Barriers To Implementation Of Skin-To-Skin Care

Objective:  As hospitals make a commitment to assist mothers with successful breastfeeding, additional research is needed to examine the impact of nursing culture on this goal. We examined hospital practices, procedures, and routines that effect skin-skin care (SSC) and ultimately the question:  Does having a Baby-Friendly Hospital Certification impact the nursing culture on the perinatal unit?  The Baby-Friendly Hospital Initiative (BFHI) standard is for SSC to be started within five minutes of delivery and continued for one hour or until the first feeding has occurred (Baby-Friendly USA, 2010).  A review of current literature revealed that many national professional groups support the BFHI and that SSC benefits breastfeeding rates, thermoregulation, maternal bonding, and infant analgesia. 

Design:  This quantitative descriptive correlational study was done to look at perinatal nurses’ perceptions of barriers to implementation of skin SSC in the acute care setting.

Setting:   Research examined nursing perceptions from two Northern California hospitals that have committed to breastfeeding and SSC.  They have similar delivery rates and geographical location, but differ in their Baby-Friendly certification status.

Sample:   The sample consisted of 76 Labor and Delivery and Neonatal Intensive Care Unit Registered Nurses from the two medical centers. 

Methods:  Nurses were anonymously surveyed using a 20-question Likert style survey developed by the researcher. The survey’s reliability was established by performing a pilot study of 10 perinatal nurses.  Cronbach’s alpha reliability coefficient was applied with a result of a 0.76 reliability coefficient, indicating that the survey would reflect fine discriminations in the levels of the construct (Burns and Grove, 2009).

Results:  The Mann-Whitney U test was applied to the sample with further calculations of z and p values to determine significance of responses.  Using standard values to reject the null hypothesis, calculations revealed that 15 of the 17 non-demographic questions demonstrated a more favorable response to the implementation of SSC per BFHI standard from nurses employed at the Baby-Friendly certified facility.

Conclusion/Implications for nursing practice: These results hold implications for facilities attempting to implement SSC and change practice from task-oriented to evidenced-based nursing care. By first evaluating the nursing culture, educators can implement training specific to the needs of the group they serve.  As evidenced by Brown et al. (2009) any successful attempt to promote evidence-based practice must consider research that addresses barriers and facilitators to the adoption of the practice by nurses. Therefore, identifying barriers should be considered a primary step in implementing evidence-based practice changes.

Keywords:  skin-to-skin, breastfeeding, nursing cultue