Improving Neonatal Outcomes Through the Implementation of

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Improving Neonatal Outcomes Through the Implementation of

Transcript Of Improving Neonatal Outcomes Through the Implementation of

Seton Hall University
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Seton Hall University DNP Final Projects

Seton Hall University Dissertations and Theses

Spring 3-11-2018
Improving Neonatal Outcomes Through the Implementation of a Delayed Bathing Program
Kathy LiVolsi
[email protected]

Follow this and additional works at: https://scholarship.shu.edu/final-projects Part of the Maternal, Child Health and Neonatal Nursing Commons
Recommended Citation
LiVolsi, Kathy, "Improving Neonatal Outcomes Through the Implementation of a Delayed Bathing Program" (2018). Seton Hall University DNP Final Projects. 26. https://scholarship.shu.edu/final-projects/26

Running head: IMPROVING NEONATAL OUTCOMES

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IMPROVING NEONATAL OUTCOMES THROUGH THE IMPLEMENTATION OF A DELAYED BATHING PROGRAM BY Kathy LiVolsi

DNP Final Scholarly Project Committee Dr. Mary Ellen Roberts, Chair Dr. Patricia Ricci-Allegra Dr. Donna Bowman
Submitted in partial fulfillment of the Requirements for the degree of Doctor of Nursing Practice Seton Hall University 2018

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Copyright © 2018 Kathy LiVolsi
All Right Reserved

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Dedication This project is dedicated to my family, especially to my parents, Carol and Jim LiVolsi, for instilling in me a genuine love of learning and role modeling values and integrity like no other. To my siblings, Tim, Kevin, Beth Anne, Teresa, Megan, and their families, for their continued support, perspective, and sense of humor, during this endeavor and throughout life. To Greg and Patricia, who are smiling down upon me from heaven and always close to my heart. During a recent hospitalization, a dear friend commented that I had won the lottery when it came to families. Truer words were never spoken.

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Acknowledgements
I would like to acknowledge Dr. Mary Ellen Roberts, the Seton Hall University DNP Director for her exceptional mentorship, support and guidance throughout my time at Seton Hall University. Her knowledge, professionalism, and graciousness have been instrumental in my success. I am in awe of her professional accomplishments and will forever consider her a true role model.
I would also like to acknowledge Dr. Patricia Ricci-Allegra for graciously participating in the defense of my DNP project. Her time, commitment, expertise, and insights are very much appreciated.
This project would not have been successful without the support, guidance, and friendship of Dr. Donna Bowman. Her clinical knowledge and mentorship have been invaluable throughout my nursing career.
I have been blessed with the incredible gift of being able to work with so many exceptionally talented and compassionate colleagues while caring for remarkable patients and families throughout my nursing career. It has been my greatest privilege and has helped me become the person I am today. I have reaped so much more than I could ever give back and I will always be eternally grateful.

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Table of Contents SECTON I: BACKGROUND ........................................................................................................ 9
Description of the Project.......................................................................................................... 12 Recipients of the Project Activity ............................................................................................. 13 Purpose of the Project ............................................................................................................... 13 Project Outcomes ...................................................................................................................... 14 Phases of Implementation ......................................................................................................... 14 Significance of Project for Nursing........................................................................................... 16 SECTION II: THEORETICAL FRAMEWORK AND LITERATURE REVIEW ..................... 18 Theoretical Framework ............................................................................................................. 18 Literature Review ...................................................................................................................... 22
Benefits of Breastfeeding ...................................................................................................... 22 Neonatal Hypoglycemia ........................................................................................................ 28 SECTION III: METHODOLOGY ............................................................................................... 31 Phase 1: Identification of Knowledge Gaps .......................................................................... 32 Phase 2: Definition of the Project/ Obtaining Stakeholders Support .................................... 34 Phase 3: Project Execution …………………………………………………………………35 Phase 4: Project Evaluation ................................................................................................... 36 Data Collection ...................................................................................................................... 37 SECTION IV: SUMMARY.......................................................................................................... 39 Project Sustainability and Recommendations ........................................................................... 39 Conclusion................................................................................................................................. 41 References..................................................................................................................................... 41 Appendix A: Survey Monkey Knowledge Assessment…………………………………………47
Appendix B: Staff Education Power Point………………………………………………….......50
Appendix C: Parent Education Fact Sheet …………………………………………………….53
Appendix D: Project Budget Proposal………………………………………………………......54

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Abstract

Background and Objective: Until 2010 newborns at most community-based hospitals were

subjected to their initial bath within two hours of birth. However, this practice has recently

changed due to the evidence-based recommendations that demonstrate improved outcomes for

neonates when the first bath is delayed for 12-24 hours after birth. Upon delivery, infants are

placed skin-to-skin with their parents to promote thermoregulation, breast feeding and bonding.

The purpose of this project was to implement a program that delayed infant bathing until the

infant was approximately 24 hours old. Rates of neonatal hypoglycemia, neonatal hypothermia,

exclusive in-hospital breastfeeding and formula supplementation rates were explored after

implementation of the delayed infant bath. The population targeted in the project included well

infants at a local community hospital. The primary objectives were to discuss the traditional

versus more recent evidence-based nursing practices for newborns, review the implementation

plan for the delayed sponge bathing program, and review newborn clinical outcomes as a result

of implementing this evidence-based practice.

Significance: This project is significant to the improvement of the overall health of neonates. This can be achieved by providing education to hospital staff aimed at improving nursing knowledge and practice, which will, in turn, promote improved neonatal outcomes.

Methods: Orlando’s nursing theory provided the theoretical framework for the implementation of this program. The methodology was comprised of the following: needs assessment,

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presentation of the program to the stakeholders to obtain approval and support, staff and parent education, and the implementation of the delayed infant bathing program including benchmarking clinical outcomes data.

Project Outcomes: Before the implementation of this evidence-based practice, clinically stable infants were bathed within two hours of life. The infants and parents participating in the program benefited from the improved nursing care that was a direct result of the education and knowledge gained during this program implementation. In-hospital breastfeeding rates improved by 10 percent and formula supplementation decreased by 10 percent. It was also noted that delayed infant baths resulted in a two percent decrease in the frequency of hypoglycemia and a four percent decrease in the incidence of hypothermia in low-risk infants. The results of the program promote overall infant health.

Clinical Relevance: The implementation of a delayed infant bathing program has substantial health benefits to newborns and families, including increased bonding, improved breastfeeding rates, reduced incidence of hypoglycemia and demonstrated parent participation in their infant’s care. Nurses, in turn, are driving evidence-based care which standardizes healthcare practices and reduces unsubstantiated variations in care.

Keywords: Evidence-based care, infant baths, in-hospital breastfeeding, nursing practice, neonatal hypoglycemia.

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SECTON I: BACKGROUND The clinical setting where this project takes place is a 305-bed community teaching hospital in the Northeast. Maternal-Child Health services include high-risk antepartum care, labor and delivery and maternity services including mother-baby couplet care, a newborn nursery, neonatal intensive care unit and an inpatient pediatric unit. There are approximately 2,500 births annually, a cesarean section rate of 42%, 325 neonatal intensive care admissions and 800 patients that are triaged through labor and delivery prior to giving birth. The hospital provides high-risk Perinatology, Neonatology and lactation services as well as in-house Pediatric Hospitalist and Anesthesia services. Nursing staff from all clinical areas are cross-trained to at least one other clinical setting within Maternal-Child Health other than their primary unit. The hospital has several prestigious designations, including Magnet (American Nurses Credentialing Center, n.d.) and Planetree (Planetree, 2018), a Patient Centered Care Designation representing the highest level of achievement in patient centered care based on evidence and standards. Additionally, the hospital has received an A rating in patient safety from the Leapfrog Group, which has inspired and led a movement uniting purchasers and patients to improve the safety and quality of our health care system (The Leapfrog Group, n.d.). The institution is not a designated Baby Friendly facility, but the Maternal-Child services currently practices 9 of the 10 tenets of Baby Friendly Designation. The Baby Friendly Hospital Initiative was established in 1991 by the United Nations Children’s Fund (UNICEF) and the World Health Organization (WHO), with the goal of encouraging and recognizing birthing facilities that offer an optimal level of care for infant feeding and couplet bonding (Baby Friendly USA, 2012). Currently, the
ImplementationOutcomesProjectProgramInfants