NRS-490 - Early Skin-to-Skin Contact's Impact on Newborn Health

This report, prepared for NRS-490 at Grand Canyon University, investigates the impact of early skin-to-skin contact (SSC) on newborn health. The paper explores the benefits of SSC, including reduced hypothermia, improved breastfeeding, and enhanced mother-child bonding. It addresses the barriers to implementing SSC, such as lack of knowledge and motivation among healthcare professionals, and proposes strategies for successful implementation within a 10-week timeframe. The report includes a PICOT question to guide the research, a literature search strategy, and an analysis of relevant research articles. The paper emphasizes the importance of teamwork among nurses, doctors, and mothers to achieve the desired outcomes of improved infant health and maternal well-being. The report highlights the role of nurses in promoting SSC and the need for education and support to overcome implementation challenges. The paper also includes a literature evaluation table and discusses the limitations of the research studies analyzed.

Running head: IMPACTS OF SKIN TO SKIN CONTACT
How Early Skin to Skin Contact Within the First Hour of Life Influences Newborn Health
Lajuanna Barnett
Grand Canyon University: NRS-490
May 16, 2019

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How Early Skin to Skin Contact Within the First Hour of Life Influences Newborn Health
Background Statement and Evidence Summary
Skin-to-skin contact (SSC) has been observed to cause positive results in neonatal health
conditions. These positive outcomes include improved breastfeeding of infants and a strong bond
between the infant and mother. Hypothermia is a condition that affects most of the infants,
therefore leading to an abnormal decrease in body temperatures below normal levels. More than
20% of infants experience several problems when SSC is not introduced immediately after birth
(Chan et al. 2016). The symptoms of the recession may have negative impacts on both the
mother and the newborn. Skin-to-skin contact between the infant and the mother is effective in
the reduction of the problems related to postnatal care. Research outcomes from various nursing
studies have shown that SSC is important in reducing infant mortality rates (Alenchery et al.
2018). SSC also promotes mental growth and development in infants as well as leads to the
cognitive development of infants (Feldman, Rosenthal, & Eidelman, 2014). Poor maternal care
has led to serious clinical problems that relate to lack of regular SSC during the early lives of
infants (Vilinsky, Sheridan & Nugent, 2016). The time period taken to accomplish the project is
ten weeks to allow for proper evaluation of the benefits of SSC. This paper will succinctly
analyze the positive effects of SSC and barriers associated with the implementation of this
project into nursing practice.
Discussion
Comparing of the Research Questions

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The analysis and comparison of the research questions are crucial in the implementation
of this project. Research questions provide a guideline for effective understanding of the barriers
related to SSC and interventions to eliminate these barriers, therefore, leading to improved
newborn care (Baley, 2015). The first research question focuses on the barriers and strategies to
be used in the implementation of SSC during the postnatal care period. This research question
analyses the main enablers. The enablers in the implementation of SSC include the availability of
knowledge on the benefits of this practice in maternal care. One of the known benefits of SSC is
the development of a stronger bond between the infant and the mother. From the research study,
it is identified that the scarcity of skilled personnel is the main barrier interfering with the
implementation and adoption of SSC in infant care practices. There was a reduced number of
competent nursing personnel in the labor room as compared to a large number of women giving
birth. Another barrier in the implementation of SSC practice was the doubts from the people on
the efficacy of the practice in neonatal and maternal care. Lastly, the lack of motivation from the
experienced staff was another barrier that influenced the adoption of SSC. Teamwork is one of
the strategies to be used in avoiding the negative effects related to the implementation barriers
(Moore, Bergman, Anderson & Medley, 2016).
The second research question focuses on the safety of patients during caesarean section
deliveries. Safety of the mother and the newborn is a critical factor to be achieved through active
participation of skilled obstetricians and nurses to improve the efficacy of SSC in nursing
practices (Armbrust, Hinkson, von Weizsäcker, & Henrich, 2016). The research question
presented on the third article by Chan summarizes the importance of Kangaroo care in the
prevention of hypothermia and breastfeeding. Through breastfeeding, stimulation of the nervous

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system is achieved therefore, leading to relaxation and dilation of blood vessels leading to
thermal regulation (Koopman et al. 2016).
Comparing of the Sample Populations
Different designs were used in the collection of data during the research studies. The first
design was done based on a qualitative study whereby moderators were interviewed in two
Indian hospitals. In this case, 41 healthcare workers were selected for an interview. The
healthcare workers were those working in the labor and delivery unit. Moderator's guide was
used during the interview to improve the relevancy of the data collected. The main idea obtained
through this design were the barriers, enablers, and interventions that can be used to overcome
the negative implication of SSC on the health of both the mother and the infant and improve
postnatal care. The use of Likert’s scale was effective in providing choices to the interviewers
(Ludington-Hoe, 2015). The questionnaire materials contained multiple choice questions to be
answered and selected by population sample. The third design involved the analysis of data
obtained from the World Health Organization (WHO). The regional databases were evaluated
because the implementation and efficacy of SSC vary depending on the geographical areas. For
instance, the data from India are different variations from data from Africa. The benefits of
kangaroo care were then analyzed because it improves mother-to-infant bonding. In the last
research study, 73 premature infants during a consecutive period of two weeks were compared
with a case in which 73 participants were receiving standard care. A follow up was done to
record and analyze cognitive and psychological changes in these infants in one year.
Comparing the Limitation of the Study

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The available models used in the analysis of the collected research data were tiresome
and consumed a lot of time because it involved sorting of quotes and data, identification of
thematic issues and familiarizing with the data. In the first research, the interpretation of the data
was difficult because different healthcare workers had different views on the barriers of SSC and
the appropriate measures to improve its efficacy and reduce infant mortality rates. Another
limitation of the research was the lack of relevant models used in the analysis of the collected
data. The analysis of randomized data is not appropriate; therefore, does not support the
implementation of SSC practice in mothers and infants (Sharma, 2016). The main problem
identified from the research involving the analysis of the articles from WHO was the lack of
regional databases in articles. The limitations vary depending on the research design used in the
data collection and analysis (Safari et al. 2018).
Problem statement
Maternal-newborn contact influences the infant’s psychological system including sleep
patterns, stress reactivity, anatomical functioning, and support brain developments enchasing
both behavioural and cognitive controls(Armbrust, Hinkson, Von Weizsäcker, & Henrich, 2016).
In addition, skin to skin contact encourages mother-child bonding, breastfeeding and maintain
infants body temperatures. Therefore, encouraging early skin to skin contact is crucial for child
development(Hsu, 2014). This project intends to evaluate what are the benefits of early skin to
skin contact, barriers, and create a project plan for implementation of various strategies that can
be used to support early skin contact within the first hours of life and within the ten-week time
period.

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Purpose of the Change Proposal
The purpose of this project is to demonstrate and enhance the practice of SSC in the early
life of a newborn within the first hour during the next ten weeks. Studies, as illustrated in the
literature review, shows that early SSC has both physical and mental benefits to an infant.
However, most of the nurses do not understand the need for SSC basically due to a lack of
knowledge, lack of motivation and other staff related issues. This project intends to provide a
strategic plan that can be used with proposed implementations in a given timeframe to encourage
SSC.
PICOT Question: 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, encourage breastfeeding and improve
maternal-newborn bonding, when implemented within the first hour after birth, within a 10-week
time period?
P: Population: Newly born infants and Mothers
I: Intervention: Skin-to-Skin Contact
C: Comparison: Avoidance of Skin-Skin Contact
O: Outcome: Alleviation of Hypothermia, improved breastfeeding, and mother-child bonding
T: Time Period: 10 weeks

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Literature search strategy
The search strategy was conducted on three online databases which include CINHAl
hosted by EBSCOhost, PubMed hosted by NCBI, and Medline hosted by Ovid. The inclusion
criteria included all articles that were published not more than five years ago, peer-reviewed and
systematic journals and those that were full text. In addition, the study included articles that
tacked about skin to skin contacts, kangaroo care, barriers to the skin to skin contacts, its benefits
to newborn and methods of implementation. All other articles were excluded from the study.
Key terms used
The key terms used in the research include Skin to skin contact, Kangaroo care, implementation,
barriers, benefits
Evaluation of Causes
There are various barriers that prevent the implementation of early skin to skin contact
within the first hour of life. One of the major courses is lack of knowledge, skills and
understanding the benefits of early SSC to an infant by nurses and doctors in the labor room.
Most health care professionals do not see the need for SSC and they fail to practice it regularly or
not at all (Chan, Valsangkar, Kajeepeta, Boundy, & Wall, 2016). In addition to that, the lack of
motivation from experienced staff and personal confidence is also another major barrier that
prevents the practice of SSC in many novice nurses. Finally, there could be a large number of

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mothers delivering than the number of nurses and doctors staffed and thus they may fail to
practice SSC due to work overload.
Identification of stakeholders
The project covers all parties that are involved in care and delivery within a labor room and
antenatal care. This involves midwives, registered nurses, and doctors. In addition, the mother is
also a stakeholder as determined by compliance and benefits she will achieve.
Discussion of stakeholders
In order for the implementation of SSC to work all stakeholders including nurses, doctors
and mothers must work as a collaborative team for the purpose of the infant to produce the
desired outcomes. Nurses play a major role in the delivery process. This includes delivering the
baby, patient education, monitoring mother during delivery, caring for the infant, managing and
foreseeing both physical and psychological issues that may arise and maintain good,
comfortable, quality and safe conditions of the mother and the baby after delivery. SSC is one of
the major primary procedures that nurses are expected to perform after delivery. For successful
SSC, nurses need to be committed to the procedure by preparing the mother for SSC as soon as
possible. This includes encouraging the mother to hold her baby, explaining the need for SSC to
the mother and performing a follow up to make sure the procedure is implemented. In order to do
that, nurses need to be motivated, have the skills and knowledge and be willing to perform the
procedure as guided by principles and standards of care.

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Doctors are other major stakeholders that play a vital role in implementing SSC. Doctors
are involved in performing and confirming the various diagnosis and health assessment of a
mother and her baby. Doctors also are responsible for performing deliveries whether it takes
place in the labor room or the operating room. Therefore, physicians should also commit
themselves to encourage mothers and explaining to them the need of SSC after delivery. The
physician should also work together as a team with nurses to make sure the required
implementations are done. On the other hand, it is the responsibility of the mother to ask for her
baby as soon as she delivers. Putting other factors aside like psychological and labor
complication issues, the mother should always comply with the procedure and follow medical
instruction regarding SSC at home.
Proposed Implementation with outcome measures
In order to facilitate early SSC in labor rooms certain strategies need to be put into place
with expected outcomes. First, all nurses need to be educated using current guidelines and best
available evidence knowledge and skills regarding early SSC.(Alenchery et al., 2018) This, in
turn, will make them understand the need for SSC, equip them with competent skills and
knowledge they need to perform quality early SSC. The outcomes for educating nurses will
increase the practice of SSC in labor units and thus promoting infant physical and cognitive
abilities. Documentation of skin to skin contact should be utilized in the EMR system for
monitoring and tracking.
The other strategy includes encouraging the experienced nurses and nurse leaders to
motivate and teach novice nurses the need for SSC practice. Motivation and use of influence can
create a great impact on how often nurses perform early SSC in labor units. Nurse leaders should
advocate policy for change that allows more nurses to be employed in labor units where

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deliveries are much more than staff(Moore, Bergman, Anderson, & Medley, 2016). This would,
therefore, instil self-confidence in nurses allowing them to practice early SSC all the time. The
outcome measures will be reduced overload as a barrier for implementation, increased
motivation and self-confidence and thus the practice of early SSC in every infant born.
The last strategy involves use of Joey Band SSC products. Joey Bands have been seen to
facilitate and increase the duration of SSC and at the same time preventing fall injuries of infants
in hospitals especially in operating rooms (Janiszewski & Lee, 2014). The outcomes measure that
will be experienced include extended time for SSC, easy transportation of mother and child
together and reduced falls injuries.
Proposed change theory
This study seeks to apply the planned theory of change as developed by Lippitt, Watson,
and Westley in 1958 which focused on responsibility and roles of a change agent other than the
change itself (Udod & Wagner, 2019). This theory was adapted from Lewin’s model of change
which they expand it into seven major processes of change. These seven planned change
processes include identifying the problem, accessing motivation level in the system, assessing
motivation and resources of the changed agent, establishing change strategies and objectives,
determining the roles of the change agent, maintain those changes and gradually finalizing the
activities as the change become part of the organization (Udod & Wagner, 2019). The work of
the nurses and doctors is to adhere to the process of change in order to adopt new SSC practices
as part of their clinical practice.

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Barriers to implementation
The only barrier of implementation is the failure of nurses and doctor to adhere to the
proposed implementation. Once all nurses and doctors accept to be the agents of change and
implement the required strategies, early SSC practice will be part of their professional practice.

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References
Alenchery, A. J., Thoppil, J., Britto, C. D., de Onis, J. V., Fernandez, L., & Rao, P. S. (2018).
Barriers and enablers to skin-to-skin contact at birth in good neonates-a qualitative study.
BMC Pediatrics, 18(1), 48. https://doi.org/10.1186/s12887-018-1033-
Armbrust, R., Hinkson, L., von Weizsäcker, K., & Henrich, W. (2016). The Charité caesarean
birth: a family orientated approach of caesarean section. The Journal of Maternal-Foetal
& Neonatal Medicine, 29(1), 163-168. https://www.ncbi.nlm.nih.gov/pubmed/25572878
Baley, J. (2015). Skin-to-skin care for a term and preterm infants in the neonatal ICU.
Pediatrics, 136(3), 596-599. doi: 10.1542/peds.2015-2335.
Chan, G. J., Valsangkar, B., Kajeepeta, S., Boundy, E. O., & Wall, S. (2016). What is kangaroo
mother care? A systematic review of the literature. Journal of global health, 6(1).
https://dx.doi.org/10.7189%2Fjogh.06.010701
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. https://doi.org/10.1016/j.biopsych.2013.08.012
Janiszewski H and Lee L. 2014. Guideline for the prevention and management of baby falls whilst being
cared for in Nottingham University Hospitals NHS Trust. Available from
www.nuh.nhs.uk/handlers/downloads.ashx?id=54771 (accessed 01/02/15).
Koopman, I., Callaghan‐Koru, J. A., Alaofin, O., Argani, C. H., & Farzin, A. (2016). Early skin‐
to‐skin contact for healthy full‐term infants after vaginal and caesarean delivery: a

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qualitative study on clinician perspectives. Journal of clinical nursing, 25(9-10), 1367-
1376. http://doi.org/10.1111/jocn.13227
Ludington-Hoe, S. M. (2015). Skin-to-skin contact: a comforting place with comfort
food. MCN: The American Journal of Maternal/Child Nursing, 40(6), 359-366. doi:
10.1097/NMC.0000000000000178
Moore, E. R., Bergman, N., Anderson, G. C., & Medley, N. (2016). Early skin‐to‐skin contact
for mothers and their healthy new-born infants. Cochrane database of Systematic
Reviews, (11). doi: 10.1002/14651858.CD003519.pub4.
Sharma, A. (2016). Efficacy of early skin-to-skin contact on the rate of exclusive breastfeeding
in term neonates: a randomized controlled trial. African health sciences, 16(3), 790-797.
doi: http://dx.doi.org/10.4314/ahs.v16i3.20.
Udod, S., & Wagner, J. (2019). Common Change Theories and Application to Different Nursing
Situations. Retrieved from
https://leadershipandinfluencingchangeinnursing.pressbooks.com/chapter/chapter-9-
common-change-theories-and-application-to-different-nursing-situations/
Vilinsky, A., Sheridan, A., & Nugent, L. E. (2016). Preventing peri-operative maternal and
neonatal hypothermia after skin-to-skin contact. Journal of Neonatal Nursing, 22(4), 163-
170. doi: https://doi.org/10.1016/j.jnn.2016.02.002

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Appendixes
Appendix A. Action Plan Strategy
Strategy for implementation Expected outcomes Timeline
1. Educate nurses the need for SSC by
equipping them with the required
knowledge and skills.
a. Production of competent
nurses that can perform
Quality SSC with
confidence and in the right
way
b. Increase in a number of
early SSC done in labor
units and within the first
hour of life.
First two
weeks
2. Encouraging experienced nurses to
motivate and encourage novice nurses
to perform early SSC.
c. Existence of lively nurses
who are willing to perform
early SSC with confidence
Week
three
3. Development of guidelines using best
available evidence on the standards that
healthcare professionals will be using to
perform SSC and putting it inform of
charts at labor rooms
d. Existence of a consistent
way or protcol in which all
health professionals will be
following when performing
SSC.
e. Active reminders for
novice nurses on what they
are expected to do after
delivery of a newborn.
Week four
4. Advocating for additional employees
where the workload is more than nurses
f. Reduced workload
g. Performance of SSC in all
infants
Week five
and six

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Appendix B Literature Evaluation Table
Criteria Article 1 Article 2 Article 3 Article 4
Author,
Journal
(Peer-
Reviewed
), and
Permalin
k or
Working
Link to
Access
Article
(Alenchery et al.,
2018) BMC
Pediatrics
https://
www.ncbi.nlm.nih
.gov/pubmed/
29426317
(Armbrust et al.,
2016) The Journal
of Maternal-Fetal
& Neonatal
Medicine
https://
www.ncbi.nlm.nih
.gov/pubmed/
25572878
(Chan et al., 2016)
Journal of global
health
https://
www.ncbi.nlm.nih
.gov/pubmed/
27231546
(Feldman,
Rosenthal, &
Eidelman, 2014)
Biological
psychiatry
https://doi.org/
10.1016/
j.biopsych
.2013.08.0
12
Article
Title and
Year
Publishe
d
Barriers and
enablers to skin-
to-skin contact at
birth in a healthy
neonates-a
qualitative study,
2018
The Charité
cesarean birth: a
family orientated
approach of
cesarean section,
2016
What is kangaroo
mother care? A
systematic review
of the literature,
2016
Maternal-preterm
skin-to-skin
contact enhances
child physiologic
organization and
cognitive control
across the first 10
years of life, 2014
Research
Question
s
(Qualitati
ve)/Hypo
thesis
(Quantita
tive), and
Purposes/
Aim of
Study
This study was
conducted to
determine
enablers, barriers
and any potential
strategies or
measures that can
be used to
implement SSC at
birth in healthy
newborns.
This study was
conducted to
evaluate the safety
of patients
experiencing
Charite Cesarean
Birth, integrating
the delivery
process with skin
to skin contact
(SSC) and cutting
of the umbilical
cord
The purpose of
this research was
to describe the
Kangaroo Mother
Care in a different
setting and how
they influence skin
to skin contact and
breastfeeding.
This study was
conducted to
evaluate how
SSC helps in
child
psychological and
cognitive control
in the first decade
of life.
Design
(Type of
Quantitat
ive, or
Type of
Qualitati
ve)
A qualitative study
which used a
phenomenological
design as
developed by
Husserl and
Marleau-Ponty
Quantitative
research
Systematic
reviews
Case-control
design
Setting/ The research was Hospital setting at A total number of A total number of

16
Sample conducted in a
hospital setting
(St. John Medical
College Hospital,
Bangalore, India.
A sample of 41
health care
workers from the
labor unit was
used.
Charite University
Hospital in Berlin
1035 of articles
were included
73 premature
infants were used.
Methods:
Intervent
ion/Instr
uments
The study was
conducted using
an interview guide
and a focus group
discussion
moderator’s guide.
Randomized
control trials using
Modified Likert
Scale and
questioners
An online search
using key terms on
Embase, WHO
regional databases,
Scopus Web of
Science, and
PubMed.
73 premature
infants for 14
consecutive days
were compared
with 73 case-
matched
participants
receiving
standard care. A
follow up on their
first decade of
life recording all
cognitive and
psychological
activities were
done.
Analysis Data analysis was
conducted using a
framework
analytical
approach which
had the following
five steps-
familiarization of
data and coding,
identification of
themes, sorting
quotes, placing
quotes under the
thematic category
and finally
mapping and
interpreting.
Not Available Data analyzed
using a
standardized form
with categorical
components
Not Available.
Key
Findings
Main barriers
found include
inadequate staff-
CCB is a
significant and
useful option
Skin to skin
contact is a major
component that is
By 10 years,
children receiving
Kangaroo care

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patient ratio, the
rise of newborn
conditions and
parochialism
towards SSC.
Enablers included
workers
motivation,
knowledge and
skills toward SSC
and positive
experiences
when
recommended. It
improves early
infant to mother
interaction and
breastfeeding.
used to describe
Kangaroo Mother
Care.
showed improved
stress response,
better cognitive
control and
organized sleep.
Recomm
endations
 Increase
antenatal
awareness
among
patients
and nurses
 Frequent
interdepart
mental
training
and
teaching.
CCB should be
practiced more
often where
possible rather
than normal CS.
A standardized
operational
definition tool for
KMC should be
developed in order
to differentiate
SSC and other
KMC components.
Early touch
interventions are
recommended in
order to enhance
child psychology
in the following
lifetime.
Explanati
on of
How the
Article
Supports
EBP/Cap
stone
Project
The article gives
key strategies that
can be used to
prevent barriers of
SSC as one of the
major objectives
of the project.
This study
supports the
project in essence
that, it
demonstrates how
SSC can be
implemented in
CS patients.
This article helps
in understanding
what SSC means
and how important
it is especially in
Kangaroo Care.
This research
demonstrates how
effective SSC is
in promoting
child
psychological
development.