Obstetric Residents’ and Nurses’ Critical Thinking Skills and Their Attitudes towards the Baby Friendly Initiative [9M]

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The Baby Friendly Hospital Initiative (BF) is shown to improve breastfeeding outcomes. Systems thinking (ST), a subset of critical thinking, helps individuals make inferences about behavior by developing a deeper understanding of underlying structure. The objectives of this project were to 1) explore characteristics of Ob/Gyn residents and nurses and their opinion of BF, 2) analyze the relationship between their ST skills and opinion of BF, adjusting for differences between residents and nurses.


Participants completed a survey assessing 1) opinions of BF 2) ST using the Systems Thinking Scale and 3) demographics. A linear regression examined the relationship between ST and BF scores, adjusting for factors significantly associated with the scores in univariate analysis.


Thirty residents and 86 nurses participated. Residents had more males (p=.003), were less likely to have children of their own (p<.001), and were younger (p<.001). ST scores were not significantly different between residents and nurses (median=63 vs. 66, p=.93); however, residents had higher BF scale scores, indicating a more favorable opinion of the policy (median= 28 vs 24, p<.001). Higher ST scores were related to higher BF scores after adjusting for group (resident or nurse) and age (β=.218, p<.001).


ST is significantly related to both residents’ and nurses’ opinions of BF; residents have a higher baseline for the relationship due to higher BF scores. Hospital administration can leverage this relationship by incorporating more ST into continuing education, resulting in more favorable opinions of new policies among their workforce and greater investment in the policy’s success.

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