Effect of Nursing Teaching Protocol On Mastitis.13

308 Original article
Effect of nursing teaching protocol on mastitis prognosis:

quasi-experimental research design
Eman Mohammed Hashema, Wafaa Ramadan Ahmeda,
Nagm Eldin Abu Elnga Ahmedb, Amna Abdullah Desoukya
Downloaded from http://journals.lww.com/egnj by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AW
a
Medical-Surgical Nursing, Faculty of Nursing, Background
Assiut University, Egypt, bGeneral Surgery, Mastitis is a problematic issue because it may lead to many complications as early
Faculty of Medicine, Assiut University, Egypt
termination of breastfeeding, formation of breast abscess, deformity of breast
Correspondence to Eman Mohammed tissue, and recurrence. Nursing management is conducted to deepen patients’
nYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC1y0abggQZXdgGj2MwlZLeI= on 09/23/2024
Hashem, Faculty of Nursing, Assiut university,

understanding of the diseases, enhancing self-care ability, and establishing healthy
Department of Medical- Surgical Nursing.
Mobile: +01100407910; living habits.
e-mail: emanmohammed@aun.edu.eg Aim
Received: 17 August 2023
The aim of this study is to evaluate the effect of a nursing teaching protocol on
Revised: 25 October 2023 mastitis prognosis.
Accepted: 29 October 2023 Design
Published: 29 January 2024 A quasi-experimental research design was utilized.
Egyptian Nursing Journal 2023, 20:308–318 Setting
The study was conducted in the breast unit in general surgery department at Main
Assiut University Hospital.
Sample
A convenient sample of sixty adult female patients diagnosed with mastitis was
included.
Toolss
Four tools used I: An interview questionnaire sheet, II: Mastitis self-care practices,
III: Numeric Pain Rating Scale, and IV: Mastitis prognosis sheet.
Results
The mean age of both study and control groups was (37.57±9.01, 38.30±9.24
respectively). (60.0% and 50.0% respectively) of both groups had lactational
mastitis. There was statistically significant improvement in study group’s level of
knowledge and self-care practices at follow up. Moreover, (63.3%, 70.0%
respectively) of both groups had severe pain at base line. However, at follow up
(66.7%,) of study group didn’t have any pain and cured completely. while (40.0%) of
control still having severe pain, (33.3%) discontinued breast feeding and (20.0%)
converted into breast abscess.
Conclusion
Implementation of a nursing teaching protocol had a positive outcome on mastitis
prognosis.
Recommendation
Distribution of a mastitis teaching protocol for patients with mastitis to improve
prognosis.
Keywords:
mastitis prognosis, nursing, teaching protocol
Egypt Nurs J 20:308–318
© 2024 Egyptian Nursing Journal
2090-6021
Effect of a Nursing Teaching Protocol on Mastitis lactational mastitis among biopsies for benign breast
Prognosis: Quasi-Experimental Research Design diseases is 3% (Boakes et al., 1018).
Inflammation of breast can be broadly categorized as

Introduction non-infective mastitis which may result from milk
Mastitis is an inflammatory condition of the breast, stasis, blocked ducts, engorgement or physical injury
which may or may not be accompanied by infection. It to the breast, infective mastitis may result from cracked
is usually associated with lactation, so it is called
lactational mastitis or occurs spontaneously and
called non lactational mastitis. It usually affects This is an open access journal, and articles are distributed under the terms
of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0
fertile women but can be seen at all ages and even in
License, which allows others to remix, tweak, and build upon the work
males. The incidence of mastitis in lactating women non-commercially, as long as appropriate credit is given and the new
ranged from 3% to 33% and the frequency of non- creations are licensed under the identical terms.
© 2024 Egyptian Nursing Journal | Published by Wolters Kluwer - Medknow DOI: 10.4103/enj.enj_23_23
Teaching protocol on mastitis prognosis Hashem et al. 309
or traumatized nipples; interruption in the nipples’ (Axelsson and Blomberg, 2019). Many complications
integrity provides a route for micro-organisms to may arise if mastitis not treated and managed
enter the breast. It may occur in one or both breasts. effectively such as breast abscess, long antibiotic
Diagnosis of mastitis is usually based on clinical course, recurrence, and in many lactating women
symptoms and signs, such as breast pain, heat, may contribute to discontinuation of breast feeding.
swelling, fever, and chills that lasts from two to Furthermore, from the researchers’ experiences in the
three days up to a couple of weeks or more breast unit at general surgery department, in addition
(Crepinsek et al., 2020; Chou et al., 2022). to non-lactational mastitis cases; it has been noted that
patients with lactational mastitis referred from their
The most common complications of lactational obstetrician and came to the breast unit to seek more
mastitis are early termination of breastfeeding. specialized care. Also, it was found that patients’
Breast abscess is another complication of lactational knowledge and practice about mastitis care are
mastitis which may require surgical treatment. Non- inadequate and need for improvement. Therefore,
lactational mastitis is associated with recurrence and this study is considered the first one in this
can lead to scarring and deformity of breast tissue. geographical location that try to help those patients
Mastitis may also contribute in some women to increasing their knowledge and practice about mastitis
experience negative emotions, including distress, care which may improve their prognosis.
depression and anxiety as well as a feeling of
helplessness (Nabil et al., 2019).
Aim
Mastitis should be treated immediately, as a delay in The aim of the study was to evaluate the effect of a
treatment or inappropriate management can lead to nursing teaching protocol on mastitis prognosis.
breast abscess. The initial management of lactational
Outcome measures primary outcomes
mastitis is symptomatic treatment. Effective
management is essential to control the discomfort,
reduce the likelihood of discontinuation of (1) Knowledge level of participants regarding mastitis
breastfeeding, and recurrence of mastitis. Scientific care and management.
rehabilitation exercise and health education are (2) Practice level of participants regarding mastitis
effective measures to improve the outcomes of care and management.
mastitis (Wang and Sun, 2022).
Secondary outcomes
Nursing role is conducive to deepening patients’ (1) Pain level.

understanding of their own diseases, enhancing their (2) Number of completely cured participants.
self-care ability, improving treatment compliance, and (3) Number of lactating participants who
establishing healthy living habits (Chen et al., 2020). discontinued breast feeding.
Patients should be encouraged to continue breastfeed, (4) Number of participants who their condition
pump milk, non-steroidal anti-inflammatory drugs complicated with breast abscess formation.
(NSAIDs) can be used for pain control. Heat (5) Number of recurrences.
applied to the breast just before emptying can help
milk letdown and facilitate with emptying. Cold packs Hypotheses
applied to the breast after emptying can help reduce H1: The total mean scores of both knowledge and
edema and pain. If the symptoms of lactational mastitis practice levels regarding mastitis care and management
persist beyond 12 to 24 h, antibiotics should be after implementation of a nursing teaching protocol
administered, some patients require hospitalization. among study group will be higher than control.
Non lactational mastitis is treated empirically with
antibiotic therapy (Rose Strickland and Sharma, 2021). H2: The total mean score of pain level among study
group patients after implementation of nursing
teaching protocol will be less than those of the
Significance of the study control group.
Worldwide, mastitis occurs approximately in 10
percent of U.S persons. It ranges from a low of H3: Complications associated with mastitis will
1,000 per 100,000 to a high of 10,000 per 100,000 be less among the study group than the control
persons with an average 4,700 per 100,000 persons group.
310 Egyptian Nursing Journal, Vol. 20 No. 2, May-August 2023
Tool I: An interview questionnaire sheet: It was

Methods
developed by researchers after reviewing extensive
Design
Quasi-experimental designs provide Level III evidence literatures to assess the following parts:
and have a higher risk of bias because randomization is
absent. Evidence that the characteristics of the Part 1: Biodemographic data: This part assessed
biodemographic data of studied patients as age,
intervention group and control groups are measured

and then compared (even if not randomly assigned) and marital status, educational level, pattern of disease,
attempt is made to control for the main differences in type of mastitis, and risk factors which had been
the analyses (Geri et al., 2019). suggested to increase the risk of mastitis.
Part 2: Patients’ knowledge about mastitis care: This

Setting
The study was conducted in the breast unit where is part consisted of ten questions that was formulated by
affiliated to the general surgery department at Main researchers based on the literature reviews to assess
Assiut University Hospital. It was established in 2021 patients’ knowledge regarding mastitis care and
and staffed by a specialist breast care team. It serves all management.
Upper Egypt population. It is a specialized unit that
Scoring
offers breast cancer screening services. Diagnosis and
management of other breast problems, enhances breast Each answered question scored from 0 to 3 marks as
care awareness and health for all women, by providing follows; (3) marks for complete correct answer, (2)
the needed guidance and emotional support. marks for incomplete correct answer, (1) mark for
incorrect answer and zero for not known answer.
The range of total score lies between 0-30, the
Sample
A convenience sample of all available women who were scoring system for patients’ knowledge was
seeking for health care about mastitis was chosen interpreted in the results into satisfactory and
(target population). Sixty adult patients were studied. unsatisfactory based on literature review (Crepinsek
Patients were divided equally into two groups (study et al., 2020); satisfactory: if the total knowledge score
and control), 30 patients for each. The study group was ≥ 60% and unsatisfactory if the total knowledge
received intervention (nursing teaching protocol) while score was < 60%.
the control group received the routine care. Women
Tool II: Mastitis self-care practices
diagnosed with mastitis (lactational or non-
lactational), age ranged from 20 to 65 years were This tool was developed by the researchers based on
included in the study. Patients who were suffering previous similar studies, articles and library resources to
from mental health problems, visual or hearing assess self-care practices that should be done by women
problems and patients who were uncooperative or for mastitis including relaxation techniques, heat and
refused to participate in the study were excluded. cold application, scraping technique, and breast
massage.
Sample size
Scoring
The sample size was determined statistically by power A total score of 60% or higher was considered as
analysis. The calculation was done considering the adequate self-care practices and less than 60% was
following: Target population through the year of considered as inadequate. Three points scale was
2021 to 2022 was 300 cases. Type I error with used to grade the steps. Two points for doing
significant level (α)=0.5, Type II error by power test correctly. One point for doing incorrectly and zero
(1-B)=80% and found the minimum sample size was point for not doing at all (Nabil Hussien et al., 2019).
26 patients for each group. Although the minimum
number of 52 patients was required by power analysis, Tool III: Numeric Pain Rating Scale (NPRS)
the researcher had obtained 60 patients in this study This scale was developed by (McCaffery and Beebe,
because non-response rate was expected to be lost from 1989). It was adopted in this study for assessing
the subjects. mastitis pain. It was asked from each patient to rate
pain level from 0 to10 with understanding that 0 is
Tools equal to no pain and 10 is equal to worst possible pain.
To accomplish the aim of the study; four tools were The NPRS is a valid, reliable measure that has test
utilized to collect data for this study. −retest reliability (0.79).
Scoring:0 is equal to no pain, 1-3 is equal to mild pain, analyzing the pilot study results, slight modifications
4-6 is equal to moderate pain and 7-10 is equal to sever were done accordingly. These patients had been
pain. omitted from the study and replaced by another.
Tool IV: Mastitis prognosis sheet Ethics considerations

It was developed by the researchers to assess prognosis The study was affirmed by the ‘Research Ethics
of mastitis after three weeks from providing nursing Committee‘ of Faculty of Nursing, Assiut University
teaching protocol which may be either good prognosis (IRB:1120230422), according to the World Medical
(completely cured) or bad prognosis (breast abscess, Association Declaration of Helsinki (1997) Ethical
discontinuation of breast feeding and recurrence).
Principles for Medical Research Involving Human

Subjects Varghese and Patwa (2020). The trail was
Nursing teaching protocol registered at Clinical Trial.gov, Aservice of the US
It was developed by the researchers based on previous National Institutes of Health) with identifier. NCT
similar studies, articles and library resources. It was NCT05974956 (August 2023) under the brief title
given for study group patients as a handout. It consisted ‘Effect of a Nursing Teaching Protocol on Mastitis
of three parts; the first part under the title of ‘Disease Prognosis: Quasi-Experimental Research Design‘.
overview‘ included basic information about the Informed consent was obtained from every patient to
mastitis to acquire the basic knowledge about disease participate in the study. The study maneuvers didn’t
(definition, causes, risk factors, types, clinical entail any risk to patients. The participants have the
manifestation, diagnosis, complications, and right to withdraw at any time. Confidentiality and
management). The second part under the title of anonymity of the subjects were assured. Study
‘Non pharmacological measures for mastitis‘ to subject privacy was considered during data collection.
relieve symptoms and prevent further complications;
it included (relaxation techniques, gentle massage,
Administrative approval
application of heat and cold packs to the breast,
Official endorsement and administration permission
scraping technique). The third part included ‘Other
were adopted from the head of the general surgery
measures‘ to complement the intervention provided
department and outpatient surgery clinic at Assiut
which included mixed measures as dietary education,
University Hospital.
rest, medication and follow up.
The study was carried out on four phases
Procedure
Planning phase
Tools validity
This phase is concerned with construction and
Data collection tools were submitted to a group of five
preparation of the different data collection tools and
experts in Medical Surgical Nursing and General
designing nursing teaching protocol after reviewing the
Surgery at Assiut University to test the tools
related literature, journals, and text books. The researchers
content validity. Some modifications were done
translated nursing teaching protocol booklet into Arabic
according to the experts’ judgment on clarity of
language, which were delivered to all the study group.
sentences, appropriateness of content and sequence
of items.
Assessment phase
The researchers introduced themselves to the selected
Reliability participants and clarified the objective, process, and
Cronbach’s alpha is the most widely used method for expected outcomes. Participants’ approval was
evaluating internal consistency of the research tools. It obtained. Each patient was interviewed individually
can be interpreted like other reliability coefficients. The by the researchers to collect demographic and medical
normal range of value is between 0.00 and 1.00, and data using tool I (Parts 1). Initial assessment of the
higher values reflect a higher internal consistency. The study participants’ knowledge was done using tool I
reliability of the study tools was (0.868). The NPRS (Parts 2) also patient’s self-care practices and pain level
test −retest reliability was (0.79). were assessed by using tool II and III. The structured
interview was filled out by the researcher, and the
A Pilot study length of meeting was 20–30 min.
It was conducted on 10 patients to evaluate the
applicability and clarity of the tools, estimate the Medical treatment protocol
time needed for data collection, and test the The treatment protocol for the study group patients
feasibility of conducting the research. After was similar to the control group, it involved a 10-day
course of antibiotics 2 times a day and pain relievers breast feeding and avoid sudden cession of
such as acetaminophen and ibuprofen. However, the breastfeeding with correct latch and positioning
study group received nursing teaching protocol in of baby during breast feeding. As lactational
addition to the course of treatment. mastitis usually develops after a period of
incomplete drainage and milk stasis, also nipple
Implementation phase pain is a common complaint in breastfeeding
The control group received the routine care in addition women and may lead to less frequent nursing.
to the medical treatment protocol. After filling the So, it was important to counsel patients on ways
study tools; sessions about mastitis care had been to manage and decrease their pain. Furthermore,
started for the study group. One of the family researchers clarified that breastfeeding with
members was existing in the session to ensure mastitis is safe and it should be continued. If
patient support. The researchers worked with patients do not wish to continue breastfeeding,
surgeons, nurses regarding anticipated expectations they had been counseled on the importance of
of patients. continuing to empty the breasts by using
alternative methods such as the use of a breast
Sessions that were given during the implementation pump. Teaching method/media: Lecture,
phase to the study group were described as the demonstration and re-demonstration/ illustrated
following: pictures, recorded videos on mobile screen, and
printed hand out. By the end; a summary was
(1) The first face to face education session: Aim: To made and time allowed for questions and
empower patients with basic knowledge and skills answers& plan for next session was made.
about mastitis care. Time: 40 min. Contents: (3) Weekly follow-up phone calls: Objectives: To
Educate patients basic information about provide feedback and suggestions according to
lactational and non-lactational mastitis as: patients’ feedback. Time: 30 min. Contents:
definition, causes, clinical features, diagnosis and Ask and emphasize the compliance with nursing
complications. Demonstrate steps of self-care teaching protocol that should be followed by
practice skills and assist patients to select three participants to maintain the achieved results.
skills to practice it regularly from the following: Conclude what is discussed and encourage
(practicing relaxation techniques as deep breathing patients to contact healthcare providers when
exercises, walking 30 min two/three times per they have health problems. Teaching method/
week for three weeks, applying warm compresses media: Interactive conversation, active listening/
for affected breast for 20 min 3 times a day, and audio phone media.
massaging the breast gently for up to 30 to 45 min
with small circular motion from inner to outer Evaluation phase
toward the lymph nodes in the axilla). Help In this phase, both the study and control group
patients to use different strategies to apply the patients returned for follow-up after three weeks
selected three skills. Encourage patients to ask from the first assessment to the breast unit in
questions and confirm that patients understand general surgery department at Assiut University
what they were told. Teaching method/media: Hospital to evaluate their prognosis using tool II, III
Lecture, demonstration and re-demonstration/ and IV.
illustrated pictures, recorded videos on mobile
screen, and printed hand out. By the end; a Statistical analysis
summary was made and time allowed for Data analysis performed using the Statistical Package
questions and answers& plan for next session for the Social Sciences (SPSS) version 23. Categorical
was made. variables described by number and percent (N, %).
(2) 2ndface to face education session: Aim: To Continuous variables described by mean and
educate patients on the right information and standard deviation (Mean, SD). Chi-square test and
skills about healthy life style habits that are Fisher exact test had been used to compare between
necessary for good mastitis prognosis. Time: categorical variables. While T-test and Pearson’s chi-
40 min. Contents: Instruct patients to increase square used to clear the association between patients’
fluid intake and vitamin C. Wearing well fitted knowledge, practice, and mastitis prognosis before
supportive bra also, using cold packs when warmth implementation of nursing teaching protocol and
is felt to reduce pain. For lactational mastitis, three weeks post. P values less than 0.05 were
women were instructed to increase frequency of statistically significant.
Table 2 Reflects that; At base line assessment the

Results
highest percentage of both the study and control
Table 1 Shows that; the mean age of both study and
group had unsatisfactory level of knowledge (90.0%
control groups was (37.57±9.01, 38.30±9.24) years
and 86% respectively) and inadequate level of self-care
respectively. As regard the marital status, the
practice about mastitis care (90.0% and 83.3%
majority of patients in both study and control groups
respectively). On the other hand, there were
were married (66.7% and 73.3%) respectively.

statistically significant improvement in the level of
Regarding educational level, majority of patients in
knowledge and self-care practices after three weeks
both groups (73.3%) were educated. Regarding type of
follow up with P. value =0.001**.
mastitis; (60.0%) of the study group and (50.0%) of the
control group had lactational mastitis. Concerning the

Table 3 Reveals that both the study and control groups
pattern of disease, mastitis was unilateral in the
had various degree of breast pain with the highest
majority of patients in the study and control groups
percentage for sever level (63.3%, 70.0%) respectively
(80.0% and 86.66%) respectively. in relation to
at base line assessment. While at follow up, there was a
anatomical risk factors, the majority of patients in
statistically significant difference (P=0.001**) between
the study and control groups had nipple cracks
the study and control groups regarding level of pain as
(86.7% and 80.0%) respectively. Also, about half of
about two thirds of the study group (66.7%) had no
the study group (50.0%) and more than half of the
pain and more than one third of the control group still
control group (53.3%) were multiparous as mastitis risk
having severe pain (40.0%).
factors too.
Table 1 Biodemographic data of studied participants (n=60)

Biodemographic data Study group (n=30) N (%) Control group (n=30) N (%) χ2 P- value
Age groups
20> 30 8 (26.7) 6 (20.0)
30> 40 11 (36.7) 12 (40.0) 0.66 0.882
40<50 10 (33.3) 10 (33.3)
50≥65 1 (3.3) 2 (6.7)
Mean±SD
37.57±9.01 38.30±9.24 t=0.31 0.757
Marital status
Single 2 (6.7) 2 (6.7)
Married 20 (66.7) 22 (73.3) 0.76 0.859
Divorced 4 (13.3) 4 (13.3)
Widowed 4 (13.3) 2 (6.7)
Educational level
Educated 22 (73.3) 22 (73.3) 0.03 1.000
Non educated 8 (26.7) 8 (26.7)
Type of mastitis
Lactational mastitis 18 (60.0) 15 (50.0) 0.26 0.436
Non lactational mastitis 12 (40.0) 15 (50.0)
Pattern of disease
Unilateral 24 (80.0) 26 (86.66) 0.12 0.448
Bilateral 6 (20.0) 4 (13.33)
Mastitis anatomical risk factors
Nipple cracks 26 (86.7) 24 (80.0) 0.12 0.488
Lactating duct obstruction 15 (50.0) 19 (36.3) 0.65 0.435
Wearing tight-fitting bras 6 (20.0) 3 (10.0) 0.52 0.469
Use of a manual breast pump 6 (20.0) 3 (10.0) 0.52 0.469
Other mastitis risk factors:
Primiparous 8 (26.7) 9 (30.0) 1.07 0.774
Multiparous 15 (50.0) 16 (53.3) 0.08 0.796
Previous breast biopsy 8 (26.7) 7 (23.3) 0.41 0.766
Increased stress levels 7 (23.3) 5 (16.7) 0.88 0.519
Infections with S. aureus 8 (26.7) 5 (16.7) 0.09 0.347
Don’t clean nipple before breastfeeding 6 (20.0) 7 (23.3) 0.08 0.754
Table 2 Knowledge level and self- care practices for study and control groups at base line and three weeks follow up (n=60)
Base line assessment Follow up after three weeks
Study (n=30) Control (n=30) χ2 P. Value Study (n=30) Control (n=30) χ2 P. Value
N (%) N (%) N (%) N (%)
Knowledge level
Satisfactory 3 (10.0) 4 (13.3) 0.16 1.00 28 ()93.3 5 (16.7) 21.4 0.001**
Unsatisfactory 27 (90.0) 26 (86.7) 2 (6.7) 25 (83.3)

Mean SD 12.7±2.48 13.33±3.1 T= 0.73 0.465 3.86±26.57 14.27±2.57 T=14.3 0.001**
Self-care Practices
Adequate 3 (10.0) 5 (16.7) 0.57 0.706 30 (100.0) 7 (23.3) 37.29 0.001**
Inadequate 27 (90.0) 25 (83.3) 0 (0.0) 23 (76.7)

Mean SD 7.93±2.86 3.2±8.37 T=0.55 0.583 18.57±2.1 9.73±2.64 T=14.53 0.001**
* *=statistically significant (P<0.01).
Table 3 Comparisons between the study and control groups regarding pain level at base line and three weeks follow up (n=60)
Base line assessment Follow up after 3 weeks
Pain level Study (n=30) Control (n=30) χ2 P.value Study (n=30) Control (n=30) χ2 P- value
N (%) N (%) N (%) N (%)
No Pain 0 (0.0) 0 (0.0) 20 (66.7) 6 (20.0)
Mild pain 4 (13.3) 2 (6.7) 7 (23.3) 5 (16.7)
Moderate pain 7 (23.3) 7 (23.3) 0.767 0.682 3 (10.0) 7 (23.3) 21.47 <0.001**
Severe pain 19 (63.3) 21 (70.0) 0 (0.0) 12 (40.0)
Mean±SD 6.47±2.26 6.87±2.15 t=0.7 0.484 1.07±1.74 4.9±3.46 t= 5.42 <0.001**
* *=statistically significant difference (P<0.01).
Figure 1 Illustrates that, there was statistically scores and pain level at three weeks follow up
significant difference (P=0.001**) between study interval. This means that as the patient’s knowledge
group and control groups (P=0.001**) regarding and practice increased, the pain score decreased and
prognosis of mastitis whether study group vice versa.
completely cured from mastitis at follow up while
one third of control group (33.3%) discontinued Table 5 Reflects that; there was a statistically
breast feeding and (20.0%) had breast abscess. significant relation between patient’s self- care
practice and mastitis prognosis among the control
Table 4 Shows that; there was a negative group at three weeks follow up interval with P.
correlation between patients’ knowledge, practice value = 0.005**.
Figure 1
Mastitis prognosis for both groups (study & control) at 3 weeks follow up (n=60).
Table 4 Correlation between patients’ knowledge, practice and pain level before nursing teaching protocol and three weeks post
protocol for the study and control groups (n=60)
Study(n=30) Control (n=30)
Base line assessment Follow up after Base line assessment Follow up after
three weeks three weeks
Variables knowledge practices knowledge practices knowledge practices knowledge practices
knowledge 1 1 1 1
practices 0.087 1 0.799** 1 0.488** 1 0.499** 1
pain intensity scale −0.506-** −0.214 −0.571-** −0.370-* −0.102 −0.043 −0.127 −0.067
Table 5 Relation between mastitis prognosis and practice score level for the control group three weeks post-protocol (n=30)
Self- care practice score level
Mastitis prognosis Inadequate N (%) Adequate N (%) χ2 P-value
Mastitis is completely cured 7 (30.4) 7 (100.0)
Breast abscess is formed 6 (26.1) 0 (0.0) 10.34 0.005**
Breast feeding is discontinued 10 (43.5) 0 (0.0)
than two thirds of patients in both groups were

Discussion
married. This result was similar to Alikhassi et al.
Within the framework of the Egyptian state’s keenness
(2020) who mentioned that, the majority of women
to preserve the health of the family and society as a
in both groups were married. In contrast to these
whole, the Egyptian President’s Women’s Health
findings Viduedo et al. (2015) who revealed that the
Initiative was launched to enhance the health of
majority of the study group were widows or had no
Egyptian women. Women in particular were
partner.
targeted as they were a group in dire need of
education and health care. The initiative aims to Regard clinical data; the current study displayed that
screen breast cancer at an early stage and follow up more than half of patients in the study and control
with clinical examination. This initiative played a group had lactational mastitis. From the researchers’
major role in helping early detection of any point of view, these results could be accepted because of
problems in the breast such as mastitis (State the culture of our society puts pressure on wife to
information service, 2022). quickly have children immediately after marriage
without preparing that result in reproductive health
The present study revealed that the mean age of the literacy, including lack of awareness regarding breast
study group was 37.57±9.01 years and the mean age of care, breast feeding and also lack of support from
the control group was 38.30±9.24 years. Nearly to this family. This result was supported by Wilson et al.
finding Wang and Sun, (2022) mentioned that the (2020) who conducted a study entitled‘ Incidence
mean age of the studied sample at the time of diagnosis and risk factors for lactational mastitis: a systematic
was 44.52±12.64 for experimental group and 44.84 review ‘reported that mastitis can affect patients at any
±10.87 for control group. Another study by Steuer time but it represents significance burden to lactating
et al. (2020) reported that the highest percentage of women. This could be attributed to the increased
their studied women was above 30 years. activity of the breast tissue in response to female
hormones’.
Regard educational level; the current study showed that
most of the study and control groups had secondary On the other hand, non-lactational mastitis represents
education. In the same line Pardeshi et al. (2019) a considerable percentage (forty percent in study group
reported that the majority of the studied women had and half of patients in control group) and this
secondary education too. In contrast with Varghese and percentage should not be neglected. From the
Patwa, (2020) who reported that the majority of the researchers’ point of view, although this condition is
studied women had primary education. This difference rare but it can be easily diagnosed because of our skilled
may be due to different study settings. Regarding the surgeons and advanced technology that help in early
marital status; the present study clarified that more and an accurate diagnosis (Zhang et al., 2018) reported
that ‘Non-lactational mastitis is a breast inflammatory Also, the researcher emphasized up on the importance
condition in young women. In accordance Costa of reinforcement of patient’s knowledge. This result
Morais Oliveira et al. (2021) in their systemic review was in agreement with Wang and Sun, (2022) who
reported that non-lactational mastitis is a complex showed that there was statistically significant difference
public health problem with diagnostic and treatment regarding the mean knowledge score at two different
challenges. interval pre, post intervention regarding mastitis as a
disease as well as mastitis management. Also, they

Concerning the disease pattern; the study’s findings concluded that health education was carried out to
showed that most of the study and control groups were enhance the awareness of patients with mastitis, which
diagnosed with localized, unilateral breast pain, eliminated their fear and tension to a large extent and
tenderness and erythema. From the researchers’ boosted their confidence in treatment.
point of view, patients complain from localized
breast pain because of engorgement and Regarding patient’s self-care practices, the present
inflammation of the breast. This result was in study revealed that the majority of the study and
harmony with Baeza (2016) who reported that a control groups had inadequate level of practice
higher percentage of women typically present with before application of nursing teaching protocol.
unilateral breast tenderness. While the study group showed significant
improvement at period interval of follow up 3 weeks
In relation to risk factors; the present study showed that post-intervention. From the researchers’ point of view
nipple damage or nipple crack was the most frequently these results could be because of lack of patient’s
investigated risk factor for mastitis followed by blocked knowledge about the disease that reflects on their
milk duct. This finding was in accordance with Nabil practice level of self-care. Gresh et al. (2019) were
Hussien et al. (2019) who carried out a cross sectional disagreeing with our study results and found that
study to assess the prevalence and risk factors of majority of the patients had adequate self- care
mastitis in lactating women and found that the most practices during the follow-up period and explained
frequent diagnosis among women was lactational this by mastitis may be clinically described as ‘self-
mastitis and 75% suffered from nipple cracks. limiting‘ as it usually resolves without medical
Another risk factor was more than half of women in intervention through self-management, for example
both groups was multiparous. This result finding was massaging the affected breast, feeding or expressing
consistent with Ding et al. (2021) who stated that the frequently enough to empty the affected breast, and
incidence of mastitis is prominent in multipara and using cold compresses to soothe the inflammation.
seriously affect quality of life and breast feeding after
delivery. In contrast Yin et al. (2020) reported that In addition, the study findings were consistent with
primiparous women were found significantly more Ren et al. (2022) who showed that the implementation
frequent in the mastitis group than in the control of effective clinical interventions can largely reduce the
group and rationalized that; as primipara is without clinical symptoms of mastitis in patients and enhance
previous experience of childbirth, lacks healthcare the quality of life of patients with the administration of
knowledge and preventive measures for postpartum care. conventional western medicine.
Concerning the patients’ knowledge; the present study As regard pain severity, the current study revealed that
revealed that, the majority of patients in both study and the majority of women in the study and control groups
control groups had unsatisfactory level of knowledge had severe pain before application of nursing teaching
before application of nursing teaching protocol. From protocol, this may be due to the presence of
the opinion of the researcher, level of knowledge was inflammation of the breast tissue. However, there
insufficient due to most physicians and nurses did not was statistically significant difference between the
routinely counsel women or providing written study and control groups concerning pain severity
information about mastitis and self-care practice. after application of intervention, in which about two
However, after implementing of nursing teaching third of the study group had no pain and more than one
protocol, the study group patients had a highly third in the control group had severe pain. This may be
statistically significant improvement than those of due to that women in the study group become
control in relation to all items of knowledge. This knowledgeable and performed self-care practices
might be due to health education and instructions such as warm compress, gentle massage and
given to study patients using different teaching relaxation techniques as it handled in teaching
strategies as lecture, discussion, and colored booklet. protocol.
In this regard Abd Elhakam and Abd Elmoniem follow up interval. Moreover, there was a statistically
(2016) stated that there was a highly significant significant relation between patient’s self- care practice
difference between study and control groups after and mastitis prognosis among the control group at
intervention as the most of study group recovered three weeks follow up interval.
from pain and reported significant reduction of pain
scores. Also, the current results agreed with Karaçam Recommendation
and Sağlık (2018) who observed that effective A hand out copy of mastitis care teaching protocol
managements such as education, counseling and should be available for all patients diagnosed with
monitoring are essential to control the pain and mastitis to prevent complications and achieve better
discomfort of mastitis. outcome. Replication of the current study on a larger
probability sample is recommended to attain

Regarding prognosis of mastitis; the present study generalizability and wider utilization of the nursing
found that the study group completely cured after teaching protocol.
application of nursing teaching protocol while about
one quarter of the control group developed breast Acknowledgements
abscess after mastitis. From the researchers’ point of Source(s) of support:There was no funding
view, these results are a good proof for the importance
of health education and training of females about breast Presentation at a meeting:
care during lactation period or even at non- lactation
time. This finding was consistent with Cooney and Organisation
Petty-Saphon (2019) who mentioned that about
3–11% of acute mastitis are still prone to develop Place
breast abscess in the case of rapid progression and Date
improper treatment. In addition, add that if left
under- or un-treated, mastitis can lead to breast Financial support and sponsorship
abscess or septicemia, which may necessitate Nil.
hospitalization and may be surgery.
Conflicts of interest
Unfortunately, about one third of patients discontinued There is no conflict of interest.
breast feeding. and to avoid this big problem we enforce
the importance of education and continuing breast
feeding. Pevzner and Dahan, (2020) requested from References
Abd Elhakam E, Abd Elmoniem S (2016). Effectiveness of nursing intervention
the women with mastitis to overcome difficulties with measures on minimizing puerperal mastitis and promoting breast feeding.
mastitis as pain, fear, or false conception ‘antibiotics may India: IOSR Journal of Nursing and Health Science (IOSRJNHS); 55–66.
Alikhassi A, Azizi F, Ensani F (2020). Imaging features of granulomatous
pass through the milk‘, and to continue breastfeeding. mastitis in 36 patients with new sonographic signs. Journal of Ultrasound
Also, the choice of a proper treatment and the provision 23:61–68.
of therapeutic instructions to the patient are crucial for a Axelsson D, Blomberg M (2019). ‘Prevalence of postpartum infections: a popula-
tion-based observational study‘. Acta Obstet Gynecol Scand 93:1065–8.
cure, for a successful duration of breastfeeding, and for Baeza C (2016). Acute, subclinical, and subacute mastitis. Clinical Lactation
preventing complications for mother and baby. 7:7–10.
Furthermore; Wilson et al. (2020) reported that Boakes E, Woods A, Johnson N, Kadoglou N (1018). Breast infection: a review
of diagnosis and management practices. European journal of breast health
lactational mastitis is a painful condition that can lead 136:5 and 44.
to discontinuation of breastfeeding and recommended Chen Y, Li X, Jing G, Pan B, Ge L, Bing Z (2020). Health education interventions
that mothers should be reminded of the many benefits of for older adults with hypertension: a systematic review and meta-analysis.
Public Health Nursing 37: 461–9.
breastfeeding and encourage persevering. Chou S-H., Huang C-C., Lin C-H., Wu K-C., Chiang P-J (2022). General Use of
Chinese Herbal Products among Female Patients with Mastitis in Taiwan.
Evidence-Based Complementary and Alternative Medicine.
Conclusion Cooney F, Petty-Saphon N (2019). The burden of severe lactational mastitis in
Ireland from 2006 to 2015. 2019
Nursing teaching protocol for patients with mastitis led Costa Morais Oliveira V, Cubas-Vega N, López Del-Tejo P, Baía-da-Silva DC,
to better prognosis that was apparent in fewer Araújo Tavares M, Picinin Safe I (2021). Non-lactational infectious mastitis in
the Americas: a systematic review. Frontiers in medicine 8:672513.
complications rate, decreased pain level, improved
Crepinsek MA, Taylor EA, Michener K, Stewart F (2020). Interventions for
knowledge and practice among study group who preventing mastitis after childbirth. Cochrane Database of Systematic
received and applied the nursing teaching protocol. Reviews 9:1–71.
Ding S-T., Gao Y-J., Qin C-X., Liu H-Y., Zhang H-W., Li Y (2021). Granuloma-
Also, there was a negative correlation between patients’ tous mastitis in multiparae during pregnancy and lactation: Observational
knowledge, practice scores and pain level at three weeks study (STROBE compliant). Medicine
Geri XX, et al. (2019). Evidence-based practice for nursing and healthcare Steuer AB, Stern MJ, Cobos G, Castilla C, Joseph K-A, Pomeranz MK (2020).
quality improvement. El sevier, China, ch 6:76 available at: http://www. Clinical characteristics and medical management of idiopathic granuloma-
elsevier.com/permissions tous mastitis. JAMA dermatology 156:460–4.
Gresh A, Robinson K, Thornton CP, Plesko C (2019). Caring for women Varghese B, Patwa A (2020). Effectiveness of hospital based
experiencing breast engorgement: A case report. Journal of Midwifery & teaching programme on knowledge regarding home management
Women’s Health 64:763–8. for breast engorgement among postnatal mothers. Int J Res Rev 7:
Karaçam Z, Sağlık M (2018). Breastfeeding problems and interventions per- 486–93.
formed on problems: Systematic review based on studies made in Turkey. Viduedo ADFS, Leite JRDC, Monteiro JCDS, Reis MCGD, Gomes-Sponholz
Turkish Archives of Pediatrics/Türk Pediatri Arşivi 53: pp. 134. FA. (2015). Severe lactational mastitis: particularities from admission.
McCaffery M, Pain BA. (1989). Clinical Manual for Nursing Practice. St. Louis: Revista Brasileira de Enfermagem, 68(6):1116–1121.
Mosby. Wang X., Sun X (2022) Application Value of Health Education Combined
Nabil Hussien N, E Arafa N, O Refaat D (2019). Breastfeeding Self-Efficacy with Aerobic Exercise in Nursing of Patients with Mastitis Found in
Score with Lactational Mastitis a Cross Sectional Study in a Family Health Physical Examination. Computational Intelligence and Neuroscience.
Unit, Sharkia Governorate, Egypt. The Egyptian Family Medicine Journal pp. 33.
3:1–14. Wilson E, Woodd SL, Benova L (2020). Incidence of and risk factors for
Pardeshi P, Pathak N, Patil A, Shaikh T, Raut S, Bera L (2019). Assess lactational mastitis: a systematic review. Journal of Human Lactation.
knowledge regarding breast complication during puerperium among postna- 36:673–86.
tal mothers. Education 30: pp. 7. World Medical Association (WMA) (1997). Declaration of Helsinki − Ethical
Pevzner M, Dahan A (2020). Mastitis while breastfeeding: Prevention, the Principles for Medical Research Involving Human Subjects − WMA. − The
importance of proper treatment, and potential complications. MDPI. p. 2328 World Medical Association [Internet]. [cited 2022 Sep 19]. Available from:
https://www.wma.net/policies-post/ wma-declaration-of-helsinki-ethical-prin-
Ren L, Zhang J, Guo R, Lyu C, Zhao D, Dong Z, Wang Q (2022). The efficacy
ciples-for-medical-research-involving-human-subjects/
and safety of Chinese massage in the treatment of acute mastitis: A protocol
for systematic review and meta-analysis of randomized controlled trials. Yin Y, Yu Z, Zhao M, Wang Y, Guan X (2020). Comprehensive evaluation of the
Medicine 101:e28504. risk of lactational mastitis in Chinese women: combined logistic regression
analysis with receiver operating characteristic curve. Bioscience Reports
Rose Strickland S, Sharma RD (2021). Management of breast infections in
40:1–14.
primary care. InnovAiT 14:318–24.
Zhang Y., Zhou Y., Mao F, Guan J, Sun Q (2018). Clinical characteristics,
State information service (2022). Egyptian Women’s Health Initiative, Adopted
classification and surgical treatment of periductal mastitis. Journal of thoracic
from: https://sis.gov.eg/Story/173151/Egyptian-Women's-Health-Initiative?
disease 10:2420–2427. https://doi.org/10.21037/jtd.2018.04.22
lang=en-us

Effect of Nursing Teaching Protocol On Mastitis.13

Uploaded by

Document Informationclick to expand document informationResearch Paper

Document Informationclick to expand document information

Copyright:

Available Formats

Effect of Nursing Teaching Protocol On Mastitis.13

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Effect of Nursing Teaching Protocol On Mastitis.13

Uploaded by

Copyright:

Available Formats

308 Original article

Effect of nursing teaching protocol on mastitis prognosis:

Hashem, Faculty of Nursing, Assiut university,

Inflammation of breast can be broadly categorized as

Nursing role is conducive to deepening patients’ (1) Pain level.

Tool I: An interview questionnaire sheet: It was

intervention group and control groups are measured

Part 2: Patients’ knowledge about mastitis care: This

Tool IV: Mastitis prognosis sheet Ethics considerations

Principles for Medical Research Involving Human

Table 2 Reflects that; At base line assessment the

were married (66.7% and 73.3%) respectively.

control group had lactational mastitis. Concerning the

Table 1 Biodemographic data of studied participants (n=60)

Unsatisfactory 27 (90.0) 26 (86.7) 2 (6.7) 25 (83.3)

Inadequate 27 (90.0) 25 (83.3) 0 (0.0) 23 (76.7)

than two thirds of patients in both groups were

disease as well as mastitis management. Also, they

probability sample is recommended to attain

You might also like