Post-implementation experiences of the breastfeeding promotion entrustable professional activities project in undergraduate nursing education: A qualitative descriptive study.

AIM: To explore nursing instructors' and clinical nurses' experiences following the implementation of the Breastfeeding Promotion Entrustable Professional Activities (BFP-EPAs) programme and to understand the contextual factors influencing its implementation and sustainability within academic-clinical partnerships.

BACKGROUND

Entrustable Professional Activities (EPAs) are increasingly adopted to bridge competency-based education and clinical practice. However, evidence regarding their implementation in undergraduate nursing education, particularly in breastfeeding education, remains limited.

DESIGN

Qualitative descriptive study.

METHODS

Purposive sampling was used to recruit 20 participants from 14 academic-clinical partnership sites implementing the BFP-EPAs programme in Thailand. Data were collected through semi-structured interviews and analysed using thematic analysis. The Consolidated Framework for Implementation Research guided data interpretation.

RESULTS

Six themes were identified: (1) reframing breastfeeding education towards entrustable practice; (2) programme characteristics; (3) outer setting influences; (4) organisational readiness and collaboration; (5) individual attitudes and professional identity; and (6) implementation processes. Participants perceived that the BFP-EPAs programme enhanced educational structure, clarified performance expectations and strengthened students' clinical confidence. However, implementation was influenced by contextual constraints, including workload, staffing limitations and policy-practice misalignment. Feedback mechanisms and strong academic-clinical collaboration were central to competency development and sustained implementation.

CONCLUSION

The implementation of the BFP-EPAs programme represents a system-level transition that requires alignment across educational and clinical settings. While early outcomes are promising, sustainability depends on organisational readiness, ongoing support and integration into routine educational and clinical practice.