Capstone week 6-

PICOT: Skin-to-skin Contact Education for Postpartum Mothers

PICOT: Skin-to-skin Contact Education for Postpartum Mothers

The immediate care provided to a mother and a newborn immediately after delivery plays a critical role in their short-term acclimatization. However, the absence of standard best practices results in worrying practices such as the separation of mothers and their newborns in the first minutes of life to conduct non-urgent care. Medical practitioners remove the baby from the mother’s chest to provide care that can either be delayed or conducted while the newborn is still subject to skin-to-skin contact with the mother. The unjustified non-urgent care processes often entail injecting vitamin K, applying ophthalmic ointments, and assessing vital signs. Turenne et al. (2016) also finds that the separation of mothers and newborns is prevalent and aligns with considerable postnatal care protocols in various healthcare institutions. Such clinical practices result in increased birth-related stress for newborns and maternal stress that delays breastfeeding and placenta expulsion. Accordingly, limited skin-to-skin contact (SSC) results in higher risks of using formula supplementation because of delayed breastfeeding, higher crying frequencies and intensity, and overall mother and baby stress. Despite the growing body of research supporting the relevance of SSC, Brimdyr et al. (2020) report on a UNICEF finding that only 45% of newborn babies are exposed to immediate SSC and breastfeeding. Moreover, 83% of United States reported SSC, implying that SSC is not practiced in 17% of United States’ hospitals. Accordingly, the PICOT project proposes the integration of an SSC education program for postpartum mothers to improve their SSC knowledge while probabilities of postpartum depressive symptoms.

The quality improvement initiative leverages the following PICOT question: Among postpartum mothers from the maternal and newborn care unit (P), does the integration of a skin to skin contact (SSC) education program (I), compared to control group without this intervention (C), improve knowledge on SSC and reduce the incidence of postpartum depressive symptoms (O), over a period of six weeks (T)? Postpartum mothers are focused population because of their susceptibility to emotional distress and depressive symptoms following after birth, especially when an immediate maternal-and-newborn bond is not attained. An SSC education program will foster requisite self-care skills, facilitating a desirable bond with newborn babies and the related maternal physiobiological benefits. Effectiveness of the intervention will be assessed after comparing results from self-reported surveys that will target SSC knowledge and self-reported depressive symptoms. These outcomes will be assessed after six weeks.

Vulnerable Population

Postpartum mothers are an ideal vulnerable population for this project because of the potential risk factors that can result in postpartum stressors and depressive symptoms. Social determinants of health can influence the depressive symptoms. For example, the lack of financial resources can result in stress and anxiety for women as they worry regarding baby care after discharge. The absence of social support can also exacerbate the probability of maternal stress and postpartum depression (Ghaedrahmati et al., 2017). Lack of social and family support in decision-making can also limit advocacy, which would otherwise influence shared decision-making, resulting in the incorporation of immediate SSC. Education level can also enhance vulnerability of postpartum mothers. A low education level can imply limited literacy, which would act as a barrier to SSC education.

Proposal

Skin to skin contact (SSC) is a critical best practice because of its considerable advantages to the mother and child. On one end, it enables a newborn to quickly progress through the nine instinctive stages of crying, relaxing, awakening, activity, resting, crawling, familiarizing, suckling, and sleeping. Other benefits entail a significant reduction in the adverse effects of birth-related stress, improved ideal thermoregulation that progresses to the subsequent days, and reduction in cry frequency (Widstrom et al., 2019). SSC also has considerable benefits to the mother. For example, research by Bigelow and Power (2020) find that SSC plays an important role in placenta expulsion, reducing bleeding, and enhancing breastfeeding self-effectiveness. In addition, SSC triggers the considerable increase in mothers’ oxytocin, which plays a critical role in lowering maternal stress level and fostering enhanced mother-infant bonding.

Nursing Theory

The Health Belief Model will be instrumental to the project. This theory helps to elucidate the rationale behind the acceptance or rejection of healthy behaviors by patients. The Health Belief Model will help outline the motivation for mother’s and medical practitioners’ adoption of the SSC practice. The theory argues that health-related behaviors are influenced by factors such perceived susceptibility to a health condition, perceived severity of the condition based on consequences, the assumed benefits of health-promoting actions, perceived hindrances to the ideal action, presence of action enablers, and perception or confidence in one’s ability to engage in the ideal action. In line with the PICOT project, perceived susceptibility to the ignorance of SSC should be highlighted when educating the mothers, considering that Brimdyr et al.’s (2020) study finds that only 45% of newborns are exposed to immediate SSC. Perceived severity of the negative repercussions should also be highlighted to influence a belief of consequences such as the adverse impact on mother-newborn bonding, placenta exclusion, breast feeding, and the newborn’s cry (Turenne et al., 2016). Reducing maternal and newborn’s distress and countering the risks of postpartum depressive symptoms. Perceived hindrances can include the existing clinical practice culture where SSC is not integrated, the lack of appropriate medical practitioner competency, or environmental barriers such as lack of practical arrangements to ensure that the mother’s clothes are conveniently arranged. Enablers of the ideal action will involve the education program focusing on postpartum mothers.

References