Use of a Video-Ethnographic Intervention to Improve Skin-to-Skin Care and Breastfeeding Rates

Crenshaw, Jeannette T.

Sunday, June 24, 2012

Title: Use of a Video-Ethnographic Intervention to Improve Skin-to-Skin Care and Breastfeeding Rates

Woodrow Wilson (Gaylord National Harbor)

Jeannette T. Crenshaw, DNP, MSN, RN, LCCE, IBCLC, NEA-BC , College of Nursing, University of Texas at Arlington, Arlington, TX

Kajsa Hilarie Brimdyr, PhD, CLC , Healthy Children Project, East Sandwich, MA

Karin Cadwell, PhD, RN, IBCLC, FAAN, ANLC , Healthy Children Project, East Sandwich, MA

Ann-Marie Widström, PhD, RN, MTD , Department of Woman and Child Health, Division of Reproductive and Perinatal Health Care, Karolinska Institute, Stockholm, Sweden

Kristin Svennson, PhD, RN, MTD , Division of Reproductive and Perinatal Health Care Karolinska Institute, Karolinska Institute, Stockhom, Sweden

Elizabeth H. Winslow, PhD, RN, FAAN , Texas Health Presbyterian Hospital Dallas, Dallas, TX

Richard E. Gilder, RN, BSN, MS, CNOR, BCNI , Office of Patient Safety, Baylor University Medial Cetner, Dallas, TX

Jane Dimmitt Champion, PhD, RN, FNP, CNS, FAAN , School of Nursing, Texas Tech Health Sciences Center, Lubbock, TX

Discipline: Newborn Care (N)

Learning Objectives:

Describe the use of a video-ethnographic intervention (PRECESS Immersion Method) to promote rapid and sustainable clinical change.
Discuss the major results of a 5-day quality improvement research study to enhance the rates of skin-to-skin care after birth and exclusive breast milk feeding at hospital discharge
Discuss interprofessional strategies for implementing immediate skin-to-skin care during and after cesarean surgery, identified during a 5-day quality improvement intervention.

Submission Description:

Objective: Part 1: Describe the rate of exclusive breastfeeding at hospital discharge in healthy mothers & babies who had immediate & uninterrupted skin-to-skin care after vaginal or cesarean birth during a 5-day intervention (PRECESS immersion method) Part 2: Assess for improvements & sustainability in monthly skin-to-skin & exclusive breastfeeding rates
Design: Part 1: Descriptive, observational, non-experimental with video-ethnography and interactive analysis (PRECESS—Practice, Reflection, Education and training, Combined with Ethnography for Sustainable Success) during a 5-day quality improvement pilot research study. Part 2: Electronic medical record review to test for differences in monthly skin-to-skin & exclusive breastfeeding rates at hospital discharge after the PRECESS intervention
Setting: 793 bed nonprofit private medical center in the Southwest US with 6,000 births per year
Patients/Participants: Part 1: convenience sample of 11 healthy English speaking women > 18 years, admitted to L&D for vaginal birth or scheduled cesarean surgery. Part 2: electronic medical record review.
Methods: Part 1: descriptive statistics; PRECESS Immersion Method (August 13-17, 2010); barriers & potential solutions identified by staff; comments about skin-to-skin experiences. Part 2: inferential statistics Pearson Chi Square to test for significant differences between & among monthly rates of skin-to-skin care & exclusive breastfeeding (95% confidence interval; p < 0.05) (baseline, July 2010; post-intervention, August-December, 2010).
Results: Part 1: 10 (91%) received immediate and 8 (73%) received uninterrupted skin-to-skin care; 6 (67%) of the babies whose mothers planned to breastfeed went through all 9 instinctive stages during skin-to-skin care; 5 (83%) of the 6 babies who went through all 9 stages were discharged as exclusively breastfed. Part 2: Comparison rates (Pearson Chi-Square 23.798, df = 5) between and among months showed a significant difference in month-to-month rates (p=0.000)
Conclusion/Implications for nursing practice: PRECESS immersion method may rapidly improve skin-to-skin care; babies who complete all 9 states during skin-to-skin may be more likely to exclusively breastfeed at discharge; mothers need support during skin-to-skin-to-skin care to recognize their baby’s readiness to breastfeed; staff who are educated about babies’ 9 instinctive stages during skin-to-skin may be more effective at providing evidence-based clinical care after birth skin-to-skin care may reduce maternal stress & improve satisfaction, particularly during cesarean surgery.
Keywords: skin-to-skin care; skin-to-skin contact; 9 skin-to-skin stages; exclusive breastfeeding; video-ethnography; reflective practice; evidence-based maternity practices; PRECESS