NRS433V Evidence Base Practice and Nursing Research

Background of Study:

• Identify the clinical problem and research problem that led to the study. What was not known about the clinical problem that, if understood, could be used to improve health care delivery or patient outcomes? This gap in knowledge is the research problem.
• How did the author establish the significance of the study? In other words, why should the reader care about this study? Look for statements about human suffering, costs of treatment, or the number of people affected by the clinical problem.
• Identify the purpose of the study. An author may clearly state the purpose of the study or may describe the purpose as the study goals, objectives, or aims.
• List research questions that the study was designed to answer. If the author does not explicitly provide the questions, attempt to infer the questions from the answers.
• Were the purpose and research questions related to the problem?

Method of Study:

• Were qualitative methods appropriate to answer the research questions?
• Did the author identify a specific perspective from which the study was developed? If so, what was it?


Did the author cite quantitative and qualitative studies relevant to the focus of the study? What other types of literature did the author include?
Are the references current? For qualitative studies, the author may have included studies older than the 5-year limit typically used for quantitative studies. Findings of older qualitative studies may be relevant to a qualitative study.
Did the author evaluate or indicate the weaknesses of the available studies?
Did the literature review include adequate information to build a logical argument?
When a researcher uses the grounded theory method of qualitative inquiry, the researcher may develop a framework or diagram as part of the findings of the study. Was a framework developed from the study findings?

Results of Study

• What were the study findings?
• What are the implications to nursing?
• Explain how the findings contribute to nursing knowledge/science. Would this impact practice, education, administration, or all areas of nursing?

Ethical Considerations

• Was the study approved by an Institutional Review Board?
• Was patient privacy protected?
• Were there ethical considerations regarding the treatment or lack of?

Answer:

The utilization of appropriate skin-to-skin contact has been found to implicate beneficial effects on the vital signs, cardiovascular, respiratory, oxygenation and breastfeeding factors of the baby. This report aims to critically assess the following qualitative and quantitative uses, concerning the usage of appropriate skin-to-skin contact in newborn infants. These include:

• Koller Kologeski, T., Strapasson, M.R., Schneider, V., & Renosto, J.M. (2017). Skin to skin contact of the newborn with its mother in the perspective of the multiprofessional team. Journal of Nursing UFPE / Revista De Enfermagem UFPE, 11(1), 94-101. Doi:10.5205/reuol.9978-88449-6-1101201712
• Nimbalkar, S. M., Patel, V. K., Patel, D. V., Nimbalkar, A. S., Sethi, A., & Phatak, A. (2014). Effect of early skin-to-skin contact following normal delivery on incidence of hypothermia in neonates more than 1800 g: randomized control trial. Journal of Perinatology, 34(5), 364-368. Doi: 10.1097/01.ogx.0000453819.39234.0

Nursing Practice Problem and PICOT Statement

Nursing Practice Problem

The condition of ‘hypothermia’ is characterized as state of body temperature in the infant, which is low at abnormal levels (An et al., 2018). The usage of effective skin contact has been proven to be beneficial in the conductance of enhanced thermoregulation, stability in the cardiovascular and respiratory functioning and the resultant decrease in hypothermia in the newborn (Dalal et al., 2016). The lack of sufficient research, followed by strong adherence to standardized nursing practices, has resulted in reduced utilization of skin contact. Hence, the need of the hour, is to modify the present nursing curriculum, in order to place greater emphasis concerning the effective usage of skin-to-skin contact in the management of hypothermia (Steven et al., 2014).

PICOT Statement

The clinical question is: In full term newborns, how does direct skin-to-skin contact, compared to absence of skin-to-skin contact, affect the incidence of hypothermia in newborns, as measured by the infant’s body temperature within the normal range of 36.5 C and 37.5 C, when implemented after the first 48 hours after birth over a 10 week time period? Hence based on this, the PICOT statement would include newborn infants as the population group with full term birth, receiving skin-to-skin contact as the intervention practice, as compared to the absence of skin-to-skin contact resulting in positive health outcomes associated with an easier transition from intra-uterine to extra-uterine life, over a time of 10 weeks.

Qualitative Study

1^st Study

Background of Study

The significance of this study by Koller Kolegeski et al., (2017), lied at advocating the usage of effective skin contact on the alleviation of the harmful effects of hypothermia on the new born infants, along with the possibilities of beneficial results such as improved oxygenation and thermoregulation and the resultant improvements in cardiovascular functioning, despite considerable avoidance in the usage of such practices by nurses and medical staff, due to adherence  of standardized medical practices and skepticism. The purpose of this qualitative study was to assess the understanding the level of awareness amongst the clinical professional staff workforce, considering the implementation of skin-to-skin contact between mother and her infant, 48 hours after birth. (Koller et al., 2017).

Methods of Study

The references used to support this study, ranged between the years of 2012 to 2017 the theoretical framework used was phenomenological, since it aimed to assess the responses of the subjects based on the real life experience of birth and childcare. The subjects included fifteen members belonging to the team of professionals in a public hospital from Rio Grande, who were part of an obstetric center. The participant’s knowledge was assessed upon conductance of a semi-structured interview. The interview time was of twenty minutes, consisting of questions pertaining to the knowledge concerning the beneficial impacts of skin-to-skin contact, along with possible hurdle in implementation. A lack of quantified analysis followed by a small sample size proved to be major limitations (Koller et al., 2017).

Results of Study

While the chosen subjects presented an impressive array of information concerning the usage of skin-to-contact in the increase of infant body temperatures to 36.5 to 37.5 C, along with advancements in breastfeeding, there still seemed skepticism in its implementation, due to perceived dangers of the baby’s safety, the need for constant supervision and the mother’s sense of nausea and vomiting upon C-section. This study hence reported the prevalence of unawareness concerning usage of skin-to-skin contact, despite possessing knowledge concerning its benefits, and is hence significant to nursing by emphasizing the need for nurses to not only acquire information but also actively implement skin-to-skin for reduction in hypothermia.

Ethical Considerations

The author successfully considered the ethical aspects through submission of the paper for approval in the Ethics in Research Department of the University of Vale dos Sanos River. The consent of the participants were taken and privacy protected through maintenance of unanimity. (Koller et al., 2017).

Quantitative Study

2^nd Study

Background of Study

The significance of this study by Nimbalkar et al., (2014) aimed at an increased advocacy considering the usage of skin-to-skin contact between the baby and the mother, for the alleviation of symptoms pertaining to hypothermia, despite its reduced usage and awareness at present. The purpose of the above study was to assess the effect of skin-to-skin contact upon the occurrences of hypothermia in infants, hence assessing the research question of whether skin-to-skin contact leads to beneficial health transitions from intra-uterine to extra-uterine life. (Nimbalkar et al., 2014).

Methods of Study

A randomized controlled trail was conducted to assess the effects of skin contact. The sample size involved infants who were stable, with a weight of 1800 kg or more, and were delivered vaginally. A total of 100 babies were selected, who were divided into two groups, with 50 infants receiving skin-to-skin contact, while the rest 50 received conventional care. The dependent variable was the temperatures of the infants, while the independent variable included the usage of skin-to-skin contact and various alternative methods. In the group which included the intervention, the mothers begun using skin-to-skin contact within half an hour or an hour of delivery, which continued every day, with sessions of an hour. For the control group receiving conventional care, mothers used warm blankets and caps for their babies. The heart rates and temperatures of all the babies in each group were recorded within half an hour and then at intervals of one hour, for the rest of the day. The distinctions in each of the mean temperatures were evaluated using t-test and in order to measure the implications of hypothermia based on usage of skin-to-skin contact relative risk method was use. While improved body temperatures and mother-baby bonding were the benefits, the major risks lied in harm to the baby if left unattended, resulting in falls. (Nimbalkar et al., 2014).

Results of Study

The heart rates measured for every infant in each group, was found to be 128-159 beats per minute., with average temperatures of 36.6 to 36.7 degrees Celsius respectively. A total of sixteen infants were inflicted with hypothermia, of which five were preterm and ten were of abnormally low birth weight, who were part of the control group. However, with respect to the infants receiving skin-to-skin contact, only two new born infants who were pre term and of low birth weight were inflicted with hypothermia, while the rest of the infants reported no incidences of the same, upon commencement of the first three years. There was even a reported increase in the average temperatures of the infants, receiving skin-to-skin contact, from the time of first hour, lasting till the forty eight hours after birth (p = < 0.05). Infants belonging to the group receiving routine care in the control group were reported to be at a greater, eight fold risk of being affected with hypothermia  (Confidence interval 95%, 1.94 to 32.99). Hence, as evident from the results of this study, the implementation of skin-to-skin contact proves to be beneficial in the reduction on infant hypothermia, especially in regions where there is a difficulty in usage of methods such as radiant warmers of incubators. Hence, nurses are required to now adopt methods of greater feasibility and ease, such as skin-to-skin contact for the neonatal care of infants, for which further education and information awareness is required to be imparted. The research bias was reduced through regression analysis and usage of appropriate methods like t test proved to be the rigor of this research. Despite the detailed results outlined in this study, the usage of a relatively small sample size along with lack of assessment of the effects of skin-to-skin contact on breastfeeding, proved to be major limitations. Hence, this study was significant in nursing practice due to its availability of information of beneficial effects of skin-to-skin contact, further encouraging nurses to undertake such practices for improved transition from intra to extra-uterine life. Based on the limitations, further research on effects of skin-to-skin contact can pose as future research possibility (Nimbalkar et al., 2014).

Ethical Considerations

The authors considered obtained the consent of the participants and maintained privacy through identity confidentiality. The study was ethically approved by the committee of human research ethics in the HM Patel Center for Medical Care and Education, Karamsad (Nimbalkar et al., 2014).

Proposed Evidence-Based Practice Change

There has been considerable research pertaining to the advantages of establishing skin-to-skin contact for the purpose of alleviation of hypothermia, and enhancements in thermoregulation, cardiovascular, respiratory and breastfeeding functioning, and improvements in oxygenation (Feldman, Rosenthal & Eidelman, 2014). However, there has been reported a considerable lack of information and awareness amongst nurses and mothers. Hence the need of the hour is to establish the usage of skin-to-skin contact in nursing practices, for the purpose of enhancement of ease in transition, from the intra-uterine to extra-uterine life, of the concerned baby (Marie et al., 2014). Hence, this clinical statement, proves to be beneficial in nursing practice, as it paves the way for nurses to educate themselves and utilize easier, scientifically proven methods such as skin-to-skin contact in the care of newborn infants, who are at a greater risk of development of hypothermia.

Conclusion

The usage of skin to skin contact amongst mother and baby, is a cost-effective and simple method (Aghdas, Talat & Sepideh, 2014). The usage of effective skin contact, has been reported to implicate additional beneficial effects such as enhanced thermoregulation, enhanced breast feeding and improved respiratory and cardiovascular functioning (Renfrew et al., 2014). However, there still lies a lack of information and awareness amongst nurses, for the implementation of such practices, often due to lack of education or skepticism (Smith & Lucas, 2016).  Hence, the need of the hour, is to educated novel nurses concerning the usage and the beneficial impacts of establishing skin contact between the mother and their new born babies.

References

Aghdas, K., Talat, K., & Sepideh, B. (2014). Effect of immediate and continuous mother–infant skin-to-skin contact on breastfeeding self-efficacy of primiparous women: A randomised control trial. Women and Birth, 27(1), 37-40. Retrieved from: https://doi.org/10.1016/j.wombi.2013.09.004

An, J., Jin, B. K., Jo, H. S., Kim, H. R., Cho, K. H., & Lee, K. H. (2018). Risk Factors Associated with Hypothermia Immediately after Birth among Preterm Infants. Perinatology, 29(1), 20-26. Retrieved from:  https://doi.org/10.14734/PN.2018.29.1.20

Dalal, P. G., Porath, J., Parekh, U., Dhar, P., Wang, M., Hulse, M., ... & McQuillan, P. M. (2016). A quality improvement project to reduce hypothermia in infants undergoing MRI scanning. Pediatric Radiology, 46(8), 1187-1198. Retrieved from: https://doi.org/10.1007/s00247-016-3592-0

Feldman, R., Rosenthal, Z., & Eidelman, A. I. (2014). Maternal-preterm skin-to-skin contact enhances child physiologic organization and cognitive control across the first 10 years of life. Biological Psychiatry, 75(1), 56-64. Retrieved from: https://doi.org/10.1016/j.biopsych.2013.08.012

Koller Kologeski, T., Strapasson, M.R., Schneider, V., & Renosto, J.M. (2017). Skin to skin contact of the newborn with its mother in the perspective of the multiprofessional team. Journal of Nursing UFPE / Revista De Enfermagem UFPE, 11(1), 94-101. Doi:10.5205/reuol.9978-88449-6-1101201712

Maria, A., Shukla, A., Wadhwa, R., Kaur, B., Sarkar, B., & Kaur, M. (2018). Achieving early mother-baby skin-to-skin contact in caesarean section: A quality improvement initiative. Indian Pediatrics, 55(9), 765-767. Retrieved from: https://link.springer.com/article/10.1007/s13312-018-1377-2

Nimbalkar, S. M., Patel, V. K., Patel, D. V., Nimbalkar, A. S., Sethi, A., & Phatak, A. (2014). Effect of early skin-to-skin contact following normal delivery on incidence of hypothermia in neonates more than 1800 g: randomized control trial. Journal of Perinatology, 34(5), 364-368. Doi: 10.1097/01.ogx.0000453819.39234.0

Renfrew, M. J., McFadden, A., Bastos, M. H., Campbell, J., Channon, A. A., Cheung, N. F., ... & McCormick, F. (2014). Midwifery and quality care: findings from a new evidence-informed framework for maternal and newborn care. The Lancet, 384(9948), 1129-1145. Retrieved from: https://doi.org/10.1016/S0140-6736(14)60789-3

Smith, R. L., & Lucas, R. (2016). Evaluation of nursing knowledge of early initiation of breastfeeding in preterm infants in a hospital setting. Journal of Neonatal Nursing, 22(3), 138-143. Retrieved from: https://doi.org/10.1016/j.jnn.2015.07.009

Stevens, J., Schmied, V., Burns, E., & Dahlen, H. (2014). Immediate or early skin?to?skin contact after a C aesarean section: a review of the literature. Maternal & Child Nutrition, 10(4), 456-473. Doi: https://doi.org/10.1111/mcn.1212