Nurses know that even small changes in practice can have big implications for patients. For the past three months, the postpartum unit at Emory Hospital Midtown has been conducting research on the warming of newborns after their first baths.
“A newborn’s temperature is unstable at birth, but once it stabilizes, usually within two hours, nurses give the baby a sponge bath and wash his head. Afterward, the standard practice is to place the infant in a radiant warmer to help him regain and maintain normal body temperature,” said Sino George, RNC, MSN, WHNP/BC, clinical nurse specialist for perinatal services at Emory’s Women’s Center.
An article that her staff read as part of their Journal Club (an initiative to stay abreast of new scientific evidence) made them question their standard rewarming practice. They wondered if skin-to-skin contact — or rewarming a baby on its mother’s chest — would be just as effective.
“We knew that skin-to-skin contact was beneficial for premature babies. Studies had shown that it helped with mother/baby bonding, breastfeeding outcomes and baby weight gain,” George said. “We wondered how healthy infants would fare with skin-to-skin warming. We couldn’t find much in the literature, so we decided to conduct our own study.”
George wanted help so she turned to Susan Shapiro, associate chief nurse for evidence-based practice, associate clinical professor and assistant dean for strategic clinical initiatives at Emory University’s Nell Hodgson Woodruff School of Nursing.
“I was hired by both Emory’s nursing school and Emory Healthcare to strengthen the ties between nurses in both organizations,” said Shapiro, Ph.D., RN. “It’s the best job in all creation. I get to work with enthusiastic and talented groups of nurses, as nursing research is growing across our system.”
She connected George with assistant clinical professor of nursing Maeve Howett, who helped design the study protocol.
“What often happens with new technology is that we keep applying it wherever we can. We don’t take the time to look at where it works best and evaluate its effectiveness in every case,” Shapiro said. “We got radiant warmers because we need them in certain circumstances, but do they need to be our standard practice? We couldn’t answer that without evidence.”
With a goal of gathering information that will inform their practice and improve care, Emory Hospital Midtown nurses have enlisted mothers of healthy, average-sized, vaginally born newborns into the study. So far, all have chosen the skin-to-skin option.
Nurses carefully monitor the babies to make sure that skin-to-skin rewarming is safe and effective, taking temperature readings every 30 minutes. Fathers have also been allowed to participate when mothers are too tired or not feeling well.
“So far, our data collection has been very positive,” George said. “Every baby has been successfully warmed by the mother’s skin within the hour, and the mother’s love it.”
That intimacy is good for mothers and their newborns.
“We know that babies do better when there is early bonding and we’re hoping that this could encourage breastfeeding,” George said. “When the baby is alert and lying on the mother’s chest he will naturally turn his head and begin rooting for the breast. Even if the mother chooses to bottle feed, she will begin to recognize when her baby is hungry.”
George aims to study 100 to 200 participants using both rewarming methods and hopes to collect enough data within six months.
“If the results warrant it, we’ll change our standard of practice,” she said.
Serving as the principal investigator of the first nurse-led study in women’s health at her hospital has been time-consuming and gratifying for George. “I had no idea how much work was involved, but this is something that nurses at the bedside do.”
As nurses in the study become aware of issues, they look at practice changes that will bring about better patient outcomes. George sees that as nurses performing evidence-based practice.
“Women’s hormones are raging after birth and they can have feelings of inadequacy or insecurity,” George said. “This keeps them much more attuned to their babies and makes them a part of the post-partum process.
“We’re showing that skin-to-skin [method] is just as effective for rewarming and offers added advantages. This is something we can do for our moms and babies and for other nurses. We’d like to publish our findings and present at national meetings to share what we’ve learned.”
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