Construction Of Evidence-Based Management Program For Breastfeeding Related Nipple Pain And/Or Trauma

Objective:To summarize the best national and international evidence on breastfeeding related nipple pain and/or trauma management over the last decade.Use qualitative interviews to understand obstetric care staff and maternal requirements for breastfeeding related nipple pain and/or trauma management;Integrate the results of the first two parts,to develop management program for breastfeeding related nipple pain and/or trauma through Delphi expert correspondence.Methods:1.This study adopted the "PIPOST" of the Evidence-Based Health Care Center of Fudan University to identify evidence-based questions.According to the "6S evidence model" as the guidance system,we searched 9 Chinese and English databases such as CNKI,Wanfang Data,Pub Med and Embase.Evidence on breast-feeding related nipple pain and/or trauma management strategies from five guideline sites,including the National Institute for Health and Service Excellence(NICE),the National Database of Clinical Guidelines(NGC).The search period was January 1,2012 to March 31,2022.AGREE II and JBI literature evaluation criteria are used to evaluate the guidelines and each literature type respectively.Content analysis,extraction and integration of the above evidence,According to the "JBI Evidence Grading and Evidence Recommendation Level System(2014 edition)",the evidence was graded and evaluated,and the best evidence was summarized.2.From August to October 2022,maternal patients with nipple pain and/or trauma during this period were selected and interviewed by purpose sampling method,to investigate the cognition and behavior of obstetric front-line nurses on nipple pain and trauma,and the factors affecting the implementation of pain and trauma management programs;From November to December 2022,the objective sampling method was adopted to select the obstetric nursing staff of a Grade-A hospital in Jinan,Shandong Province as the respondents,understand all aspects of maternal requirements.A preliminary management protocol of breast-feeding related nipple pain and/or trauma was developed using qualitative interview results and a summary of evidence.3.The Delphi expert correspondence method was used to seek expert advice and recommendations for the initial formulation of breastfeeding related nipple pain and/or trauma management program.Experts score each entry in terms of importance and operability,and suggest whether the entry needs to be modified,added or deleted to determine the final version of the breastfeeding related nipple pain and/or traumatic maternal management program.Results:1.Semi-structured interviews of breast-feeding associated nipple pain and/or trauma revealed that obstetric caregivers needed expertise,influencing factors and coping strategies for the management of breast-feeding associated nipple pain and/or trauma;Medical staff should provide patients with professional knowledge about nipple pain and trauma,love and belonging of family members,self-management of pregnant and pregnant women,and the creation of online public platforms.2.A total of 1054 literatures were systematically retrieved and 22 were included,including 5 guidelines,3 evidence summaries,6 systematic reviews,1 expert consensus,and7 randomized controlled trials.It was preliminarily summarized into 28 pieces of evidence from 6 aspects,including pain assessment,education and training,non-drug intervention,drug intervention,self-management and precautions.3.After two rounds of expert correspondence,a total of 5 pieces of evidence were deleted and 3 pieces of evidence were modified.Finally,the management progarm of breastfeeding related nipple pain and/or nipple trauma was established,including 6 firstlevel items and 25 second-level items.The recovery rates of the first and second rounds of expert letter consultation were 100% and 100%,respectively.The proposed rates were 37.5%and 13.3%,respectively.The expert authority coefficient of the first round of expert correspondence consultation was 0.96,the coordination coefficient was 0.35,0.24,and the coefficient of variation(CV)was between 0.00 and 0.41,and the significance test result P <0.05.In the second round,the expert authority coefficient was 0.97,the coordination coefficient was 0.20,0.21,the coefficient of variation(CV)was between 0.00 and 0.28,and the significance test result P < 0.05.Conclusions:1.Based on qualitative interviews,a summary of the best evidence,and a Delphi expert letter,a breast-feeding related nipple pain and/or trauma management protocol was constructed,consisting of 6 primary items and 25 secondary items,including pain assessment,education and training,non-drug interventions,drug interventions,selfmanagement,and precautions.2.The program is scientific,reliable and feasible,and has a reference and guidance role in promoting the clinical practice of scientific implementation of nipple pain and/or trauma management in the field of obstetrics.