The Impact of Time out Hours for Breast Feeding on Work Performance among Nurses in Bahrain

The world health organization and the American Academy of Paediatrics emphasize the importance of breastfeeding for mothers as well as children. Literatures reveal that this right eventually will create a new healthy generation better immune towards diseases. Female nurses in the kingdom of Bahrain, who resume duty on hospitals after two months of maternity leave, face difficulty to continue natural feeding although a two hours breast feeding system is implemented. Caring of patients in the hospital is a very stressful role that requires high level of accuracy, concentration and tolerance to pressure and work load. Therefore, nurses’ mothers face difficulty to balance between work performance and early outing for breastfeeding. Nurses’ mothers intrinsically sense helping others people but are unable to help their own babies. This study aimed to identify difficulties nurses’ mothers’ face in hospital which constraint continuation of breast-feeding practices. Quantitative design was used, and data was collected by using formulated questionnaire with a total sample of 73 nurses’ mothers and 6 nurse supervisors. Interviews were conducted in different acute health care settings in one of the governmental hospitals in Bahrain. Result revealed that the existing system is ineffective in the hospital although it may be effective in other organizations. Set of recommendations were raised. Firstly, to increase the duration of maternity leave up to 6 months. Secondly, to establish a breast feeding Centre, facilitating mothers feeding their babies or storing mothers’ milk in the working areas. Lastly, increase nursing manpower in order to ease the implementation of this system.


Introduction
Breast feeding is important for mothers and babies for a healthy generation. A new system of releasing working mother two hours for breast feeding for two years was applied in the Kingdom of Bahrain by June 2006 but when this system was implemented in the biggest governmental hospital in Bahrain essential evaluation was required [1]. The rate of female are highly seen in nursing field and increasing rate of nurses on breast feeding system will create difficulties. This study will compromise between the nurse mother Rights in breast feeding for two years. Caring of patients in the hospital is a very stressful role that needs high level of accuracy, concentration and tolerance to pressure and work load, in fact, two hours out for breast feeding will impact the work performance especially the quality of patient care. It is important to consider the changes that will take place in order to reach the desired quality [2]. Managing such process in the medical field is not an easy task because the expense is human life (patient life) if not administered very well [3]. The result will help policy makers in making plans and programs and shape recommendations for protection, promotion, in order to get institutional support for breastfeeding mothers in the work force and help them to continue breast feeding.

Objective
To identify the difficulties faced by the nurse's mothers, colleagues and the nurse supervisor when implementing the two hours breastfeeding practices in government hospital.

Methodology
Quantitative design was used, and data was collected by using formulated questionnaire with a total sample of 73 nurses' mothers and 6 nurse supervisors. Interviews were conducted in different acute health care settings Because of the time constrain and effort limitation, some units were taken as a sample in this study since they are best reflection of the population. The study conducted from August till September 2012.
Total number of nurses in SMC are 1316, 1219 are Females, 97 are Males and from the total numbers there are 236 nurses on breast feeding hours. The selections of the sample study were on critical units such as Accident and Emergency Unit (A&E), Intensive Care Unit (ICU), and Cardiac Care Unit (CCU). Accident and Emergency (A&E) total nurses are 171 (female 153 nurses) (male 18 nurses) (nurses mother on breast feeding hours (BFH) are 29 16.96%). Intensive Care Unit (ICU) Total nurses 120 (nurses mother on BFH 13 10.83%). Coronary cardiac Unit (CCU) Total nurses 77 (nurses mother on BFH is 9 11.68%). Almost all lactating nurses refuse to stop breast-feeding before they return back to work as illustrated in figure because they feel that this is the infant rights [4].

Data Analysis
The data result shows that lactating mothers insisting the continuation of breast feeding and will not stop breast feeding after returning to the work, even though they are working in sensitive units with critical patients on ventilators who need close monitoring and concentrations (Figure 1).

Figure 2
Breast feeding changes and effects on infants.
After returning back from maternity leave, Nurse's mother should provide a safe place and plan the schedule of timing for breast feeding. Most babies become sick after their mothers leave them for long time due to their duties.
The data shows that (52%) said infant become sick after returning back to work as the time of breast feeding changed. (47%) said infant do not become sick after returning back to work as the time of breast feeding changed [5]. 1% no response.
The result of data shows that majority of nurse's mother feels their babies become sick after returning to work as the time of breast feeding changed (Figure 2). Most of nurses are facing breast engorgement as milk accumulation in the breast, severe pain in that area and since they are not feeding their babies on time the milk will wet their uniforms. This cause embarrassment for lactating nurses while they are on duty. Babies need their feeding and mothers are away from them. The mothers need to do some action to relieve those symptoms [6].
• Express milk Immediately in Toilet (25%) • Express milk in bottle feeding in feeding room (7%) • No Time for expressing the milk (62%) • Others (5%) • No response 1% It is clear from data that the organization doesn't provide proper place such as feeding centre for lactating nurses while they are on duty so the milk will be wasted, the baby would suffer from hunger and the mother would complain of breast pain during the work (Figure 3). The lactating nurse facing difficulties of how to balance between the long and tough duty in the hospital on one hand and breast feeding their babies on the other hand. Because of that, she will developed symptoms such as pain, discomfort and emotional disturbances [7]. Almost all the respondents (92%) positively acknowledge the feeling of pain, discomfort, and emotional disturbances.
The lactating nurses having no symptom of pain or discomfort or emotional disturbances while they are on duty were (8%) which is almost negligible percentage. The result of data shows that the majority of lactating mothers complain of breast pain, discomfort and emotional disturbances while they are on duty. Those symptoms will have negative consequences on their work performance and may result in incidents due to lack of concentrations, especially since they are health care providers dealing with humans (Figure 4).

Figure 5
Opinions on the existing system.
The employee is eligible to get 2 hours reduction of the work duty either to come late for 2 hours or leave the duty before 2 hours. The data of the pie chart shown in the figure shows that (75%) of respondents said 2 hours is appropriate system for breast feeding [8]. However (22%) of respondents said two hours is not appropriate system for breast feeding. (3%) of respondents did not respond on this particular question ( Figure  5).

Figure 6
How far 2-hours existing system is implemented.
The data shows that the system is not equally implemented in all units as the nature of those units caring of critical stage required close monitoring of sick patients. Releasing nurses in those areas for 2 hours will affect patient's conditions as their health is not stable and suddenly will be deteriorated which need professional nurses to stay with patient all the time [9]. The majority of respondents (64%) responses positively that the 2 hours breast feeding system has been applied. This is an important result which means that no less than 32% having negative perception about the implementation of such system in SMC. The system is there, but the hesitation of implementation is undeniable [10].
The data of the study were not equal but the highest percentage (64%) said yes. (32%) said no, which could be due to the fact that there are a number of nurses on the breast feeding system in certain units who are limited and cannot be released regularly for 2 hours compared to the other high rate of nurses (Figure 6).

Figure 7
How management manage this process.
The manager play an important role in adjusting releasing nurse's mother for 2 hours while they are caring for sick patients, they need to balance between the effectiveness and efficiency of work performance in the critical care unit and implementation of nurses mother Rights of breast feeding. Organized release of nurse's mother for 2 hours should be done according to work situations and human resource availabilities [11].
The data result shown in figure (5-16) indicates that high percentage of nurse's mother about (56%) was not allowed to breast feed. Once nurse mother released for 2 hours breast feeding no coverage will be available as the work force is very limited in each unit. A quite significantly large percentage (37%) respondent responds positively (yes) to the question which means they implement the system fully (Figure 7).

Figure 8
Compensation for inability to fulfill the breast feeding.
The nurse mother faces difficulties to leave sick patient without nurse replacement. The breast feeding hours can't be implemented when there are no extra nurses available in the concerned unit. Some managers compensate in case they are unable to halt for breast feeding during the busy day [12].
The data shows that (53%) nurse mother got compensation from the manager in case they are unable to halt for breast feeding during the busy day.

ISSN 2471-9803
Vol.3 No.2:8 (41%) nurse mothers didn't get any compensation from the manager in case they were unable to halt for breast feeding during the busy day [13].
(5%) no response from nurse mother in regards to getting compensation from the manager in case they were unable to halt for breast feeding during the busy day. The system is not implemented equally in all units and in all shifts. There is little differences in reading the result which mean the nurses' mother are not getting their Right of breast feeding (Figure 8).

Figure 9
Extra work load dissatisfaction. The nurse's mother faces difficulties to leave sick patient without nurse replacement [14]. Even though it's her right of getting child care hours as the work performance will be negatively affected as the colleagues in that particular unit will look after their patients meanwhile they will take extra work load when breast feed mother released for breast feeding hours.
More importantly (62%) which is the majority of the coworkers in the unit are not satisfied to take extra work load when their partners were released for breast feeding [15][16][17]. The vast majority of nurses not on breast feeding hours is not satisfied to take additional work especially since their patients' condition is not stable and need close assessment and observation as mentioned earlier the care ratio in those area 1:1 (Figure 9).

Figure 10
How management manage this process.
The nurse's mother should plan their work efficiently since their time is limited and the amount of work required of them is more than the time available that lead nurses to be fast work performers. Moreover, they feel panic and under pressure as they are on a breast feeding plan [18].
The data of figure (4-20) indicates the feeling of nurse's mother on breast feeding plan. Among them (42%) respondents were responding that they have positive feeling of panic and under pressure when they are on Breast feeding Plan whereas (56%) respondents were responding negatively [19]. This is quite astonishing result but it is attributed to either unclear understanding of the question or they were managing well their time because they cope enough with the stressful work to the extent that there is no psychological effect associated with the inability to leave the work to feed their infants (Figure 10).

Conclusion
The study revealed that the existing system is ineffective in the hospital although it may be effective in other organizations. In this study , the majority of nurses are not getting their Rights of releasing two hours feeding their baby natural milk as they are working in acute health care setting ( Table 1). Prolonged duration of breast feeding causes milk accumulation pain, discomfort, panic and emotional disturbances. Therefore, nurses' mothers face difficulty to balance between work performance and early outing for breast feeding. Nurses' mothers intrinsically sense helping others people but are unable to help their own babies. On the other hand, Nurse supervisor not permitting nurse mother to take two hours for breast feeding as there are some influences such as Peak time, when it is not possible to release the nurses on breast feeding hours because of the intensive work load and Unsafe time during the night shift.