Evidence Based Nursing Research

This study focuses on skin-to-skin contact and incubator care for newborns. The research aims to provide a recommendation on the best mode of care that the parents should adopt for their children. The available literature suggests that kangaroo care is the most popular standard practice in Australia, as it has many benefits. However, there are still uncertainties surrounding the use of skin-to-skin and artificial care for newborn children. The literature also highlights the importance of providing effective antenatal care to infants.

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Evidence Based Nursing Research
Name
Lecturer
Course
Date

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Evidence Based Nursing Research
1. Provide an overview of the area of evidence uncertainty and justification of why this topic was
selected, including overall significance of the problem.
The main question in this study is: Is skin to skin contact more effective than incubator
when it comes to the prevention of hypothermia? A newborn child often faces a challenge
fitting into a new environment in which it had not been before. A child can stabilise its
temperature by having a skin-to-skin contact with the mother or by spending the first days in n
incubator. This kind of care is mostly recommended for the children with a low-birth weight. A
child who is born after nine months is usually mature and has the right birth weight (Schaaf,
Vergara-Tabares, Peralta, Díaz & Peluc 2018). Meaning, such a child can cope up with life as a
newborn without unnecessarily having an artificial support. At the same time, such a child has
higher chances of surviving and leading healthy life if provided with appropriate care. However,
this does not always apply to those born prematurely-before nine months (Chan, Labar, Wall &
Atun 2016). Such children require additional support either by becoming into a direct body
contact with the mother/care taker or and they should be supported by an artificial incubator.
Both skin-to-skin and incubation have been proven to be helpful when it comes to the upbringing
of such premature babies. They are also suitable for any other normal child. Each of them has
made significant contributions in providing the required support to such infants and increasing
their chances of survival after birth and prevention of hypothermia (Schaaf, Vergara-Tabares,
Peralta, Díaz & Peluc 2018).
However, despite the significant contributions of these practices, there are still
uncertainties that the current and previous researches have not resolved (Conde‐Agudelo & Díaz‐
Rossello 2016). There are some uncertainties that are identified in the evidence based practice, in

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that the practice can a times be harmful for the mothers who have undergone caesarean section
(Seidman, et al. 2015). The wounds do take a lot of time to heal and if the mother adopts the
kangaroo care it can be harmful. There is also lack of enough education to the staffs on the skin
to skin care and the parents too are not given enough education on the benefits the practice
(Boundy, et al. 2015). This topic was selected because it has contributed to reduction of the
infant death and it is a new practice that has been introduce in most hospital to prevent infant
mortality. There are several benefits of the skin to skin care; the baby will be safe in that there
will be reduced infection of the infant at early months, the baby will not loss so much weight,
there will be more rest time and natural cycle of sleep.
From this preview, it is evident that both the skin-to-skin and the incubation care have
strengths as well as weaknesses that revolve around their usage. The topic is, therefore,
important because it will help in addressing the uncertainties that have surrounded the use of
skin-to-skin and artificial care for the newborn children. It seeks to conduct a rigorous research
to find out an answer on the best alternative to adopt for the infants (Schaaf, Vergara-Tabares,
Peralta, Díaz & Peluc 2018). The overall significance of the research, hence, is to provide a
recommendation on the best mode of care that the parents should adopt for their children.
2. Summarise the current use of evidence based practice in the Australian health care setting, in
relation to their topic; this may include anecdotal experience of the issue in practice.
According to the Department of Health, maternity care is an area of concern. The
department has been investing resources to support prenatal and neonatal care because it means a
lot for the Australian mothers and infants. Maternal care still remains a major issue of concern in
Australia. The Pediatric Association of Australia is concerned that there are so many low-weight
children who are born in the country each month. Most of these children are always at a risk of

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contracting hypothermia. Research has established that hypothermia is a condition that results
from the exposure of the body to extreme cold (Schaaf, Vergara-Tabares, Peralta, Díaz & Peluc
2018). It usually takes place when the body temperature declines to below 35.0 °C. At such a
temperature, the body absorbs less heat than it dissipates. Such a condition can be disastrous for
a new born because it cannot actually cope-up with it (Conde‐Agudelo & Díaz‐Rossello 2016).
In this regard, it should be the responsibility of the parents and the maternal care providers to
provide that kind of child with the necessary support that it needs. Research has reported that
low-birth weight is a problem in Australia (Anderson, Crengle, Kamaka, Chen, Palafox &
Jackson-Pulver 2006). However, the Australian mothers have a relief because they can rely on
the kangaroo and incubation care to bring up their hypothermia-risky infants. The use of
kangaroo and incubation should, however, not be restricted to those with low-birth weight, but to
all the infants in Australia because it means a lot for their health and growth.
Personally, I not only know about incubation and skin-to-skin care because I have read
about it. Apart from the evidence I have gathered from scientific research, I have an anecdotal
experience about them. I remember an instance when my auntie gave birth to a low-weight child
in one of the hospitals in Sydney. Although my auntie and her husband wanted to put the child in
an incubator, the medics recommended a skin-to-skin care. We had no choice, but to listen and
abide by our medic’s advice. The end result is that the child was given a kangaroo care which
ended up providing it with a conducive condition for growth. My auntie managed to organize
how to start breast feeding as well as creating a close relationship with the kid (Gabrysch,
Civitelli, Edmond, Mathai, Ali, Bhutta & Campbell 2012). Through a continued kangaroo
support, the child managed to develop and grow up to be mature, intelligent, healthy, and active

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human being today. This is a clear justification that low-birth weight is a problem whose solution
lies in the provision of effective antenatal care to the infant.
3. Synthesise the available literature (minimum 6 articles are required) regarding
the intervention/treatment/approach/program you selected and consider the outcomes of the
selected studies.
Newborn child care is a topic that has been extensively studied. Over the years,
researchers have done a commendable for studying this topic to gather and disseminate
information that can be used to understand the challenge and arrive at a feasible solution that can
be used to address. According to the research conducted, Australian children are provided with
two kinds of care. One, they may benefit from the kangaroo care which basically involves a
direct contact between the newborn and the mother (Schaaf, Vergara-Tabares, Peralta, Díaz &
Peluc 2018). The kangaroo care is more natural because it creates a strong bond between the
mother and child right from that early age. Two, the Australian healthcare facilities sometimes
opt for an incubator in which a child is provided with the right warmth in an artificial setting.
Meaning, once born, the child is kept enclosed in an incubator where there is enough oxygen and
the temperature that favors the condition and supports growth and development (Charpak,
Tessier, Ruiz, Hernandez, Uriza, Villegas, Nadeau, Mercier, Maheu, Marin & Cortes 2016).
Such an environment can be suitable for a newborn because it does not allow any unnecessary
shocks that might arise due to the variation in the body temperatures.
In their research, Charpak, N., Tessier, R., Ruiz, J.G., Hernandez, J.T., Uriza, F.,
Villegas, J., Nadeau, L., Mercier, C., Maheu, F., Marin, J. and Cortes, D., found out that
kangaroo care still remains the most popular standard practices in Australia, its widely

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recognized being that it has so many benefits (Charpak, Ruiz-Peláez &Charpak 2001). There is
holistic approach that is taken to provide for the preterm babies by the use of the skin to skin care
which is known as the kangaroo care (Charpak, Tessier, Ruiz, Hernandez, Uriza, Villegas,
Nadeau, Mercier, Maheu, Marin & Cortes 2016). Most hospitals in Australia prefer it because
the practice supports breastfeeding, physiologic, social and psychological care for both the
mother and the child that is born preterm. The country hospitals advocates for the immediate skin
to skin care on the mother’s chest after birth. The baby should remain there without interruption
unless there are other specific medications to be administered. These sentiments were echoed by
Charpak, N., Ruiz-Peláez, J.G. and Charpak, Y., who, in their research, found out that kangaroo
care can be more beneficial to an infant because it helps in the stabilization of the body
temperature. The stabilization of the child’s temperature which begins during pregnancy can
continue if the mother provides a skin-to-skin care to the newborn. Although the same service
can be provided by an artificial incubator, the researchers believe that the mother or father’s skin
is much better because it cannot be compared to electrical warmers in any way. It brings a
natural setting that cannot be replaced by any innovation.
The supremacy of skin-to-skin over the incubation care was reported by Worku, B. and
Kassie, A., who, in their studies, found out that kangaroo care is much better because it enables
the mother to initiate the breastfeeding process. The research revealed that immediately after
birth, the mother should organize to breastfeed the newborn because breast milk is the best food
for the child at that time (Worku & Kassie 2005). Although the child has instincts that naturally
enable it to identify the mother’s breast, it can be much better if it happens when the two have a
direct skin contact. Once such a contact is made, the mother would not struggle to initiate the
breastfeeding process because it would have been enabled by the contact. And rapport so far

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established between the mother and the newborn. Ibe, O.E., Austin, T., Sullivan, K., Fabanwo,
O., Disu, E. and Costello, A.D.L., relate this benefit when they link it to the transmission of
bacteria from the mother to the newborn. Although a child also has an opportunity of getting
vaginal bacteria from the mother during birth, the same can e acquired through a direct skin-skin
contact (Ibe, Austin, Sullivan, Fabanwo, Disu & Costello 2004). Such bacteria are important
because, just like the breast milk’s antibodies, they can help in protecting the infant from
diseases and allergies that might be a bother to the child as it grows up.
The significance of kangaroo care was also reported by Bergman, N.J., Linley, L.L. and
Fawcus, S.R., who, in accordance to their research, discovered that skin-to-skin care can be
benefiting the newborn by preventing them from crying. According to this study, the skin contact
between the mother and the child helps in creating some communication that prevents the child
from crying (Bergman, Linley & Fawcus 2004). Crying, according to this research is a distress
kind of call that a child gives in the absence of the mother. Cattaneo, A., Davanzo, R., Worku,
B., Surjono, A., Echeverria, M., Bedri, A., Haksari, E., Osorno, L., Gudetta, B., Setyowireni, D.
and Quintero, S., say that crying helps in calling the mother especially at a time when the child
feels insecure and requires the protection and company of the mother. That is the funny way
through which the newborn babies communicate. Apart from the prevention of crying, skin-to-
skin care can create a favorable environment for the child to reduce the pain that is experience
following birth (Cattaneo,, Davanzo, Worku, Surjono,, Echeverria, Bedri, Haksari, Osorno,
Gudetta, Setyowireni & Quintero 1998). It fastens the recovery process.
4. Compare and contrast findings from different studies and highlight study strengths and
limitations of those you included in the review

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The studies that were reviewed in this paper provide invaluable information on the care
of the newborn babies. Low-birth weight is a challenge that should be addressed because it does
not mean well for the new born children. In this section, a thorough comparison is made on the
publications whose findings have been analysed above. The comparison is based on the
similarities and differences that appear in the research and findings of each of the scholars. It
also goes ahead to analyse the limitations of the literature. The limitation that I identified in the
resources is that most of the resources do not have enough evidence to prove their claims. The
research design and methodology used by most of the writers was not sufficient enough to enable
them produce extensive and reliable results. The use of Randomised Controlled Trial might not
be efficient enough in providing evidence because some of them used a small sample size. For
example, in the “A comparison of kangaroo mother care and conventional incubator care for
thermal regulation of infants< 2000 g in Nigeria using continuous ambulatory temperature
monitoring,” the authors only used a sample of 13 infants. The same limitation was identified in
“Randomized controlled trial of skin‐to‐skin contact from birth versus conventional incubator for
physiological stabilization in 1200‐to 2199‐gram newborns” in which a sample of 34 infants was
used to participate in the study. The use of such a small sample size was inappropriate because it
might have compromised the results. This might have affected the generality of the findings.
The first major similarity between the articles is that they all acknowledge that the care of
low-birth weight children is a major issue that should be taken so seriously. The researchers
agree that all the low-weight born children should be provided with appropriate care that can
enable them to overcome their challenges and be able to catch up with life in the new
environment to which they are introduced (Baley 2015). The other similarity that was noticed in
the publications is that each of them acknowledges the significant contributions of kangaroo and

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incubation care. Each of the scholars says that the care is essential to a child because it means a
lot for them. Articles like “Kangaroo Mother Care: A Randomized Controlled Trial on
Effectiveness of Early Kangaroo Mother Care for the Low Birth-weight Infants in Addis Ababa,
Ethiopia,” “Kangaroo mother care for low birth-weight infants: a randomized controlled trial in
different settings,” and “A Randomized, Controlled Trial of Kangaroo Mother Care: Results of
Follow-Up at 1 Year of Corrected Age” established that kangaroo mother care is superior to the
incubation care. Similar assertion was made in “Randomized controlled trial of skin‐to‐skin
contact from birth versus conventional incubator for physiological stabilization in 1200‐to 2199‐
gram newborns” where the researchers established that kangaroo care is superior when it comes
to the stabilization of the child’s conditions. This clearly demonstrates that without it, it might
not be possible for the newborn to survive, get used to the new environment, and grow as
expected. Moreover, the researchers did an extensive study because they were mainly based on
the collection of data from the secondary sources. Meaning, the research methodology was more
or less similar because it was based on a similar design and methodology. For example, in their
research, Charpak, Figueroa, Ruiz-Pelaez, and Charpak used a randomized study of kangaroo
care. The same style was replicated by Fawcus and Bergman who also used the same approach to
conduct a comparative study of the skin-to-skin and the incubator care. In fact, all the studies
used the same approach to collect analyse and present their data.
However, despite all these similarities, these publications had different findings. The
findings were different because each of them was aimed are providing the desired answers to the
respective research question and objectives that had been pre-set by the researchers. Although all
studies were based on the kangaroo and incubation care, each of them was touching on a specific
concept that was apparently not falling within the scope of another research. For example, in “A

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comparison of kangaroo mother care and conventional incubator care for thermal regulation of
infants< 2000 g in Nigeria using continuous ambulatory temperature monitoring,” the main focus
of the study was on the concept of thermal regulation. Meaning, it mainly centered on the issues
to do with the control of the infant’s body temperature. This differs from what other scholars
reported in their articles. These differences vary from one writer to the other because each of
them was seeking to address a certain audience which suit the kind of message to be delivered.
5. Based on your review of the evidence, Explain the rationale for your decision making to your
situation of uncertainty
According to the research that I undertook, I decided to make the following conclusions.
One, newborn children require a specialized care which can be given through the use of
kangaroo or incubation care. Two, kangaroo care should be used by Australian mothers because
it is better than the incubator (Charpak, Tessier, Ruiz, Hernandez, Uriza, Villegas, Nadeau,
Mercier, Maheu, Marin & Cortes 2016). I made these decisions because the evidence I got
proves me right. The rationale for my conclusion is, therefore, based on the fact that scientific
evidence proves that skin-to-skin care can bring more benefits than the incubation (Worku &
Kassie 2005). Although an incubator also provides the child with appropriate warmth and the
temperature that it needs, it cannot outweigh the mother’s skin (Seidman, et al. 2015). My
decision was purely based on the assertion that kangaroo care does much better in as far as the
stabilization of the child’s temperature is concerned. At the same time, the studies convincingly
expressed that kangaroo care can benefit the child because it prevents pain and crying (Johnson
2008). Further still, the kangaroo care can give the mother an ample opportunity develop a strong
bond with the newborn and initiate the breastfeeding exercise. All these cannot be effectively
done in the incubator.

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Summary Table
Author, Year Title / Key words Aims/
Objectives
Methods Sample Key Findings Limitations
Bergman, N.J.,
Linley, L.L. &
Fawcus, S.R., 2004.
Randomized
controlled trial of
skin‐to‐skin
contact from birth
versus conventional
incubator for
physiological
stabilization in
1200‐to 2199‐gram
newborns.
To
compare
the
effectivene
ss of skin-
to-skin
contact and
incubator
care
Randomise
d
controlled
trial
34 infants
used as a
sample
Skin-to-skin
care is more
effective in
the
stabilisation
of the infant’s
physiological
growth
Small
sample size
used
Cattaneo, A.,
Davanzo, R.,
Worku, B.,
Surjono, A.,
Echeverria, M.,
Bedri, A., Haksari,
E.,
Osorno, L.,
Gudetta, B.,
Setyowireni, D. &
Quintero, S., 1998
Kangaroo mother care
for low birth weight
infants: a randomized
controlled trial in
different settings
To study
the skin-to-
skin care
for the
newborns
with low-
birth
weight
Randomise
d
controlled
trial
570 sample
size drawn
from
Ethiopia,
Indonesia
and Mexico
Kangaroo
care is
advantageous
because it
helps in
creating
favourable
development
condition for
the infant
during the
early stages of
growth
Possibility
of biasness
in the
findings
Charpak, N.,
Tessier, R., Ruiz,
J.G., Hernandez,
Twenty-year follow-
up of
kangaroo mother care
To find out
the
effectivene
ss of skin-
o-skin and
the other
Randomise
d
controlled
trial
716
participants
used in the
study to
represent
the target
Skin-to-skin
care is more
effective than
the
conventional
incubation
Possibility
of biasness
in the
findings

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J.T., Uriza, F.,
Villegas, J.,
Nadeau, L.,
Mercier, C.,
Maheu, F., Marin,
J. & Cortes, D.,
2016
versus traditional care convention
al care that
has been in
use
population care
Charpak, N., Ruiz-
Peláez, J.G. &
Charpak, Y., 2001
A randomized,
controlled trial of
kangaroo mother care:
results of follow-up at
1 year of corrected age
To study
the
effectivene
ss of skin-
to-skin care
A
randomized
, controlled
trial
A sample of
746 infants
born at at≤
2000 g was
used for the
study
Skin-to-skin
care is more
effective in
providing the
child with
good
conditions for
growth.
Possibility
of biasness
in the
findings
Ibe, O.E., Austin,
T., Sullivan, K.,
Fabanwo, O., Disu,
E. & Costello,
A.D.L., 2004
A comparison of
kangaroo mother care
and conventional
incubator care for
thermal
regulation of infants<
2000 g in Nigeria
using continuous
ambulatory
temperature
monitoring
To
establish
the
effectivene
ss of skin-
to-skin care
and
incubator
in the
stabilisatio
n of body
temperatur
e
Randomise
d
controlled
trial
13 infants
with a birth
weight of <
2000 g
Although both
methods are
good, the
research
proved that
skin-to-skin
care is more
effective in
thermal
regulation of
the infants
Study only
based in
Nigeria. So,
it might not
be
applicable
to other
contexts

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Worku, B. &
Kassie, A., 2005.
Kangaroo mother care:
a randomized
controlled trial on
effectiveness of early
kangaroo mother care
for the low birth
weight infants in
Addis
Ababa, Ethiopia
To study
the
effectivene
ss of early
kangaroo
mother
care for the
low birth
weight
children
Randomize
d
controlled
trial
A total of
123 low
birth-weight
infants were
included in
to the study.
Sixty-two
infants were
enrolled as
Kangaroo
Mother Care
(KMC)
and the
remaining
61 were
Convention
al Method
of Care
(CMC)
cases
Skin-to-skin
care is more
effective for
the low-birth
weight
children
Study based
in Ethiopia
and might
not be
generalised
to other
areas

14
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