the
BINGO arm, mothers were randomly assigned to one of three different groups. Either the
electronically prompted (EP) only group (n= 207), the lactation consult (LC) only group (n= 70),
or the EP and LC group (n=218). A total of 275 participants were from the PAIRINGS arm and
mothers were randomly assigned to one of two groups. Either the usual care group (n=123) or
the EP and LC group (n=122). The EP groups had electronic prompts that appeared in the
medical records for the 5 prenatal visits, each prompt had two or three open ended questions that
portrayed breastfeeding as the norm. The LC group included two 30-minute sessions, a hospital
visit, and regular phone calls through 3 months. Follow up telephone interviews were done with
both locations at 1, 3, and 6 months postpartum. The results of the BINGO arm was the intensity
was higher in the EP and LC group (OR 2.7, 95%, CI 1.08-6.84) and the LC only group (OR
3.22, 95%, CI 1.14-9.09). As for the PAIRINGS arm, the intervention group rates greatly
exceeded the usual care group (OR 2.86, 95%, CI 1.21-6.76). Overall it was found that LC
integrated into routine care alone or in combination with EP increased the intensity of
breastfeeding at 3 months postpartum.

PICOT PROPOSAL

The strengths of this study include: (1) The trial was randomized. (2) The mothers were
blind to which group they were placed. (3) There was a large sample size. (4) The interventions
were clearly defined in the study. Based on these strengths, the results seem to be valid and
reliable.
Bonuck, K., Trombley, M., Freeman, K., & McKee, D. (2005). Randomized, controlled trial of a
prenatal and postnatal lactation consultant intervention on duration and intensity of
breastfeeding up to 12 months. Pediatrics, 116(6), 1413-1426.
This study was conducted to determine whether an individualized, prenatal and postnatal,
lactation consultant intervention resulted in increased cumulative intensity of breastfeeding up to
52 weeks. Baseline interviews covered demographic data and breastfeeding experience,
intention, and knowledge. There was a total of 304 participants that were randomized into two
different groups, the intervention (n=188) or the control (n=159). The intervention involved two
prenatal meetings, postpartum hospital visit, and/or home visits and telephone calls. The control
group received standard care. Cumulative intensities were drawn at 13 and 52 weeks from
interviews were conducted at 1,2,3,4,6,8,10, and 12 months postpartum through the mothers self
report of weekly breast feedings on a 7 level scale. The results were that the intervention group
was more likely to breastfeed through week 20 (month 5), 53.0% in the intervention group
versus 39.3% in the control group. The control had lower breastfeeding intensities at 13 weeks
(OR1.90, 95%, CI 1.13-3.20) and at 52 weeks (OR 5.25, 95%, CI 2.44-11.29). It was found that
there were no significant differences between the two groups for exclusive breastfeeding. This
indicates that other areas like breastfeeding knowledge were increased.
The strengths for this study include: (1) The trial was randomized. (2) The reasons were
listed for why some participants did not complete the study. (3) There was a large sample size.

PICOT PROPOSAL

There was one weakness, the study was not done as a blind study. However, it did not cause a
problem nor did it alter the validity of the study. It did not make a difference if the researchers
and lactation specialists knew which group was which. The same care was given whether these
individuals knew the groups or not. Based on this information, the study is valid and reliable.
Mattar, C., Chong, Y., Chan, Y., Chew, A., Tan, P., Chan, Y., & Rauff, M. (2007). Simple
antenatal preparation to improve breastfeeding practice: A randomized controlled
trial. Obstetrics & Gynecology,109(1), 73-80.
This study was conducted to address the impact of simple antenatal educational
interventions on breastfeeding practice. There was a total of 401 mothers recruited from clinics
in Singapore that participated in the study. Randomization was conducted by a computergenerated list that was used to distribute the women into the three different groups, A, B and C.
Group A (n=123) received an information booklet with techniques and benefits of breast feeding,
a 16 minute video with demonstrations, and a 15 minute session with a lactation counselor.
Group B (n=132) received only the same booklet and video, but no counseling session. Group C
(n=146) was the control, which did not receive any additional education. Investigators found that
Group A was the most successful with breastfeeding at 3 months due to the lactation counseling
(OR 2.6, 95%, CI 1.2-5.4), and at 6 months (OR 2.4 95% CI 1.0-5.7). The results also concluded
that printed and audiovisual materials were not enough and that nurses should make an effort to
make face-to-face contact with the mothers.
The strengths of the trial include: (1) The trial was randomized. (2) The women and the
second researcher were blind to the intervention groups. (3) The questionnaires to report data
were assessed for reliability and validity. (4) The participants were demographically similar.
Based on these strengths, the results seem to be valid and reliable.