Publication Date


Degree Type

Doctoral Project

Degree Name

Doctor of Nursing Practice (DNP)



First Advisor

Carrie Holschuh

Second Advisor

Kerri Klassen

Third Advisor

Gretchen Nelson


Breastfeeding, perinatal nurse training, oral cleft defects, trisomy 21, congenital heart disease


The American Academy of Pediatrics (American Academy of Pediatrics [AAP], 2018), the World Health Organization (World Health Organization [WHO)], 2018), and The March of Dimes (March of Dimes, 2016) recommend exclusive breastfeeding for the first six months of life. In 2014, 79% of women in the United States began breastfeeding their infants, but only 40.7% and 18.8% continued breastfeeding exclusively at three and six months respectively (Centers for Disease Control and Prevention, 2017). This doctoral project promotes breastfeeding by creating and testing simple teaching algorithms for training registered nurses to support breastfeeding, including for infants with trisomy 21, congenital heart defects, and oral cleft defects. To validate the new algorithms, two focus groups were held with a total of nineteen registered nurses in Central California (four registered nurses in one focus group and fifteen in the other). Participants tended to be older with an average of 29.6 years of experience primarily in obstetrical nursing. A qualitative study showed the nurses enjoyed learning through role play and felt they learned valuable information. The biggest barrier to learning identified was feeling overwhelmed by the amount of information presented in the algorithm for infants with common congenital anomalies and defects.


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