Research Critique & PICOT Statement - Final Draft

This report aims to critically assess the following qualitative and quantitative uses, concerning the usage of appropriate skin-to-skin contact in newborn infants. 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 intrauterine to extra-uterine life, over a time of 10 weeks.

Running head: RESEARCH CRITIQUE & PICOT - FINAL
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Research Critique & PICOT Statement – Final Draft
Student’s Name
NRS-433V Introduction to Nursing Research
Grand Canyon University
Due Date

RESEARCH CRITIQUE & PICOT
Research Critique & PICOT Statement - Final Draft
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
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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
1st 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
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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.
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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
2nd 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
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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
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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
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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.
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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
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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.12128
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