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Effectiveness of Breast Massage on Expression of Breast Milk among Mothers of Neonates admitted in Neonatal Intensive Care Unit

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Abstract

Massaging the breast may help a postnatal mother to improve breast milk production, alleviate breast engorgement and facilitate breast milk expression. The purpose of the present study was to identify the effect of breast massage on breast milk expression in terms of volume of breast milk expressed, pain during breast milk expression and experience of breast milk expression among mothers of neonates admitted in neonatal intensive care unit (NICU). Materials and methods The quasi-experimental study was conducted among 30 postnatal mothers whose babies were admitted in NICU, selected as a sample of convenience. The design used was time series research design. After the pretest, breast massage was taught to the mothers by the investigator. Breast massage was performed for 10 minutes prior to each expression. The practice of breast massage and breast milk expression is observed by the investigator using a checklist during the next expression. Volume of breast milk expressed and pain during breast milk expression were assessed three times before and after the intervention using a standardized measuring cup and numerical pain scale respectively. The experience of breast milk expression was assessed before and after intervention using breast milk expression experience measure. Analysis was done using mean, frequency, percentage and paired t-test. Major findings The results show that the mean pretest volume of milk expressed in milliliters was 7.33 ± 4.86, which increased to 15.56 ± 8.38 (t = 4.22, p = 0.001) after the intervention. The mean pretest pain score was 7.50 ± 1.42 which decreased to 5.01 ± 1.37 (t = 11.73, p = 0.001) after the intervention. The experience of breast milk expression in post-test 37.6 ± 3.88 was significantly higher than pretest 28.4 ± 4.73 (t = 11.25, p = 0.001). Conclusion The study findings conclude that the breast massage is effective in increasing the volume of expressed breast milk, reducing the pain during breast milk expression and improving the experience of breast milk expression. How to cite this article Divya A, Viswanath L, Philip A. Effectiveness of Breast Massage on Expression of Breast Milk among Mothers of Neonates Admitted in Neonatal Intensive Care Unit. J South Asian Feder Obst Gynae 2016;8(1):21-24.
Effectiveness of Breast Massage on Expression of Breast Milk among Mothers of Neonates
Journal of South Asian Federation of Obstetrics and Gynaecology, January-March 2016;8(1):1-4 1
JSAFOG
ABSTRACT
Massaging the breast may help a postnatal mother to improve
breast milk production, alleviate breast engorgement and
facilitate breast milk expression. The purpose of the present
study was to identify the effect of breast massage on breast
milk expression in terms of volume of breast milk expressed,
pain during breast milk expression and experience of breast milk
expression among mothers of neonates admitted in neonatal
intensive care unit (NICU).
Materials and methods: The quasi experimental study was
conducted among 30 postnatal mothers whose babies were
admitted in NICU, selected as a sample of convenience. The
design used was time series research design. After the pretest,
breast massage was taught to the mothers by the investigator.
Breast massage was performed for 10 minutes prior to each
expression. The practice of breast massage and breast milk
expression is observed by the investigator using a checklist
during the next expression. Volume of breast milk expressed and
pain during breast milk expression were assessed three times
before and after the intervention using a standardized measuring
cup and numerical pain scale respectively. The experience
of breast milk expression was assessed before and after
intervention using breast milk expression experience measure.
Analysis was done using mean, frequency, percentage, and
paired t-test.
Major ndings: The results show that the mean pretest volume
of milk expressed in milliliters was 7.33 ± 4.86, which increased
to 15.56 ± 8.38 (t = 4.22, p = 0.001) after the intervention. The
mean pretest pain score was 7.50 ± 1.42 which decreased to
5.01 ± 1.37 (t = 11.73, p = 0.001) after the intervention. The
experience of breast milk expression in post-test 37.6 ± 3.88
was signicantly higher than pretest 28.4 ± 4.73 (t = 11.25,
p = 0.001).
Conclusion: The study findings conclude that the breast
massage is effective in increasing the volume of expressed
breast milk, reducing the pain during breast milk expression and
improving the experience of breast milk expression.
Keywords: Breast massage, Experience of breast milk
expression, Expression of breast milk, Neonates admitted in
NICU, Pain, Volume.
How to cite this article: Divya A, Viswanath L, Philip A.
Effectiveness of Breast Massage on Expression of Breast Milk
among Mothers of Neonates Admitted in Neonatal Intensive
Care Unit. J South Asian Feder Obst Gynae 2016;8(1):1-4.
Source of support: Nil
Conict of interest: None
INTRODUCTION
Breastfeeding high risk babies especially preterm, low
birth weight babies, babies with congenital anomalies,
etc. are often a challenge for the postnatal mothers.
These babies may not be able to suck properly due
to physiological immaturity or physical problems.
The nutritional needs of such babies are usually met
by expressed breast milk or formula feeds. Feeding
with expressed breast milk is considered as a best
alternative for such babies, as articial feeds may lead
to problems like infections, possibility for producing
gas and constipation, vomiting, rashes, etc. Commercial
formula feeds are designed close to the breast milk. The
fat in the breast milk is more easily digested whereas
fat in formula is digested more slowly than breast milk
and may not be as well tolerated. Breast milk contains
antibodies from mother to protect babies from infection
whereas commercial feeds do not have. This protection
is important when babies are sick or premature and
may have higher chance of developing an infection. A
randomized and quasi randomized trial done by Oshom
DA, Sinn Jon on formulas containing hydrolized protein
for prevention of allergy and food intolerance in infants
found no evidence to support feeding with a hydrolized
formula for the prevention of allergy in preference to
exclusive breastfeeding.4
Mothers of those babies admitted in neonatal intensive
care unit (NICU) are in severe stress because of poor
maternal child bond, disturbed physical appearance
JSAFOG
TYPE OF ARTICLE
10.5005/jp-journals-10000-0000
Effectiveness of Breast Massage on Expression of Breast
Milk among Mothers of Neonates Admitted in Neonatal
Intensive Care Unit
1A Divya, 2Lekha Viswanath, 3Anju Philip
1Postgraduate Nursing Students (2nd Year)
2Associate Professor, 3Assistant Professor
1-3Department of Obstetrics and Gynecology Nursing, Amrita
College of Nursing, Amrita Vishwa Vidyapeetham Health
Sciences Campus, Amrita Institute of Medical Sciences, Kochi
Kerala, India
Corresponding Author: Lekha Viswanath, Associate Professor
Department of Obstetrics and Gynecology Nursing, Amrita
College of Nursing, Amrita Vishwa Vidyapeetham Health
Sciences Campus, Amrita Institute of Medical Sciences, Kochi
Kerala, India, Phone: 0484-6681234, e-mail: lekhaviswanath3@
gmail.com
A Divya et al
2
of baby and inability to feed their baby. Depending on
the conditions of the baby feeding may be started when
baby becomes stable usually with expressed breast
milk. Mothers may not be able to express enough breast
milk needed for the baby due to decreased breast milk
production. As the breastfeeding is not initiated in the
initial days the mothers may develop many breastfeeding
problems. The most common among them is breast
engorgement. During direct breastfeedings the baby
removes the needed milk through sucking which helps
to develop more milk and is a normal physiology. For
mothers of high risk babies, the colostrums develop in the
breast is not removed out from the breast. This results in
plugged milk ducts, results in infection and engorgement.
Breast engorgement causes discomfort to the mothers like
pain, redness and hardening of breast tissues. It further
decreases production of breast milk as emptying of milk
does not take place. Facilitating emptying of breast of
milk would be an appropriate intervention to relieve
breast engorgement in such mothers. Often women may
need assistance in expressing breast milk. Breast milk
expression helps not only to relieve problems related to
engorgement but also improve or maintain breast milk
production.
The present study was undertaken with a view to help
mother in expressing breast milk. Breast massage was
selected as the intervention as it helps to open the plugged
milk ducts and improves the breast milk production.
Breast massage acts as an external stimuli which opens
the milk ducts whereas for a newborn who directly feeds
lips of newborn act as massager. The objectives of the
present study were as follows:
Find out the effect of breast massage on volume of
breast milk expression among mothers of neonates
admitted in NICU.
Find out the effect of breast massage on pain during
breast milk expression among mothers of neonates
admitted in NICU.
Find out the effect of breast massage on experience
of breast milk expression among mothers of neonates
admitted in NICU.
MATERIALS AND METHODS
The study used a Quasi experimental research approach
with time series design. Sample consists of 30 postnatal
mothers whose babies were admitted in NICU and
were on expressed breast milk feeding, selected as a
sample of convenience. Inclusion criteria were mothers
of neonates aged between 18 and 45 years, from third to
eighth postpartum days and those who do not have any
medical comorbidities. Ethical clearance was obtained
from Thesis Review Board of Amrita Institute of Medical
Sciences, Kochi and the period of data collection was from
November 2014 to January 2015. A detailed explanation
of the study and nature of participation was given to
the postnatal mothers who met the sampling criteria.
Participation was based on willingness and written
informed consent was obtained prior to enrolment.
The demographic data were collected using a
proforma prepared by the investigator. The volume
of breast milk expressed and pain during breast milk
expression were measured during three consecutive
expressions. A measuring cup was used to measure the
breast milk in milliliters and numerical rating scale was
used to measure the pain score. The experience of
breast milk expression was assessed using breast milk
expression experience measure after three observations.
Breast milk expression experience measure is a ve point
likert scale developed by Flaherman to evaluate women
experience of expressing breast milk. The tool consists
of three subscales, they are social support, learning
experience and personal experience. Reliability of the tool
is established by checking the internal consistency and
had a Cronbach’s alpha coefcient of 0.703.
After the pretest, the breast massage is taught to the
mother with the help of a video showing breast massage
and breast milk expression and was demonstrated to
the mother by the investigator. Breast massage includes
rubbing stroking and kneading each breast followed by
massaging breast with nger pads, in a circular motion
around the whole breast in a clockwise manner. It also
incorporates hot fomentation prior to the intervention
and expression of breast milk using Marmet technique.
Breast massage is given for 5 minutes to each breast.
Then expression is done using Marmet technique for
10 minutes. To ensure the correct method practiced
by the mother, the rst expression after the teaching is
evaluated by the researcher with the help of a checklist.
The volume of breast milk and pain during expression
for the next three expressions is measured, followed by
measurement of experience of breast milk expression.
The pretest and post-test scores of volume of breast
milk, pain during breast milk expression and experience
of breast milk expression were compared using paired
t-test. Average of the three observations of volume and
pain before and after the intervention was considered as
pretest and post-test respectively.
RESULTS
Most of the mothers 18 (60%) of subjects were in age
group 25 to 30 years, and 23 (76%) were graduates.
Majority of mothers [21 (70%)] were primigravida and
Effectiveness of Breast Massage on Expression of Breast Milk among Mothers of Neonates
Journal of South Asian Federation of Obstetrics and Gynaecology, January-March 2016;8(1):1-4 3
JSAFOG
Graph 1: The volume of breast milk expressed and pain during
breast milk expression
underwent delivery above 36 weeks of gestation. About
the type of delivery, 19 (64%) mothers underwent normal
vaginal delivery and 11 (36%) underwent lower segment
cesarean section (LSCS). None of the mothers took any
medication to increase breast milk production.
The volume of the breast milk and the pain during
breast milk expression before and after breast massage is
presented in Graph 1 and it shows that following breast
massage there is an increase in the volume of breast milk
and decrease in the pain during expression.
In order to nd out the effect of breast massage on
breast milk expression, the pretest and post-test scores
were compared using paired t-test. The average of three
observations before the intervention is considered as the
pretest and average of the three observation following
the breast massage is considered as post-test for volume
of breast milk expressed and pain during breast milk
expression.
Table 1 shows that the post-test (15.56 ± 8.38) volume
of milk is signicantly higher than the pretest (7.33 ± 4.86)
volume of milk (t = 4.22, p = 0.001).
Table 2 shows that the post-test (5.01 ± 1.37) pain score
is signicantly lower than the pretest (7.50 ± 1.42) pain
score (t = 11.73, p = 0.001).
Table 3 shows that the experience of breast milk
expression score is significantly higher in the post-
test than the pretest score. So breast massage helps in
improving breast milk expression experience.
DISCUSSION
The present study nding is more or less consistent with
the literature ndings. The pretest volume of breast
milk expressed is 7.33 ± 4.86 and in post-test the volume
increased to 15.56 ± 8.38. The study results interpret that
the breast massage is effective in increasing the volume of
breast milk at 0.001 level of signicance. An experimental
study conducted on 36 postnatal mothers found that the
volume of breast milk expressed was high with breast
massage than without massage in sequential pumping
(78.71 vs 51.32 gm) as well as simultaneous pumping
( 125.08 vs 87.69 gm). The above ndings supports the
results of the present study.
The result of the present study shows that post-test
pain score (5.01 ± 1.37) is signicantly lower than pretest
pain score (7.50 ± 1.42) at 0.001 level of signicance. A
study conducted among 60 postnatal mothers evaluate
the effect of breast massage on breast pain and new
born sucking. Compared to the control group, women
in the intervention group reported signicant decreases
in breast pain (p < 0.001), increases in number of times
newborns suckled after the rst and second massage
(p < 0.001), and a decrease in breast-milk sodium after
the rst massage (p = 0.034).10 These studies suggest that
breast massage is effective in reducing the pain.
As an intervention breast massage requires no
additional equipments or cost. It just requires training
the postnatal mothers on breast massage and expression.
By reducing the pain and improving the experience of
breast milk expression, it improves the mothers comfort
and condence in an extremely stressful situation. By
Table 3: Comparison of experience of breast milk expression between pretest and post-test
n = 30
Pretest Post-test Mean difference t-value p-value
Social support 7.56 ± 1.38 8.13 ± 1.38 0.57 3.458 < 0.002
Learning experience 9.40 ± 2.38 14.46 ± 2.52 5.06 9.98 < 0.001
Personal experience 11.43 ± 2.81 15.06 ± 2.75 3.63 6.46 < 0.001
Total score 28.4 ± 4.73 37.6 ± 3.88 9.2 11.25 < 0.001
Table 1: Comparison of volume of milk expressed between
pretest and post-test
n = 30
Mean SD Mean difference t-value p-value
Pretest 7.338 4.86 8.22 4.22 < 0.001
Post-test 15.56 8.38
Table 2: Comparison of pain score between pretest and post-test
n = 30
Mean SD Mean difference t-value p-value
Pretest 7.50 1.42 2.49 11.73 < 0.001
Post-test 5.01 1.37
A Divya et al
4
increasing the volume of breast milk it helps to avoid
the problems related to formula feeds. The ndings of
the study highlight the role of the nurse in the postnatal
care especially the mothers of high risk babies.
CONCLUSION
Based on the ndings of the study, it can be concluded
that breast massage is effective in increasing the volume
of breast milk expressed, reduces the pain during breast
milk expression and improves the breast milk expression
experience among mothers. Breast massage can be
incorporated as an intervention for the care of postnatal
mothers not only to facilitate the breast milk expression
but also to relief breast engorgement.
ACKNOWLEDGMENT
I extend my sincere gratitude towards Dr Radhamany K,
Professor and Head of Obstetrics and Gynecology
Department, Amrita Institute of Medical Sciences, Kochi
for their full support, inspiration and suggestions in
completing this work successfully. I also thankful to
Thesis Review Committee of Amrita Institute of Medical
Sciences, Kochi, Kerala.
REFERENCES
1. Singh M. Care of the Newborn. 6th ed; New Delhi; Sagar
Publications, p. 152.
2. Lowdermilk, Perry, Cashion. Maternity Nursing. 8th ed;
Mosby Elseviers Publication; p. 548-549.
3. Problems associated with high risk newborn. [online]; 2015;
Available at: http://www.baptistjax.com/health-library/
pediatric-disease-and-condition/high-risk-newborn
4. World Health Organisation, Global strategy for infants and
young child feeding. Geneva. 2003, Retrived August 8 2011.
5. Infant and young child feeding and care, UNICEF, Retrived
June 8 2007.
6. How to manually express breast milk. Available at: http://
www.medelabreastfeedingus.com/tips-and-solutions/130/
howto manually express breast milk.
7. Polit DF, Beck CT. Nursing research principles and methods.
7th ed. Philadelphia: Lippincott Williams and Wilkins 2006.
8. Marriner A. Nursing theorist and work. 5th ed. Toronto:
Mosby Publications, 1986.
9. Jones E, Dimmock PW, Spencer SA. A randomised controlled
trial to compare methods of milk expression after preterm
delivery. Arch Dis Child Fetal Neonatal Ed. 2001 Sep;
85(2):F91-5.
10. Ahn S, Kim J, Cho J. Effects of breast massage on breast pain,
breast-milk sodium, and newborn suckling in early postpar-
tum mothers. J Korean Acad Nurs 2011 Aug;41(4):451-459.
... Other five studies proved that Breast massage [9][10][11][12][13] is very effective in improving the quality and quantity of breast milk expressed or fed by the postnatal women and has improved the maternal comfort and neonatal outcomes. ...
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Background: Mothers of infants who are dependent on expressed breast milk often find difficulty to express adequate quantity of breast milk to ensure exclusive breast feeding to their babies and it has become a major stress factor among these mothers. Many cost-effective adjuvant techniques are proved to be very useful in improving the quantity and quality of expressed breast milk. Objective: To determine the effect of two traditional breast stimulation techniques such as warm compress and breast massage as adjuvant to breast milk expression on maternal and lactational outcomes. Methodology: A hospital-based cross over trial will be considered to compare the effects of two interventions such as breast massage and warm compress, adjuvant to breast milk expression method (breast pump) on lactational outcomes (Quantity and quality of expressed breast milk) and maternal outcomes (Nipple pain, anxiety and experience of breast milk expression). The setting of the study will be selected tertiary level hospital of New Delhi. Approval from Institutional the Ethical approval is obtained from Institutional Ethical Committee, DMIMS (DMIMS (DU)/IEC/2017-18/6979) and also from the institutional ethical committee of armed forces medical services hospital of New Delhi where the study will be conducted. The data collected will be entered to an electronic data sheet and analysis will be done using SPSS. Expected Results: There will be a positive impact of interventions on locational outcomes such as quantity of expressed breast milk and quality of expressed breast milk. There will be a positive impact of interventions on maternal outcomes such as nipple pain. Anxiety and breast milk expression experience. This nurse led interventions will be made as a part of hospital policy to provide routine care to the mothers who are expressing breast milk in hospital settings. Conclusion: Conclusion will be drawn after the analysis of data collected from the predetermined sample size. The findings of the study will be published in an open access peer reviewed journal.
... This study also supports a study conducted by Divya (2016), who compared prolactin and oxytocin levels in postpartum mothers 3-5 days of manual massage on the breast and around the nipple to empty breast milk and mothers who only breastfed. The results obtained for breast and nipple massage stimulated oxytocin (OT) and prolactin (PRL) secretion better (basal level of OT in the group / breastfeeding group only 1.90 ± 0.18 while the breast massage group was 8.61 ± 0.84, the basal level of PRL in the control group was 79.30 ± 11.1, while in the breast massage group 99.64 ± 11.76). ...
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Background: In addition to suffering stress and anxiety owing to being separated from their babies, mothers whose babies are hospitalized in neonatal intensive care units suffer breastfeeding problems. Moreover, their breast milk production may decrease over time. Objective: Examining the effect of circular and oscillating breast massage on the amount of breast milk produced. Materials and Methods: This randomized controlled experimental study used a pretest-posttest model. The participants included 120 mothers (experimental group: 60, control group: 60) who went to a breast milk pumping unit of a hospital between December 1, 2017, and July 31, 2019. A circular and oscillating breast massage device was used to massage both breasts for 10 to 15 minutes, three times a day, for 3 days, and milk production was measured daily. The sociodemographic characteristics, perceptions regarding breast massage, and daily breast milk amounts of the mothers were collected. Results: The average age of the mothers that participated in the study was 30.21 ± 5.58 years; the average birth week of their babies was 32.31 ± 4.10 weeks. There were no significant differences in the mothers' amounts of milk production before the procedure in the experimental and control groups. In the study group, milk production increased by 7.92%, 5.25%, and 5.02% on days 1, 2, and 3 of the procedure, respectively. The mothers' total amount of milk production before and after the procedure (3 days) increased by 22.28%. Significant differences were found between the study groups on days 1, 2, and 3 and the total amount of milk produced after the procedure. Conclusion: Our study found circular and oscillating breast massage increased the amount of breast milk produced and decreased breast pain and swelling. Similar studies on the clinical use of this treatment should be conducted in line with the results of this study.
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Background: Improved health outcomes for critically ill infants including neurodevelopmental, immunological, and cost benefits are dependent upon the dose and duration of mother's own milk feedings. However, mothers of infants admitted to the neonatal intensive care unit (NICU) must express their milk (pump-dependent) and often struggle with milk production. Purpose: To examine the state of the science on nonpharmacologic modifiable expression factors that may influence milk production in pump-dependent mothers of critically ill infants admitted to the NICU. Data sources: PubMed, Embase, and CINAHL databases from 2005 to 2020. Search strategy: Guided by the lactation conceptual model, the authors searched for peer-reviewed studies with terms related to milk volume, pump dependency, critically ill infants, and modifiable factors, which may influence milk volume and assessed 46 eligible studies. Data extraction: Data were extracted by 3 reviewers with a systematic staged review approach. Results: Evidence from 26 articles found expressed milk volume may be influenced by multiple potentially modifiable factors. Simultaneous expression with a hospital-grade electric pump at least 5 times per day beginning 3 to 6 hours after delivery, and adding complementary techniques including hand expression, hands-on-pumping, music, breast massage, warm compresses, skin-to-skin care, and the mother expressing near her infant may promote increased milk volume. Implications for practice and research: Healthcare providers should assist pump-dependent mothers with early initiation and frequent milk removal with a hospital-grade breast pump. Further research is needed to explore optimal frequency of expressions, dose and timing of skin-to-skin care, and other targeted strategies to improve expressed milk volume.
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Full-text available
In this study the effects of breast massage on breast pain, breast-milk sodium, and newborn suckling in early postpartum mothers were investigated. The design was a non-synchronized nonequivalent control group pretest-posttest design. Sixty postpartum mothers who were admitted to a postpartum care center and had problems with breastfeeding were recruited. Of these mothers, 44 were assigned to the intervention group and received two 30-minute breast massages within 10 days of postpartum period. The others were assigned control group and received only routine care. Breast pain was measured using a numeric pain scale and number of times newborns suckled was observed throughout breastfeeding. Breast milk was self-collected to evaluate breast-milk sodium. Mean age of postpartum mothers was 30 years old. Compared to the control group, women in the intervention group reported significant decreases in breast pain (p<.001), increases in number of times newborns suckled after the first and second massage (p<.001), and a decrease in breast-milk sodium after the first massage (p=.034). Breast massage may have effects on relieving breast pain, decreasing breast-milk sodium, and improving newborn suckling. Breast massage can be used to solve breast problems. Further research is needed to validate our findings.
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Primary: to compare sequential and simultaneous breast pumping on volume of milk expressed and its fat content. Secondary: to measure the effect of breast massage on milk volume and fat content. Sequential randomised controlled trial. Neonatal intensive care unit, North Staffordshire Hospital NHS Trust. Data on 36 women were analysed; 19 women used simultaneous pumping and 17 used sequential pumping. Women were randomly allocated to use either simultaneous (both breasts simultaneously) or sequential (one breast then the other) milk expression. Stratification was used to ensure that the groups were balanced for parity and gestation. A crossover design was used for massage, with patients acting as their own controls. Women were randomly allocated to receive either massage or non-massage first. Volume of milk expressed per expression and its fat content (estimated by the creamatocrit method). Milk yield per expression was: sequential pumping with no massage, 51.32 g (95% confidence interval (CI) 56.57 to 46.07); sequential pumping with massage, 78.71 g (95% CI 85.19 to 72.24); simultaneous pumping with no massage, 87.69 g (95% CI 96.80 to 78.57); simultaneous pumping with massage, 125.08 g (95% CI 140.43 to 109.74). The fat concentration in the milk was not affected by the increase in volume achieved by the interventions. The results are unequivocal and show that simultaneous pumping is more effective at producing milk than sequential pumping and that breast massage has an additive effect, improving milk production in both groups. As frequent and efficient milk removal is essential for continued production of milk, mothers of preterm infants wishing to express milk for their sick babies should be taught these techniques.
Nursing research principles and methods
  • D F Polit
  • C T Beck
Polit DF, Beck CT. Nursing research principles and methods. 7th ed. Philadelphia: Lippincott Williams and Wilkins 2006.
Nursing theorist and work
  • A Marriner
Marriner A. Nursing theorist and work. 5th ed. Toronto: Mosby Publications, 1986.