Review the feedback on the change proposal professional presentation and make required adjustments to the presentation. Present your evidence-based intervention and change proposal to an interprofessional audience of leaders and stakeholders. Be prepared to answer questions and accept feedback.

After presenting your capstone project change proposal, write a 250-350 word summary of the presentation. Include a description of the changes that were suggested by your preceptor before your presentation and how you incorporated that feedback. Describe how this interprofessional collaboration improved the effectiveness of your presentation. Include a description of the feedback and questions from your audience after your presentation, and how this experience will affect your professional practice in the future.

While APA style is not required for the body of this assignment, solid academic writing is expected, and documentation of sources should be presented using APA formatting guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

(I attached a sample presentation, this is based on the powerpoint you wrote about Capstone Project change proposal presentation of fostering after discharge follow up

Runninghead: IMPACT OF SKIN TO SKIN ON NEWBORNS 1

Impact of Skin to Skin on Newborns in the Clinical Setting

Grand Canyon University

Professional Capstone

Instructor: Professor Leslie Greenberg

March 26, 2017

IMPACT OF SKIN TO SKIN ON NEWBORNS 2

Impact of Skin to Skin on Newborns in the Clinical Setting

Care of the newborn after delivery is critical for the outcome and health of the baby.

Numerous factors are included with the care of the newborn, including stabilization immediately

after delivery, medications, feeding, bonding, and adjusting to the outside environment. Failure

to implement basic treatment plans and interventions can result in negative health outcomes for

the newborn, potentially causing harm or death. Early interventions can help to promote health

early on in the newborn’s life. Implementing a standard plan of care and monitoring its outcome

and effects can help to ensure the establishment of the intervention.

Background

Early interventions immediately after delivery, or when deemed necessary, can create the

best outcome for the newborn. Skin to skin care, also referenced as kangaroo care, is a non-

invasive, natural and humane way to promote the adaptation and evolutionary habits of infants

(Jesus, Vieira, Alves, Rodrigues, Souza, & Paiva, 2015). This method includes placing the naked

infant directly on the mother’s, or recipient of choice, skin. This intervention allows the body,

legs, arms, and face of the infant to have direct contact to the parent’s bare chest or torso (Baker-

Rush, 2016). The newborn is placed on the mother’s abdomen once delivered as well as

whenever required or requested. Allowing a non-invasive intervention such as this can help to

promote numerous benefits for the infant. Assessment of the newborn as well as developing and

implementing a protocol for skin to skin care has the potential of reducing illness and morbidity

in newborns.

Problem Statement

Worldwide, more than 2.7 million newborns die each year, and 44% of children die

before five years of age. With this, interventions and implementations are essential in decreasing

this rate (Chan, Labar, Wall, & Atun, 2016). Assessment of the newborn both in-utero and

IMPACT OF SKIN TO SKIN ON NEWBORNS 3

immediately after delivery are important factors that will be included in the care of the newborn.

Interventions are required and should be implemented to ensure that the newborn has the greatest

chance of survival.

Technology has changed tremendously over the years, impacting the outcomes for

patients throughout healthcare. For newborns, radiant warmers have evolved and can be very

beneficial in some circumstances. However, the intervention of skin to skin care can be used, and

in some instances, can be more beneficial. The problem that can present is when nursing

professionals use the radiant warmers rather than placing the newborn skin to skin with the

mother, father, or recipient of choice. Newborns are susceptible to hypothermia, a temperature

below 36.5 degrees Celsius or 97.7 degrees Fahrenheit. Newborns are susceptible to this as a

result of a large surface area to body mass ratio and an immature thermoregulatory system

(Rodgers, 2013). If the newborn has a temperature that requires an intervention, rather than

placing the newborn under the warmer, the infant can be placed naked, skin to skin, with the

mother. This promotes bonding and comfort, all while increasing body temperature. Research

has been conducted, proving that there are benefits that exist from using skin to skin care.

Without intervening, complications such as hypoxia, hypoglycemia, respiratory distress,

acidosis, hyperbilirubinemia, renal failure, and coagulation defects may occur (Rodgers, 2013).

Change Proposal

Using evidence and research to implement a plan of care that promotes comfort, bonding,

and physiological benefits is crucial for the outcome of the newborn. The purpose of the change

proposal includes the standardization of care for skin to skin care as well as protocols for the use

of the intervention. This will allow education and promote emphasis for the use of skin to skin

care when required or desired. Many barriers may exist when implementing this intervention.

IMPACT OF SKIN TO SKIN ON NEWBORNS 4

Education on ways to handle these barriers will help enhance the use of skin to skin care. Using

research and evaluating the outcomes can help to promote this beneficial, yet non-invasive

intervention.

Using evidence to employ skin to skin care can help to employ its success as an

intervention. Using the Plan-Do-Study-Act model can help to thoroughly think through the

project and examine what is the best way to implement and follow through with it. Beginning

with the first step, plan; the problem is identified, the desired outcome is organized, and the

process for the change is developed (Stikes & Barbier, 2013). The next step, do; incorporates the

change process and collecting data. The study step includes collecting evidence and results, and

determining if the results are desired. The final step, act, includes acting on what was developed

and determining if the change method was beneficial or not. From this, the change can be either

accepted or denied (Stikes & Barbier, 2013).

PICOT

PICOT questions are developed once a clinical issue or problem has been developed.

These questions are used with research and determining if evidence-based practices can be

developed and implemented. The P in PICOT stands for the population of the subjects that will

be used for the study. The I in PICOT refers to the intervention to the treatment that will be used

in the study. The C in PICOT refers to the comparison of the study. This is the reference or

control group for the study. The O in PICOT stands for the outcome of the study. This will reveal

the result that is measured to determine the effectiveness of the intervention. The T in PICOT

refers to the time that the study was performed (Riva, Malik, Burnie, Endicott, & Busse, 2012).

The patient population (P) for the study and intervention of skin-to-skin care is term

newborns. The intervention (I) for this study is skin-to-skin care, also known as kangaroo care.

IMPACT OF SKIN TO SKIN ON NEWBORNS 5

The comparison (C) in this study is not using skin-to-skin care with infants. The outcome (O) for

this study is to determine if skin-to-skin care affects thermal regulation, early breastfeeding

initiation, and stress reduction, which will show with maintaining a normal range for vital signs

such as heart rate, blood pressure, and oxygen level. The time frame (T) for this study would be

infants immediately after delivery.

Literature Search

In terms of research and evidence, employing an appropriate and adequate research

strategy is critical for the outcome of a change proposal. Using a method that is organized and

has various key words can help to broaden the results. For the change proposal of implementing

skin to skin care, the key words of skin to skin care, kangaroo care, newborn, delivery, and

temperature were all used. The databases that were used were through Grand Canyon

University’s library. The databases include CINAHL, MEDLINE, and Science Direct. These

databases allow access to numerous health based journals with full text options.

Using validated and reliable resources can help to bring accurate and up to date

information to the patients receiving care. This can help to deliver the safest and most

appropriate care, ensuring health and well-being. Using this research to support skin to skin care

for newborns immediately after delivery helps to promote the intervention in health care settings.

Understanding that the information has been reviewed and has been validated, helps with the

promotion of skin to skin care.

Data and information with statistics and literature from studies help to promote the

beneficial outcomes for the topic. Many articles were researched regarding skin to skin care.

Background information, history, and statistics of skin to skin care were apparent in these

articles. Using the statistics from these articles can help to implement this intervention.

IMPACT OF SKIN TO SKIN ON NEWBORNS 6

Literature Evaluation

Using the evidence from journals and articles to promote skin to skin care is essential in

the success of the intervention. Several journal articles were reviewed and will be referenced,

supporting skin to skin care. Skin to skin care is a non-invasive intervention that should be

promoted, allowing the newborn as well as their mother to reap the benefits it has to offer. After

analyzing the data, benefits that exist are thermal regulation, adjusting to the environment,

duration of crying, pain management, regulation and control of pulse rate, oxygen rate, and blood

pressure, and bonding between the mother, father, or recipient of choice. Sometimes parents may

not be available, so surrogate caretakers or individuals may partake in skin to skin care.

Manifestations may present shortly after delivery, requiring interventions and medical

treatments for the newborn. Implementing skin to skin care immediately after delivery has shown

positive outcomes. A quasi-experimental study took place with infants aged 15-60 days.

Kangaroo care was implemented and the duration of crying and fussiness was evaluated. Before

using kangaroo care, the duration of crying was an average of 2.21 plus or minus 1.54 hours per

day. After kangaroo care was implemented, the average duration of crying was 1.16 plus or

minus 1.3 hours per day (Baker-Rush, 2016).

Newborns are required to have a routine heel stick procedure in order to collect blood for

the newborn screening for various diseases that may exist. With this, the newborn may feel pain.

In a randomized control trial, seventy-five preterm infants were included in the study. These

infants were randomly assigned to either an incubator group or kangaroo mother care group.

Four routine heel stick procedures were included and the pain was assessed with each procedure

and group. Crying, grimacing, and heart rate were evaluated. The results for the infants in the

IMPACT OF SKIN TO SKIN ON NEWBORNS 7

kangaroo mother care group were impacted with the use of skin-to-skin care. The infant’s heart

rate was lower, the duration of crying was shorter, and the facial grimacing was decreased

(n=38) (Gao, Xu, Gao, Dong, Fu, Wang, Zhang, & Zhang, 2015).

A single blind experimental study included thirty-three newborns which were randomly

assigned to either a control group or the intervention group of kangaroo care. Newborns in the

intervention group received kangaroo care for thirty minutes prior to the newborn screening

process. The control group did not receive kangaroo care prior to the procedure. Infants receiving

kangaroo care 1 and 3 minutes after the procedure benefitted from the use of kangaroo care,

showing the comfort measures provided (Campo, Amancio, Egipto, Fojas, Moreno, Olivar,

Regno, Siquig, Tawaran, & Yepez, 2014).

Assessment of the newborn is essential in determining their ability of their body to adjust

to the outside world and work independently. A study cohort included 265 mother and infant

pairs and the physiological data regarding respiratory rate, oxygen saturation, axillary

temperature, and heart rate of the infant. The assessment occurred for three consecutive days,

immediately before and after kangaroo mother care. The mean temperature increased while using

kangaroo care by 0.4 degrees Celsius. The respiratory rate increased by 3 breaths per minute, the

heart rate increased by 5 beats per minute, and the oxygen saturation increased by 5 percent

following skin-to-skin (Bera, Ghosh, Singh, Hazra, Som, & Munian, 2014).

With the implementation of early skin to skin care, newborns and their mothers will see

benefits that follow. Breastfeeding mothers who use skin to skin care have shown evidence and

success in the art of nursing. Newborns have innate capabilities in the use of sensory

mechanisms to smell and locate the breast upon delivery. When the newborn is placed directly

on the mother’s skin, near the breast, this sensory mechanism is activated. The research

IMPACT OF SKIN TO SKIN ON NEWBORNS 8

conducted concluded that early skin to skin contact between mother and infant promoted

interaction, less crying, better cardio-respiratory stability, and better initiation and longer

duration of breastfeeding (Hugill, 2015).

With numerous benefits apparent with the use of this non-invasive, low-cost intervention,

both the newborn as well as the facility benefit as a result. The known benefits from skin to skin

care include a decrease in cost for the facility. Increases in breastfeeding associated with skin-to-

skin care was a success, generating between £68,486 and £582,432 (Lowson, Offer, Watson,

McGuire, & Renfrew, 2015). A major benefit that was revealed was the reduction of

gastroenteritis and necrotizing enterocolitis in the hospitalized neonates (Lowson, Offer, Watson,

McGuire, & Renfrew, 2015).

Research and evidence has shown that implementing skin-to-skin care immediately after

birth, during painful procedures, or when the infant or parents desire, will benefit the newborn in

various ways. Using evidenced-based research to implement an intervention helps to promote

and benefit health and well-being. The literature provides background information as well as

supportive statistics and data to promote the use of skin to skin care.

Nursing Theory

Just as with nursing research, nursing theories help with implementing change. There are

two change theories that exist and are factors of how healthcare is evolved and delivered. Change

theories occur as a result of many different factors, including increasing costs, workforce

shortages, professional obligations, aging population, a strive to increase patient population, and

the promotion of patient and employee safety (Mitchell, 2013). Kurt Lewin developed a change

theory using unfreezing, moving, and refreezing methods. Lewin’s change model recognizes

IMPACT OF SKIN TO SKIN ON NEWBORNS 9

when change is needed, known as unfreezing. Examining and increasing the need and driving

force for change are all included in the first step of Lewin’s change model (Mitchell, 2013).

The second step in Lewin’s change model is moving, which includes initiating change.

This occurs by taking action, making the change, and involving people in the change (Mitchell,

2013). The last phase, the refreezing phase, includes making the change that was implemented

permanent and establishing new methods and procedures. The desired changes can then be

rewarded. Implementations can be established and practiced in order to prevent the action from

reverting to the previous practices (Mitchell, 2013).

The second change theory is Lippitt’s theory, similar to the nursing theory. This theory

uses the elements of assessment, planning, implementation, and evaluation (Mitchell, 2013). In

the first phase of the theory, similar to the assessment phase, diagnosis of the problem is

established. Next is assessing for the capacity to change. Then, the motivation and resources for

the change are assessed. The objective for the change is developed as the planning phase

continues. In the implementation phase, the change is maintained, promoting continuation of the

change with continual monitoring (Mitchell, 2013).

Both the Lewin and Lippitt’s change theories assess the situation, assess where change

can occur, and implement the change. Once the change is initiated, the helping agent is

terminated and the new practice is implemented and monitored. Lippitt’s theory uses an

approach similar to the nursing process; assessing, planning, implementing, and evaluating the

change. Lewin’s theory may seem simpler and concrete, using methods such as unfreezing,

moving, and refreezing. Although this may seem less in-depth, changes are initiated with both

methods (Mitchell, 2013).

IMPACT OF SKIN TO SKIN ON NEWBORNS 10

In regards to implementing skin to skin care, using either of the change theories would be

beneficial. In Lewen’s theory, the recognition for change is acknowledged, a plan is developed,

and is then put into place. This correlates with the change proposal because the plan of

implementing skin to skin care is developed and then put into place. The outcome is evaluated

and actions are altered if needed.

With Lippitt’s theory, the assessment of skin to skin care in the nursing facilities is

monitored. Change is developed in the planning stage and then implemented. The outcomes are

evaluated and altered if needed. Feedback from both change theories is critical in this situation as

it depends on the likelihood that the change will maintain in practice.

Implementation

Providing quality and safe patient care is essential for all patients’ alike, especially

newborn babies. Developing a plan that is patient specific while assessing and monitoring the

newborn will help to decrease negative outcomes. Monitoring the newborn immediately after

birth until discharge will promote wellness and detect any changes in condition. Noticing the

change immediately will allow interventions to take place, as newborns can spiral downhill quite

quickly.

Normal physiological signs that indicate the newborn is adjusting to the outside life are

normal vital signs. Temperature; heart rate; blood pressure; oxygen saturation; respiratory rate;

indicators of pain; activity; and temperament can all be used in the assessment of the newborn.

Indicators that the newborn may require skin to skin care would be a temperature lower than 97.7

degrees Fahrenheit, low oxygen level or requiring supplemental oxygen, an inconsolable infant,

despite other efforts to relieve distress, and a newborn that is restless, hungry, or appears in pain

or distress (Rodgers, 2013).

IMPACT OF SKIN TO SKIN ON NEWBORNS 11

When implementing skin to skin care, there are various time factors that this intervention

can occur. Immediately after the baby is born via vaginal delivery, the infant should be placed on

the mother’s abdomen for delayed cord clamping and an adjustment to the outside life. Using the

sense of olfaction and hearing, the newborn can begin the start of their life. Thermal stability,

glucose regulation, and breastfeeding can all begin and become established (Rodgers, 2013).

If the baby is born via cesarean section, skin to skin care can be established, with the help

of nursing professionals. As seen in some facilities, pass through drapes are being implemented,

allowing the infant to be transferred sterilely through the opening and placed on the mother’s

chest. Although some barriers do exist with the success of implementing skin to skin care,

factors can be developed to overcome this.

A third example of when skin to skin care may be implemented is after the baby is born.

The newborn may get too cold, experience pain from a medical procedure, or experience other

medical complications. All of the mentioned are examples of when skin to skin care can be

implemented, however, if the mother, father, or surrogate desire the newborn to be placed skin to

skin, then they absolutely can at any given time.

Assessing and examining the signs and symptoms of the newborn to determine the

necessity of skin to skin care is important. Using the

Newborn Assessment Evaluation Tool

(Appendix A) for evaluating the condition of the infant can help to determine the need for skin to

skin care. The healthcare professional caring for the newborn at that time would be responsible

for assessing and determining the needs of the infant. The newborn assessment evaluation tool

would be administered by the delivering nurse immediately after delivery. This tool would then

either be re-evaluated or administered at a later time, when deemed necessary.

IMPACT OF SKIN TO SKIN ON NEWBORNS 12

The NAET score is either a zero or one. Zero for the absence of certain conditions on the

assessment tool, and one for the presence of conditions on the assessment tool. If more than 2

answers are yes, then a re-assessment and re-evaluation is necessary and required. If the newborn

scores a zero on the assessment, then no further reassessments of the tool are required. Standard

monitoring of the newborn should resume.

Perhaps the newborn scores a higher score than the previous assessment or still has the

same score, skin to skin care should be implemented. The newborn should be reassessed thirty

minutes later. If the re-assessment remains the same or scores higher, a healthcare provider

should be notified. Scores will be kept in the patient medical records and in the electronic

charting. This enables all personnel caring for the newborn to view previous and current

assessments.

Education and informational presentations would be presented to all nursing

professionals as well as managers and leaders of the unit. This will enable all personnel to

become educated and understand the process for assessing and evaluating the assessment tool.

Questions would be answered and clarified during the educational session. Feedback would be

provided regarding the success of the evaluation tool. Suggestions would be accepted from

current nursing professionals as well as parents of the newborns. Prior to the release and use of

this assessment tool, management and higher officials would review and discuss the process and

evaluation tool for skin to skin care.

Potential Barriers

Initiating change and ensuring that the change will remain in practice is one of the many

obstacles in healthcare that can occur. With maintaining the change, its impact will show its

results for the patients, staff, and unit itself. Barriers will exist, posing a potential risk for the

IMPACT OF SKIN TO SKIN ON NEWBORNS 13

intervention to either fade out or not be effective. A few potential barriers that may impact the

evidence-based practice change proposal of skin to skin care for newborns are resistance to

change and family and visitor involvement. Cesarean sections as well as the administration of

certain medications during labor can hinder the success of skin to skin care, as well.

The resistance to change can occur when staff members feel differently about the

importance of implementing skin to skin care. Instead of placing the infant skin to skin with the

mother or father, the nurse may just use the radiant warmer to increase the temperature of the

newborn. This can affect the success of the intervention because over time, the process of

implementing skin to skin care may phase out and not occur as it should. The strategy for

overcoming this barrier is to educate staff members, continuously evaluate the intervention, and

have regularly staff meetings to discuss the feelings and potential concerns of the intervention.

This will allow an open line of communication.

The other barrier that may occur is the interference of the parents or visitors. Immediately

after the baby is born, many family and visitors want to hold the baby immediately. This takes

away from skin to skin care. It is in the best interest of the newborn and mother to advocate and

promote that the newborn be placed skin to skin for at least the first hour of life. This is where

the nurse can educate the importance of the intervention and hope that the parents realize the

benefits that result from the simple intervention. The strategy for overcoming this barrier include

education and creating a rapport with the patient as well as family members. This will allow the

patient to listen and understand.

Cesarean sections also pose a risk as a barrier for skin to skin care. Once delivered via

cesarean section, the newborn is typically transferred to the radiant warmer. Once stabilized, the

newborn can then be wrapped up and either handed to the father or held by the nurse, enabling

IMPACT OF SKIN TO SKIN ON NEWBORNS 14

the mother to look at the infant. The barrier that is obvious is that the newborn is missing the

opportunity for the initial skin to skin time. Numerous research has been conducted, attempting

to increase the skin to skin contact time for cesarean delivered newborns.

Methods to overcome the barriers in the operating room include having the pass through

drape available so the infant can be sterilely transferred directly from the uterus to the mother’s

upper chest area. Providing pain medications for the mother immediately in order for the mother

to want to provide skin to skin care is essential for its success. If the mother is nauseous or

simply is unable to perform skin to skin care with the infant, there is always the opportunity for

the father or surrogate to perform skin to skin with the newborn (Zwedberg, Blomquist, &

Sigerstad, 2015).

Other methods to overcome barriers in the operating room include educating other

members of the operating room and having a designated nurse for the newborn as well as the

mother. Speaking with the parents about the importance of skin to skin immediately before

delivery can help as the mother will be prepared for the infant on her chest and the father can

help to stabilize the infant. Barriers such as IV poles and drapes can be altered without disrupting

the sterile field from the surgery (Grassley & Jones, 2014). Education to mother’s regarding the

idea that breastfeeding success has shown to increase as a result of early initiation of skin to skin

care can help promote the implementation of skin to skin care (Gregson, Meadows, Teakle, &

Blacker, 2016).

Maternal medication administered during labor can cause a potential barrier for the

success of skin to skin care. With the administration of Fentanyl, a pain relieving medication,

studies have revealed that a transmission ratio of 0.892 has transferred from the maternal

epidural space to the fetus through the circulation of the placenta. This poses a potential barrier

IMPACT OF SKIN TO SKIN ON NEWBORNS 15

to skin to skin care as the newborn may not be stable enough to perform skin to skin. The infant

may need to be transferred to the nursery for assistance with breathing and stabilization

(Brimdyr, Cadwell, Widstrom, Svensson, Neumann, Harrington, & Phillips, 2015). Methods to

overcome this barrier include close monitoring of the mother and infant immediately after

delivery. If the infant does require assistance, ensure that skin to skin care occurs as soon as

possible. Stay with the infant and mother as they may require additional help.

Developing and promoting a change proposal plan takes assessment, planning,

evaluating, and dedication. Involving research and evidence to support the change is essential in

the success of the intervention. Determining a problem and need for change, developing a change

proposal, researching, presenting the change, and evaluating the results and outcomes of the

change are all important steps in the change proposal.

Skin to skin care, although a simple, non-invasive intervention, requires critical thinking

and in-depth knowledge. Promoting the intervention and transferring the knowledge to other

healthcare professionals as well as parents is critical. Determining potential barriers that will

pose a risk and developing methods to overcome these is vital in the success of the change

proposal. Early interventions, establishing the plan of care, and implementing a protocol for skin

to skin care has the potential of reducing illness and morbidity in newborns.

IMPACT OF SKIN TO SKIN ON NEWBORNS 16

References

Assessments of newborn babies. (2017). Retrieved from

http://www.stanfordchildrens.org/en/topic/default?id=assessments-for-newborn-babies-

90-P02336.

Baker-Rush, M. (2016). Reducing stress in infants: Kangaroo care. International Journal of

Childbirth Education, 31 (4).

Bera, A., Ghosh, J., Singh, A. K., Hazra, A., Som, T., & Munian, D. (2014). Effect of Kangaroo

Mother Care on Vital Physiological Parameters of the Low Birth Weight Newborn.

Indian Journal of Community Medicine, 39 (4).

Brimdyr, K., Cadwell, K., Widstrom, A. M., Svensson, K., Neumann, M., Hart, E. A.,

Harrington, S., & Phillips, R. (2015). The association between common labor drugs and

suckling when skin-to-skin during the first hour after birth. Birth: Issues in Perinatal

Care, 42 (4).

Campo, M., Amancio, M. J., Egipto, M., Fojas, J., Moreno, R. C., Olivar, R. M., Regno, L.,

Siquig, H., Tawaran, T., & Yepez, K. (2014). Kangaroo care in the reduction of pain in

full term neonates undergoing newborn screening. Journal of Nursing Practice

Applications and Reviews of Research, 4 (1).

Chan, G. J., Labar, A. S., Wall, S., & Atun, R. (2016). Kangaroo mother care: A systematic

review of barriers and enablers. Bulletin of the World Health Organization, 94, 130-141.

doi: http://dx.doi.org/10.2471/BLT.15.157818.

Gao, H., Xu, G., Gao, H., Dong, R., Fu, H., Wang, D., Zhang, H., & Zhang, H. (2015). Effect of

repeated kangaroo mother care on repeated procedural pain in preterm infants: A

randomized controlled trial. International Journal of Nursing Studies, 52, 1157-1165.

IMPACT OF SKIN TO SKIN ON NEWBORNS 17

Grassley, J. S., & Jones, J. (2014). Implementing skin-to-skin contact in the operating room

following cesarean birth. Worldviews on Evidence-Based Nursing, 11 (6).

Gregson, S., Meadows, J., Teakle, P., & Blacker, J. (2016). Skin to Skin Contact after elective

cesarean section: Investigating the effect on breastfeeding rates. British Journal of

Midwifery, 24 (1).

Hugill, K. (2015). The senses of touch and olfaction in early mother-infant interaction. British

Journal of Midwifery, 23 (4).

Jesus, N. C., Vieira, B. D. G., Alves, V. H., Rodrigues, D. P., Souza, R. M. P., & Paiva, E. D.

(2015). The experience of the kangaroo method: The perception of the father. Journal of

Nursing, 9 (7), 8542-8550.

Lowson, K., Offer, C., Watson, J., McGuire, B., & Renfrew, M. J. (2015). The economic

benefits of increasing kangaroo skin-to-skin care and breastfeeding in neonatal units:

analysis of a pragmatic intervention in clinical practice. International Breastfeeding

Journal, 10 (11).

Mitchell, G. (2013). Selecting the best theory to implement planned change. Nursing

Management, 20 (1).

Pexton, C. (2017). Overcoming the barriers to change in healthcare system. Retrieved from

How Change Management Benefits Your Organization

implementation/overcoming-barriers-change-healthcare-system/

IMPACT OF SKIN TO SKIN ON NEWBORNS 18

Riva, J. J., Malik, K. M. P., Burnie, S. J., Endicott, A. R., & Busse, J. W. (2012). What is your

research question? An introduction to the PICOT format for clinicians. The Journal of the

Canadian Chiropractic Association, 56 (3), 167-171.

Rodgers, C. (2013). Why kangaroo mother care should be standard for all newborns. Journal of

Midwifery and Women’s Health, 58 (3).

Stikes, R. & Barbier, D. (2013). Applying the plan-do-study-act model to increase the use of

kangaroo care. Journal of Nursing Management, 21, 70-78.

Zwedberg, S., Blomquist, J., & Sigerstad, E. (2015). Midwives’ experiences with mother-infant

skin-to-skin contact after a cesarean section: ‘Fighting an uphill battle.’ Midwifery, 31

(1), 215-220.

IMPACT OF SKIN TO SKIN ON NEWBORNS 19

Appendix A

Newborn Assessment Evaluation Tool

The Newborn Assessment Evaluation Tool (NAET) is a brief assessment tool used to detect the

condition of the newborn, determining if there is a need for skin to skin care. This evaluation tool

is administered to all parents or surrogates of the newborn in the nursing facility, initially after

birth and whenever deemed necessary.

Newborn Assessment Evaluation Tool Yes (1) No (0)

Is the infant’s temperature less than 97.7° F (36.5 ° C)?

Is the infant’s oxygen saturation (without supplemental

oxygen) less than 91%?

Is the infant restless, crying, inconsolable, or irritable

despite comfort or feeding efforts?

Is the infant’s heart rate either above or below normal

limits (below 110 or above 160)?*

Is the infant’s respiration rate less than 40 or greater than

60? *

*(Assessments for newborn babies, 2017).

Scores are either a 0 or 1; 1 for yes and 0 for no.

 A score of 2 or more is deemed clinically significant and requires further assessment and

investigation.

o Skin to skin care should be initiated.

 A reassessment of the NAET in 30 minutes should be administered.

 If the reassessed score remains the same or scores greater than the previous assessment, a

healthcare provider should be notified.

Running Head: CAPSTONE PROJECT: FOSTERING AFTER DISCHARGE FOLLOW UP 1

CAPSTONE PROJECT: FOSTERING POST-DISCHARGE FOLLOW UP 2

Capstone Project: Fostering After Discharge Follow-Up

Dalianis Diaz

Professional Capstone and Practicum Comment by Toniya Koolikunnel Thomas: Write the name of the university followed by colon before the course name.

02/06/2021

Capstone Project: Fostering After Discharge Follow-Up

Nonadherence to post-discharge recommendations has been one of the biggest setbacks in the race towards achieving a healthy America. The case is so because despite prescribing the appropriate medications, patients fail to adhere to the set dosages, which results in deteriorated medication effectiveness. Nonadherence can take various forms rather than medication including but not limited to failure to adhere to set appointments, and not following the recommended lifestyle or dietary changes. As a result, nonadherence to post discharge follow up plan does not only have significant financial implications but also results in frequent rehospitalization among other challenges (Jimmy & Jose, 2011). Since, the costs associated with nonadherence to post-discharge recommendations are high, it is essential to implement measures to foster adherence to after discharge plans through incorporating self-management strategy in the healthcare settings in order to enhance the overall effectiveness of the healthcare interventions. Comment by Toniya Koolikunnel Thomas: Good introduction

Background

Medications nonadherence has overtime been reported to range between 20 to 50 percent, with 75 percent of U.S residents reporting to exhibit difficulties taking their medication as directed by their providers. Such a number is high given that nonadherence can have far-reaching consequences on one’s health and in worst-case scenario, it can result in death. Failure to adhere to after discharge follow-up plans is estimated to contribute to a staggering 125,000 deaths annually. Besides, about 30 to 69 percent of the America’s total number of medication-related readmission result from poor adherence to post-discharge plans (Oliveira-Filho et al., 2014). The overall cost estimates associated with nonadherence to after discharge follow-up plans ranges between $100 billion and $300 billion annually when both indirect and direct costs are taken into account. By promoting adherence to post-discharge follow-up plans, the above amount can be redirected to other economy-building initiative or even further improve the existing healthcare facilities (Flink & Ekstedt, 2017). Therefore, nonadherence to after-discharge plans has become a national challenge that is blocking achievement of a fit and healthy nation, while preventing excellent patient outcomes.

Clinical Problem Statement

Although adhering to post-discharge follow-up can help improve the patient’s health outcomes, while saving on costs, the current population rarely adheres to the after-discharge plan which triggers far-reaching consequences in both financial and non-financial terms. If the nonadherence problem is not resolved, then the nation and individuals will continue to lose billions of dollars through readmission and other-related costs and the patient outcomes will continue to suffer greatly. Comment by Toniya Koolikunnel Thomas: can even lead to death due to serious complications. You can elaborate on the selected clinical problem.

Purpose of Change Proposal

The purpose of the proposed change project is to integrate a self-management strategy in the healthcare setting to facilitate post-discharge adherence to the recommended follow-up plan. The proposed patient self-management project is aimed at preparing patients and training them for an out-of-hospital experience that will encourage them to adhere to follow-up plans. Since the patients will be imparted with critical knowledge about their health condition and design a follow-up plan that suits their daily routine, collaboration between them and their healthcare providers will be promoted, thus facilitating overall adherence. Comment by Toniya Koolikunnel Thomas: You can also include the effects of overall adherence.

Picot Question

When dealing with the homeless, African Americans and Haitians struggling with various behavioral problems. Is a standard discharge letter effective than imparting self-management skills to patients in facilitating post-discharge medication adherence? The population in question comprises of poor and illiterate individuals, which makes it difficult to them to decode standard discharge letters containing the follow-up plan, which makes it an inefficient approach to facilitating adherence. The proposed intervention is a self-management program that will see the population get educated about the necessary information through various ways including integrating a customized post-discharge follow-up plan that matches their daily routine and sending reminders to patients about their upcoming post-discharge interventions such as appointment and medication refilling.

Since standard discharge letters have been in existence for years, yet nonadherence to after-discharge plans continues to be rampant on a daily basis, it is crucial to attempt the new self-management strategy, which will see patients get informed about the importance of adherence and measures to put in place to enhance their ability to adhere to follow-up plans. The expected outcome is to achieve lesser patient rehospitalization due to nonadherence to after discharge plans and promote more adherence, while improving the overall patient outcomes. Comment by Toniya Koolikunnel Thomas: Use the PICOT mnemonic

Literature Search Strategy

The selected topic is associated with after-discharge follow-up. The U.S. National Institutes of Health’s National Library of Medicine (NIM/NLM) was used to search for filtered information, while MEDLINE database and the school library were used to search for unfiltered content. In all databases, the keyword used to search for information was “Post-discharge follow-up adherence.” Every source concluded that there exists a need to modify how post-discharge follow-up plans are disseminated to patients, while quoting it as a major contributor to the rampant nonadherence to such plans. I found 17 results that have been peer-reviewed or critically appraised by experts. The information found in 6 of the 17 results was primarily attributed to

medication adherence and plans to improve adherence.

Evaluation of Literature

Jimmy, B., & Jose, J. (2011) researches on patient medication adherence: measures in daily practice. The article is authentic and its information can be trusted because the authors are lectures at University of Nizwa in Oman. Besides, the source is published in a reliable academic journal, the PubMed Central (PMC). Also, it is related to my topic because it addresses patient medication adherence, which is part of the after-discharge follow-up plan.

The article by Flink, M., & Ekstedt, M. (2017) discusses planning for the discharge, not for patient self-management at home. The source by Flink and Eksted is authentic because the authors are affiliated to an academic institution, that is Linnaeus University. Besides, the source has been reviewed by experts. The source is relevant to my research because it addresses preparing for discharge in a way that will foster post-discharge follow-up adherence. Also, it is published in a credible journal, PMC. The sources used in the literature are all trustworthy because before using them, their author’s credentials, their usefulness to the research topic and reliability were all reviewed as their assessment criteria. Comment by Toniya Koolikunnel Thomas: You can talk about other literature and how they support your change proposal.

Applicable Change or Nursing Theory

The applicable change theory in the proposed project is the Lewin’s change theory. The case is so because it involves three main concepts, that is the driving forces, equilibrium and restraining forces. In this case, the driving forces is minimizing nonadherence to after discharge follow-up and its consequences. The restraining force is the use of traditional post-discharge letters as a way of facilitating follow-up adherence. It forms a force that tends to act against the implementation of a new approach to facilitating post-discharge follow-up. The equilibrium in this case is the state where there is a balance between restraining and driving forces. This balance will be achieved upon implementing a strategy that will see improved patient adherence to after-discharge plans.

Proposed Implementation Plan with Outcome Measures

To implement the self-management change project that fosters adherence to after-discharge follow-up plan, a room fitted with all patient education facilities will be created. Secondly, retraining of healthcare professionals will be conducted to prepare them to deliver patient-centered regimen characteristics. Patient and family communication is another thing that will be fostered under the new after-discharge follow-up implementation plan. A help center will then be established to house healthcare support assistants who will be sending reminders to patients, with a future option of automating the process. The outcome measures that will be utilized to assess the effectiveness of the project include the rate of after-discharge rehospitalization, patient satisfaction level, and the adverse cases among the discharged patients. Comment by Toniya Koolikunnel Thomas: Good implementation plan

How Evidence-Based Practice was Used in the Creation of the Intervention Plan

When creating the intervention plan, several Evidence-Based Practice (EBP) were involved. One of the is that a medical question was posed that triggered identification of a problem. The question was, “why is there high rate of nonadherence to post-discharge follow-up?” Secondly, evidence was gathered from various authentic sources and analyzed to determine the primary factor leading to patient nonadherence. Furthermore, the types of research used in EBP was similar to those used in the research. Randomized control trials and opinions from medical experts, that are in line with reports, studies, and experiences were some of the research methodologies that were utilized in the development of the intervention plan. Comment by Toniya Koolikunnel Thomas: Please describe how you used EBP in the intervention plan.

Plan for Evaluating the Proposed Nursing Intervention

The plan to evaluate the proposed intervention is will assess the relationship between various activities undertaken during the implementation phase and the outcome measures, goals, activities, objectives, and impacts. It will be made up of four steps, that is selection of outcomes and impacts, identification of the evaluation method, and compiling a report consisting of the evaluation outcomes. In the impact an outcome identification step, the two aspects will be selected based on the project’s goals such as reduction of cost and readmission rates. The selection of the evaluation method will involve identifying the most appropriate method that can facilitate effective measurement of the project’s outcome and effect on patient’s health status. In this case, randomized controlled trials will be used with both post- and pretests being done to assess the effectiveness of the proposed intervention (Lavinghouze & Snyder, 2013). Evaluation tools including interviews and questionnaires will also be deployed to determine the intervention’s impact.

Potential Barriers to Plan Implementation and Strategies to Overcome Them

One of the key barriers to the implementation of the project is resources. The case is so because there exists a need to create a new health system in the facility to include a help center, retrain healthcare professionals, which will spike the cost. To address this issue, a cost benefit analysis will be conducted to evaluate the respective direct and indirect costs and benefits associated with the project. Due to the huge amounts of benefits attributed with the project, I will work closely with the management to extend the resources allocated to the project, when need arises.

Secondly, changing patient beliefs is another barrier to implementation of the plan. The case is so because patients are accustomed to various beliefs and complex routines that are difficult to change. To address this barrier, healthcare workers will be trained on their communication to enhance their ability to address diverse communities. Doing so will enable them to change their beliefs with undermining the existing ones.

Conclusion

Since, the costs associated with nonadherence to post-discharge recommendations are high, it is essential to implement measures to foster adherence to after discharge plans through incorporating self-management strategy in the healthcare settings in order to enhance the overall effectiveness of the healthcare interventions. There is a high rate of nonadherence to post-discharge follow-up plans among patients due to various reasons including but not limited to lack of understanding about the importance of the follow-up plans. As a result, it costs the U.S. billions of dollars, while negatively affecting the patient’s outcome. The purpose of this project is to integrate a self-management plan that will foster patients’ understanding about the importance of adherence to the provider’s recommendation, while integrating a system that will foster their ability to adhere to the follow-up. Keyword search was used to collect evidence from various sources. The applicable change theory in this case is the Lewin’s theory of change. Various evaluation plans will be used to evaluate the proposed change project, with resources being a major barrier to its implementation. However, since the rate of nonadherence have been high overtime, it is essential to integrate a new patient self-management plan that will prepare patient for after-discharge life and voluntary adherence to follow-up plans.

References

Flink, M., & Ekstedt, M. (2017). Planning for the discharge, not for patient self-management at home–an observational and interview study of hospital discharge. International journal of integrated care, 17(6).

Jimmy, B., & Jose, J. (2011). Patient medication adherence: measures in daily practice. Oman medical journal, 26(3), 155.

Lavinghouze, S. R., & Snyder, K. (2013). Developing Your Evaluation Plans: A Critical Component of Public Health Program Infrastructure. American journal of health education, 44(4), 237–243.

Oliveira-Filho, A. D., Morisky, D. E., Costa, F. A., Pacheco, S. T., Neves, S. F., & Lyra-Jr, D. P. (2014). Improving post-discharge medication adherence in patients with CVD: a pilot randomized trial. Arquivos brasileiros de cardiologia, 103(6), 503-512. Comment by Toniya Koolikunnel Thomas: Please include all the references you have used in the previous assignments for your capstone project.