Skin-to-skin contact after birth: Developing a research and practice guideline.

AIM: Skin-to-skin contact immediately after birth is recognised as an evidence-based best practice and an acknowledged contributor to improved short- and long-term health outcomes including decreased infant mortality. However, the implementation and definition of skin-to-skin contact is inconsistent in both practice and research studies. This project utilised the World Health Organization guideline process to clarify best practice and improve the consistency of application. METHODS: The rigorous guideline development process combines a systematic review with acumen and judgement of experts with a wide range of credentials and experience. RESULTS: The developed guideline received a strong recommendation from the Expert Panel. The result concluded that there was a high level of confidence in the evidence and that the practice is not resource intensive. Research gaps were identified and areas for continued work were delineated. CONCLUSION: The World Health Organization guideline development process reached the conclusion immediate, continuous, uninterrupted skin-to-skin contact should be the standard of care for all mothers and all babies (from 1000 g with experienced staff if assistance is needed), after all modes of birth. Delaying non-essential routine care in favour of uninterrupted skin-to-skin contact after birth has been shown to be safe and allows for the progression of newborns through their instinctive behaviours.

Implementing a Resilience Bundle for Emergency Nurses: An Evidence-Based Practice Project.

INTRODUCTION: Resilience bundles are designed to work within and enhance existing routines. In the wake of COVID-19, nurses are reporting high levels of burnout and are leaving the field at an alarming rate. Hospital system leaders across the country are working to develop wellness programs to improve nurse morale, decrease burnout, and enhance resilience. Resilience can help mitigate nurse burnout, and using a bundle of tools to help nurses develop resilience is more effective than a single strategy. METHODS: Using the Connor-Davidson Resilience Scale-10 and the Perceived Stress Scale 4, emergency nurses were surveyed to measure resilience and stress before and after implementation of a 3-strategy resilience bundle. We surveyed at baseline, phase 1 (6 weeks after implementation), and phase 2 (15 weeks after implementation). RESULTS: A statistically significant increase in the Connor-Davidson Resilience Scale-10 scores was identified between the baseline and phase 1 surveys. A measurable decrease in the Perceived Stress Scale 4 was found between the baseline survey and the phase 1 and phase 2 postintervention surveys. DISCUSSION: Although evidence suggests a multifocal approach to improving resilience, use of resilience bundles is new. To enhance nurse resilience and mitigate burnout, nurse leaders may consider resilience bundles to prioritize the mental health and wellness of their staff.

Measuring health professionals' beliefs about skin-to-skin care during a cesarean.

Women and their newborns are at risk of delayed or withheld skin-to-skin care (SSC) during a caesarean, which is about one-third of births, worldwide. To date, no instrument exists to assess health professionals' (HPs) beliefs, and potential barriers and strategies for implementing SSC during a cesarean. The study aims were to (1) develop an instrument, Health Professionals' Beliefs about Skin-to-Skin Care During a Cesarean (SSCB ), (2) establish its validity and reliability and (3) describe HPs' beliefs about SSC during a caesarean. Quantitative and qualitative analyses were used to test the SSCB and describe HPs' beliefs. SSCB analysis yielded a content validity of 0.83 and reliability of α = 0.9. We grouped all practice roles as either nurses or physicians. The mean rank score for nurses (n = 120, M = 90) was significantly higher (p = 0.001) than physicians (n = 46, M = 79). Despite this difference, scores for both roles reflected support for SSC. Participants identified hospital readiness to implement SSC and maintaining maternal and newborn safety as major issues. SSCB is a valid, reliable instrument to measure HPs' beliefs about SSC during a caesarean birth. HPs can use the SSCB during quality improvement initiatives to improve access to immediate SSC for women who have a caesarean birth. Improved access can enhance breastfeeding outcomes and promote optimal maternal and child health.

Trends in Perinatal Care and Implications for Frontline Nurse Leaders.

The perinatal trends presented in this article are based on recent topics from conferences, journals, the media, as well as from input from perinatal nurses. Trends in patient care are influenced by evidence known for decades, new research, emerging and innovative concepts in healthcare, patient and family preferences, and the media. Trends discussed in this article are rethinking the due date, birth outside the hospital setting, obstetric hospitalists as birth attendants, nitrous oxide for pain in childbirth, hydrotherapy and waterbirth in the hospital setting, delayed cord clamping, disrupters of an optimal infant microbiome, skin-to-skin care during cesarean surgery, and breast-sleeping and the breast-feeding dyad. In addition, the authors developed implications for perinatal nurses related to each trend. The goal is to stimulate reflection on evidence that supports or does not support current practice and to stimulate future research by discussing some of the current trends that may influence the care that perinatal nurses provide during the birthing year.

Risk Taking: A Required Competency for Merger, Acquisitions, and Partnerships.

Today's nurse executive is likely to find himself or herself in the middle of a merger, acquisition, and/or partnership (MAP). This is the result of health care agencies vying for market share in the midst of stiff competition, as well as decreased reimbursement in a rapidly changing payment system. The phenomenon of MAPs is fueled by the focus on care coordination and population health management. To be prepared for the ongoing and increasing MAP activity, nurse executives need to develop the skill of risk taking as an essential competency for leading change. This article emphasizes the need to maintain and improve health care quality and patient safety.

Succession planning: a call to action for nurse executives.

AIM: To discuss the organisational benefits of strategic succession planning in acute care hospital settings as a responsibility of chief nurse executives. BACKGROUND: A formal succession planning process is crucial to the financial and operational viability and sustainability of acute care hospitals. A succession plan is an essential business strategy that promotes effective leadership transition and continuity while maintaining productivity. EVALUATION: Nursing and business literature were reviewed; reports contrasting institutions with and without succession plans were examined; and, operational implications were considered. KEY ISSUES: It is imperative that chief nurse executives respond to the business benefits of an effective succession planning programme, identify common barriers and solutions, and implement best practices for a successful strategic succession planning programme. CONCLUSION: A strategic succession planning programme may offer many benefits to an acute care hospital, including improved retention rates, increased staff engagement and enhanced financial performance. IMPLICATIONS FOR NURSING MANAGEMENT: Considering the ageing nursing workforce and the potential increase in demand for nursing services in the near future, nurse executives and other nurse leaders must actively engage in a formal succession planning process. A formal succession planning programme will help to provide strategic leadership continuity, operational effectiveness and improved quality of care.

Implementing the evidence: Routine screening for depression and anxiety in primary care.

Background: Primary care providers are qualified to treat, diagnose, and manage common mental health issues like anxiety and depression. Anxiety and depression are common among college age students, with the average age of onset occurring in one's late teens to early 20s. Screening tools are commonly used to recognize patients who may be at risk for anxiety and depression. Purpose: The purpose of this evidence-based practice project was to (a) implement evidence-based guidelines for screening and management of college-aged patients with anxiety and/or depression and (b) to develop an algorithm that describes evidence-based management to guide providers at two student health centers. Methods: All patients who registered for a sick visit or other appointment at the project site were screened for anxiety and depression using two validated tools. An algorithm to help healthcare providers properly assess and better treat anxiety and depression was developed and implemented for this project. Results: A total of 366 patients were screened for depression and anxiety over a 3-month period. Using the created algorithm, patients received education on anxiety and/or depression and a counseling referral. If warranted, patients were prescribed medication therapy for depression and/or anxiety. Conclusion: Screening for anxiety and depression has become the standard of care in primary care clinics. Routine screening tools help healthcare providers identify patients with anxiety and depression. Early identification and diagnosis of anxiety and depression leads to better outcomes in treatment.

Use of video-feedback, reflection, and interactive analysis to improve nurse leadership practices.

The chronic shortage of registered nurses (RNs) affects patient safety and health care quality. Many factors affect the RN shortage in the workforce, including negative work environments, exacerbated by ineffective leadership approaches. Improvements in the use of relationship-based leadership approaches lead to healthier work environments that foster RN satisfaction and reduce RN turnover and vacancy rates in acute care settings. In this article, an innovative approach to reduce nurse turnover and decrease vacancy rates in acute care settings is described. Video feedback with reflection and interactive analysis is an untapped resource for nurse leaders and aspiring nurse leaders in their development of effective leadership skills. This unique method may be an effective leadership strategy for addressing recruitment and retention issues in a diverse workforce.

Hospital Care Practices Associated With Exclusive Breastfeeding 3 and 6 Months After Discharge: A Multisite Study.

Maternity care practices influence breastfeeding outcomes long after women leave the birth setting. We conducted this study to describe, from mothers' perspective, maternity care practices associated with breastfeeding at 3 and 6 months. Mothers who recalled having skin-to-skin care (SSC) and rooming-in for 23 or more hours/day were more likely to report exclusive breastfeeding when surveyed at 3 months. Perception of not enough milk and difficulty latching explained more than 85% of supplementing and weaning at 3 months. Women also reported that returning to work influenced their decision to supplement or wean. Our multisite study supports implementing low cost and evidence-based interventions such as immediate and uninterrupted SSC and rooming in to improve breastfeeding exclusivity. Findings highlight the ongoing need to bridge the gap between hospital discharge and community breastfeeding support, including workplace accommodations.

Healthy Birth Practice #6: Keep Mother and Newborn Together-It's Best for Mother, Newborn, and Breastfeeding.

Mothers and newborns have an emotional and physiological need to be together at the moment of birth and during the hours and days that follow. Keeping mothers and newborns together is a safe and healthy birth practice. Evidence supports immediate, undisturbed skin-to-skin care after vaginal birth and during and after cesarean surgery for all medically stable mothers and newborns, regardless of feeding preference; and, no routine separation during the days after birth. Childbirth educators and other health-care professionals have an ethical responsibility to support this essential healthy birth practice through education, advocacy, and implementation of evidence-based maternity practices.

Effects of Skin-to-Skin Care During Cesareans: A Quasiexperimental Feasibility/Pilot Study.

Introduction: Our aim was to describe feasibility and outcomes of skin-to-skin care (SSC) that began during cesarean surgery and continued, uninterrupted, for about 5 hours. We described maternal/newborn measures of physiologic stability and stress; maternal measures of comfort; maternal satisfaction with surgery and SSC; and exclusive breast milk feeding at discharge. Materials and Methods: We used a quasiexperimental, time-interrupted design and randomly assigned women to receive SSC that began during surgery (Group 1, intervention; n = 20) or after surgery, before transfer to recovery (Group 2, standard care; n = 20). We analyzed differences across time and for five observations: before transfer to the operating room (OR); in the OR, about 20 minutes after birth; in the recovery room, about 1 hour after admission; in the New Family Center (NFC), about 1 hour after admission; and in the NFC, about 2 hours after admission. Results: Group 1 began SSC an average of 0.89 minutes after birth and continued an average of 300 minutes and Group 2 began an average of 46 minutes after birth and continued an average of 126 minutes. Women who began SSC during surgery were more satisfied with the experience (p = 0.015) and had lower levels of salivary cortisol across time (p = 0.003). We found no negative effects on maternal or newborn measures of physiologic stability and no difference in exclusive breast milk feeding rates at discharge. Conclusion: Immediate and uninterrupted SSC during medically uncomplicated cesarean surgery is a feasible, low-cost intervention that can safely begin during surgery and continue, uninterrupted, for extended durations.

Preoperative fasting duration and medication instruction: are we improving?

Research has shown that preoperative fasting practices commonly are much longer than national guidelines, and medication instructions are not always given to patients before surgery. After implementation of an evidence-based preoperative fasting policy and educational efforts for health care providers at one facility, a follow up project was conducted to determine whether these efforts had improved fasting practices. The project findings indicate that preoperative fasting in excess of safe minimum guidelines persists. Improvements were found in the percentage of patients receiving specific instructions about whether to take their routine medications on the morning of surgery. Continued efforts must be made to implement best practices for preoperative fasting.

Effect of Timing of the First Bath on a Healthy Newborn's Temperature.

OBJECTIVE: To determine if a healthy newborn's age in hours (3, 6, or 9 hours after birth) affects thermoregulatory status after the first bath as indicated by axillary and skin temperatures. DESIGN: Quasi-experimental, mixed-model (between subjects and within subjects) design with hours of age as the nonrepeated variable and prebath and postbath temperatures as the repeated variables. SETTING: Family-centered care unit at an urban hospital in the southwestern United States. PARTICIPANTS: Healthy newborns (N = 75) 37 weeks or more completed gestation. METHODS: Mothers chose time of first bath based on available time slots (n = 25 newborns in each age group). Research nurses sponge bathed the newborns in the mothers' rooms. Axillary temperature, an index of core temperature, was measured with a digital thermometer, and skin temperature, an index of body surface temperature, was measured with a thermography camera. Temperatures were taken before the bath; immediately after the bath; and 5, 30, 60, and 120 minutes after the bath. Immediately after the bath, newborns were placed in skin-to-skin care (SSC) for 60 or more minutes. RESULTS: We found a difference (p = .0372) in axillary temperatures between the 3- and 9-hour age groups, although this difference was not clinically significant (0.18 °F [0.10 °C]). We found no statistically significant differences in skin temperatures among the three age groups. Regardless of age group, axillary and skin temperatures initially decreased and then recovered after the bath. CONCLUSION: For up to 2 hours postbath, axillary and skin temperatures were not different between healthy newborns bathed at 3, 6, or 9 hours of age. Thermography holds promise for learning about thermoregulation, bathing, and SSC.

Influence of Immediate Skin-to-Skin Contact During Cesarean Surgery on Rate of Transfer of Newborns to NICU for Observation.

We conducted an evidence-based practice project to determine if skin-to-skin contact immediately after cesarean birth influenced the rate of transfer of newborns to the NICU for observation. We analyzed data for 5 years (2011 through 2015) and compared the rates for the period before implementation of skin-to-skin contact with rates for the period after. The proportion of newborns transferred to the NICU for observation was significantly different and lower after implementing skin-to-skin contact immediately after cesarean birth (Pearson's χ2 = 32.004, df = 1, p < .001). These results add to the growing body of literature supporting immediate, uninterrupted skin-to-skin contact for all mother-newborn pairs, regardless of birth mode.

Actual versus instructed fasting times and associated discomforts in women having scheduled cesarean birth.

OBJECTIVES: To measure actual and instructed preoperative fasting durations in women undergoing scheduled cesarean birth, to compare these times with national guidelines for healthy patients undergoing elective procedures, and to describe discomforts associated with preoperative fasting. DESIGN: One group, nonexperimental, comparative, descriptive. SETTING: Nonprofit private medical center in Texas with 6,000 births/year. PATIENTS: Convenience sample of 51 hospitalized postpartum women. INTERVENTIONS: Participants were interviewed an average of 44 hours after their cesarean birth, and their medical records were reviewed for fasting information. MAIN OUTCOME MEASURES: Duration of actual and instructed fasting, comparison with national guidelines, and ratings of thirst and hunger. RESULTS: The participants fasted from liquids and solids an average of 11 and 13 hours, respectively. Both actual and instructed fasting durations were significantly longer than national guidelines. Most participants (70%) were instructed to be nulla per os after midnight whether they were to have a.m. or p.m. surgery. Thirst and hunger scores averaged 5 and 4, respectively, on a 0-10 scale. CONCLUSION: Patients having scheduled cesarean birth fast for unnecessarily long periods. Nurses should be knowledgeable about evidence-based preoperative fasting practices and collaborate with physicians to implement them.

Preoperative fasting: old habits die hard.

OVERVIEW: Prolonged preoperative fasting is a time-honored tradition. The typical order of "npo after midnight" (or no liquid or food after 12 am on the day of surgery) has been challenged in recent years-so much so that in 1999 the American Society of Anesthesiology (ASA) revised its practice guidelines for preoperative fasting in healthy patients undergoing elective procedures. The newer, more liberal recommendations, based on studies showing that pulmonary aspiration occurs only rarely as a complication of modern anesthesia, allow the consumption of clear liquids up to two hours before elective surgery, a light breakfast (tea and toast, for example) six hours before the procedure, and a heavier meal eight hours beforehand. There is a well-known lag between the dissemination and implementation of practice guidelines, so the authors sought to determine whether the publication of the revised ASA recommendations had changed preoperative fasting practices. They interviewed 155 patients in one hospital about their preoperative fasting, comparing instructed, actual, and ASA-recommended fasting durations for liquids and solids. Their findings demonstrate that the majority of patients continued to receive instructions of npo after midnight for both liquids and solids, whether they were scheduled for early or late surgery. On average, the patients fasted from liquids and solids for 12 and 14 hours, respectively, with some patients fasting as long as 20 hours from liquids and 37 hours from solids. These fasts were significantly longer than those recommended by the ASA, indicating that inappropriate preoperative fasting is an issue that demands attention. The authors conclude that more collaboration between nurses and physicians is needed to assure that fasting instructions are consistent with the ASA guidelines and that patients understand these directives.

Healthy Birth Practice #6: Keep Mother and Baby Together- It's Best for Mother, Baby, and Breastfeeding.

Mothers and babies have a physiologic need to be together at the moment of birth and during the hours and days that follow. Keeping mothers and babies together is a safe and healthy birth practice. Evidence supports immediate, uninterrupted skin-to-skin care after vaginal birth and during and after cesarean surgery for all stable mothers and babies, regardless of feeding preference. Unlimited opportunities for skin-to-skin care and breastfeeding promote optimal maternal and child outcomes. This article is an updated evidence-based review of the "Lamaze International Care Practices That Promote Normal Birth, Care Practice #6: No Separation of Mother and Baby, With Unlimited Opportunities for Breastfeeding," published in The Journal of Perinatal Education, 16(3), 2007.

Redefining "charge nurse" within the front line.

Don't overlook the importance of charge nurses. Learn how one organization redefined the role and strengthened these leaders, increasing patient and staff satisfaction.

Content analysis of continuing education for cervical cytology.

AIM: The purpose of this project was to assess free and low-cost web-based continuing education activities to determine if they reflect updated national guidelines for cervical cancer screening. METHODS: A qualitative design and descriptive statistics were used to conduct a content analysis. An abstraction tool was used to evaluate 15 continuing education activities. Data collection was conducted between January and February 2013 by two registered nurses. The results were recorded independently and compared for agreement between data collectors, as well as inter-rater reliability of the data collectors, and the abstraction tool was used to collect data for the analysis. RESULTS: The majority of the continuing education activities included the updated guidelines for screening intervals, the age to begin screening and when to discontinue screening. Most of the activities also indicated that human papillomavirus (HPV) DNA testing is not recommended for younger women. Very few of the continuing education activities included tips for providers to use when counselling patients. CONCLUSIONS: The correct information on age-appropriate screening intervals and HPV co-testing was included in the continuing education activities reviewed. The areas that were largely underrepresented in the continuing education activities were the risk factors, prevention measures for transmission of HPV, patient counselling about HPV and the appropriate screening practices.