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Innovative Method for Teaching Manual Expression of Breast Milk in a Laboratory Setting
principles and practice Innovative Method for Teaching Manual Expression of Breast Milk in a Laboratory Setting CAROLYN P . BURDIN, BSN, MS, and NELLIE T . CAFFERY, BSN
A demonstration breast model was devised and cmstructed for nursing students to use in practicing manual expression of colostrum and milk. It can also be used for demonstration and practice of exercises for preparation for breastfeeding. T h e 15 x 27 inch model has proved to be an excellent teaching device. It is economical, can be conveniently stored and is available to students in the audiovisual setting at all times, Instructions for construction are given.
At Arkansas State University Division of Nursing we, like so many other nursing instructors, discovered difficulty in providing specific learning experiences for all nursing students within the hospital setting. Without question, there is a need for innovative ways of providing learning experiences for the nursing student within a college laboratory setting. One specific problem this nursing faculty encountered involved teaching nursing students the method of manually expressing colostrum and milk from the breast. A demonstration model was devised in an effort to give each student a realistic learning experience and to further her ability to teach the lactating mother this procedure. Exercises for preparation for breastfeeding, such as nipple rolling and toughening of the nipples, can also be demonstrated and practiced on the model. This 15 X 27 inch model is realistic to operate, always available for student practice and can be conveniently stored. The size can be adjusted to meet the teaching needs of any nursing faculty. It costs less than five dollars. 30
The following items are needed to construct this model: poster board, 15 x 27 inches foam rubber ball, 6 to 7 inches in diameter rubber baby bottle nipples narrow flexible rubber tubes, 12 inches in length 2 disposable syringes without needles, 5 or 10 ml 1 plywood sheet, 15 X 27 inches 2 hinges with screws 2 plywood sheets, 8 x 15 inches Aluminum foil Glue Scotch tape Scissors Drill Screwdriver Electric carving knife Hemostat Telfa dressing 1 1 2 2
May/June 1973 JOGN Nursing
Figure 1. Structural diagrams of a demonstration breast model. ( A ) Cross section of side view. ( B ) Front view.
T o prepare the demonstration model: Cover the poster board with aluminum foil to protect it from moisture. (Do not forget to make holes in both the poster board and aluminum foil for passage of the rubber tubing.) Then cut the foam rubber ball in half with an electric knife or other sharp instrument which provides a sharp, even cut with little or no crumbling. With the scissors, carefully hollow out a major portion of the center foam from the flat side of the halfspheres to allow for insertion of the nipples. Save the foam rubber that is removed. Make a small hole in the center of the rounded part of each ball to allow for the insertion and protrusion of the nipple. (Note Figure 1A) T o allow for insertion of the tubber tubing, cut the holes in the nipples slightly larger. A hemostat may be used to pull the piece of narrow tubing through the nipple hole, but not past it. Insert Some Of the saved snlall pieces Of foam inside the nipples and around the rubber tubing. This will May/June 1973 JOGN Nursing
Figure 2. Photographs of a working demonstration breast model. (A) Viewed from behind. (B) Front view.
31
help keep the tubing in place. The prepared nipples are now placed in position within the foam rubber half-spheres. T h e nipples should protrude approximately one-half inch. Again, use the excess foam rubber to pack the nipples securely in place. A piece of Telfa dressing may be cut to the desired shape and glued around the nipple to represent the areola. (Note Figure
IB) Cut two holes in the foil-covered poster board for passage of the rubber tubing. Glue the halfspheres to the poster board and pass the tubing through the holes. Mount the poster board model on a piece of scrap plywood. (Do not forget the holes in the plywood for the passage of the rubber tubing.) Attach the disposable syringes to the end of the tubing, placed behind the plywood. Attach the two sides of plywood with the hinges and screws. This provides a more stable model and one that will stand alone. (Note Figures 2A and B) T o use the demonstration model, fill the syringes with water. As the student practices manual expression of breast milk, gently exert pressure on the plunger so that some fluid is actually expressed from the model breast. This same procedure may be used with a breast pump. The demonstration model has been an excellent teaching device for the nursing students who are unable to practice this method within the hospital setting. They are no longer forced to rely solely on a textbook description. With practice on the model, the students gain confidence in their skill and ease in using their hands. Thus, they are better prepared to teach patients the technique of manual expression of breast milk when the need arises.
Address reprint requests to Mrs. Carolyn P. Burdin, Division of Nursing, Arkansas State University, State University, AR 72467.
T h e authors are instructors in the Division of Niirsiiig at Arkansas State University. Mrs. Rurdin holds n RSN f Y 0 7 i l the University of Southwestern Loirisinm mid c1 M S N f r o w the Uiiiversity of Alnhniiin. Mrs. C g f f r e y received her BSN from the University of Tennessee. 32
FAMILY PLANNING TRAINING PROGRAM An intensive 12-week program for training professional nurses t o expand their role in family planning patient care as Family Planning Nurse Practitioners will be offered September 3 through November 2 3 in Newark, New Jersey. I t is cosponsored by the N e w Jersey College of Medicine and Dentistry, Planned Parenthood-World Population, and Planned Parenthood of Essex County. T h e program is designed to equip the nurse to carry, under medical supervision, full responsibility for the ihitiation and management of patients in a family planning regimen as well as to provide nursing leadership for all aspects of a comprehensive family planning service. Learned clinical skills will include pelvic and breast examinations, taking Pap smears, techniques of diaphragm fitting and IUD insertion, and selection of oral contraceptives. Other skills will include family planning service organization and administration, interviewing and communication. Classroom and clinical teaching and experience will be provided. Full tuition scholarships will be available plus stipends of $250 per month for students who are not commuting from their homes. Further information and applications can be obtained from the Program Coordinator, Mrs. Miriam Manisoff, Planned Parenthood-World Population, 810 Seventh Avenue, New York, N Y 10019.
HIGH-RISK NEONATE AND FAMILY PLANNING WORKSHOPS T h e University of Illinois College of Nursing, Department of Maternal-Child Nursing, will sponsor two 3-week workshops on “Nursing Care of the High-Risk Neonate” (July 9-27; Mrs. Maurer) and “The Nurse and Family Planning” (June 18-July 6; Mmes. Cash and Rice). Pending approval of funding, the workshops will be tuition free; a limited number of stipends will also be available. T h e high-risk neonate workshop will be a combination of theory and practice. Applicants must be RN’s currently working or planning to work in high-risk nurseries. T h e family planning workshop will include lecture, group, and skills practice.
For further information contact Mrs. Marcia Maurer or Mrs. Reba Cash, University of Illinois at the Medical Center, College of Nursing, P. 0. Box 6998, Chicago, IL 60680, or call (3 1 2 ) 996-7937.
May/June 1973 JOGN Nursing
A demonstration breast model was devised and cmstructed for nursing students to use in practicing manual expression of colostrum and milk. It can also be used for demonstration and practice of exercises for preparation for breastfeeding. T h e 15 x 27 inch model has proved to be an excellent teaching device. It is economical, can be conveniently stored and is available to students in the audiovisual setting at all times, Instructions for construction are given.
At Arkansas State University Division of Nursing we, like so many other nursing instructors, discovered difficulty in providing specific learning experiences for all nursing students within the hospital setting. Without question, there is a need for innovative ways of providing learning experiences for the nursing student within a college laboratory setting. One specific problem this nursing faculty encountered involved teaching nursing students the method of manually expressing colostrum and milk from the breast. A demonstration model was devised in an effort to give each student a realistic learning experience and to further her ability to teach the lactating mother this procedure. Exercises for preparation for breastfeeding, such as nipple rolling and toughening of the nipples, can also be demonstrated and practiced on the model. This 15 X 27 inch model is realistic to operate, always available for student practice and can be conveniently stored. The size can be adjusted to meet the teaching needs of any nursing faculty. It costs less than five dollars. 30
The following items are needed to construct this model: poster board, 15 x 27 inches foam rubber ball, 6 to 7 inches in diameter rubber baby bottle nipples narrow flexible rubber tubes, 12 inches in length 2 disposable syringes without needles, 5 or 10 ml 1 plywood sheet, 15 X 27 inches 2 hinges with screws 2 plywood sheets, 8 x 15 inches Aluminum foil Glue Scotch tape Scissors Drill Screwdriver Electric carving knife Hemostat Telfa dressing 1 1 2 2
May/June 1973 JOGN Nursing
Figure 1. Structural diagrams of a demonstration breast model. ( A ) Cross section of side view. ( B ) Front view.
T o prepare the demonstration model: Cover the poster board with aluminum foil to protect it from moisture. (Do not forget to make holes in both the poster board and aluminum foil for passage of the rubber tubing.) Then cut the foam rubber ball in half with an electric knife or other sharp instrument which provides a sharp, even cut with little or no crumbling. With the scissors, carefully hollow out a major portion of the center foam from the flat side of the halfspheres to allow for insertion of the nipples. Save the foam rubber that is removed. Make a small hole in the center of the rounded part of each ball to allow for the insertion and protrusion of the nipple. (Note Figure 1A) T o allow for insertion of the tubber tubing, cut the holes in the nipples slightly larger. A hemostat may be used to pull the piece of narrow tubing through the nipple hole, but not past it. Insert Some Of the saved snlall pieces Of foam inside the nipples and around the rubber tubing. This will May/June 1973 JOGN Nursing
Figure 2. Photographs of a working demonstration breast model. (A) Viewed from behind. (B) Front view.
31
help keep the tubing in place. The prepared nipples are now placed in position within the foam rubber half-spheres. T h e nipples should protrude approximately one-half inch. Again, use the excess foam rubber to pack the nipples securely in place. A piece of Telfa dressing may be cut to the desired shape and glued around the nipple to represent the areola. (Note Figure
IB) Cut two holes in the foil-covered poster board for passage of the rubber tubing. Glue the halfspheres to the poster board and pass the tubing through the holes. Mount the poster board model on a piece of scrap plywood. (Do not forget the holes in the plywood for the passage of the rubber tubing.) Attach the disposable syringes to the end of the tubing, placed behind the plywood. Attach the two sides of plywood with the hinges and screws. This provides a more stable model and one that will stand alone. (Note Figures 2A and B) T o use the demonstration model, fill the syringes with water. As the student practices manual expression of breast milk, gently exert pressure on the plunger so that some fluid is actually expressed from the model breast. This same procedure may be used with a breast pump. The demonstration model has been an excellent teaching device for the nursing students who are unable to practice this method within the hospital setting. They are no longer forced to rely solely on a textbook description. With practice on the model, the students gain confidence in their skill and ease in using their hands. Thus, they are better prepared to teach patients the technique of manual expression of breast milk when the need arises.
Address reprint requests to Mrs. Carolyn P. Burdin, Division of Nursing, Arkansas State University, State University, AR 72467.
T h e authors are instructors in the Division of Niirsiiig at Arkansas State University. Mrs. Rurdin holds n RSN f Y 0 7 i l the University of Southwestern Loirisinm mid c1 M S N f r o w the Uiiiversity of Alnhniiin. Mrs. C g f f r e y received her BSN from the University of Tennessee. 32
FAMILY PLANNING TRAINING PROGRAM An intensive 12-week program for training professional nurses t o expand their role in family planning patient care as Family Planning Nurse Practitioners will be offered September 3 through November 2 3 in Newark, New Jersey. I t is cosponsored by the N e w Jersey College of Medicine and Dentistry, Planned Parenthood-World Population, and Planned Parenthood of Essex County. T h e program is designed to equip the nurse to carry, under medical supervision, full responsibility for the ihitiation and management of patients in a family planning regimen as well as to provide nursing leadership for all aspects of a comprehensive family planning service. Learned clinical skills will include pelvic and breast examinations, taking Pap smears, techniques of diaphragm fitting and IUD insertion, and selection of oral contraceptives. Other skills will include family planning service organization and administration, interviewing and communication. Classroom and clinical teaching and experience will be provided. Full tuition scholarships will be available plus stipends of $250 per month for students who are not commuting from their homes. Further information and applications can be obtained from the Program Coordinator, Mrs. Miriam Manisoff, Planned Parenthood-World Population, 810 Seventh Avenue, New York, N Y 10019.
HIGH-RISK NEONATE AND FAMILY PLANNING WORKSHOPS T h e University of Illinois College of Nursing, Department of Maternal-Child Nursing, will sponsor two 3-week workshops on “Nursing Care of the High-Risk Neonate” (July 9-27; Mrs. Maurer) and “The Nurse and Family Planning” (June 18-July 6; Mmes. Cash and Rice). Pending approval of funding, the workshops will be tuition free; a limited number of stipends will also be available. T h e high-risk neonate workshop will be a combination of theory and practice. Applicants must be RN’s currently working or planning to work in high-risk nurseries. T h e family planning workshop will include lecture, group, and skills practice.
For further information contact Mrs. Marcia Maurer or Mrs. Reba Cash, University of Illinois at the Medical Center, College of Nursing, P. 0. Box 6998, Chicago, IL 60680, or call (3 1 2 ) 996-7937.
May/June 1973 JOGN Nursing