Virtual Lactation Counseling Simulation Sessions for Diverse Lactation Minor Students: Using Grounded Theory to Classify Students’ Debriefing Questions
Main Article Content
Abstract
Introduction: This study explored the value of simulations to improve programs that train and prepare lactation counselors from diverse communities. Breastfeeding rates are lower than desired. Increasing diverse rural lactation counselors is critical. Classification of student input will help strengthen future telehealth lactation counseling simulations for students’ understanding, and communication.
Methods: Multiple one-hour small virtual lactation counseling simulation sessions with diverse students included five patient questions and consultations by an International Board Certified Lactation Consultant (IBCLC) with debriefs. Qualitative design with Grounded Theory based on National League of Nursing (NLN) Jeffries Simulation Theory and Lewin’s Change Theory was used.
Results: Guiding students to communicate with new parents, demonstrating how to support parents’ autonomy, providing clear definitions of terms and intent, and understanding physiologic outcomes are critical elements of training students for future lactation practice.
Discussion: Not only were there students from diverse cultures, but also students within a wide age range, and wide life-experience range. Having small groups of students on the virtual simulation sessions allowed each student to be called on after each question to maximize their participation and answer or clarify any questions. It appears that as students became more familiar with the course content and with the simulation methodology, they were more comfortable participating in the session debriefs. Students often seemed surprised by the questions and the answers.
Conclusions: Results suggest virtual lactation counseling simulations as an addition to class instruction are a successful format for training students with the knowledge and skills needed to work as lactation counselors.
Article Details
How to Cite
MENDELSON, Sherri Garber et al.
Virtual Lactation Counseling Simulation Sessions for Diverse Lactation Minor Students: Using Grounded Theory to Classify Students’ Debriefing Questions.
Medical Research Archives, [S.l.], v. 13, n. 7, july 2025.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/6732>. Date accessed: 06 dec. 2025.
doi: https://doi.org/10.18103/mra.v13i7.6732.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
1. Wood HL, Acherjee A, Pearce H, et al. Breastfeeding promotes early neonatal regulatory T cell expansion and immune tolerance of non-inherited maternal antigens. Allergy, 2021; 76(8), 2447-2460. doi.org/10.1111/all.14736.
2. Moon JH, Hyengseok K, Kim H, et al. Lactation improves pancreatic β cell mass and function through serotonin production. Science Translational Medicine. 2020; 12(541). https://doi.org/10.7748/nm2013.04.20.1.32.e10133.
3. Binns C, Lee M, Low WY. The long-term public health benefits of breastfeeding. Asia Pac J Public Health. 2016; 28: 7-14. doi:10.1177/1010539515624964. www.sciencedaily.com/releases/2022/01/220111091356.htm.
4. Fox M, Siddarth P, Oughli HA. Women who breastfeed exhibit cognitive benefits after age 50. Evolution, Medicine, and Public Health. 2021; 9(1): 322-331. https://doi.org/10.1093/emph/eoab02731.
5. Lopez DA, Foxe JJ, Mao Y, et al. Breastfeeding duration is associated with domain-specific improvements in cognitive performance in 9–10-year-old children. Frontiers in Public Health. 2021;9. https://www.frontiersin.org/journals/public- health/articles/10.3389/fpubh.2021.657422. Doi:10.3389/fpubh.2021.657422.
6. American Heart Association. Breastfeeding reduces mothers’ cardiovascular disease risk. ScienceDaily. Science Daily, 11 January 2022
7. Raju TNK. Achieving healthy people 2030 breastfeeding targets in the United States: challenges and opportunities [published correction appears in J Perinatol. (2023) 43(1),131-132. doi: 10.1038/s41372-022-01561-9]. J Perinatol, 2023;43(1):74-80. doi:10.1038/s41372-022-01535-x. https://doi.org/10.1186/s12939-021-01408-3.
8. Meedya S, Fahy K, Kable A. Factors that positively influence breastfeeding duration to 6 months: a literature review. Women Birth, 2010;23(4):135-145. doi:10.1016/j.wombi.2010.02.002
9. Schlesinger E, Hatiel K, Hod N, et al. Longer skin-to-skin contact after birth enhances breastfeeding quality and duration: A cohort study. Acta Paediatr. 2024;113(12):2637-2642. doi:10.1111/apa.17388.
10. D'Hollander CJ, McCredie VA, Uleryk EM, et al. Breastfeeding support provided by lactation consultants in high-income countries for improved breastfeeding rates, self-efficacy, and infant growth: a systematic review and meta-analysis protocol. Syst Rev. 2023;12(1):75. doi:10.1186/s13643-023-02239.
11. McFadden A, Siebelt L, Marshall JL, et al. Counselling interventions to enable women to initiate and continue breastfeeding: a systematic review and meta-analysis. Int Breastfeed J. 2019;14:42 https://doi.org/10.1186/s13006-019-0235-9.
12. Center For Disease Control. https://www.cdc.gov/.../recommendations-benefits.html. (2023). Accessed 6 Dec 2024.
13. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/infant-and-young-child-feeding. (2024). Accessed 5 Dec 2024.
14. National Institute of Child Health and Development www.nichd.nih.gov/health/topics/factsheets/breastfeeding. 2019). Accessed 10 Dec 2024.
15. Cleminson J, Oddie S, Renfrew MJ, et al. Being baby friendly: evidence-based breastfeeding support. Arch Dis Child Fetal Neonatal Ed. 2015;100(2):F173-F178. doi:10.1136/archdischild-2013-304873.
16. Chiurco A, Montico M, Brovedani P, et al. An IBCLC in the maternity ward of a mother and child hospital: A pre- and post-intervention study. International Journal of Environmental Research and Public Health. 2015;12(8): 9938–9951. https://doi.org/10.3390/ijerph120809938
17. Nilsson L, Hofflander M. What if it was like a departure lounge at an airport? - ehealth for healthcare staff in a Swedish healthcare organization, a participatory design study. Studies in health technology and informatics. 2016;225:923–924.
18. Uscher-Pines L, Mehrotra A, Bogen D L. The emergence and promise of telelactation. American Journal of Obstetrics and Gynecology, 2017;217(2):76–178.e1. https://doi.org/10.1016/j.ajog.2017.04.043
19. Otiv A, Bhat M, Koli C. et al. Impact of early postnatal support by lactation consultant on breastfeeding outcomes in urban population: A prospective observational study. The Journal of Clinical and Scientific Research. 2024;13(2):107-111. Doi:10.4103/jcsr.jcsr_89_23
20. Orchard LJ, Nicholls W. A systematic review exploring the impact of social media on breastfeeding practices. Curr Psychol 2022;41::6107–6123. https://doi.org/10.1007/s12144-020-01064-w
21. Patel S, Patel S. The effectiveness of lactation consultants and lactation counselors on breastfeeding outcomes. Journal of Human Lactation. 2015;32(3):530-41. Doi:10.1177/0890334415618668.
22. Centers for Disease Control and Prevention, The Breastfeeding Report Card 2016. https://www.cdc.gov/breastfeeding/data/reportcard.htm. (2016). Accessed 5 Dec 2024.
23. Majob CG. The lactation equity action committee: A brief history of ILCA’s role, The International Consultant Association. 2014. Available at http://www.ilca.org/main/about/values-vision-mission/equity/new-item/equityinitiative.
24. Flood JL. Breastfeeding supports and services in rural Hawaii: Perspectives of community healthcare workers. Nursing Research & Practices. 2017;1-14. doi:10.1155/2017/6041462.
25. Mannel R, Mannel RS. Staffing for hospital lactation programs: recommendations from a tertiary care teaching hospital. Journal of Human Lactation. 2006;22:409:417.
26. Ventura County Community Health Needs Assessment Collaborative (“VCCHNAC”), Ventura County Community Health Needs Assessment, available at https://www.dignityhealth.org/-/media/cm/media/documents/CHNA/CHNA-St-Johns- Pleasant-Valley.ashx?la=en. (2019). Accessed 25 Nov 2024.
27. Flower KB, Willoughby M. Cadigan RJ. et al. Understanding breastfeeding initiation and continuation in rural communities: a combined qualitative/quantitative approach. Matern Child Health J. 2008;12(3):402- 414. doi:10.1007/s10995-007-0248-6
28. MacNeill V, Sanders C, Fitzpatrick R, et al. Experiences of front-line health professionals in the delivery of telehealth: a qualitative study. The British Journal of General Practice: The Journal of the Royal College of General Practitioners, 2014;64(624): e401–e407. https://doi.org/10.3399/bjgp14X680485.
29. Chamberlain K, Westmoreland Miller C. Virtual lactation education in a pandemic. Journal of Human Lactation, 2022;8(4):603–608. doi:10.1177/08903344221082029.
30. Rhodes EC, Damio G, LaPlant HW, et al. Promoting equity in breastfeeding through peer counseling: the US Breastfeeding Heritage and Pride program. Int J Equity Health. 2021;20(128). doi: https://doi.org/10.1186/s12939-021-01408-3.
31. The Academy of Lactation Policy and Practice Demographic Report of Current CLCs available at https://www.alpp.org/pdf/CLC_demographics.pdf. (2019). Accessed 10 Dec 2024.
32. United States Department of Education, College Scoreboard available at https://collegescorecard.ed.gov/. (2020). Accessed 15 Dec 2024.
33. Lavoie P, Pepin J, Cossette S. Development of a post-simulation debriefing intervention to prepare nurses and nursing students to care for deteriorating patients. Nurse Education in Practice. 2015;15(3):181-191. https://doi.org/10.1016/j.nepr.2015.01.006.
34. Kvedar J, Coye MJ, Everett W. Connected health: a review of technologies and strategies to improve patient care with telemedicine and telehealth. Health Affairs (Project Hope). 2014;33(2):194–199. https://doi.org/10.1377/hlthaff.2013.0992.
35. Rojjanasrirat W, Nelson E, Wambach, KA. A pilot study of home-based videoconferencing for breastfeeding support. Journal of Human Lactation 2012;28(4):464–467. Doi:10.1177/0890334412449071.
36. Thomas J. Policy and public health recommendations to promote the initiation and duration of breast-feeding in developed country settings. Public Health Nutrition. 2010;13:137-44. https://www.usda.gov/sites/default/files/documents/rural-prosperity-report.pdf.
37. Ahmad A, Ouzzani M. Development and assessment of an interactive web-based breastfeeding monitoring system (LACTOR). Maternal Child Health J. 2013;17: 809–815. DOI 10.1007/s10995-012-1074-z.
38. Felix HM, Simon LV. Conceptual frameworks in medical simulation. StatPearls [Internet]. StatPearls Publishing; 2022. Available from: https://www.ncbi.nlm.nih.gov/books/NBK547741/
39. Lalli M, Ruysen H, Blencowe H. et al. Saving lives at birth; development of a retrospective theory of change, impact framework and prioritised metrics. Globalization and Health. 2018;14(1):13. ISSN 1744-8603 doi: https://doi.org/10.1186/s12992-018-0327-z
40. Stichler J. Leading change one of a leader's most important roles. Nursing for Women’s Health. 2011;15(2):166-170. https://doi.org/10.1111/j.1751-486X.2011.01625.x
41. Manchester J, Gray-Miceli DL, Metcalf JA, et al. Facilitating Lewin's change model with collaborative evaluation in promoting evidence-based practices of health professionals. Evaluation and Program Planning, 2014;47: 82-90. https://doi.org/10.1016/j.evalprogplan.2014.08.007.2014.
42. Mitchell G. Selecting the best theory to implement planned change. Nursing Management. 2013;20(1): 32–37.
43. Cowperthwait A. Jeffries NLN/simulation framework for simulated participant methodology. Clinical Simulation in Nursing, 2021;42:12-21.
44. Glaser BG, Strauss AL. Awareness of dying. 1965. Aldine Publishing.
45. Glaser BG, Strauss AL. The discovery of grounded theory: Strategies for qualitative research. 1967. Aldine de Gruyter.
46. Groom JA, Henderson D, Sittner BJ. NLN/Jeffries simulation framework state of the science project: Simulation design characteristics. Clinical Simulation in Nursing, 2014;10(7):337-344, https://doi.org/10.1016/j.ecns.2013.02.004.
47. Lazard L, McAvoy J. Doing reflexivity in psychological research: What’s the point? What’s the practice? Qualitative Research in Psychology. 2020;17(2):159–177. https://doi.org/10.1080/14780887.2017.1400144.
48. Olukotun O, Mkandawire E, Antilla J. et al. An analysis of reflections on researcher positionality. The Qualitative Report. 2021;26(5):1411-1427.17.
49. Cummings S, Bridgman T, Brown, KG. Unfreezing change as three steps: Rethinking Kurt Lewin’s legacy for change management. Human Relations, 2016;69(1):33-60. https://doi.org/10.1177/0018726715577707.
2. Moon JH, Hyengseok K, Kim H, et al. Lactation improves pancreatic β cell mass and function through serotonin production. Science Translational Medicine. 2020; 12(541). https://doi.org/10.7748/nm2013.04.20.1.32.e10133.
3. Binns C, Lee M, Low WY. The long-term public health benefits of breastfeeding. Asia Pac J Public Health. 2016; 28: 7-14. doi:10.1177/1010539515624964. www.sciencedaily.com/releases/2022/01/220111091356.htm.
4. Fox M, Siddarth P, Oughli HA. Women who breastfeed exhibit cognitive benefits after age 50. Evolution, Medicine, and Public Health. 2021; 9(1): 322-331. https://doi.org/10.1093/emph/eoab02731.
5. Lopez DA, Foxe JJ, Mao Y, et al. Breastfeeding duration is associated with domain-specific improvements in cognitive performance in 9–10-year-old children. Frontiers in Public Health. 2021;9. https://www.frontiersin.org/journals/public- health/articles/10.3389/fpubh.2021.657422. Doi:10.3389/fpubh.2021.657422.
6. American Heart Association. Breastfeeding reduces mothers’ cardiovascular disease risk. ScienceDaily. Science Daily, 11 January 2022
7. Raju TNK. Achieving healthy people 2030 breastfeeding targets in the United States: challenges and opportunities [published correction appears in J Perinatol. (2023) 43(1),131-132. doi: 10.1038/s41372-022-01561-9]. J Perinatol, 2023;43(1):74-80. doi:10.1038/s41372-022-01535-x. https://doi.org/10.1186/s12939-021-01408-3.
8. Meedya S, Fahy K, Kable A. Factors that positively influence breastfeeding duration to 6 months: a literature review. Women Birth, 2010;23(4):135-145. doi:10.1016/j.wombi.2010.02.002
9. Schlesinger E, Hatiel K, Hod N, et al. Longer skin-to-skin contact after birth enhances breastfeeding quality and duration: A cohort study. Acta Paediatr. 2024;113(12):2637-2642. doi:10.1111/apa.17388.
10. D'Hollander CJ, McCredie VA, Uleryk EM, et al. Breastfeeding support provided by lactation consultants in high-income countries for improved breastfeeding rates, self-efficacy, and infant growth: a systematic review and meta-analysis protocol. Syst Rev. 2023;12(1):75. doi:10.1186/s13643-023-02239.
11. McFadden A, Siebelt L, Marshall JL, et al. Counselling interventions to enable women to initiate and continue breastfeeding: a systematic review and meta-analysis. Int Breastfeed J. 2019;14:42 https://doi.org/10.1186/s13006-019-0235-9.
12. Center For Disease Control. https://www.cdc.gov/.../recommendations-benefits.html. (2023). Accessed 6 Dec 2024.
13. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/infant-and-young-child-feeding. (2024). Accessed 5 Dec 2024.
14. National Institute of Child Health and Development www.nichd.nih.gov/health/topics/factsheets/breastfeeding. 2019). Accessed 10 Dec 2024.
15. Cleminson J, Oddie S, Renfrew MJ, et al. Being baby friendly: evidence-based breastfeeding support. Arch Dis Child Fetal Neonatal Ed. 2015;100(2):F173-F178. doi:10.1136/archdischild-2013-304873.
16. Chiurco A, Montico M, Brovedani P, et al. An IBCLC in the maternity ward of a mother and child hospital: A pre- and post-intervention study. International Journal of Environmental Research and Public Health. 2015;12(8): 9938–9951. https://doi.org/10.3390/ijerph120809938
17. Nilsson L, Hofflander M. What if it was like a departure lounge at an airport? - ehealth for healthcare staff in a Swedish healthcare organization, a participatory design study. Studies in health technology and informatics. 2016;225:923–924.
18. Uscher-Pines L, Mehrotra A, Bogen D L. The emergence and promise of telelactation. American Journal of Obstetrics and Gynecology, 2017;217(2):76–178.e1. https://doi.org/10.1016/j.ajog.2017.04.043
19. Otiv A, Bhat M, Koli C. et al. Impact of early postnatal support by lactation consultant on breastfeeding outcomes in urban population: A prospective observational study. The Journal of Clinical and Scientific Research. 2024;13(2):107-111. Doi:10.4103/jcsr.jcsr_89_23
20. Orchard LJ, Nicholls W. A systematic review exploring the impact of social media on breastfeeding practices. Curr Psychol 2022;41::6107–6123. https://doi.org/10.1007/s12144-020-01064-w
21. Patel S, Patel S. The effectiveness of lactation consultants and lactation counselors on breastfeeding outcomes. Journal of Human Lactation. 2015;32(3):530-41. Doi:10.1177/0890334415618668.
22. Centers for Disease Control and Prevention, The Breastfeeding Report Card 2016. https://www.cdc.gov/breastfeeding/data/reportcard.htm. (2016). Accessed 5 Dec 2024.
23. Majob CG. The lactation equity action committee: A brief history of ILCA’s role, The International Consultant Association. 2014. Available at http://www.ilca.org/main/about/values-vision-mission/equity/new-item/equityinitiative.
24. Flood JL. Breastfeeding supports and services in rural Hawaii: Perspectives of community healthcare workers. Nursing Research & Practices. 2017;1-14. doi:10.1155/2017/6041462.
25. Mannel R, Mannel RS. Staffing for hospital lactation programs: recommendations from a tertiary care teaching hospital. Journal of Human Lactation. 2006;22:409:417.
26. Ventura County Community Health Needs Assessment Collaborative (“VCCHNAC”), Ventura County Community Health Needs Assessment, available at https://www.dignityhealth.org/-/media/cm/media/documents/CHNA/CHNA-St-Johns- Pleasant-Valley.ashx?la=en. (2019). Accessed 25 Nov 2024.
27. Flower KB, Willoughby M. Cadigan RJ. et al. Understanding breastfeeding initiation and continuation in rural communities: a combined qualitative/quantitative approach. Matern Child Health J. 2008;12(3):402- 414. doi:10.1007/s10995-007-0248-6
28. MacNeill V, Sanders C, Fitzpatrick R, et al. Experiences of front-line health professionals in the delivery of telehealth: a qualitative study. The British Journal of General Practice: The Journal of the Royal College of General Practitioners, 2014;64(624): e401–e407. https://doi.org/10.3399/bjgp14X680485.
29. Chamberlain K, Westmoreland Miller C. Virtual lactation education in a pandemic. Journal of Human Lactation, 2022;8(4):603–608. doi:10.1177/08903344221082029.
30. Rhodes EC, Damio G, LaPlant HW, et al. Promoting equity in breastfeeding through peer counseling: the US Breastfeeding Heritage and Pride program. Int J Equity Health. 2021;20(128). doi: https://doi.org/10.1186/s12939-021-01408-3.
31. The Academy of Lactation Policy and Practice Demographic Report of Current CLCs available at https://www.alpp.org/pdf/CLC_demographics.pdf. (2019). Accessed 10 Dec 2024.
32. United States Department of Education, College Scoreboard available at https://collegescorecard.ed.gov/. (2020). Accessed 15 Dec 2024.
33. Lavoie P, Pepin J, Cossette S. Development of a post-simulation debriefing intervention to prepare nurses and nursing students to care for deteriorating patients. Nurse Education in Practice. 2015;15(3):181-191. https://doi.org/10.1016/j.nepr.2015.01.006.
34. Kvedar J, Coye MJ, Everett W. Connected health: a review of technologies and strategies to improve patient care with telemedicine and telehealth. Health Affairs (Project Hope). 2014;33(2):194–199. https://doi.org/10.1377/hlthaff.2013.0992.
35. Rojjanasrirat W, Nelson E, Wambach, KA. A pilot study of home-based videoconferencing for breastfeeding support. Journal of Human Lactation 2012;28(4):464–467. Doi:10.1177/0890334412449071.
36. Thomas J. Policy and public health recommendations to promote the initiation and duration of breast-feeding in developed country settings. Public Health Nutrition. 2010;13:137-44. https://www.usda.gov/sites/default/files/documents/rural-prosperity-report.pdf.
37. Ahmad A, Ouzzani M. Development and assessment of an interactive web-based breastfeeding monitoring system (LACTOR). Maternal Child Health J. 2013;17: 809–815. DOI 10.1007/s10995-012-1074-z.
38. Felix HM, Simon LV. Conceptual frameworks in medical simulation. StatPearls [Internet]. StatPearls Publishing; 2022. Available from: https://www.ncbi.nlm.nih.gov/books/NBK547741/
39. Lalli M, Ruysen H, Blencowe H. et al. Saving lives at birth; development of a retrospective theory of change, impact framework and prioritised metrics. Globalization and Health. 2018;14(1):13. ISSN 1744-8603 doi: https://doi.org/10.1186/s12992-018-0327-z
40. Stichler J. Leading change one of a leader's most important roles. Nursing for Women’s Health. 2011;15(2):166-170. https://doi.org/10.1111/j.1751-486X.2011.01625.x
41. Manchester J, Gray-Miceli DL, Metcalf JA, et al. Facilitating Lewin's change model with collaborative evaluation in promoting evidence-based practices of health professionals. Evaluation and Program Planning, 2014;47: 82-90. https://doi.org/10.1016/j.evalprogplan.2014.08.007.2014.
42. Mitchell G. Selecting the best theory to implement planned change. Nursing Management. 2013;20(1): 32–37.
43. Cowperthwait A. Jeffries NLN/simulation framework for simulated participant methodology. Clinical Simulation in Nursing, 2021;42:12-21.
44. Glaser BG, Strauss AL. Awareness of dying. 1965. Aldine Publishing.
45. Glaser BG, Strauss AL. The discovery of grounded theory: Strategies for qualitative research. 1967. Aldine de Gruyter.
46. Groom JA, Henderson D, Sittner BJ. NLN/Jeffries simulation framework state of the science project: Simulation design characteristics. Clinical Simulation in Nursing, 2014;10(7):337-344, https://doi.org/10.1016/j.ecns.2013.02.004.
47. Lazard L, McAvoy J. Doing reflexivity in psychological research: What’s the point? What’s the practice? Qualitative Research in Psychology. 2020;17(2):159–177. https://doi.org/10.1080/14780887.2017.1400144.
48. Olukotun O, Mkandawire E, Antilla J. et al. An analysis of reflections on researcher positionality. The Qualitative Report. 2021;26(5):1411-1427.17.
49. Cummings S, Bridgman T, Brown, KG. Unfreezing change as three steps: Rethinking Kurt Lewin’s legacy for change management. Human Relations, 2016;69(1):33-60. https://doi.org/10.1177/0018726715577707.