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Less Separation Between Mothers and Their Newborns, Research Paper Example

Pages: 12

Words: 3326

Research Paper

Quality improvement evidence-based or knowledge-based practices within healthcare settings have emerged as major problem area that nurses as leaders must directly address in a swift manner. More specifically, quality improvement to decrease separation time of mother and infant by implementing the practice of bedside transition of newborns would enhance the efficacy and quality of healthcare delivered to patients. This issue is significant because of its efficacy in the enhancement of the newborns health via skin to skin contact a there are various studies that attest to this reality. It is the job of healthcare leaders to ensure that new mothers not only receive optimal healthcare upon giving birth to their children, it is also their prerogative to monitor the health of the mother and child throughout the process. There is an undergirding necessity for healthcare professionals to focus on the significance and ramifications of both emotional and physical intimacy/closeness between a parent a parent and an infant that is pre-term within the neo-natal intensive care unit. Physical closeness means that the mother and child achieve emotional proximity and that they are spatially close so that the mother and child achieve an emotional connection to the newborn with regards to warmth, love, and affection. Doing so not only enhances positive outcomes for the mother but also for the newborn later on in his or her life. The culture and environment of the neonatal unit influence the physical, social, and emotional well-being of both parent and newborn in an idiosyncratic fashion. As such, the culture and environment in which a newborn is born and the practices deployed therein are of paramount importance.

Women have always wanted and needed their newborns close to them and in their arms after giving birth whether they are sleeping or just resting. Such yearning for proximity represents the emotional and physical necessity shared by both newborns and mothers alike (Moore & Anderson, 2007). Evidence-based practices attest to this assertion that mother and child seek one another after birth. Oxytocin is the hormone that makes a mother’s uterus contract, and it stimulates maternal feelings once a baby is born and the mother breastfeeds and holds their newborn (Uvnas-Moberg, 1998). The more skin-to-skin contact a mother has with her baby, the more oxytocin will be released, and the brain will then release endorphins that further amplify such maternal feelings. These hormones have the effects that are akin to narcotics and thus enhance the responsiveness of mothers as well as their level of calmness, thereby raising the temperature of the mother’s breast in order to keep the newborn warm. This cause-and-effect prompts an adrenaline rush in the newborn follow his or her birth, which renders the baby alert and ready for a mother to nurse it quickly (Porter, 2004). Evidence shows that increased interaction between mother and newborn will enable mothers to learn how to communicate with their baby by reading cues.

Taking into consideration the corpus of literature within this field of inquiry, it is unequivocal that there are a multitude of reasons why both physical and emotional proximity are of paramount importance in the enhancement of the health and well-being of both parent and child. Benefits include straight scientific facts such as that the brain development of the newborn is amplified, as several studies have shown that shortening the separation incubation enhances the psychological health and well-being of a parent regarding the infant-parent relationship in addition to the growth and development of the newborn itself. The culture detected within the neonatal unit culture and environment profoundly impacts the emotional and physical proximity that has hitherto been discussed with regards to the efficacy on the quality of care given to mothers who have just given birth. Ultimately, it is unequivocal that culturally sensitive healthcare practices, procedures, and the actual physical environment must take into consideration and adjust to facilitate the proximity between a parent and her newborn. This can only be achieved through a protracted yet early type of family-centered care in which skin on skin contact is encouraged in addition to more visiting hours, enhanced family-centered care, and the maximization of unit space in order to facilitate such efforts. More research is required in order to adequately explore the factors that enable both emotional and physical closeness to make sure that the intimate connection  between newborn and mother is of paramount importance within neonatal care today in major healthcare contexts.

Nurse practitioners occupy an integral role in addressing the challenges that face new mothers and their infant child. These challenges include new practice change for the unit; role expansion for all areas as all nursing staff including Labor and Delivery Nurses to learn the newborn transitioning process; staff discomfort with change initiative;  resistance from staff; and financial impact for implementing the change (educating staff, overtime, etc.). Some strategies used by nurse practitioners to address problems include the following but is an ongoing list that develops on an ad hoc basis: Promoting change initiative; identifying champions for change initiative; incorporating staff in the roll out process to increase buy-in from the staff; and transparency.

DNPs are charged with the task of implementing strategies and post-partum interventions that increase the amount of time that newborns and mothers spend together in throughout the mother and child’s postpartum hospitalization. Doing so is done to enhance the rate and efficacy of breastfeeding exclusivity (Maugans et al., 2013).  Evidence-based practices underscore the need for DNPs to engage in such strategies and interventions. One design used to take measurements of breastfeeding exclusivity rates  following birth in addition to the amount of time that newborns spend in the nursery prior to and following the implementation of interventions and strategies to abate the time that mothers and babies are separated. Maugans et al. (2013) describe on project that was tested in a neonatal unit in a teaching hospital where more than three thousand mother/newborn dyads seek care on an annual basis. There was a census that was monitored in the nursery between eleven at night and seven in the morning both pre- and post-implementation to ascertain the progress in the direction of non-separation. Breasfeeding exclusivity and the time that the first feeding was engaged were both assessed to trace if any improvement was made prior to and following the implementation of an intervention.  A perinatal team composed of various different medical personnel that was well versed in the Lean Six Sigma methodology which aimed at decentralizing care for newborns. As such, mobile equipment was bought for evaluating newborns when they were beside their mothers. Newborn feeding methodologies were detailed by the DNPs to the mother who underwent mandatory education regarding evolving clinical practices. The results of this intervention demonstrated that there was a 54% increase in in-rooming hospitalization. In addition, newborns how were breastfed within an hour after being born increased by to a rate of 96%. As such, breastfeeding exclusivity increased 38% (Maugus et al., 2013). These results reveal that research evident bolsters breastfeeding exclusivity if they are breastfed immediately in comparison to babies who are separated from their mothers. Such evidence points to the efficacy of the practice of rooming-in of mothers for enhancing breastfeeding and amplifying mother’s attentiveness to the needs of their baby, which results in a reduction of discomfort and crying (Maugus et al., 2013).

Nurse Practitioners occupy a unique position within the healthcare system to promote the resourcefulness and benefits of breastfeeding for diverse maternal populations. There are a handful of opportunities to promote how breast milk benefits the overall health of newborns, as it boosts the newborn’s immunity for many maladies while reducing the incidence of debilitation disease such as obesity and diabetes. Moreover, the mother also benefits from lower incidences of several illnesses such as ovarian, breast, and uterine cancers. In addition, NPs must stress how cost-effective and readily available breast milk is in addition to how employers benefit because there will be less time that parents are absent from work due to illness for parents who are breastfeeding. Ultimately, society at large benefits because there would be less healthcare costs yielded and the environment would be less adversely affected. DNPs must recognize these stakeholders in this issue in order to improve the quality of neonatal and perinatal care. Maugus et al. (2013) note that regulatory agencies and professional medical organizations recognize that breast milk is the most optimal food for babies to ingest immediately after they are born because of the health benefits mentioned above. Research further attests to the fact that hospital practices direct affects breastfeeding behaviors and duration throughout the first year of a newborn’s life. Separating newborns from their mothers spawns a litany of missed opportunities for mothers to pinpoint feeding cues, which is why DNPs must educate their patients and provide support for breastfeeding behaviors. The decentralization of newborn care that bolsters non-separation practices gives DNPs the opportunity to close the chasm that exists in the healthcare system and tout breastfeeding exclusivity throughout their hospitalization.

Cvach and Williamson (2013) devised a program in which minimizing the duration of time that mother and baby at delivery were separated in order to analyze and assess the stabilization and benefits of mother/baby bonding at delivery. A task force that was nurse-driven integrated the assessment carried out by the neonatal nurse into the process of delivering babies. This task force ascertained that inconsistent healthcare practices as reported by healthcare providers profoundly impacted the quality of neonatal care provided and the satisfaction of mothers. This, Cvach & Williamson (2013) carried out this project in order to established a new role designed to provide transitional care at the bedside of mother for newborns who fit a certain criteria. Hospital nurses volunteered to participate in this project in order to ascertain what changes needs to be made in order to enhance the quality of neonatal care. The proposed change derived from the clinical assessment dubbed NAN and was implemented in order to facilitate the newborn’s transition from fetus to newborn baby in a positive manner; enhance the satisfaction of mothers; decrease the period of time when the mother and newborn are separated, boost the rate of skin on skin contact, and phase out the current practice of separating the mother from her newborn.

For the implementation, evaluation and the assessment of outcomes, the authors procured approval by the Hospital Institutional Review Board. To ensure that the NAN assessment was successful, meticulous role description was provided; priorities for patient care; the expectations of nurses id the labor and delivery rooms did not have any neonatal patients therein; and finally a conclusive assessment plan for newborns who need supportive monitoring and care that are not rendered intensive.  Furthermore, there is a pedagogical element included in this study as nurses, according to their level of expertise, provided both clinical orientation and education on the nuances of neonatal care across the continuum of care. Nurse leaders incorporated technology via simulation of particular scenarios in order to reinforce evidence-based practices in addition to educating adjuncts adequately.

The NAN-identified nurses combined with the staffing models that had been devised and created by the maternal-child health unit nurses made sure that the nurses were fully covered by insurance every day of the week. Inventory was then carried out prior to and following the NAN to ascertain the nurses’ perspective regarding the health care services they were providing to newborns and new mother who had been in this world for less than four hours. This specific survey underscored the importance of maternal perspective and was chosen due to the fact they both survey and tool was in conjunction with the hospital’s Watson Caring Theory which provided both a structure and a framework that governed current nursing practices today. Ultimately, this study retains a litany of implications for nursing practice today with regards to improving this field of practice. Within the LDR,  the role of NAN has gained new currency as it now grants a litany of benefits of having a nurse and nurse leader(s) who are dedicated too providing the most optimal neonatal car in scenarios when the transition period necessitates monitoring using an oxometer in addition to evaluations after stabilization. While there remains a dearth or studies and literature on this very topic, nonetheless any and all positive results of this particular plan that has been implemented will aid others embrace similar roles according to their clinical setting.

The identification of key stakeholders and measures or indicators of healthcare outcomes that are important to the stakeholders and that are used in addressing the problem area must also be discussed in order to adequately address the  problem that are present therein, Key stakeholders in this particular medical care issue include the executive Leadership Team; obstetrical team that includes both nurse practitioners as well as the gynecologist; physicians, including the various obstetricians, anesthesiologists, neonatologists, etc; and of course finally the patient. Following the delivery of the baby and ensuing treatment, healthcare measures must be taken in order to optimize healthcare for mothers in the near future. Such healthcare measures taken to assess performance include patient Satisfaction scores, breast-feeding rates, evidenced Based Practices,  perinatal core measures, and baby-friendly Initiative (prestigious designation).

Within this discussion, it is of paramount importance that a paradigm shift takes place within the culture of closeness fomented in the NICU in order for tangible results to be achieved. In conjunction with structural changes to the policy of what transpires in the aftermath of a baby being born, there also must be a persistent change in the culture itself within neonatal units in hospitals within the very specific context of neonatal intensive care (Meaney & Szyf, 2005). There has indeed already been a structural alteration in the general attitude amongst medical personnel in the neonatal care unit that has reoriented focus towards family-centered care, although there remains both a technical and a medical focus in addition to there being chasm between healthcare policies and/or practices and the evidence that is available from both infant and family research and epistemologies. Moreover, when parents visit their newbords or infants in the NICU, many of them remain limited in their options in several western countries, especially in European countries that steadfastly refuse to let the parents of newborns be present  when their babies are undergoing medical rounds and testing in addition to when the nurse shift ends and the handover and quiet periods commence.

There has been a dearth of studies on the visiting patterns and behaviors once a newborn comes into the world, yet Franck & Spencer (2005) demonstrate that the majority of mothers went to the NICU with their spouses or not at least once a day for a period of at least 3 hours. It is interesting that while the mothers went to spend time with their babies on a quotidian basis, only one third of the fathers went to go see their babies every day for a much shorter period of time. Experts noted that mothers who visited their baby infrequently have been pinpointed as a risk factor in the cognitive development in their infants much later on in their lives. Some parents did, however, lack the economic and monetary means to be able to stay with newborns throughout the duration the child’s hospital stay. Long distances to travel to the hospital, work that limits the amount of paid maternity and/or paternity leave, siblings, and other mitigating factors also constricted to opportunities parents had to be with their newborns in the NICU. In cases such as these, modern technology is often used to support contact between newborns and their parents. For example, web cameras and other applications on smart phones such as FaceTime are used for parents to be able to visit their baby in the neonatal unit vis-à-vis virtual means

While so-called virtual visits contribute to the parental/baby bonding, nurse practitioners have come up with several ways to facilitate contact between mothers and their newborns in a celeritous manner, Staff members in the neonatal unit welcome and even encourage parents to participate in the care of newborns in addition o instructing parents how to effectively adapt/infuse the parental touch into the quotidian care of their newborns. Indeed, many parents, especially younger parents who have never had a child before, need to be explicitly instructed with regards to care in a baby’s nascent stages of care. The parental touch, retains the capacity to induce stress in newborns who are very sick. Family-centered cultures often constrain the utilization of institutional powers and the role of NICU staff which shifts from a more active role of doing to one of  supervising and serving as a facilitator and resource for newborns’ families. Within such a culture in which family-centered power and healthcare is located within a culture that underscores the efficacy and currency of professional care, issues often arise regarding incoherent responsibilities delineated in addition to problems pertaining to power and control.  As such, hospital staff, especially those working in the NICU, are encouraged to actively facilitate the forging of strong relationships between newborns and their parents. Parent-infant bonding thus has emerged as the main goal in these settings, and successful transition mandates both sound education and constructive feedback to the hospital staff as specific demands on them as well as the way that care is administered follows suit. There are a variety of interventions that have proven to work in order to increase the amount of parental involvement, aimed at empowering them when their newborns are in the neonatal unit, that have worked with regards to pain management, observing nascent behaviors, and the utilization of skin-to-skin care for an extended period of time in order to empower their children and instill appropriate behavioral traits.

References

Carter, B.S., Carter, A., & Bennett, S. (2008). Families’ views upon experiencing change in the neonatal intensive care unit environment: From the ‘baby barn’ to the private room. Journal of Perinatology, 28, 827–9.

Cvach, K. & Williamson, K.M. (2013). Implementing the neonatal assessment nurse role in the LDR: Improving neonatal outcomes while supporting family-centered care. Journal of Obstetrics, Gynecologic, & Neonatal Nursing, 42(1).

Feldman, R., Weller, A., Sirota, L., & Eidelman, A.I. (2002). Skin-to-Skin contact (Kangaroo care) promotes self-regulation in premature infants: sleep-wake cyclicity, arousal modulation, and sustained exploration. Developmental Psychology, 38, 194–207.

Feng, X., Wang, L., Yang, S., Qin, D., Wang, J., & Li, C., et al. (2011).  Maternal separation produces lasting changes in cortisol and behavior in rhesus monkeys. Proc National Academy of  Science, 108, 14312–7.

Franck, L.S., Bernal, H., & Gale, G. (2002). Infant holding policies and practices in neonatal units. Neonatal Network, 21, 13–20.

Franck, L.S., & Spencer, C. (22003).  Parent visiting and participation in infant care-giving activities in a neonatal unit. Birth, 30, 31–35

Lagercrantz, H. & Changeux, J.P. (2009). The emergence of human consciousness: from fetal to neonatal life. Pediatric Residency, 65, 255–60.

Latva, R., Lehtonen, L., Salmelin, R.K., & Tamminen T. (2007). Visits by the family to the neonatal intensive care unit. Acta Paediatrics, 96, 215–20.

Maugans, R.E., Buchko, B.L., & Gutshall, C.H. (2013). Minimizing mother-baby separation to promote breastfeeding exclusivity: Closing the gap in nursing practice. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 42(1), 75-76.

Meaney M.J. & Szyf, M. (2005). Maternal care as a model for experience-dependent chromatin plasticity? Trends in Neuroscience, 28, 456–63.

Moore E. R. & Anderson G. C. (2007). Randomized controlled trial of very early mother-infant skin-to-skin contact and breastfeeding status. Journal of Midwifery & Women’s Health, 52(2):116–125

Nordho, S.M., Ronning, J.A., Dahl, L.B., Ulvund, S.E., Tunby, J., & Kaaresen, P.I. (2010). Early intervention improves cognitive outcomes for preterm infants: randomized controlled trial. Pediatrics, 126, 1088–94.

Porter, R. H. (2004). The biological significance of skin-to-skin contact and maternal odors. Acta Paediatrica, 93,1560–1562.

Uvnas-Moberg, K. (1998). Oxytocin may mediate the benefits of positive social interactions and emotions. Psychoneuroendocrinology, 23(8), 819–838.

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