Running head: Capstone Change Project: Draft 1

Capstone Change Project: Draft

Jessica R. Evans

Grand Canyon University: NSG448

31 March 2019
Capstone Change Project: Draft 2

Capstone Change Project: Draft

Introduction and Proposal

As women prepare to give birth to their babies, the delivery can be unpredictable. A

woman can plan for a vaginal birth; however, complications can arise and she might need a

cesarean section instead. A cesarean section is a “surgical procedure to deliver a baby by making

incisions in the abdomen and uterus” (Mayo Clinic 2018). On the other hand, a cesarean section

could be planned and wanted. Skin-to-skin contact has many benefits to the baby such as:

“greater respiratory status, temperature, and glucose stability” (Phillips 2013). However, mothers

who have a cesarean section do not have the opportunity to do skin-to-skin contact. Per protocol,

mother and baby are separated for hours before they are reunited. Because of this separation,

mother and babies are deprived of the experience and benefits of skin-to-skin contact. So, the

question is: how can skin-to-skin contact after a cesarean section provide positive outcomes such

as improving health, attaching strongly, and feeding, compared to no skin-to-skin contact?

For this capstone project, mothers are the focus. Specifically, mothers who have done

skin-to-skin contact after a cesarean section. This is to understand the effects of skin-to-skin

contact such as: a difference in the baby’s health, creation of a connection with their mother, and

feeding. As the nurse, they would immediately place the baby on mother’s chest after delivery.

To compare results, information would be gathered on mothers who also had a cesarean section

delivery but did not have skin-to-skin contact right after birth. This is to demonstrate how skin-

to-skin contact is highly beneficial to the baby, especially after a cesarean section because they

are more likely to have health issues. This demonstration can influence medical professionals to

implement skin-to-skin contact with mother and baby after a vaginal birth and a cesarean section.

Lastly, there is no specific timeline for this research, however, additional studies on the topic are
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used as well for research, dating back to five years ago. If skin-to-skin contact cannot be done

immediately after birth, an alternative is to provide the opportunity within two hours after

delivery.

Identify the Needed Resources and Why They are Needed.

For this change project to be successful, there needs to be resources available. The

resources that are needed include added staff and increased hygiene precaution. When a mother

is having a cesarean section, there are many medical professionals that are present. However,

additional staff is required when a newborn is in the operating room and skin-to-skin contact is

performed. This is to ensure that both mother and baby are doing good and interventions can be

done immediately if complications arise. More staff improves patient safety because they will be

more assessments done. Furthermore, because the baby will just be born, hygiene precaution

must be increased while in the operating room, so mother and baby do not contract an infection.

Despite the extra cost of staff and hygiene products, this change will benefit the hospital because

it will help with infant and mother mortality and improved outcomes for both as well.

Additionally, the cost of each patient lowers because there will be shorter stays due to the

benefits of skin-to-skin contact.

Identify the Needed Stakeholders and Their Role.

Additionally, stakeholders are extremely important for any change to happen. A

stakeholder is “any individual, organization, or institution who holds an interest,” to the change

project (Sonoma 2019). For this change project, the stakeholders include: patients, nurses who

specialize in labor and delivery, postpartum, and NICU, physicians, insurance, and health policy

officials. Patients are essential for the change because this directly affects them. If they do not

like it, it will not continue forward. Nurses are the ones who are implementing the change and
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advocate for the best of their patients. Physicians are included because help drive the process

forward. Insurance covers the cost, so they need to be interested. Lastly, health policy officials

are the ones who will make the change happen. In the end, skin-to-skin contact has more benefits

for mother and baby after a cesarean section than without.

Literature Review

Today, cesarean sections are becoming more common for deliveries. Because skin-to-

skin contact is not used as much for cesarean sections as it is for vaginal births, it is important to

understand if skin-to-skin contact provides the numerous benefits such as: improving health,

strong attachments, and better feeding, compared to no skin-to-skin contact after a cesarean

section. Furthermore, there are many articles for research on the topic. For this proposal, there is

a series of articles to review for the benefits of skin-to-skin contact after a cesarean section.

What are the Main Components of the Articles and How it Supports the PICOT?

To begin, a study that was performed in January 2016 that examined the mother’s

experience after a cesarean section that performed skin-to-skin contact immediately after their

babies’ delivery. After observing and conducting intensive interviews of eleven women around

the same gestational age, it was concluded that mothers were extremely grateful of the

opportunity to have skin-to-skin contact with their newborn (Frederick 2016). This is because

both could form a stronger bond. This supports that skin-to-skin contact helps mother and baby

form a stronger attachment because they are immediately forming a connection. Typically,

mother and baby are separated after a cesarean section for hours. Additionally, another study was

done in February 2018. By separating the subjects into two groups, researchers can compare how

skin-to-skin contact makes a difference after a cesarean section. The subjects in the study were

eighty women and their newborns. They were separated into an experiment group that performed
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skin-to-skin contact immediately after a cesarean section birth and the other group did not do

skin-to-skin contact. The key findings showed skin-to-skin contact did not have an impact of

behavior but had an impact on the baby’s emotional state. This means that it had lower the

amount of stress and anxiety the baby was experiencing, increase better communication between

mother and baby, and increase the duration of breastfeeding (Pouraboli 2018). In conclusion, this

article helps determine that skin-to-skin contact is beneficial for newborns because it has helped

mother and baby form a stronger connection and increase feeding. Both increase the newborn’s

health because the infant can relax and receive the needed antibodies from mother.

According to a study done in 2017 that focused on how skin-to-skin contact impacted the

duration of breastfeeding, it has shown that if done after a cesarean section, then it extends the

amount of time Mother spends breastfeeding baby. Before skin-to-skin contact after a cesarean

section has started to be researched, breastfeeding after a cesarean section has a significant

decline. However, after performing an experiment where enrolled into two different groups, it

has proven that skin-to-skin contact after a cesarean section extends the duration of

breastfeeding. Around 300 women consented to this study and had followed up after six months

(Guala 2017). This supports skin-to-skin contact after a cesarean section influences breastfeeding

because without skin-to-skin contact, breastfeeding was given up earlier after a cesarean section.

In addition, another study was performed that synthesizes the results of skin-to-skin contact on

the newborn’s responses. Over forty women were placed into separate groups that showed that

the newborns that had skin-to-skin contact showed they had better sleeping and flexed

movements. Physiologically, the baby on its Mother’s bare chest helps it function better and

lower the amount of stress and anxiety (Ferber 2017). This supports the PICOT because it

demonstrates how important skin-to-skin contact is after a cesarean section delivery. The
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intervention has helped the baby with its health and attachment to mom. Therefore, it has proven

to benefit the baby with specific results.

Lastly, a study was done in November 2014 that used observation and questionnaires to

determine a new method of a cesarean section that concluded with skin-to-skin contact. During

this type of cesarean section, the consenting women had direct visualization, ability to cut the

cord, and have skin-to-skin contact. The key findings showed after compiling the results showed

that the mothers had a higher satisfaction rates and better breastfeeding rates (Armbrust 2014). In

the end, this research study has helped support the PICOT by showing that skin-to-skin has

improved on baby’s feeding and attachment because mother was able to be involved in the whole

process.

Discuss Limitation, Similarities, and Differences Between the Articles.

Throughout the research of different articles, there are multiple similarities and

differences between all. All articles focused on how skin-to-skin contact benefited the baby with

better breastfeeding rates and attachment. The quantitative designed studies all divided the

subjects into two different groups: skin-to-skin contact and no skin-to-skin contact. The

qualitative designed studies used observation. However, one study utilized interviews and the

other used questionnaires. A controversy in one of the studies is the use of a different approach

to a cesarean section. For instance, the use of direct visualization of the procedure. Additionally,

a limitation for this type of research includes physicians who do not want to provide the

opportunity for skin-to-skin contact.

Furthermore, based on the current evidence, skin-to-skin contact is proven to be

beneficial in every way to mother and baby after a cesarean section. This is known because the

results determine that it helps with forming a stronger bond with mom and increase the rates of
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breastfeeding. However, not many articles determine what skin-to-skin contact does for the

health of baby, other than lower stress and anxiety. For further research, more facts need to be

researched in the health of baby after a cesarean section. The health problems need to be

determined from the cesarean section and what skin-to-skin contact has done to improve it.

Nursing Theory

Furthermore, after conducting research, it is important for the nurses involved to identify

their nursing theory. Nursing theories have been applied and created for many years. They help

direct and guide nurses into making clinical decisions. These theories help nurses establish a

motive in finding new evidence-based practice projects. A nursing theory “helps nurses

understand their purpose and role,” meaning that it guides their nursing practice and philosophy

and promote change in the nursing field because it provides a foundation to the project (Colley

2013).

Identify the Nursing Theory. What are the Core Concepts?

Skin-to-skin contact is a personal and emotional event in a mother’s life, especially after

a cesarean section where they have been cut open to meet their baby. Many cesarean sections are

not planned and are the only way the infant can be birthed. However, after the cesarean section

delivery, mother and baby are separated for hours. The change that will be occurring is

implementing skin-to-skin contact immediately after a cesarean section delivery to better the

baby’s health, attachment, and feeding. Jean Watson’s theory of nursing emphasizes caring of

the human being. Her theory describes a human being as a “valued person in and of him or

herself to be cared for, respected, nurtured, and understood,” meaning that every individual

needs to be treated with the same respect and have equal opportunities. Additionally, Watson’s
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theory describes nurses to implement nursing practice holistically. This means that not just the

physical injuries be cared for but the whole person.

What Evidence is There to Support this Theory? How Has It Been Used in the Past?

Include Evidence.

For this theory, there has been many pieces of research that supports it. For instance,

there has been a study on alternative therapies for care that focused on the patient holistically:

physically, mentally, emotionally, and spiritually. This research used Watson’s theory as a

backbone because it used her concept of providing care for the patient as a whole. This piece of

research focused on alternative therapies that focused on healing the mind, body, and soul. It

focused on the importance of relationships and being cared for (Bringold 2013). Another piece of

research is to show the effectiveness of Watson’s theory on the quality of life with blood

pressure issues and hypertension. This research was a study on how effective Watson’s theory

can be when utilized for patients with hypertension. Nurses used the theory to create trusting

relationships and provide education. By the end of the study, patients began to manage their

hypertension better because they understood the diet and lifestyle had to be maintained from

their nurses they created a caring relationship with (Bringold 2013). In conclusion, Watson’s

theory has been widely used in nursing practice and research.

What Predictions Does the Theory Make About Health, Environment, and Population in

the Clinical Problem?

Based on this theory, caring is the ultimate key to nursing. Taking the time to understand

patients and their wishes helps form a caring relationship. By actively listening to mothers in

their wish to participate in skin-to-skin contact with their newborns after a cesarean section, this

theory predicts that the health of mother and baby will be at a “high-level of overall physical,
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mental, and social functioning” (Nursing Theory 2019). Additionally, the environment and

atmosphere will be calm, loving, and filled with care for centuries to come. Nurses and patients

will continue to form a trusting relationship from this population because their needs are being

met. With this theory, skin-to-skin contact after a cesarean section will provide beneficial

outcomes.

Change Theory

In the medical field, change is always occurring because medicine is always being

innovated. As medical professionals, it is important for them to be flexible with change because

it has been proven by evidence-based practice to be safe and helpful to patients. Change theories

were developed to help medical professionals accumulate to change and help them adapt their

behaviors, feelings, and actions towards the change. While change is not always welcomed, there

are strategies to help it become accepted. For skin-to-skin contact after a cesarean section,

Roger’s Change Theory will help facilitate this change.

Describe the Change Theory. How will it Help Support the Implementation of the Change?

Roger’s Change Theory emphasizes the idea of adopting an innovating idea early and

adapting to the new process. This means that “people adopt a new idea, behavior, or product,” by

doing “something differently than what they have done previously” (LaMorte 2018). However,

for individuals to begin to adapt to the change, they must “perceive the idea, behavior, or product

as new or innovated and diffusion makes that happen” (LaMorte 2018). His theory is comprised

of five stages: “knowledge, persuasion, decision, implementation, and confirmation” (Agency for

Clinical Innovation 2015). First, providing knowledge to stakeholders gives them exposure to the

idea. Persuading is important to spark interest by explaining the necessity of the change. From

there, a decision is made whether to accept or reject the idea and move forward. Based on that,
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the stakeholders can seek out more information and implement the change. Last, determine the

confirmation of change and allow adaption to change to happen to those who were slow to it.

Describe the Concerns Stakeholders May Hold About the Change Initiative.

Change can be difficult if stakeholders hold concerns over the project and can lead to

resistance. Skin-to-skin contact in the operating room means more resources such as: staff and

equipment. This leads to additional costs by the hospital and patients. This can be a concern to

patients because insurance can decide whether to cover that additional cost of skin-to-skin

contact. Hospitals can be unwilling to provide the extra resources due to the cost as well.

Additionally, physicians may not want to implement the change because the infant would be in

the operating room longer than necessary and can increase their exposure to pathogens.

Furthermore, resistance can happen by several stakeholders, however, it is important to

implement the change theory to help facilitate the change.

How Can the Change Theory Help Overcome Resistance?

Using Roger’s theory of change, stakeholders can gather the necessary information and

make an informed decision to move forward. The first step would be to introduce the idea early

to all stakeholders and inform them the benefits of skin-to-skin contact after a cesarean section:

better health outcomes, attachment, and feeding. It is important to appeal to the stakeholders and

management who are risk-takers and generally younger, sociable, and financially stable (Agency

for Clinical Innovation 2015). Furthermore, holding meetings and seminars that provide proven

studies of the change is important to help persuade. This will help stakeholders decide to move

forward. A trial period of the change can be implemented to showcase the results and an

evaluation of these positive results can make the change permanent.

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Predict an Obstacle. How can the Change Theory Help Overcome it?

For this project, an obstacle that can happen is the cost of additional resources. To ensure

the safety of the mother and infant, cleaning protocols must be increased and more staff must be

present in the operating room to step in if anything goes wrong. The additional costs can prevent

the hospital from offering skin-to-skin contact and insurance companies can deny coverage. With

the change theory, providing the information and proven studies to the parties can help overcome

the obstacle because then it would be classified as a needed expenditure.

Implementation

With the medical field always changing, implementing change can be a process. It is not

instantaneous but slow and gradual. For skin-to-skin contact after a cesarean section, there is a

plan to implement the change, so it can be helpful for the infants’ health, attachment, and

feeding. However, there needs to be strategies in place with effective communication and

considerations of education and any safety or ethical issues.

Describe the Plan for Change and Strategies for Success with a Discussion of the Role of

the Stakeholders at Each Step of the Plan.

For change to be successful, there must be a series of steps to implement it. Skin-to-skin

contact after a cesarean section is not normal practice, however, through research on the infant’s

improving health outcomes, attachment, and feeding, the change needs to happen. By using

Roger’s change theory, implementing change is successful. The first step to implement change is

to present the idea of the change to the stakeholders. It is important to display previous studies

and research on the benefits of skin-to-skin contact after a cesarean section with additional

evidence on the amount of money the hospital and insurance can save. The research that needs to

be presented are the studies that show the difference between the implementation of skin-to-skin
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contact and no skin-to-skin contact. For instance, the article, “The Effect of Skin-to-Skin Contact

of Mother and Neonate Immediately After Cesarean on Behavioral State,” was an experimental

study to determine how skin-to-skin contact affected neonate’s behavioral status. While the study

proved that skin-to-skin contact did not impact the behavioral status, it did improve the infant’s

health by lowering their anxiety and stress and creating a stronger bond between Mom and baby

(Pouraboli 2018). Additionally, another study proved the duration of breastfeeding was longer

with skin-to-skin contact (Guala 2017). The stakeholders involved in this step are physicians,

nurses, insurance, and health policy officials and their role is to decide whether to proceed with

the project.

Furthermore, the second step of the process is identifying the resistant stakeholders and

determine the reasons why. To proceed in the project, stakeholders need to be on board with it. A

strategy to help them accept the project is to have a sit-down meeting with them and discuss their

concerns and present further research and suggest a trial basis to assess the pros and cons of the

project (Gesme 2010). The stakeholders involved in this step are those who are resisting to the

change and their role is to gain a different perspective on the project and collaborate with them to

discuss different ideas that can be helpful. Additionally, the third step of the process is to

implement a trial basis of the change for about three months with a team of stakeholders: nurses,

physicians, insurance, and patients. There are also different members included in the team as

well such as: charge nurse, scrub technicians, and anesthesia. The stakeholders’ role is to

implement the change and gather data and document the benefits of skin-to-skin contact after a

cesarean. Also, it is important for the selected patients to give their permission to implement

skin-to-skin and a survey after to determine the benefits.

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Additionally, the fourth step includes assessing the gathered data and present the results

to the stakeholders for approval or denial of the progression of the change process. As the trial

went on, it was important to document the progress and gather data of the results of skin-to-skin

contact after a cesarean section and with those who did not perform skin-to-skin to show a

difference between the infant’s health, attachment, and feeding. Then, present the data. The

stakeholders involved include the original team of stakeholders from the first step to “provide

credible feedback” and approve or deny the project (Gesme 2010). After the approval of the

project, the last step is to implement the change. It is important to determine which patients want

skin-to-skin contact after their cesarean section and maintain a positive attitude during the

transition phase. Also, for the project to continue to move forward, empower the leaders by

providing support and encouragement (Gesme 2010). The stakeholders are the team from step

three and their role, again, is to implement the change. In the end, it is important to provide an

option for skin-to-skin contact after a cesarean section because medical professionals care about

their patients.

What are Different Communication Strategies Utilized During the Change Process?

Effective communication is extremely important in any given situation; however, it is

essential during the implementation of a change project. Miscommunication is commo during

change and can lead to adverse outcomes. To be successful, it is important for the sender of the

message has specific strategies when communicating and the receiver is actively listening to

absorb the information. For the sender, it is important to follow a series of characteristics of

effective communication, so the receiver is given clear and accurate information (Martelli 2018).

First, the information must be complete, meaning that all the information is present and the

receiver will have no confusion about the message. Then, to save time and to highlight the main
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message, it is important to be concise. Next, consider the audience and take a "you" approach

and what is possible for the project. Then, make sure that the information is clear because then

the understanding will be easier for the stakeholders. Next, making sure the information is

concrete helps provide confidence and make sure the message is not misunderstood. Then, being

courteous helps show respect to the stakeholders. Lastly, making sure the information is correct

for accuracy.

Discuss Education Requirements and Training.

For education, the stakeholders such as: nurses and physicians must be educated and

trained to care for these types of patients and situations where complications arise. These

situations include the mother hemorrhaging or there is fetal distress. There are additional

education classes that are required when taking on a specialty. For instance, these nurses must

have education on fetal heart monitoring. This allows for the change to occur because the

cesarean section is not occurring because of an emergency. Additionally, there must be training

on situations if a mother does hemorrhage and the appropriate steps.

Discuss Safety Issues, Ethical Considerations, or Scope of Practice that Must be Considered

for the Plan.

Since the skin-to-skin contact will be occurring in the operating room, the infant can be

exposed to infections, even though the operating room is supposed to be a sterile area. A strategy

to help lower the chances of infection is to increase the hand hygiene protocol and ensure all

personnel is wearing appropriate sterile clothing. Additionally, after a study is done with women

of three different cultural backgrounds showed that all three women enjoyed their experience

with skin-to-skin contact. This means that medical professionals “need to be more open to

women’s expressed preferences” despite perceived ethical considerations (Finigan 2014). To

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overcome this, it is important to ask all women whether they would like to experience skin-to-

skin contact, no matter what ethnicity. Lastly, nurses will hand the newborn to the mother while

cleaning it off on the mother’s chest since it is in their scope of practice.

Evaluation and Dissemination

For any change to be successful, it must be evaluated first to determine whether it met the

goals and outcomes of the project. Evaluation is done after implementing the change and

collecting data (Joshi 2012). The data that is collected is assessed to decide whether there needs

to be additional changes as it did not meet the needs of the problem or continue to implement the

change as it is. Additionally, dissemination is another important step in this process as

stakeholders can see evidence based on the data presented (Center for Innovation and Teaching

2018). For skin-to-skin contact after a cesarean delivery, evaluation and dissemination begins

after the implemented trial period and designated time afterwards for the data retrieval.

Evaluation: What Data is Needed for Assessment of the Change?

Before evaluation can begin, the trial of the change is implemented for a period of three

months and further assessments three months after the trial. During this time, it is essential to

gather the data important to evaluate after the trial is complete. A team of stakeholders are the

ones implementing the change and gathering results. First, gaining permission and participation

of patients is the top priority. The patients participating are educated on the project and the

necessary information afterwards. During the trial period, it is important to gather the

perspectives of the patients, nurses, and physicians on the experience (Gesme 2010). The data

collected is the perspective of Mom and baby’s bond and baby’s feeding. Then, any data that

pertains to the baby’s health after skin-to-skin contact after the cesarean section. In addition to
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gathering information on those who are participating in skin-to-skin contact, it is important to

gather data on those who have a cesarean section and do not perform skin-to-skin contact.

Evaluation: Describe the Methods to Obtain the Needed Data for Assessing the Change.

During the trial period, surveys are given to the patients after their experience and three

months afterwards that discuss their bond with their infant and the infant’s feeding patterns.

Additionally, nurses and physicians take a survey after the cesarean section and the patient’s

duration of stay to gain their perspective. The infant’s assessments are recorded from the nursery

and postpartum nurses and further pertinent documentation on the infant, with the permission of

the participating patients. As well as recording their assessments, the infant’s checkups with their

pediatrician are recorded to assess their health, bond, and feeding. Additionally, with the

permission of the patients participating that did not perform skin-to-skin contact after their

cesarean section, data must be collected through surveys, assessments, and additional

documentation surrounding the infant’s health, bond, or feeding.

Evaluation: Describe the Points in Where the Data is Evaluated and Why.

To determine whether the change has been successful, data must be collected and

assessed. For this project, there is a trial period that is three months and further assessments

performed three months after birth. After the final amount of data is collected, that is when the

project will be evaluated. This is a point where the change is evaluated because all the necessary

data is there and a difference will be able to be seen from both participating parties of the trial:

those who performed skin-to-skin and those who did not. It is important to evaluate the data after

it has been collected because the results from the trial need to be accurate (MEERA 2018). Also,

it is important to gain the information three months after birth to determine whether skin-to-skin

contact has long-lasting effects.

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Dissemination: Identify the Stakeholders Included in the Dissemination and the

Information That Will be Received.

After evaluating the data, it is important to disseminate the results. The stakeholders that

are involved in the process are: physicians who specialize in obstetrics and pediatrics, nurses

who specialize in obstetrics, nursery, postpartum, and surgery, insurance companies, and

healthcare policy officials. These stakeholders are important for the change because they are

directly involved and help spread the knowledge about the change (Agency for Healthcare

Research and Quality 2018). The information that they will receive are the conclusion of the data

from the trial. This means the data results, statistics, and survey answers from participants.

Additionally, the team the was involved in the trial will discuss their experience and assessment

of the change.

Dissemination: How Will the Information be Communicated?

Furthermore, the data from the trial must be communicated to all stakeholders involved.

A meeting will be held after the conclusion of the trial period and all the data has been assessed

and evaluated. The meeting with all stakeholders involved will be when the dissemination will

take place. If any stakeholder cannot be present during the meeting, they will be available to

video conference and a copy of the results will be sent to their office. Then, they can participate

and disseminate the results from the trial.

In conclusion, it is important for data to be evaluated and disseminated because the

change must meet the predicted goals and outcomes of the project. This is where changes can

occur to help the change project succeed in its original goal or to continue to improve and help

patients.
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Sustaining Change

After making necessary changes to the project when the results have been evaluated and

disseminated, it is important ensure that the change is sustained. Medical professionals are

always changing different protocols to provide care for patients that is safe, affordable, and

evidence-based. However, change can be uncomfortable for many and that can impede progress

of the change project. For skin-to-skin contact after a cesarean section, there are barriers to

change, however, with the vital stakeholders, there are strategies that can sustain change.

Predict What Challenges or Barriers That Can Occur to Impede Change Efforts.

After implementing change, it is imperative to maintain it. There can be multiple

challenges or barriers that can halt the progress of the change that is occurring. For many, change

can be disorienting and uncomfortable, meaning there can be little participation and

collaboration from employees. This can be because the change can increase their current

workload or disrupt their familiar work patterns (Quain 2019). Staff resistance can stop the

change from progressing forward because they can ignore the new change protocol. Change

cannot continue if there is no-one implementing it. Furthermore, staff participation is essential

for skin-to-skin contact to happen after a cesarean section. Another barrier can be negative

attitudes towards the change from staff, leaders, and management (Quain 2019). A negative

attitude enables others to disregard the change and others will follow because they can feel the

same. Additionally, low patient satisfaction can be another challenge towards sustaining change.

If patients feel as though the change is focused more on improving productivity and not on them,

the change will not continue because they are not responding well to the change that is designed

for them. In conclusion, there can be many obstacles for maintaining change, however, it is

important to plan and develop strategies to overcome them.

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Identify Stakeholders Vital for Sustaining Change and Describe Their Roles.

To sustain change, there need to be individuals who advocate for the change to continue.

For skin-to-skin contact, there are stakeholders who are vital in the project and keep it going

(Weatherston 2018). For instance, patients’ approval is needed because if patients are not

satisfied with the change, it will not continue to go forward. The change that is occurring is for

patients and their infants’ health, attachment, and feeding. The patients’ role is to approve of the

project because they are the focus of the project. Other stakeholders that are vital for sustaining

change are: nurses, physicians, and health policy officials. Nurses and physicians are important

because they are the ones implementing the change. Health policy officials are essential because

they are the ones who write and develop the policy further. Without their support, a policy will

not be made. Stakeholders are important to maintain change as they are the ones who help

implement and approve of the project.

Present Clear Strategies to Help Stakeholders Adopt and Sustain Change.

Most of the time, change is uncomfortable because it is unknown. A challenge is low

staff collaboration and participation, so it is important to educate them on the benefits and

reasoning behind the change. More employees are willing to try and participate when they

understand why it is happening. This can be done with staff meetings from the beginning, so they

are not blindsided when change is being implemented (Silver 2016). Communication is also key.

Nurse leaders and management need to communicate with all staff involved as the change is

being developed and implemented. Another strategy for the staff is to hold a skills class about

what needs to be done with skin-to-skin contact after a cesarean section (Silver 2016).

Additionally, it is important for all leaders and management to maintain a positive attitude and be

transparent and cooperative. When leaders are seen to have negative outlook about the change, it
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promotes delaying the change. A positive attitude helps the change progress because it is

perceived as needed. Additionally, leaders and management need to be understanding when it is

first implemented that mistakes happen and many can forget about the change. However, with

positive reinforcement and encouragement, change will continue. More staff is willing to comply

with the change when they are being rewarded and eventually, the change will be second nature.

Change can be challenging to maintain because many do not like it. However, with the

right strategies and attitude, it will move forward. It is important to emphasize the ability to be

flexible in the medical field because change is always there. In the end, skin-to-skin contact after

a cesarean section will be implemented and sustained with positive attitudes and education on its

importance.
Capstone Change Project: Draft 21

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Capstone Change Project: Draft 22

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Capstone Change Project: Draft 23

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Capstone Change Project: Draft 24