Group Prenatal Care for Breastfeeding Promotion

Prenatal Breastfeeding Workshop: Teaching and Learning Package

All credible health authorities, with even a remote interest in maternal and child health outcomes, spend a great deal of effort promoting the benefits of breastfeeding (AAP n.d.). The official policy statement issued and recently updated by the American Academy of Family Physicians (AAFP 2014) encourages family physicians to incorporate breastfeeding education into preconception, prenatal, and postnatal care visits. The AAFP (2014) also recommended that providers encourage family members, especially the father and maternal grandmother, to participate in supporting the mother’s intention and commitment to breastfeeding. Although an individualized education approach can be beneficial, the American College of Nurse-Midwives (ACNM 2011) recommends a group prenatal care format. The advantages of this model, aside from preserving clinic resources, include better maternal and infant health outcomes. The model mentioned specifically by the ACNM (2011) was the CenteringPregnancy model, which uses a provider- and co-facilitator-led participatory instruction.

I am a nurse who is working in a hospital obstetrics and gynecology ward in my home country, with a strong interest in patient education. Recently, I decided to provide a free prenatal breastfeeding workshop through my department on a voluntary basis and this report presents the details of the proposed teaching and learning package. The objectives will be to expand my role as a patient educator, improve the quality of patient education, expand the services offered by my department, and improve patient awareness about breastfeeding benefits. The chosen model for the prenatal breastfeeding workshop is group prenatal education, which brings women together at approximately the same gestational age to learn and share during the 2-hour workshop. This report will provide justification for the project and discuss the material that should be included in the teaching and learning package.

Overview of the Prenatal Breastfeeding Workshop

During their first prenatal care visit, women under 20-weeks gestation will be invited to attend the prenatal breastfeeding workshop. They will be given a leaflet containing an overview of the information that will be provided in the workshop, a description of how the workshop will be organized, directions, and contact information. The workshop will be in a group format that encourages active participation with facilitators and the other women attending. The topics covered will include the benefits, techniques, and strategies for breastfeeding. The didactic portion of the workshop will begin with a brief video providing a general overview of breastfeeding (Office on Women’s Health 2011). A PowerPoint slide presentation, accompanied by a verbal presentation, will represent the main teaching tools used. Workshop attendees will be asked to complete a breastfeeding knowledge assessment at the end of the workshop, in addition to evaluating the workshop and facilitator performance in written form.

The lesson plan for a 2-hour prenatal breastfeeding workshop will be presented here (Appendix). The rationale for the lesson plan is evidence-based and explained in detail below. The learning modules were adapted from published online information and informed by peer-reviewed research publications. The lesson modules are the following: (1) infant benefits, (2) maternal benefits, (3) how to breastfeed, (4) managing a breastfeeding routine, and (5) breastfeeding in public. What follows is a detailed overview of the information presented in the workshop and a discussion of the relevant learning theories.


The information that should be conveyed to pregnant women during prenatal care has been well-established, but the benefits of breastfeeding, while substantial, continue to be elaborated through experimental studies. Current recommendations are for exclusive breastfeeding for the first 6 months of life, followed by at least another year of breastfeeding as the diet is supplemented with liquids and foods (AAP 2012). Beyond that point, continued breastfeeding is optional depending on the wishes of the mother and child. The Office on Women’s Health (2010a) within the U.S. Department of Health and Human Services (HHS) maintains an updated information database on best practice recommendations for breastfeeding, including recommended positions, schedules, duration, exclusivity, diet supplementation, and solutions to any problems that may arise. What follows is an overview of this information, which will form the knowledge base for the breastfeeding prenatal workshop.

Patience and practice are the main requirements for breastfeeding, in addition to a safe and relatively stress- free environment (Office of Women’s Health 2010a). Women attempting to breastfeed for the first time may experience discomfort and frustration, but with persistence comes skill for both mother and infant. The most important things to remember are that milk will be produced in response to suckling behavior and breasts will adapt to consumption rates. Suckling triggers the maternal release of prolactin and oxytocin, in addition to dilation of the milk ducts. Prolactin causes the breast alveoli to make milk, while oxytocin controls postpartum bleeding and induces uterine muscle contraction.

The release of milk triggered by suckling is called the let-down reflex

(Office on Women’s Health 2010a). The length of time that it takes from the start of suckling to milk release can vary from a few seconds to a few minutes, therefore patience may be required. The sensation that accompanies the let-down reflex can vary from no sensation, to tingling, to mild discomfort. The let-down reflex can also be triggered several times during a feeding. Other triggers include hearing your baby cry or thinking about your baby, which may be helpful when expressing breast milk for later feedings.

Mother and infant should be brought together immediately after birth, health permitting, to provide every opportunity for breastfeeding to occur (Office on Women’s Health 2010a). How fast the baby will latch onto the mother’s nipple will vary, from immediate to several minutes. Typical searching behavior is the infant rolling the head back and forth and searching for a nipple with the mouth and lips. The steps for helping the baby latch onto the nipple are the following: (1) hold baby upright and against the chest just below the chin, (2) support the neck with one hand and the hips with the other, (3) tilt the baby’s head back slightly to naturally open the mouth and depress the tongue, (4) lower the baby until the breast naturally rests on the baby’s cheek, which will probably cause the infant to search and find the nipple, and (5) support the upper back and shoulders of the infant with one hand and pull the baby in close.

The baby’s head should never be held during suckling, since this may interfere breathing (Office on Women’s Health 2010a). If the proper position is attained, the infant’s nostrils are flared, mouth filled with breast, tongue and chin under breast, areola mostly covered, head straight, chest against torso, swallowing evident, and ears wiggling. This position should be comfortable for both infant and mother. Other useful positions include the following: (1) along the mother’s same-side forearm in a cradle hold, (2) on the opposite-side forearm in a cross-cradle hold, (3) with both forearms in a ‘football’ hold, or (4) while the mother and infant are laying on their sides. Breast pain can be caused by the infant latching onto the nipple and not the breast, which in turn may prevent the release of sufficient milk. The solution is to simply break suction by wedging a clean finger between the breast and the infant’s lips and then trying again.

Shortly after birth the number of feedings per day can range from 8 to 12, with each breast being suckled about 15 to 20 minutes (Office on Women’s Health 2010a). The best approach is to allow a healthy baby to set the feeding schedule and avoid the use of pacifiers and infant formulas unless it is medically necessary. Sharing the sleeping space with the baby increases the convenience of feeding and reduces the risk of sudden infant death syndrome. Initially, the baby may lose a little weight within the first few days after birth, but this trend should reverse after the first week of life if well-fed. The presence of a sufficient volume of pale urine, adequate bowel movements, post-feeding contentment, post-feeding softer breasts, and a healthy wake/sleep cycle are all indicators of a healthy breastfeeding routine.

Breastfeeding women can encounter many problems, including sore nipples, inappropriate milk volume, plugged ducts, infections, or an atypical nipple (Office on Women’s Health 2010b). The primary cause of sore nipples is an improper latch. The only solution to this problem is breaking the suction and repositioning the infant on the breast. A less frequent cause of pain is irritation caused by the development of an abrasion, but if this does not resolve on its own the mother should seek medical care. Getting professional advice is also recommended before the mother attempts to use creams, ointments, nipple shields, and nursing pads.

The primary cause of low milk supply is a lack of experience and knowledge (Office on Women’s Health 2010b). With experience the feeding time may shorten to as much as 5 minutes due to increased infant skill. If the baby is content after feeding and otherwise healthy, the length of feeding time is irrelevant. Adaptation to growth spurts will probably require longer and more frequent feedings, until the breasts can adapt by producing more milk. In order to promote adequate milk production, pacifiers and supplementary liquids should be avoided for the first six months. An oversupply of milk can make feedings difficult for the mother and infant, and this should be remedied promptly. Offering only one breast per feeding and lengthening the feeding time can help, as can reducing milk volume before feedings by hand expressing. Breast engorgement can occur within the first few days after birth and must be handled properly to prevent plugged ducts and mastitis (infection). Other problems that can occur include a fungal infection (thrush), infant refusing to breast feed (nursing strike), and unhealthy infants. Medical help should be sought if these problems do not resolve quickly.

Some women may feel uncomfortable breastfeeding in public, but government and medical organizations urge women to overcome this difficulty on behalf of the infant’s and mother’s health (Office on Women’s Health 2010c). Purchasing loose tops, using slings or breastfeeding blankets, discovering private spaces, and practicing at home can help. Breastfeeding at work poses its own challenges, but many of the potential difficulties can be effectively addressed (Office on Women’s Health 2010d). Practicing expressing milk at home by hand or with a pump, storing milk in the refrigerator or freezer, and bottle feeding the infant will prepare the mother and infant for her return to work. During a typical work day the milk will need to be expressed two to three times and refrigerated under sanitary conditions for the next day. A photo of the baby can help trigger let-down and expressing the milk will take about 15 minutes. Since work was cited as the primary reason for women who stopped breastfeeding, overcoming these barriers are important to infant health (Keister, Roberts, and Werner 2008).

Breastfeeding outcomes have been studied extensively, but the research quality is almost uniformly low due to ethical concerns about randomizing women to different treatment groups (Ip et al. 2007). Despite these significant limitations, systematic reviews and meta-analyses have revealed several significant maternal and infant health benefits associated with breastfeeding.

Breastfeeding confers short-term protection against respiratory infections regardless of maternal age and socioeconomic status (Horta and Victora 2013a). In addition, both hospitalization and mortality due to respiratory infections were reduced 57 and 70%, respectively. Middle ear infections (otitis media) were reduced by 23% when comparing ‘any breastfeeding’ to no breastfeeding and 50% when comparing no breastfeeding to exclusive breastfeeding, but only if exclusive breastfeeding lasted 3 to 6 months (Ip et al. 2007). Infant diarrhea was reduced by 30% when mothers had been exposed to breastfeeding promotion, but infants younger than 6 months of age obtained the greatest benefit (Horta and Victora 2013a). At 6 months, gastrointestinal infections were reduced by almost 40% when comparing ‘any’ to ‘exclusive’ breastfeeding (Ip et al. 2007). Breastfeeding was also protective against necrotizing enterocolitis in preterm infants by a small, but clinically-significant margin (5%).

To date, no conclusive evidence has been obtained that shows a significant benefit of breastfeeding for child cognitive performance (Horta and Victora 2013b); however, a recent large study (N = 11,134)

examined the association of breastfeeding with developmental milestones and found ‘ever’ breastfeeding significantly improved gross motor, fine motor, problem-solving, and personal-social by 32, 60, 20, and 38%, respectively, during the first postnatal week only (McCrory and Murray 2013). Breastfeeding has also been consistently associated with a modest 3.5 point increase in child intelligence (IQ) scores and a 24% reduction in overweight/obesity risk (Horta and Victora 2013b).

The five main reasons why women choose to breastfeed their infants are (1) infant health, (2) natural lifestyle, (3) maternal-infant bonding, (4) convenience, and (5) maternal health, in that order (Hahn-Holbrook, Schetter, and Haselton 2013). The main reasons for choosing to not to breastfeed or discontinue breastfeeding are (1) paternal opposition, (2) infant nutrition worries, (3) career obligations, (4) physically uncomfortable, and (5) concerns about physical appearance. If the published maternal risks associated with suboptimal breastfeeding practices are examined, however, there would have been an excess of 5,000 cases of breast cancer, 28.7 cases of premenopausal ovarian cancer, 4,500 cases of type 2 diabetes, 53,847 cases of hypertension, 14,000 myocardial infarctions, and 4,400 deaths before the age of 70 in 2005, at a cost of $10.5 to $44.5 billion dollars in direct and indirect health care costs (Bartick 2013). From a mental health perspective, increasing the hours of skin-to-skin contact between mother and infant provided significant protection against depression, anxiety, and elevated salivary cortisol levels (Bigelow et al. 2012).

Encouraging the retention of the above information will require the facilitators to be competent teachers. Among the many roles that nurses may encounter in patient education, those most relevant to a group prenatal breastfeeding workshop are: (1) orchestrating the many facets of workshop administration, (2) providing effective feedback, (3) identifying concerns, and (4) assessing patient knowledge, skills, and attitudes (Walsh 2010: 17). While these activities are important for the learning process the method of instructions also matters a great deal (Banning 2005). A strictly didactic means of transmitting information from the teacher to student is fraught with potential problems, including rote learning, boredom, and minimal investment in the transaction by both parties. A better approach, according to Banning (2005), is a facilitatory teaching style where the teacher helps the student to engage in self-directed learning. The teacher attributes that are needed for this teaching style is a high level of competency in the material being taught, compassion, respect, and flexibility in teaching methods. In addition, the quality of the relationship between the teacher and student is important, which is a significant departure from a didactic teaching style where the teacher and student rarely, if ever, have a personal interaction. The facilitatory teaching style is the chosen method for this workshop, because this method is ideally suited for adult learners and shifts the balance from a teacher-centered approach to a student-centered approach.

The essential requirements for facilitatory teaching are a compilation of learning materials and academic support (Banning 2005). The above discussion of breastfeeding benefits and techniques represent the knowledge base upon which the workshop will be constructed, while the academic support will be provided by a number of tools, including a PowerPoint presentation, leaflets, brochures, and practice dolls.


Learning is the process of change that can alter an individual’s cognitive, affective, and behavioral repertoire in often permanent ways (Braungart, Braungart, and Gramet 2011). The process of learning has been of significant interest to researchers wishing to improve the many forms of education. Accordingly, theories of learning have been developed in an attempt to model the independent and dependent variables involved (Braungart, Braungart, and Gramet 2011). Probably the most basic learning theory conceptually is behaviorism, because it assumes that the environment controls all behavior. Under this model, women attending a prenatal care class are assumed to be passive, reactive participants; therefore, changing the environment will alter prenatal health outcomes. Behaviorism is the least attractive model for a patient-centered approach, because it ignores the patient’s emotional and cognitive contributions to learning.

By comparison, cognitive theory assumes that learning occurs primarily by altering cognition (Braungart, Braungart, and Gramet 2011). Under this model, clients and patients are assumed to be primarily rational beings who are influenced to some extent by personality traits. The model most relevant to group prenatal care is social learning theory, because the students learn by interacting with both teachers and classmates. Under this model, the facilitators of a prenatal care class would act as role models, sources of perceived reinforcement, and as agents of influence acting upon the internal processes of the student. A woman’s lifestyle choices, past experiences, and current mood are the focus of psychodynamic learning theory; however, an instructor is required to evaluate each student in order to understand how these factors influence the learning process (Braungart, Braungart, and Gramet 2011). Accordingly, psychodynamic theory appears to be more appropriate for individual prenatal care encounters (Levy 1999). Under humanistic learning theory the facilitator would be more of a coach than teacher, which is not appropriate for the aim of this workshop

. The most recent learning theory is not so much a theory as a collection of neuropsychology empirical findings. For example, neuroscientists have discovered that emotions are essential to the learning process, in addition to cognition. Empirical findings also support the relevance of past experiences, cognitive load, sensory modalities, instructional pace, practice, motivation, arousal, and attention, to the learning process.

Based on the above analysis, a group prenatal breastfeeding workshop would benefit from cognitive, social, and neuropsychological learning theories. The main assumptions of cognitive learning theory are: (1) distinct sensory channels, (2) limited cognitive capacity, and (3) learning occurs when attending to sensory information, processing it, organizing it into meaningful categories, and integrating it with existing knowledge (Mayer 2010). The critical component, however, is the concept of ‘cognitive load,’ which implies that the information processing capacity of working memory is finite. This concept is critical because sensory memories last for a few seconds at best and unless working memory has the capacity to accept the information it will be lost (Khalil et al. 2005). In addition, information retained in working memory must transition into long-term memory (LTM) to free up capacity for incoming sensory information. This is accomplished by the creation of ‘schema’ within the LTM, which help organize information to facilitate long-term storage. Schema also speed up the transitioning of information from the working memory to LTM, thereby increasing working memory capacity and reducing cognitive load. The other essential elements of cognitive learning are motivation and rehearsal. The importance of motivation is obvious, while rehearsal helps retain information in working memory long enough for it to become encoded into LTM schema(s).

If some of the main elements from cognitive, social, and neuropsychological learning theories are combined, the result would encompass Bandura’s theory of self-efficacy and the theory of adult learning principles (Noel-Weiss et al. 2006). Self-efficacy theory has four components: (1) performance, (2) vicarious learning, (3) persuasion, and (4) emotional/physiological arousal. Adult learning principles assume that students are self-motivated, need a reason to learn, and arrive in class with a rich history of past experiences, therefore adult learners are distinct from child learners (Hand 2006a). For these reasons adult learners benefit the most from patient-centered teaching styles. Noel-Weiss and colleagues (2006) created a 2.5-hour workshop on breastfeeding using these theories and breastfeeding self-efficacy scores increased significantly compared to a control group. Women in the intervention group were also significantly more likely to be breastfeeding exclusively (78 vs. 53%) or ‘any’ breastfeeding (95 vs. 71%) 8 weeks postnatal.

There are a large number of learning theories that have been used for patient education (Bellamy 2004), but based on the above discussion the most relevant theories to a 2-hour group prenatal breastfeeding workshop are cognitive, social, and neuropsychological. The main contributions from cognitive are the importance of motivation, attention, and rehearsal, but with close attention being paid to cognitive load (Mayer 2010). The graphics and text included in the slides should be relevant and barebones, respectively, to minimize the extraneous processing load. To improve essential processing performance the following will be implemented: (1) leaflets presenting the main points of the information conveyed in the workshop will be given to women during the first prenatal care visit, thereby triggering schema formation, (2) the information will be organized into coherent modules to reduce cognitive load, and (3) the text presented in the PowerPoint slides will be also be verbally presented to make use of the distinct visual and auditory information processing pathways.

To minimize the generative processing load the information and teaching materials being presented will be relevant, well-organized, stripped down to the essentials, and presented within a pleasant surrounding and using a positive tone (Mayer 2010). With a nod to social learning theory the facilitators will become role models, provide perceived reinforcement (e.g., infant and maternal health benefits), and act as cognitive and emotional agents of influence (Braungart, Braungart, and Gramet 2011). For example, the use of graphics depicting the correct positions of breastfeeding, well-fed infants, and a mother breastfeeding in public can trigger different emotional responses, from joy to stress. Since neuroscientists have shown that emotions directly influence motivation, the graphics included in the slides will be chosen to influence the emotional climate of the workshop. In addition, the experiential histories of the women will be addressed as needed to facilitate the learning process. Both neuropsychology and cognitive learning theory recognizes that past experiences can determine learning quality. All of these facets will be considered during the design and presentation of the group prenatal breastfeeding workshop.


The 2-hour group prenatal breastfeeding workshop will contain the following modules: (1) infant benefits, (2) maternal benefits, (3) how to breastfeed, (4) managing a breastfeeding routine, and (5) and breastfeeding in public. Within each module a number of subtopics will be presented. For example, the module on breastfeeding in public will contain information about clothing choice, private spaces, returning to work, practicing at home, let-down cues, hand-expressing, and breast pumps.

A self-assessment form will be presented to the workshop participants at the end of the workshop. The purpose of this assessment form is to help the participants rehearse key points about breastfeeding, trigger discussions about breastfeeding topics, and help the facilitators monitor how effective their teaching skills and techniques are. This assessment strategy is a commonly used strategy in patient education (Hand 2006). Completion of the self-assessment form will be followed by a quick discussion to help the participants understand how much the workshop helped them to understand breastfeeding and to provide feedback.


A number of research groups have studied the outcomes of prenatal breastfeeding classes for several decades, but group prenatal care is a relatively new phenomenon (Thielen 2012). An example would be the CenteringPregnancy prenatal care program first developed by nurse-midwife Sharon Schindler Rising in 1998 (Thielen 2012). This particular program has been adopted on a national level in the United States, thereby motivating a number of research groups to investigate the relative impact of group prenatal care on infant and maternal outcomes, including breastfeeding practices (Thielen 2012). The evaluation criteria utilized by several research groups will be discussed here as justification for use in an outcome evaluation for the group prenatal breastfeeding workshop proposed here (Thielen 2012).

The evaluation approach utilized for the prenatal breastfeeding workshop described here will focus on participant perspectives of the workshop and its facilitators; therefore, only a few brief questions will be required to provide a general sense of how well the workshop was received by the women who participated. The questions included in the evaluation will be informed by a prenatal satisfaction questionnaire published previously (Raube, Handler, and Rosenberg, 1998). A one-page evaluation form will be used at the end of the workshop and participants will be expected to complete the form before leaving. A long-term evaluation will be conducted by phone six weeks postnatal and the same questions will be asked of participants verbally.



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Facilitator/Teacher: Dr. Mary Anne Donaldson, Janet a. Franks, RN, CNM

Date: 04/10/2014

Patients: Pregnant women, 20-weeks gestation

Subject: Breastfeeding

Length of Training: 2 hours





Further Reading

1. Introduce students to the session, while handing out materials.

10 minutes

1. The facilitators will:

a. Welcome antenatal women to the workshop.

b. Ask the women to sign the attendance sheet.

c. Hand out the self-assessment form.

d. Provide an overview of the workshop

2. The learners will:

a. Sign the attendance sheet.

b. Find a place to sit.

c. Complete self-assessment form

Attendance sheet

Self-assessment form

Discuss the level of breastfeeding knowledge among the women

2. General overview of breastfeeding; present modules a, B, and C

45 minutes

3. The facilitators will:

a. Present the short video (1 minute 50 seconds).

b. Present module a on infant breastfeeding benefits

c. Present module B. On maternal breastfeeding benefits

d. Present module C. On how to breastfeed

4. The learners will:

a. Watch the video

b. Take notes

c. Ask questions

d. Answer questions

Computer, internet connection, link for short video, PowerPoint presentation on a memory stick, projector, projector screen, and breastfeeding practice doll

3. Present modules D, E, and F

45 minutes

5. The facilitators will:

a. Present module D. On managing a breastfeeding routine

b. Present module E. On breastfeeding in public

6. The learners will:

a. Take notes

b. Ask questions

c. Answer questions

d. Practice correct breastfeeding position with doll

Computer, PowerPoint presentation on a memory stick, projector, projector screen, and breastfeeding practice doll

4. Self-assessment and workshop evaluation

10 minutes

7. The facilitators will:

a. End the didactic portion of the workshop

b. Hand out assessment and evaluation forms

c. Distribute a leaflet to proved the women with a handy, quick reference for the main points about breastfeeding

8. The learners will:

a. Complete the post-workshop self-assessment form

b. Complete the workshop evaluation form

Self-assessment form

Workshop evaluation form

Discuss the level of breastfeeding knowledge among the women

Collect the completed evaluation forms from the workshop attendees



10:00 am

Introductions, overview of the workshop schedule, attendance, self-assessments

Anne Donaldson, Janet Franks

10:10 am

Present the information for modules a, B, and C

Anne Donaldson

10:55 am

Break for refreshments

11:05 am

Present the information for modules D. And E

Janet Franks

11:50 am

Self-assessments, workshop evaluations

Anne Donaldson, Janet Franks

Attendance Sheet

Workshop Title: Prenatal Breastfeeding Workshop — 20 Weeks Gestation

Facilitator: Dr. Mary Anne Donaldson, Obstetrics and Gynecology Department, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114

Co-Facilitator: Janet a. Franks, RN, CNM, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA, 02115

Date: April 10, 2014

Location: Massachusetts General Hospital, Obstetrics and Gynecology Department, 55 Fruit Street, Boston, MA, 02114

Jane R. Doe

Jane R. Doe

Jane R. Doe

Jane R. Doe

Jane R. Doe

Jane R. Doe

Jane R. Doe

Jane R. Doe

Jane R. Doe

Jane R. Doe

Jane R. Doe

Jane R. Doe

Self-Assessment Form for Prenatal Breastfeeding Workshop

Instructions: Completion of this assessment form is completely voluntary. The answers you provide will help us to understand how to improve future workshops, in addition to helping mothers and infants enjoy better health.

1. List three benefits of breastfeeding for infants.

2. List three maternal benefits of breastfeeding.

3. When is pacifier use recommended?

4. How long should women try to breastfeed exclusively?

5. Who sets the breastfeeding schedule?

6. Can you name at least one indication of an infant not getting enough milk?

7. How do you prepare for returning to work?

8. If I have a fever and a breast infection should I stop breastfeeding?

Prenatal Breastfeeding Workshop Evaluation Form

Instructions: To complete the form simply circle the answer that best fits your experience.: Completion of this evaluation form is completely voluntary.

1. Do you feel your time was well spent attending the workshop?

Strongly disagree Neutral Agree Strongly Agree

2. Did you find it hard to understand the information being presented to you?

Strongly disagree Neutral Agree Strongly Agree

3. Was the workshop location convenient for you?

Strongly disagree Neutral Agree Strongly Agree

4. Was the time convenient for you?

Strongly disagree Neutral Agree Strongly Agree

5. Did you feel the workshop was well organized?

Strongly disagree Neutral Agree Strongly Agree

5. Did you feel respected by the facilitators?

Strongly disagree Neutral Agree Strongly Agree

6. Did you feel listened to by the facilitators?

Strongly disagree Neutral Agree Strongly Agree

7. Could you please add any additional comments you feel may be important:

Why too much details and explanation in the teaching part, the audience are ante natal women they should receive brief explanation, they are not students and the workshop not a quiz for marking

The purpose of the 4000-word essay was to provide an evidence-based rationale for the teaching and learning package. The Teaching Section is “What will be Taught.” This demands that I discuss breastfeeding at a Masters level — which is the level you selected in the instructions.

I told you in the essay brief explanation about the topic, the content should be in the power point

The purpose of the 4000-word essay was to provide an evidence-based rationale for the teaching and learning package. The Teaching Section is “What will be Taught.” This demands that I discuss breastfeeding at a Masters level — which is the level you selected in the instructions.

I told you in the essay brief explanation about the topic, the content should be in the power point

The purpose of the 4000-word essay was to provide an evidence-based rationale for the teaching and learning package. The Teaching Section is “What will be Taught.” This demands that I discuss breastfeeding at a Masters level — which is the level you selected in the instructions.


It is the same citation as the one provided at the beginning of the paragraph. It is not normal for each sentence to have a citation, otherwise half the text for a document would be devoted to the citation. Generally speaking, it is assumed that the most recent citation within a paragraph is where subsequent information comes from.


The purpose of the 4000-word essay was to provide an evidence-based rationale for the teaching and learning package. This demands that I discuss breastfeeding at a Masters level — which is the level you selected in the instructions.


It is the same citation as the one provided at the beginning of the paragraph. It is not normal for each sentence to have a citation, otherwise half the text for a document would be devoted to the citation. Generally speaking, it is assumed that the most recent citation within a paragraph is where subsequent information comes from.

Should be both coach and teacher as the presenter will teach and help patients if they need practice

My point is that a primary role of coach is not appropriate for this workshop. I agree with your point, yet humanistic theory is not the best framework for this workshop, especially given the 2-hour time constraint


It is the same citation as the one provided at the earlier in the paragraph. It is not normal for each sentence to have a citation, otherwise half the text for a document would be devoted to the citation. Generally speaking, it is assumed that the most recent citation within a paragraph is where subsequent information comes from.

The workshop is not for studnets..for ante natal women

I am talking about the theories behind adult learning principles here, not the workshop participants

I did not see any

If you do not pay me to do the Powerpoint slides I am not going to provide graphics.

Not for students again did not request that I will give anything in advance


It is the same citation as the one provided at the beginning of the paragraph. It is not normal for each sentence to have a citation, otherwise half the text for a document would be devoted to the citation. Generally speaking, it is assumed that the most recent citation within a paragraph is where subsequent information comes from.

You did not use any form my list except Hand 2006..Why?

Where is the rest?

This workshop is about patient education and many of your references were related to clinical education for nurses. There is a distinct difference. I wondered whether you even bothered to read the references before listing them.

Why abbriveration

Abbreviations make it easier for readers to locate the citations. This is a common technique.

This reference not included in the text citation

It is in the section on breastfeeding in public

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