Running head: AN INTEGRATIVE REVIEW: SKIN-TO-SKIN CONTACT 1

An Integrative Review: Skin-to-Skin Contact

Alexandria Lanna

Bon Secours Memorial College of Nursing

Arlene Holowaychuk

NUR 4112

November 10th, 2017

“I pledge honor code”

AN INTEGRATIVE REVIEW: SKIN-TO-SKIN CONTACT 2

Abstract

The purpose of this integrative review is to evaluate the literature regarding prompt skin-to-skin

contact (SSC) after delivery and with preterm infants in the NICU. By implementing SSC after

vaginal or cesarean delivery, it can be very beneficial for the newborn and mother. However,

there are barriers and factors that can prevent the use of SSC. The search for literature was

conducted using computer-based search engines; such as, EBSCO Discovery Services, PubMed,

and the Nursing Reference Center. The searches yielded 262 articles and five met the specific

research criteria for this topic. The results of these five articles demonstrates the support of

implementation of SSC. Findings showed the benefits of SSC, yet there can be numerous of

barriers that prevent prompt SSC. There are limitations to this review due to the researcher’s

limited background relating to research and the lack of articles available on the specific topic of

SSC. Additional research should focus specifically on the effects of prompt SSC in regard to

significant vital signs of the newborn; such as, temperature, oxygen saturation, respiration rate,

and heart rate.

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An Integrative Review

The purpose of this integrative review is to search for literature relating to implementing

prompt skin-to-skin contact (SSC) after a delivery. There are many benefits to SSC for the

mother and infant yet there are still barriers that may prevent SSC. According to Koopman,

Callaghan-Koru, Alaofin, Argani, Farzin (2016), early SSC has not been adopted as part of the

standard of care practice. This is of interest to the researcher due to the vast number of barriers

and factors that can prevent prompt SSC after delivery. The aim of this integrative review is to

gather relevant literature pertaining to the researcher’s PICO question: “In newborns of all

gestational age, does implementing prompt skin-to-skin contact after birth compared to those

who do not receive prompt skin-to-skin contact affect the newborn’s temperature and heart

rate?” By gaining insight of the benefits and how SSC can affect the newborn’s vital signs could

outweigh these barriers. There are several studies and researches pertaining to the topic. Many

focus on preterm infants in the neonatal intensive care unit (NICU) and clinicians’ perspective of

SSC. Within the articles, they all identify the barriers as to why prompt SSC is delayed.

Research Design, Search Methods, & Search Outcomes

This integrative review focuses on five research articles and three databases, PubMed,

EBSCO Discovery Services, and the Nursing Reference Center, were used to search for articles.

Specific key terms used in the searches included, ‘kangaroo care’, ‘skin-to-skin’, ‘skin-to-skin

contact’, ‘SSC’, and ‘NICU nursing’. The search yielded 98 articles from PubMed, 140 from

EBSCO Discovery Services, and 24 articles from the Nursing Reference Center. In order to

obtain current articles to the topic, the search was limited to peer-reviewed quantitative and

qualitative articles from 2012 to 2017. The articles were selected based on the stated PICO

question: ““In newborns of all gestational age, does implementing prompt skin-to-skin contact
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after birth compared to those who do not receive prompt skin-to-skin contact affect the

newborn’s temperature and heart rate?” The articles selected were related to SSC and the

researcher’s PICO question. Those articles that did not meet the specific criteria were excluded

from the review.

Findings/ Results

The findings and results of the research identify factors that could delay prompt SSC;

however, there was positive correlation of the benefits of SSC for the newborn (Bera et al., 2014;

Koopman et al., 2016; Kymre, 2014; Lee, Martin-Anderson, & Dudley, 2012; Stone, Prater, &

Spencer 2014). A synopsis of the complied research articles is located in Table 1. The researcher

framed the review according to the following categories: staff’s perceptions of SSC and the lack

of parental motivation and participation of SSC.

Staff’s Perceptions of SSC

Two qualitative studies viewed the perspectives of clinicians on SSC (Koopman et al.,

2016; Lee et al., 2012). The purpose of the study conducted by Koopman et al. (2016) was to

provide insight on the clinician’s perception on SSC after vaginal and cesarean delivery. Eleven

clinicians were interviewed, including five registered nurses and one medical doctor from the

obstetrics and gynecology unit as well as four registered nurses and one medical doctor from the

neonatal intensive care unit (Koopman et al., 2016). Semi-structured interviews were conducted

in two parts among the eleven clinicians. The first part focused on early SSC after a vaginal

delivery and the second focused on early SSC after a cesarean delivery.

The interviews were recorded and transcribed. The data analysis revealed three common

themes from the clinicians’ perceptions: institutional, familial, and implementation factors. The

study revealed that the clinicians’ perspectives consisted of inadequate staffing and education for
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institutional factors. Within the familial-level factor parental motivation and education was

identified as another perspective of the clinicians. The lack of clinical algorithm was identified as

part of the implementation factor. Both nurses and medical doctors believed that education of

clinicians and parents on the benefits can play an important role in implementing SSC.

Similarly, Lee et al. (2012) wanted to gain insight of clinician perspectives on barriers

and opportunities for SSC of premature infants in the NICU. This study had included eleven

different NICUs participate from different hospitals. There were monthly meetings that had

discussions on specific topics. Lee et al. did note that not every meeting consisted of SSC, but

each meeting was reviewed for any references.

As with the first qualitative study, the researchers recorded and transcribed the

interviews. The data was analyzed and as with the first study, similar themes were identified.

One relevant factor that pertains to clinicians’ perspective of SSC was the infant being clinically

stable enough. Clinicians did offer insight that different variables can play an important role in

determining if the infant is stable enough for SSC. Some variables discussed were the infant’s

age, weight, respiratory distress, temperature, oxygen desaturation events, blood pressure, and

bradycardia (Lee et al., 2012).

Lack of Parental Motivation and Participation of SSC

Two qualitative studies and one quasi-experimental study viewed the parental

motivations and participation of SSC (Bera et al., 2014; Kymre, 2014; Koopman et al., 2016).

The purpose of the quasi-experimental study conducted by Bera et al. (2014) was to provide

insight of the affect of kangaroo mother care (KMC) on vital physiological parameters of low

birth weight newborns born in a Hospital in India. There were 300 mother-baby participants in

study; however, 265 cases were actually used because the remaining 35 mothers could not
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implement KMC correctly. According to Bera et al., the objective of the study was to assess

physiological state of low birth weight babies during KMC. The participants provided SSC for

one hour on the first day. The second day was increased to two hours. On the third day, KMC

lasted for three hours. The babies’ vitals were assessed before and after KMC for the three days

of the study. The data collected showed there was a rise in temperature during KMC, which

supports the positive effect of SSC.

One relevant factor of the study was the parental knowledge and motivation to provide

correct SSC. Bera et al. (2014), provided education and demonstrations on properly applying

SSC. However, a major limitation for this study was 35 mothers still could not correctly provide

SSC. The underlying concern with this is how many other mothers do not understand or

adequately provide SSC.

The qualitative study completed by Kymre (2014) researched nurses’ ambivalent

attitudes with SSC. In this study, 18 nurses were interviewed and were asked to discuss their

experiences with SSC. The interviews were recorded, transcribed, and descriptive

phenomenological analysis was used for the study. Four common variables were found from the

18 interviews. The four variables consisted of professional foundation of SSC, support and

challenges by evidence, assessments and medical stability, and diverse enactments of continuous

and prolonged SSC emerged from the study (Kymre).

One major variable that is relevant came from the diverse enactments of prolonged and

continuous SSC. According to Kymre (2014) the nurses expressed their concern for babies who

needed to be comforted, but the parents were unavailable. This is a great concern because parents

need to be available in order to provide SSC. Another concern Kymre discussed was some nurses
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in the study stated that parents found it challenging to provide SSC for more than a few hours in

the day or they were not willing to provide SSC.

In the qualitative study by Koopman et al. (2016), viewed the clinicians’ perspectives on

SSC. There were 11 clinicians interviewed to gain insight of key factors that could influence

early SSC during a vaginal or cesarean delivery. Semi-structured interviews were conducted on

the unit during the work day. Three common themes emerged from the data analysis of the

clinicians’ perceptions, which were institutional, familial, and implementation factors.

One relevant theme that is pertinent that came from the familial-level factors was parental

education and motivation. According to Koopman et al., some common issues that were that

stated from the interviews were some mothers did not want to participate in SSC and some of the

mothers wanted their baby cleaned off before SSC.

Discussion/ Implications

The results from the research articles discussed clearly identify the benefits of SSC and

the barriers as to why prompt SSC can be delayed for the newborn. While not all results were

significant information on the exact PICO question. There was great value in that there was

discussion on the importance of providing immediate SSC by providing education to staff and

parents, allowing adequate staff to be present after delivery, and improvements of pertinent vital

signs. Thus, the research findings can support the researcher’s PICO question.

Improvements can be made for future research on this topic with a major focus on

eliminating known barriers and allowing prompt SSC. There are numerous of studies on this

topic, yet each study seems to discuss the barriers of SSC. Knowing that SSC has great benefits,

this should outweigh the barriers of delaying immediate SSC after delivery. This does bring

some concern to those that are preterm, low-birth weight, and complications resulted from the
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delivery. Understandably, there are safety concerns and medical priorities that surpass the

immediate SSC. With this aside, those infants that are born healthy, should be allowed to have

prompt SSC.

Limitations

There are numerous limitations that should be mentioned in regard to this integrative

review. The novice researcher has no experience completing an integrative review, thus being

the first attempt at conducting research and writing an integrative review. Also, another factor is

the researcher is a full-time nursing student with limited time available to conduct a precise and

thorough review. The class assignment allowed for five nursing journal articles within the past

five years, which limits the research available and the presented PICO question.

A limitation that can be noted from Bera et al. (2014) was the 35 mothers, who had failed

attempts of correctly providing kangaroo mother care (KMC) or skin-to-skin contact (SSC), even

after repeated demonstrations. This number of participants had they been done correctly, could

have added more statistical value to the research done. Knowing that there were mothers who

could not successfully provide KMC or SSC, this brings some attention to the importance of

providing adequate amount of education.

Conclusion

The findings of this integrative review emphasize on the barriers or factors as to why

prompt SSC can be delayed. Almost all studies identified different barriers and benefits of SSC,

which helps support the researcher’s PICO question: “In newborns of all gestational age, does

implementing prompt skin-to-skin contact after birth compared to those who do not receive

prompt skin-to-skin contact affect the newborn’s temperature and heart rate?” The articles

selected shows the need for some change in practice for providing prompt SSC. In two studies,
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there was suggestion of providing education to parents during prenatal visits in order to better

prepare the parents and so that the staff can be prepared for SSC by having adequate amount of

staff available. One study identified using a champion team concept in order to implement SSC.

This study explained there were great benefits that resulted from the use of the champion team

concept. In order for SSC to be implemented following a delivery, staff needs to be aware of

their concerns and barriers. The staff can identify and fix any possible barriers that may occur.

By addressing and eliminating the barriers, nurses and physicians can offer prompt skin-to-skin

contact with the newborns that are born.

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References

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 : Official Publication of Indian Association of

Preventive & Social Medicine, 39(4), 245–249. http://doi.org/10.4103/0970-0218.143030

Koopman, I., Callaghan-Koru, J. A., Alaofin, O., Argani, C. H., & Farzin, A. (2016). Early skin-

to-skin contact for healthy full-term infants after vaginal and caesarean delivery: a

qualitative study on clinician perspectives. Journal of Clinical Nursing, 25(9/10), 1367-

1376. doi:10.1111/jocn.13227

Kymre, I. G. (2014). NICU nurses’ ambivalent attitudes in skin-to-skin care

practice. International Journal of Qualitative Studies on Health and Well-Being, 9,

10.3402/qhw.v9.23297. http://doi.org/10.3402/qhw.v9.23297

Lee, H. C., Martin-Anderson, S., & Dudley, R. A. (2012). Clinician perspectives on barriers to

and opportunities for skin-to-skin contact for premature infants in neonatal intensive care

units. Breastfeeding Medicine, 7(2), 79–84. http://doi.org/10.1089/bfm.2011.0004

Stone, S., Prater, L., & Spencer, R. (2014). Facilitating skin-to-skin contact in the operating

room after caesarean birth. Nursing for Women’s Health, 18(6), 486-499. DOI:

http://dx.doi.org/10.1111/1751-486X.12161
AN INTEGRATIVE REVIEW: SKIN-TO-SKIN CONTACT
First Author (Year)/Qualifications
Background/Problem Statement
Conceptual/Theoretical Framework
Design/Method/Philosophical
Underpinnings
Sample/ Setting/Ethical
Considerations
Major Variables Studied (and their
definition), if appropriate
Measurement Tool/Data Collection
Method
Data Analysis
Findings/Discussion
11
Table 1 – Qualitative Article Evaluation
Alpanamayi Bera (2014)
Department of Neonatology, Institute of Post-Graduate Medical Education & Research (IPGME&R) and Seth Sukhlal
Karnani Memorial Hospital (SSKM) Hospital, Kolkata, West Bengal, India
A major problem is how newborns have the inability to control body temperature. Hypothermia is common in infants right
after birth. Kangaroo mother care (KMC) implies placing the infant in intimate skin-to-skin contact. KMC is a non-
conventional low-cost method for newborn care that offers warmth, security, and touch to the newborn.
The objective of the study was to assess physiological state of low birth weight babies during KMC.
Not listed
 Quasi-experimental with subjects serving as their own control
 Mothers and their low birth weight babies born at Institute of Postgraduate Medical Education & Research, Kolkata,
SSKM Hospital in India.
 Kangaroo Mother Care was started for 1 hour duration on the first day and then increased by 1 hour each day for next
2 days.
 Axillary temperature, respiration rate, heart rate, and oxygen saturation were assessed for 3 consecutive days,
immediately before and after KMC
300 mother/baby pairs were selected over a period of 3 years
Level III NICU facility
Mothers were volunteers & formal written informed consisted was obtained
Study protocol was approved by institutional ethics committee
Vital signs of newborn:
 Temperature
 Respiration rate
 Heart rate
 Oxygen saturation
Vital signs were assessed immediately before and after KMC for 3 consecutive days
Axillary temperature was measured by digital thermometer. Respiration rate was assessed by observing chest movements
for one full minute. Heart rate and oxygen saturation were recorded by pulse oximeter
Data was summarized by mean and standard deviation
Mean values before & after KMC were compared (two-tailed analysis)
Statistica version 6 (Tulsa, Oklahoma: StatSoft Inc., 2001) software was used for analysis
Complete data was available for 265 cases out of the 300 mother-baby pairs recruited.
 Data from those 35 cases where the mother could not implement KMC correctly or for the scheduled duration on
all 3 days were not included.
Temperature showed a small rise during KMC and changes were statistically significant for all 3 days. During KMC, the
newborns showed a steady rise in temperature and none developed hypothermia
There was no newborn that had respiratory distress. During KMC, the newborns showed regular respirations and often fell
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Appraisal/Worth to practice
asleep.
Heart rate showed a rise during KMC. During KMC sessions, all newborns had normal and stable heart rates
Oxygen saturation improved and those newborns that were on oxygen had their oxygen requirements reduced within 15
minutes of KMC.
Overall, this study shows that implementing SSC during KMC had statistical significant improvement in all 4 vital
physiological parameters.
AN INTEGRATIVE REVIEW: SKIN-TO-SKIN CONTACT
First Author (Year)/Qualifications
Background/Problem Statement
Conceptual/Theoretical Framework
Design/Method/Philosophical
Underpinnings
Sample/ Setting/Ethical
Considerations
Major Variables Studied (and their
definition), if appropriate
Measurement Tool/Data Collection
Method
13
Inez Koopman (2016)
BSC, Medical Student, Selective Utrecht Medical Master, Utrecht University, Utrecht, The Netherlands
 Current literature offers an overview of identified factors from perspective parents and clinicians that influence early
skin-to-skin contact (SSC) for hospitalized preterm infants.
 To provide insight into key factors from a clinician’s perspective that influence uninterrupted early SSC after vaginal
& cesarean delivery of health full-term infant.
None listed
Design/Methods
 Qualitative study
 Interviews were conducted at the OBGYN unit of a university-affiliated community hospital in the US and associated
level IIIb NICU
 Urban population with diverse socioeconomic & ethnic backgrounds
 Early SSC is not routinely practiced at this hospital
 The researcher (IK) went to OBGYN unit & NICU during weekdays and inquired if any staff would be willing to
participate
Sample: 11 interviews were conducted (5 RNs from OBGYN, 4 RNs from NICU, 2 MDs//one from each unit)
Ethical considerations
 Study was approved by John Hopkins University School of Medicine Institutional Review Board
 Demographics of each participants were obtained
Barriers to SSC after vaginal & caesarean delivery
 Institutional factors (Logistics & education of clinicians)
 Familial-level factors (Parental education & motivation)
 Implementation factors (Absence of protocols & mothers being uncomfortable after caesarean delivery)
Facilitating Factors
 Institutional factors (Logistics)
 Familial-level factors (parental education & motivation)
 Implementation factors (no facilitating factors identified)
Semi-structured interviews on SSC that lasted 10-30 minutes
Interviews were conducted in a private room, during work hours
Core topics were discussed for early SSC after vaginal & caesarean delivery: (1) the current practice of early SSC at the
hospital; (2) experience with early SSC; (3) opinion on early SSC; (4) factors that influence the practice of early SSC; (5)
early SSC implementation. Regarding question 4, researchers inquired specifically about facilitating factors & barriers to
early SSC. In regard to question 5, researchers inquired about the feasibility of early SSC; whether parents would be
interested in early SSC and if clinical algorithm is necessary to implement early SSC.
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Data Analysis
Findings/Discussion
Appraisal/Worth to practice
14
Thematic analysis was conducted to analyze the data & any identifying information was omitted.
Interviews were recorded and transcribed into verbatim data.
The overall themes were adopted from the thematic framework provided from Lee et al (2012), which consisted of (1)
institutional, (2) familial-level (3) implementation factors.
Interviewing, transcribing, & coding of the data were conducted by IK with input & guidance from JCK & AF
All participants indicated that early SSC was important & beneficial. The participants held different perceptions about the
extent to which SSC is currently practiced at the hospital.
Institutional factors included inadequate staffing & education on early SSC. Barriers to implementation included the
absence of a clinical algorithm & unclear definitions for those eligible mothers & infants.
Knowing and understanding the factors and barriers on early SSC from a clinician’s perspective offers a better insight into
the practice of early SSC.
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First Author (Year)/Qualifications
Background/Problem Statement
Conceptual/Theoretical Framework
Design/Method/Philosophical
Underpinnings
Sample/ Setting/Ethical
Considerations
Major Variables Studied (and their
definition), if appropriate
Measurement Tool/Data Collection
Method
Data Analysis
Findings/Discussion
Appraisal/Worth to practice
15
Ingierd Kymre (2014)
PhD student
Skin-to-skin contact (SSC) in terms of facilitating and enacting situations of direct SSC between preterm infants and parents
is common in Neonatal Intensive Care Unit (NICU) nursing practices. SSC is the main component of Kangaroo Mother Care
(KMC), which consists of continuous SSC between a mother and low-birth-weight infant. The aim is to illuminate the
essence of NICU nurses’ attitudes in SSC practice for preterm infants & their parents.
Not listed
Qualitative study
Descriptive phenomenological in terms of reflective lifeworld approach
18 willing nurses to participate from three NICUs in Sweden, Norway, and Denmark, 6 from each were interviewed at their
workplace.
Interviews were conducted in quiet rooms away from the NICU.
The study was approved by the regional committee for medical & health research ethics
Consent and permission to participate and record interviews was given by each participant. Confidentiality of the study was
assured to each individual.
 Ambivalent professional foundation of SSC
 Supported & challenged by scientific research evidence
 Varied assessments of whether to prefer SSC or incubator for unstable infants
 Diverse enactments of prolonged & continuous SSC
Interviews were recorded and transcribe verbatim by the author.
The nurses were asked to openly describe experiences about SSC and how they facilitate it in practice.
Probing questions were asked to obtain details about what participants thought were important.
Participants were asked to reflect on the issues of SSC
Descriptive phenomenological analysis was chosen for the study. To avoid misconceptions of meaning, the original
languages were kept for as long as possible during transcription and analysis. The entire interview text was initially read to
get a sense of wholeness for reflective lifeworld research.
The nurses’ attitudes in SSC practice are ambivalent and they consider sensory, wellness, and mutuality experiences primary
& vital to apply SSC as much as possible. The professional foundation of SSC of considering it nursing care or medical
treatment. The nurses felt supported and challenged by scientific research evidence on SSC within their own experiences and
beliefs. Their established practices were challenged. Environmental conditions for parental presence in the NICU were
considered as an important obstacle for optimal enactment of SSC.
This study acknowledges NICU nurses’ attitudes in SSC practice, experiences and beliefs. Clinical implications involve
acknowledging the need to balance multidisciplinary based concerns and knowledge in SSC practice. Also, acknowledging
the clinical judgments concerning SSC depend on parents and infants having access to each other, which the NICU nurses
can help influence.
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First Author (Year)/Qualifications
Background/Problem Statement
Conceptual/Theoretical Framework
Design/Method/Philosophical
Underpinnings
Sample/ Setting/Ethical
Considerations
Major Variables Studied (and their
definition), if appropriate
Measurement Tool/Data Collection
Method
Data Analysis
Findings/Discussion
16
Henry Chong Lee (2012)
Department of Pediatrics, University of California, San Francisco, CA.
Skin-to-skin contact (SSC), also known as kangaroo care, is a beneficial intervention for premature infants. Early SSC in the
neonatal intensive care unit (NICU) increases maternal milk supply and guards against insufficient lactation. SSC influences
infant health outcomes through direct physiologic effects. Previous studies shown improvement in oxygen saturation and
regulation of stress response.
The objective was to investigate key factors in promoting SSC in the NICU.
Not listed
Qualitative study
Met in person or by webcast for monthly group discussions, which involved an expert panel and clinician representatives.
11 NICUs from different hospitals
Representatives included lactation consultants, dieticians, NICU nurses, nurse managers, educators, neonatologists, infant
development experts, occupational therapists, and physical therapists.
Setting of the study was the California Perinatal Quality Care Collaborative/California Children’s Services Breastmilk
Nutrition Quality Improvement Collaborative. This was to use a multidisciplinary approach to increase the proportion of
very low birth weight infants.
The study was approved by the University of California, San Francisco Committee on Human Research
Three main categories/themes:
 Patient implementation factors
 Institutional-level factors
 Maternal or familial-level factors
Monthly meetings had a specific focus for each discussion, which topics were decided beforehand.
A moderator was involved during the discussions.
Any information that identified hospitals or individuals were omitted
Thematic analysis was conducted in an iterative fashion by two analysts (H.C.L & S.M.A)
Atlas Ti software was used, which facilitates qualitative research to analyze transcripts. The analysts independently read and
coded the transcript.
Patient implementation factors:
 Infants needed to be clinically stable to be able to participate in SSC
 Use of equipment/technology
 Policies for implementation
Institutional factors:
 Documentation and logistics—sharing information amongst physician, nurses, and mother; mother’s consent for
SSC not being obtained when SSC is being done.
 Staff education—lack of education about the importance of SSC and techniques
 Staff buy-in—participants expressed concerns that not all staff believed in the benefits of SSC or were motivated to
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Appraisal/Worth to practice
encourage it
Familial factors
 Visitation/transportation
 Parental education/motivation
This study investigates the factors for successful application of and the barriers to implementing SSC in the NICU.
AN INTEGRATIVE REVIEW: SKIN-TO-SKIN CONTACT
First Author (Year)/Qualifications
Background/Problem Statement
Conceptual/Theoretical Framework
Design/Method/Philosophical
Underpinnings
Sample/ Setting/Ethical
Considerations
Major Variables Studied (and their
definition), if appropriate
Measurement Tool/Data Collection
Method
Data Analysis
Findings/Discussion
Appraisal/Worth to practice
18
Susan Stone (2014)
DNP, FNP-BC, DNP
Implementation of early skin-to-skin contact (SSC) in nonemergent, full term caesarean surgical births among low-risk
health women. Three aims for this: (1) to develop a protocol for health care professionals’ roles in providing SSC in the
operating room; (2) to implement the protocol; (3) to evaluate the process of implementation
The framework used was Iowa Model of Evidence-Based Practice to Promote Quality Care & Lewin’s Change Theory.
Qualitative study
SSC in the OR after cesarean birth within an inner-city hospital located in the Southwestern United States.
Champion team concept was used; the project manager & nurse manager identified champion representatives. These
representatives were in charge of collaborating as a team to communicate departmental & discipline-specific concerns.
Team members consisted of obstetrician, anesthesia provider, lactation consultant, two labor & delivery nurses, two NICU
nurses, and two neonatal admission nurses.
1 hour OR simulation was completed with the team members.
Approval of the IRB of supporting institutions was obtained and all hospital personnel who participated in the
implementation of the SSC protocol gave informed consent.
First aim: developing a protocol through champion team simulation experience. Observations were taken by project manager
during the simulation and the data was used to develop the pilot protocol.
Second aim: all individuals who attend cesarean births received training on SSC protocol & completed a quiz. All received
100% on the posttest and consented to participate after the education
Third aim: accomplished with a survey questionnaire that was evaluated by the project manager
Survey questionnaire with open-ended questions
Descriptive data were analyzed for each of the four Likert Scale survey questions using SPSS version 21
Qualitative data was summarized from the open-ended questions
In the first phase of implementation, responses from the open-ended questions showed that more communication &
coordination was needed among all roles in the OR. In the second phase, this issue resolved. By constructing a network of
champion clinicians, they were able to help their colleagues with applying principles and tools for evidence-based practice.
The champion team model for evidence-based practice is effective for implementing change that involves multiple
disciplines with their own interests. Facilitating SSC after a cesarean birth in the OR is safe and can be beneficial for
newborns.