Obstetric Care: Design for Change Proposal

There have been a number of recommendations to initiate early skin to skin contact (SSC) between newborn infants and their mothers. Such recommendations have emerged from reputed sources including the WHO, giving them significance worth considering for nurses. They are based on the pretext that early SSC of the mother and the newborn has several positive effects on breastfeeding including initiation and sustenance. Other proposed benefits including bonding of the mother and the child, better brain development, less crying and generally increased chances of neonatal survival (Moore et al., 2007). However, in most clinical settings of obstetric care, children are separated from their mothers at birth, dried and wrapped for transfer into small cribs or radiant warmers. This denies them the potentially essential benefits of early SSC with their mothers especially within the first hour of birth. There is need for a change in practice, including institutionalization of early SSC between mothers and their babies more so if they are health. This paper summarizes evidence supporting practice change and an action plan based on the ACE star model of knowledge transformation. 

Change Model Overview

The ACE star model for knowledge transformation is an encompassing framework that allows for the systemic integration of evidence into practice. It has five distinct stages including knowledge discovery, evidence summary, translation into guidelines, practice integration and process outcome evaluation (Stevens, 2004). Nurses widely apply the ACE model to transfer clinical evidence into their practice settings. It is an easy to use, systematic and detailed mechanism that nurses can apply without any consultation or additional guidance.

Define the Scope of the EBP

Early skin to skin contact (SSC) of the mother and the child has been found to extend various benefits to both the mother and the child. When the child exits the maternal womb, they make a major transition into a world with different physical conditions that act as stressors to the child. Early SSC helps to moderate the impact of this transition, by stabilizing the child’s temperature, normalizing breathing and heart rate (Moore et al., 2007). They also form a strong bond with the mother, extending the relationship that existed in the womb. This may translate into initiation and sustenance of breastfeeding, with neurological mechanisms acting to ensure that babies with early SSC with their mothers breastfeed for longer periods (4-6 months). There are consequently higher chances of neonatal survival with the practice. Despite this fact, most hospitals dry and wrap the baby in readiness for some periodical separation from the mother. This widespread practice has in the process rendered contemporary obstetrics care as regressive in increasing chances of newborn survival and health (Moore et al., 2007). It potentially negates the many advantages and protective factors that are availed by hospital births in the present age. To an extent, the separation practices that delay SSC of the mother and the child contribute to the longstanding challenge of high infant mortality in the healthcare system.

Stakeholders

There are various stakeholders to be involved in this change initiative. They include two obstetric nurses to offer clinical and practice expertise, a neurologist to lay down the case for change from a neuroscience perspective, the nurse administrator to spearhead institutionalization of change and a General Practitioner (GP) who shall offer a medical perspective.

Determine Responsibility of Team Members

The various members of the team shall take different roles that are complementary to the change process. Obstetric nurses shall provide information on the status quo and possibly, their observations on the effect of the current practices on the health of the newborn, breastfeeding, neonatal mortality or any other issue. On the other hand, the neurologist shall lay the basis for change from a neuroscience perspective, explaining how SSC works to shape the relationship of the mother and the baby while influencing health aspects of the latter. The general practitioner on their part shall bring in additional medical aspects as necessary in relation to the proposed change and help in planning successfully with respect to ethics, management and practice needs. Finally, the nurse administrator shall play a critical role in examining how the designated change shall interact with existing standards and possibly augment with such guidelines.

Evidence

An external search for evidence resulted in various types of information. First, there were a number of evidence based practice (EBP) guidelines that intimated the essence of using the ACE star model of knowledge transformation in EBP. The sources indicated the importance of the model in structuring and bringing order into evidence based practice. There was also allusion to the fact that the ACE star model empowers nurses to integrate EBP independently without stakeholder or supervisory support. Other types of information included recommendations from the WHO on initiation of breastfeeding and the role played by early skin to skin contact of the mother and the baby in the process.

Summarize the Evidence

In this section, you need to synthesize the information from the systematic review article. What are some of the evidence-based interventions you discovered in your Evidence Summary that do you plan to use? Be sure and cite all of your references, in proper APA format, from any and all articles into this one paragraph.

There is sound evidence connecting early SSC of the mother and the baby to improved breastfeeding duration, initiation of the same and other positive maternal and neonatal outcomes. Moore et al. (2007) found that women with early SSC with their babies were more likely to be breastfeeding one to four months post-birth compared to with standard care (control groups). In addition, SSC mothers were more likely to breastfeed exclusively within 1-4 months, while their babies were also more likely to successfully breastfeed on their first feed. The study further uncovered a number of benefits fronted to the newborns, with better physiological scores evident. SSC infants had higher stability of the cardio-respiratory system and glucose levels. However, the temperature of SSC infants was similar to that of children under standard care.

Moore at al. (2012) investigated the impact of early SSC of the mother and the infant on breastfeeding, behavior and physiological adaptation in dyads consisting of healthy mothers and newborns. Their findings uncovered clear benefits of early SSC on breastfeeding between 1-4 months post-birth and breastfeeding duration. There was also improvement on maternal affectionate love and maternal attachment behavior. The study reaffirmed earlier findings by Moore et al. (2007) including the fact that SSC infants cried for lesser periods. The two studies effectively galvanize the premise that early SSC contains several benefits to breastfeeding, maternal and neonatal health.

Develop Recommendations for Change Based on Evidence

It is therefore recommended that all nurses in obstetrics care initiate early SSC between mothers and their newborn infants. This should be done within the first hour of birth and encompasses draying the baby and laying them on the mother’s bare chest before covering with a blanket.

Translation

Action Plan

Implementation of the plan shall begin with the development of stakeholder relationships and gaining their support. This shall be done by serving them with a copy of the proposed change with the evidence underpinning it. Next, the plan shall be fronted to the administration for review and possible institutionalization. Consequently, new practice guidelines shall be issued with any supportive material and non-material elements availed for its operationalization. At most, the entire process should take around four weeks.

Outcomes evaluation shall be carried out in every 8 weeks and shall be a key part of the implementation. Reports shall be delivered to the nurse leader to aid further practice changes and understand the benefits accorded by the practice change.  

Process, Outcomes Evaluation and Reporting

The expected outcomes include higher rates of neonatal survival, earlier initiation and sustenance of breastfeeding as well as stronger bonds between mothers and their children at large. It is also expected that the newborn infants shall have higher stability of the cardio-respiratory system, higher glucose levels and less crying. These outcomes shall be measured through clinical assessment of the mother-newborn dyads and reported to key stakeholders through periodical reports that shall be readily accessible on request.

Identify Next Steps

There is need to ensure the plan is implemented on a higher scale. This can be achieved by sharing the results with the entire facility and advocacy for institutionalization. The practice change should not just be a recommendation but rather a change that is supported and ironclad in the nursing code of practice. This shall ensure that the change becomes permanent and also spreads to other healthcare settings.

Disseminate Findings

Internally, the findings shall be communicated through a report that shall be shared on the institution’s online portal, notice-boards and other public spaces. Additionally, they shall be shared during seminars and stakeholder group meetings. Outside the organization, the findings shall be disseminated through newsletters and the institution’s public portal which is accessible to all members of the public.

Conclusion

This report outlines a design for change proposal, using the ACE five star model of knowledge transformation. The clinical issue in context is early SSC of the mother and the newborn and the benefits it accords to both neonatal and maternal health. Apparently, contemporary obstetrics care entails the separation of the mother and the child after birth, denying them various benefits in breastfeeding, bond formation, less crying and physiological stability. There is strong evidence linking positive maternal and newborn outcomes to early SSC. There is therefore need to change nursing practice and initiate SSC within the first hour of birth, by drying the baby and laying them on the mother’s bare chest prior to covering them with a blanket. To implement this change, there is need to draw stakeholder support and systematically measure and report outcomes for improvement.

References

Moore, E. R., Anderson, G. C., Bergman, N., & Dowswell, T. (2007). Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database Syst Rev, 3(3).

Moore, E. R., Anderson, G. C., Bergman, N., & Dowswell, T. (2012). Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database Syst Rev, 5(5).

Stevens, K. R. (2004). ACE Star Model of EBP: Knowledge Transformation. Academic Center for Evidence-based Practice. The University of Texas Health Science Center at San Antonio