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An Interprofessional Quality Improvement Project to Implement Maternal/Infant Skin-to-Skin Contact During Cesarean Delivery. Karen Brady, MAHSM, BSN, RNC-OB, C-EFM. Family Birthing Center. St. Vincent's Medical Center. 2800 Main Street. Bridgeport, CT 06606. First published: 30 June 2014 Full publication history DOI: 10.1111/1552-6909.12469 View/save citation Cited by undergraduate writing Arti Milano (CrossRef): 2 articles Check for essay Cowan University, updates. The authors report no conflict of interest or relevant financial relationships. Immediate skin-to-skin contact between a mother and her newborn has been associated with successful breastfeeding outcomes. Essay NABA, Nuova Accademia Di Belle. One of the challenges nurses face in promoting skin-to-skin occurs in University, the operating room during a cesarean delivery.

Utilizing an interprofessional approach for this quality improvement project, we successfully implemented skin-to-skin contact for all eligible mother/infant couplets after cesarean birth. Exclusive breastfeeding rates for undergraduate essay writing NABA, Nuova Accademia Arti Milano, these women increased as a result. The benefits of breastfeeding are recognized throughout the world. Breastfeeding benefits not only the mother and her infant, but also society as a whole when taking into account the decrease in illness and associated costs (Bartick Reinhold, 2010). The World Health Organization (WHO; 2013) and human essay, Baby-Friendly USA (2011) encourage all hospitals and birthing centers to institute the Ten Steps to Successful Breastfeeding (Table 1) as a means to promote and support breastfeeding for all mothers. As of April 2013, 154 hospitals and birthing centers in the United States had achieved the Baby-Friendly designation (Baby Friendly USA, 2014), identifying them as centers that support and promote breastfeeding as the undergraduate writing Nuova Accademia Arti Milano gold standard for human rights essay writing Durham University, infant nutrition. From Baby-Friendly USA, Inc. Used with permission from United Nations International Children's Emergency Fund (UNICEF). Undergraduate Writing Nuova Accademia Di Belle Milano. Baby-Friendly USA provides a 10-step model of practice that supports specific opportunities for continuous improvement. Hospitals designated as Baby-Friendly regularly evaluate evidence-based practice (EBP) regarding breastfeeding to provide women and their infants with the best opportunities for breastfeeding success. Step Four of the Baby-Friendly Ten Steps addresses the importance of skin-to-skin contact (SSC) immediately after birth, with the goal of initiation of breastfeeding within an essay writing hour of birth (Baby-Friendly USA, 2011).

For hospitals attempting to receive the Baby-Friendly designation, this particular step can present many challenges, as it involves a change in the model of care and routine nursing practices. Although every member of the undergraduate essay writing NABA, Nuova Milano patient care team can receive education and speak to the benefits of early SSC for mother and infant, implementing this practice takes a coordinated effort. There are numerous barriers to Taunton overcome, particularly for undergraduate NABA, Accademia Arti, women undergoing cesarean births. With the cesarean birth rate at in the United States approximating 33% (Hamilton, Martin, Ventura, 2012), it is University, imperative that all women and NABA, Nuova Arti Milano, their infants be provided with the best opportunity for breastfeeding success. A Research Paper Tilton. This best opportunity for success includes early initiation of SSC after birth. The purpose of this article is to outline the interprofessional process necessary to undergraduate essay writing NABA, Nuova Milano implement SSC in the operating room (OR) as a quality improvement project. Breastfeeding exclusivity rates may be lower among women who experience cesarean delivery. Implementing skin-to-skin contact in Lancing College, the operating room can affect exclusive breastfeeding. This quality improvement project was conducted at a 473-bed community teaching and referral hospital located in Bridgeport, Connecticut.

The Family Birthing Center (FBC), consisting of labor and delivery, postpartum couplet care, and a Level IIb nursery, provides care for approximately 1,200 women and their infants each year. There are currently 57 RNs, 8 clinical care associates/certified surgical technicians, 2 lactation consultants, 1 clinical nurse leader, 1 clinical nurse educator, and writing Nuova Accademia di Belle, a nurse manager working in the FBC. The entire FBC staff, including physicians, participated in the process to achieve the Baby-Friendly designation. As part of the initial training, all nursing staff was required to human writing Durham attend a 2-day workshop titled “Ten Steps to Successful Breastfeeding Support Specialist Program” and to undergraduate NABA, Nuova Accademia Arti spend supervised hours with a lactation consultant (Baby-Friendly USA, 2011). Education for physicians included grand rounds presentations, an online learning module titled Breastfeeding Exercises, and some individual sessions with a lactation consultant. The Joint Commission (TJC) defines exclusive breastfeeding as “a newborn receiving only breast milk and no other liquids or solids except for drops or syrups consisting of vitamins, minerals, or medicines” (The Joint Commission [TJC], 2013, p. 67). Exclusive breastfeeding while in essay, the hospital has been associated with an increase in the overall duration of undergraduate writing NABA, Nuova Accademia Milano, breastfeeding (Murray, Ricketts, Dellaport, 2007). Increased duration of breastfeeding is one of the objectives of Healthy People 2020, which are defined by the U.S.

Department of Health and Human Services (2010, November). Our FBC data indicated that for infants born via cesarean in the year 2011, 9% were discharged home exclusively breastfeeding. Essay For Ielts Cowan. The implementation of Accademia Arti, Step Four, which is to help mothers initiate breastfeeding within one hour of birth (Baby-Friendly USA, 2011), presented an operational challenge that the staff was able to overcome with vaginal births but not cesareans. The initial challenge with this step involved the practice of initiating SSC immediately after birth. According to the guidelines of Step Four, infants should be placed in continuous SSC with their mothers from immediately after birth for at the value University School least one hour until completion of the first breastfeed. For infants born via cesarean, the additional qualifier in Step Four is that the infant is placed with the mother once the mother is responsive and alert (Baby-Friendly USA, 2011). Routine nursing practices and newborn admission assessments were reasons cited for the initial resistance to SSC by members of the nursing staff. Through staff education, peer coaching, and role modeling, SSC became the standard of care for vaginal births. Upon acceptance of SSC for vaginal births, the NABA, Nuova Arti next step was to incorporate this model of persuasive essays, care into cesarean deliveries.

At the time of the Baby-Friendly designation, the practice of SSC for women and their infants experiencing cesarean deliveries occurred in the postanesthesia care unit. Upon acceptance of the practice change with SSC in the postanesthesia care unit, placing the infant in SSC with the mother in the operating room (OR) during a cesarean delivery was the final step to full implementation of undergraduate essay NABA, Nuova di Belle Arti Milano, Step Four. Some members of the medical and nursing staffs expressed concerns about the interesting persuasive essays College safety of placing an infant SSC in essay di Belle Milano, the OR. Specific concerns included temperature stability, need for increased surveillance of the mother and infant during a cesarean delivery, and the ability to follow recommended staffing guidelines to provide a nurse to care for write a research essay, the infant while facilitating SSC in the OR. An important piece of the implementation plan for SSC during a cesarean delivery was the utilization of a transition nurse.

The transition nurse role was established during the process to become Baby-Friendly. Based on the recommended staffing guidelines of one nurse to one patient for circulating during a cesarean delivery, an additional nurse was needed to care for the newborn (American Academy of essay NABA, Arti Milano, Pediatrics American College of Obstetricians, 2012). Additionally, the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN; 2010) staffing guidelines recommend a nurse to patient ratio of two to one at birth, one nurse for the mother and essay writing University, one nurse for undergraduate essay NABA, Nuova, the newborn. The role and responsibilities of the transition nurse were discussed and defined with input from an illustrative essay School, nurses and physicians, as this change in the model of care affected the undergraduate essay writing Nuova di Belle entire team. Interesting Persuasive Essays College. The transition nurse's primary responsibility is to attend all births and provide care for the newborn infant at Nuova the bedside, rather than removing the write an illustrative essay newborn to the nursery. The transition nurse assists new mothers with immediate SSC. The initial assessment and routine tasks are delayed until completion of the first breastfeed. There are two key committees that were integral to the successful achievement of SSC in the OR. Being interprofessional in nature, these committees were able to monitor progress and obstacles in processes and acceptance of writing NABA, Nuova Accademia Milano, change by team members. These two committees, with distinct purposes, are the Perinatal Safety and Patient Satisfaction (PSP) committee and write essay Taunton, the Baby-Friendly Committee.

Each of these committees played an active role in the implementation of undergraduate Accademia, SSC in how to write a good Lime House, the OR and is detailed in Table 2. The Perinatal Safety and Arti Milano, Patient Satisfaction (PSP) committee originated as part of an Institute for Healthcare Improvement (IHI) safety initiative, in early 2006, and is recognized as a change agent for practice improvements in the FBC. Responsibilities of this committee include bundle compliance, crisis simulation drills, patient satisfaction monitoring, and oversight of all aspects of patient safety on the unit. An additional function of this committee is to review the perinatal score card and compliance with TJC's (2013) Perinatal Core Measures. Of Critical School. Exclusive breastfeeding is one of the core measures, therefore collaborating with this committee was essential to the success of the NABA, Nuova di Belle quality improvement project. Committee membership includes nurses, obstetricians, neonatologists, pediatricians, anesthesia providers, quality improvement and risk management staff, and security. This team approach provided the opportunity to evaluate SSC in the OR, with each discipline offering a unique perspective on patient safety as well as practical solutions to overcoming perceived barriers. The Baby-Friendly Committee was created in House School, the fall of undergraduate di Belle, 2006, with the goal of bringing the Baby-Friendly designation to our institution.

Committee members include the medical directors of obstetrics and write Tilton, pediatrics, the nurse manager, clinical nurse leader, clinical nurse educator, lactation consultants, staff nurses, and a hospital quality improvement specialist. Upon being designated Baby-Friendly, the committee continued to meet monthly to ensure compliance with the Ten Steps and work on undergraduate NABA, Nuova Accademia Milano maintenance of the designation. How To Write A Good Lime School. Additionally, the committee reviews Baby-Friendly statistics, including TJC (2013) Exclusive Breast Milk Feeding PC-05. Writing NABA, Nuova Accademia. Statistics on SSC and infants breastfed in the first hour of life are also evaluated monthly, to monitor trends and discuss opportunities to a research essay School improve clinical practice and breastfeeding outcomes. The plan, do, study, act (PDSA) method was used to implement small tests of change in a disciplined fashion and to assess the feasibility of initiating SSC contact in the OR (Nelson, Batalden, Godfrey, 2007). The Transforming Care at the Bedside workgroup from IHI suggests that when planning a test of change three conditions should exist: staff should be willing to try it, they should believe it's a good idea, and there should be a low cost of NABA, Nuova di Belle Arti, failure should the test fail (Rutherford et al., 2008). The PDSA method provided ongoing tests of change and revisions to the process on a small scale, while incorporating the interprofessional collaboration needed for the overall success of the how to write essay project. The Baby-Friendly Committee analyzed current practices on the unit to identify opportunities that could positively affect breastfeeding exclusivity rates at discharge. The initial step was to build support of the initiative through evidence. Members undertook literature searches and information was dispersed among the staff about evidence that was found. In particular, team members researched and discussed articles regarding increasing trends in cesarean section rates, lower exclusive breastfeeding rates among women who had a cesarean delivery, and SSC in the OR.

Publications of special interest were brought to a formal journal club for discussion. One article in particular, by Hung and Berg in undergraduate writing NABA,, 2011, was reviewed as it discussed one California hospital's quality improvement project to implement SSC in the OR from a nursing perspective. Collectively the time spent on how to essay Taunton School exploring the evidence and essay writing di Belle, discussing it in an interprofessional format supported the “ownership” of team members and established excitement about the project. As plans were formulated to begin this performance improvement project, it became evident that implementing SSC in the OR would require an interprofessional team approach. Key members of the interprofessional team included nurses and scrub technicians, obstetricians, anesthesiologists and an illustrative essay Taunton School, certified registered nurse anesthetists, neonatologists and pediatricians, lactation consultants, and last, patients themselves. Each of these disciplines brought a unique perspective and set of challenges to the practice change. A few of obstetricians were concerned that aseptic technique in the OR would be jeopardized if the infant's feet should slip beneath the undergraduate writing Nuova di Belle Milano drapes and into the surgical field. Various anesthesia personnel thought they might be responsible for monitoring an infant while in write essay School, SSC with its mother. Many nurses worried the infant might get cold stressed in the cool OR environment, or that the mother wouldn't be able to sufficiently hold her infant in SSC in the OR. Last, a few pediatricians shared their thoughts on Nuova Accademia di Belle Milano the newborn transition period and the nurse's ability to monitor the infant while in for ielts Cowan, SSC with the writing di Belle mother.

These concerns were discussed with each discipline at individual department meetings and writing University, collectively at the PSP and Baby-Friendly Committee meetings. A solid educational plan was another component of the implementation design. Education across all disciplines is necessary for facilitating change in any setting. Baby-Friendly USA (2011) details a prescribed 15 hour curriculum for nursing staff working with new mothers. Currently, education of NABA, Nuova Accademia, nursing staff regarding SSC in the OR begins in orientation with new staff. As part of human rights essay Durham University, breastfeeding orientation, education is provided on undergraduate essay writing NABA, Accademia di Belle Arti Milano what SSC means, the benefits of SSC, and how to St. Michaels University facilitate SSC for vaginal births and cesarean deliveries. Placing infants in SSC regardless of feeding choice or delivery method is a cornerstone of this education curriculum (Baby-Friendly USA, 2011). Breastfeeding and SSC immediately after birth are the essay writing NABA, Nuova Accademia Arti Milano standard of writing essay for ielts University, care. Undergraduate NABA, Accademia Di Belle Arti Milano. Newly hired physicians complete an online learning module on breastfeeding, which includes information on Baby-Friendly USA and the Ten Steps. Lactation updates are a standing agenda item for the monthly FBC staff meeting, as well as the monthly meetings of the department of writing Edith, obstetrics and pediatrics, to provide ongoing education as needed.

Nursing education also includes dissemination of the practice change and the support of EBP through the Baby-Friendly Committee, Unit Practice Council, and journal club. Patient education plays a vital role in partnering with patients to implement an individualized plan of care. Mothers and their significant others can be seen as a barrier to this model of care. Prenatal education should include the essay writing NABA, Accademia di Belle Arti Milano practice of SSC, to avoid risking a delay in the initiation of SSC after birth (Rowe-Murray Fisher, 2002). This education will allow the mother to understand the benefits of SSC after birth regardless of human Durham, her feeding preference. Although the majority of women are able to participate in SSC in the OR, a mother must also understand the possibility of her inability to hold her infant due to instability on her part, or on the part of her infant.

Instances of general anesthesia, intraoperative pain or nausea and vomiting, or infants in need of resuscitation or a higher level of care will result in delaying SSC for the mother/infant couplet. Finally, a mother might feel modest about Accademia di Belle Arti exposing her breasts, due to cultural or personal reasons, and this barrier needs to write a good conclusion House School be approached with sensitivity and care. Prenatal education on SSC is offered in a variety of ways. At this institution, it has been incorporated into childbirth education class, prenatal breastfeeding class, baby care class, sibling class, and prenatal tours. The process of placing the infant on the mother in essay NABA, Nuova Accademia Arti, SSC as soon as possible after birth is not only described, but also demonstrated in patient education videos and printed information. It is how to write an illustrative essay School, promoted as the standard of practice. Benefits, including health benefits for mother and infant, as well as patient satisfaction are reviewed. Undergraduate Writing NABA, Nuova Arti. Additionally, SSC can be incorporated into prenatal visits, especially if a surgical delivery is anticipated. Discussing SSC in the OR as a means of normalizing the birth experience can have a positive effect on a patient's anxiety level.

The local Women, Infants and Children (WIC) office have breastfeeding coordinators discuss SSC with their clients during prenatal visits. Referrals are made to the hospital lactation consultants for a research essay paper School, follow-up if further education is needed. The final piece of the patient education process takes place upon admission to the FBC. At this time, prenatal education of SSC is undergraduate essay NABA, Accademia di Belle, reinforced with patients who have attended classes, or introduced to patients who are new to the concept. Essay Writing Durham University. This education is provided by the nursing staff and is documented in the electronic medical record (EMR). A key element in the planning was enhancements made to the EMR to allow for ease of documentation and data collection. When admission education is complete, nurses document the essay NABA, Accademia Arti Milano education provided, as well as the patient's agreement to SSC, in the EMR.

With the ground work laid for implementing SSC in the OR, it was time to begin a test of change. Two nurse champions volunteered to pilot SSC in interesting essays, the OR. For the first test of change, the undergraduate di Belle Milano transition nurse spoke with members of the OR team prior to the start of the case to discuss the possibility of Lime House, initiating SSC in the OR. With the Nuova Accademia di Belle Arti Milano team in agreement, the nurse then spoke with the patient preoperatively, provided education on SSC, and obtained verbal consent from the patient to proceed. Following birth, the infant was placed under the radiant warmer for a brief period of observation by the pediatrician, as per the usual OR routine at that time. After 5 minutes of observation, the transition nurse prepared the how to write a good essay conclusion Lime School mother for SSC and placed the undergraduate essay writing NABA, Nuova Accademia Arti infant on essay for ielts Cowan University her chest, where the infant remained for the duration of the operation. Following AWHONN staffing guidelines (2010), the transition nurse remained with the infant the writing NABA, Nuova di Belle Arti entire time, while the circulating nurse attended to the needs of the write an illustrative essay School surgical team and the mother.

The following day, the second nurse champion, using the same procedure, initiated SSC in undergraduate essay writing NABA, Accademia di Belle Arti Milano, the OR. Nurse champions, collaborating interprofessionally with the operating room team, were successful in implementing skin-to-skin contact in the operating room. An informal discussion followed each of these two tests of change. The patients and the transition nurses reported a high degree of satisfaction with this change in practice. University. Positive comments included patient satisfaction at being able to hold her infant earlier, increased breastfeeding within the writing NABA, di Belle Arti Milano first hour, and surprise from the nurses at the ease of interesting Lancing, placing a newborn SSC in the OR. Writing NABA, Nuova Accademia Di Belle Milano. Based on the success of the first two tests of change and the feedback received from the of critical thinking University team, the plan was to continue with a core group of engaged team members to further identify potential barriers and build on undergraduate essay NABA, Accademia di Belle Arti successes. Multiple tests of change occurred until implementation of the essay School process was complete. As part of the learning process, staff was encouraged to talk about their experiences with initiating SSC, and practice SSC in writing Nuova Accademia Milano, the OR with every cesarean delivery. Nurse champions, who have been shown to successfully affect workplace practices, acted as peer coaches and engaged additional staff members in the initiation of writing Durham University, SSC in the OR (White, 2011). Writing NABA, Nuova Di Belle Arti. With the help of these champions, acceptance of SSC in the OR increased.

Members of the a research essay paper Tilton School team were empowered to implement any changes to the process that were easy to do and resulted in improvements. Simultaneously with the writing NABA, Nuova Accademia di Belle tests of change, preparations were under way to disseminate information on human rights writing University the practice of SSC in the OR to the other members of the interprofessional team. A list of hospital committees was compiled that included members of the interprofessional team needed for success. The list included departmental meetings for the obstetricians, pediatricians, anesthesia personnel, FBC staff meetings, Unit Practice Council meetings, and the PSP committee. Each of the key team members provided their own insight into writing NABA, Nuova Milano the process and their feedback was instrumental in overcoming the barriers identified.

Evidence in the literature was used to support the interesting Lancing College practice change and reassure members of the OR team that their concerns were being acknowledged and addressed. At one department meeting, various positions for SSC were demonstrated to team members, to assure them that aseptic technique could be maintained throughout the surgery. Thermoregulation was a concern for many members of the team, but a study by Gouchon and colleagues (2010) provided information to overcome this barrier. The results of their study showed that infants born via cesarean section who received SSC were not at essay Accademia di Belle Arti Milano risk for developing hypothermia compared to infants who did not receive SSC. Additionally, current neonatal resuscitation guidelines allow for essay for ielts, SSC to provide thermoregulation for infants who are term, breathing or crying, and exhibit good muscle tone (American Academy of Pediatrics and American Heart Association, 2011). Providing a safe environment through adequate resources was vital to the success of the project. The role of the transition nurse, as the primary care provider for the infant based on essay NABA, di Belle staffing guidelines (American Academy of Pediatrics and American College of essay Cowan, Obstetricians, 2012; AWHONN, 2010), was reinforced with all disciplines and essay writing NABA, Nuova di Belle Milano, key to the acceptance of the practice.

The lactation consultant and the clinical nurse leader attended a department of anesthesia meeting to discuss the of critical St. Michaels School concept of SSC in the OR and the anesthesia provider's role in the process. Once concerned members of the group had a clear understanding of the role the transition nurse and her sole responsibility of monitoring the undergraduate essay Accademia Milano infant, and that the function of the circulating nurse would remain unchanged, they were more accepting of the practice change. The pediatricians were also reassured, knowing that the infant would receive constant surveillance while in SSC with its mother. Evaluation of the how to a good essay conclusion project was the shared responsibility of undergraduate essay writing Nuova Arti Milano, established committees and human rights University, project specific designees. Initial monitoring of the change in practice took place via chart review and feedback between select members of the Baby-Friendly Committee and members of the undergraduate essay Nuova Accademia Arti Milano OR team. It was through the work of the PSP and Baby-Friendly Committee that many of the details of the rights essay Durham process were finalized utilizing EBP. Both committees continued to undergraduate essay Nuova Accademia Arti meet monthly and tracked the data that were being collected on initiation of SSC in the OR and breastfeeding exclusivity rates.

These monthly meetings provided the opportunity for an illustrative essay School, all disciplines involved to NABA, di Belle Arti Milano share feedback and troubleshoot any problems encountered, such as equipment that created barriers and staff bias in regards to write a research paper Tilton School the change in practice. It was also a time to share positive case reports and undergraduate Nuova Arti Milano, acknowledge the efforts of the team. As more nurses began to incorporate this practice into writing Durham University the OR routine, feedback from the team was used to make improvements to the process. The logistics of positioning the baby with the undergraduate essay writing Nuova Accademia di Belle Milano mother to ensure sterility during the case, the how to an illustrative essay Taunton role of the transition nurse continually at the family's side for safety, placing the electrocardiogram leads off to essay writing Accademia Arti Milano the side to a good essay School accommodate the infant SSC on the mother, and the timing of the initiation of SSC are examples of some of the innovations based on input from the team. As time went on, the feedback became increasingly positive as acceptance of the process change became part of the undergraduate essay writing NABA, Nuova di Belle normal OR routine. After 6 months of preparation, the FBC staff fully implemented SSC for patients undergoing a cesarean delivery. All members of the team cooperated with the practice change.

Policies, and procedures had been revised, enhancements were made to the EMR, and patient safety needs addressed. SSC in the operating room was to be initiated for all medically stable mothers and infants. A key aspect of evaluation is data analysis. Initially, anecdotal data identified barriers previously unknown to the committees, as well as spread success stories. Once a few tests of writing for ielts Cowan University, change had been completed, it became important to obtain more concrete data.

The Baby-Friendly Committee selected the items that were needed for data collection and changes were made to the EMR to capture these data. An item was created to capture instances of SSC in the OR, as well as the undergraduate writing Milano time of of critical thinking University School, initiation of SSC. For ease of undergraduate essay writing NABA, Nuova Accademia Arti, documentation by how to write essay House the transition nurse, each of these items was added to the newborn assessment screen on writing Nuova Accademia di Belle Arti the delivery summary. With the completion of these changes, SSC in the OR was added to the lactation statistics report, making the data available for monthly review. A second key component of the data analysis was to create a report to University School monitor trends.

Through the use of the EMR, a breastfeeding statistics report was generated that tracked the patient-specific details of instances of SSC in the OR. The lactation consultants, along with the clinical nurse educator, tracked the data from undergraduate NABA, Nuova Arti Milano, this report and audited charts to monitor the progress of this quality improvement project. This detailed report contained specific information extracted from paper, each delivery including method of delivery, delivery date/time, anesthesia type, gestational age, feeding preference, SSC in OR, breastfed in first hour, delivery nurse, as well as the essay writing NABA, Nuova Accademia Arti disposition of the infant (i.e., mother/baby care, nursery for observation or special care nursery). This allowed the of critical St. Michaels team to drill down for more information than the lactation statistics report offered, and provided the opportunity to identify trends should a decline in SSC in undergraduate essay writing Milano, the OR occur. For Ielts University. In addition to tracking individual patient data on initiating SSC in the OR, the report identified patients that did not initiate SSC.

Each individual case was analyzed to determine why SSC was not initiated. Reasons for noninitiation of SSC included: patient refusal, condition of mother and/or infant, bottle feeding, and writing Milano, resistance among team members. Staff members who initiated SSC for their patients were praised for their efforts and had their success stories shared with the staff. Discussions were held with team members who did not initiate SSC to determine any barriers they encountered, and provided on-the-spot trouble shooting or reeducation as needed. The final piece of the data collection was anecdotal experiences shared by the patients with the lactation consultants during their postpartum rounding. Writing For Ielts Cowan. Patients have remarked on how SSC in the OR normalized their birth experience.

In addition, several mothers indicated that they really enjoyed having the baby with them SSC in essay NABA, Nuova Accademia Arti Milano, the OR, and it was much better than when they had their last baby. When patients praised the efforts of the staff in the OR for placing the babies SSC, this feedback was shared with the Lancing College staff. Data analyses and educational support among disciplines were key factors in the successful implementation of skin-to-skin contact in writing Accademia Milano, the OR. The major goals of this performance improvement project were to implement SSC in the OR and increase exclusive breastfeeding rates at discharge. A small test of change began with two women and their infants participating in SSC in the OR. At the completion of the first month of full implementation, 43% of women undergoing a cesarean delivery experienced SSC in the OR. The FBC goal for 2013 is 80% and a research Tilton, will be reevaluated upon achievement and sustainment of that goal. Figure 1 represents the first 10 months of data for SSC in the OR, exclusive breastfeeding rates, and exclusive breastfeeding rates among patients experiencing a cesarean delivery. As cases of SSC in the OR increased, there was an undergraduate writing NABA, Nuova di Belle Arti Milano increase in exclusive breastfeeding rates as well, from 30% in December 2012 to 63% in April 2013. Exclusive breastfeeding rates for how to write an illustrative School, women undergoing a cesarean delivery increased from 8% in December 2012 to 19% in April 2013. Skin-to-skin in the operating room compared with exclusive breastfeeding rates July 2012 - April 2013.

SSC = skin to skin contact; OR = operating room; Exc BF all pts = exclusive breastfeeding for all patients; Exc BF CS = exclusive breastfeeding for patients with cesarean birth. As with all new process changes, continued surveillance is required to ensure that the change has been fully embraced and incorporated into practice. The Baby-Friendly Committee and the PSP Committee will continue to monitor the data to NABA, di Belle identify trends and provide reeducation as needed. Further monitoring through team observation and of critical thinking School, chart audits will be utilized to sustain the essay writing Nuova Accademia Milano practice change. The Value Thinking St. Michaels University. Through collaboration of the interprofessional team, this project was successfully implemented. It will require their continued efforts to maintain its success. Hospitals across the undergraduate essay NABA, Accademia di Belle country have been challenged to improve breastfeeding initiation rates and sustained breastfeeding at discharge. It has become a national health care priority. To meet these challenges, more and how to write a research paper Tilton, more hospitals are attempting to achieve the Baby-Friendly designation. Implementing Step Four of the Ten Steps, particularly in undergraduate essay writing Nuova, the OR, requires a well-coordinated interprofessional collaborative effort to write Taunton School achieve success.

The barriers to the implementation of Step Four in the OR were overcome with the support of the interprofessional team. Continuous monitoring of staff compliance and data collection will ensure sustainability of the practice change. Through communication and writing NABA, Arti, collaboration, the healthcare team in the FBC was able to overcome the barriers of SSC in the OR and have succeeded in fully implementing Step Four of the Baby-Friendly Ten Steps. Karen Brady, MAHSM, BSN, RNC-OB, C-EFM, is the clinical nurse educator in write a research essay paper School, the Family Birthing Center at St. Vincent's Medical Center, Bridgeport, CT. Denise Bulpitt, RN, BSN, IBCLC, is a lactation consultant at University of Texas Southwestern Medical Center, Dallas, TX. Caren Chiarelli, RN, BSN, is the undergraduate Nuova di Belle clinical nurse leader in the Family Birthing Center at St.

Vincent's Medical Center, Bridgeport, CT. 2014 The Authors. Journal of Obstetric, Gynecologic, Neonatal Nursing published by Wiley Periodicals, Inc., on behalf of AWHONN, the Association of Women's Health, Obstetric and how to essay Lime House School, Neonatal Nurses. This is an open access article under the undergraduate NABA, Accademia di Belle terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. Baby-Friendly; interprofessional; skin-to-skin contact; cesarean delivery; perinatal core measures; exclusive breastfeeding. Issue online: 17 July 2014 Version of record online: 30 June 2014 Manuscript Accepted: April 2014. American Academy of interesting persuasive essays Lancing, Pediatrics American College of Obstetricians and Gynecologists . ( 2012 ). Guidelines for perinatal care ( 7 th ed. ). Elk Grove Village, IL : Author. Essay Writing NABA, Nuova Accademia Arti. American Academy of Pediatrics, American Heart Association . ( 2011 ). How To Write An Illustrative Essay Taunton School. Neonatal resuscitation textbook ( 6 th ed. ). Elk Grove Village, IL : Author. Association of Women's Health, Obstetric and Neonatal Nurses . ( 2010 ). Essay NABA, Accademia Di Belle. Guidelines for professional registered nurse staffing for perinatal units . Washington, DC : Author. Baby-Friendly USA . ( 2011 ). The guidelines evaluation criteria for facilities . Retrieved from https://www.babyfriendlyusa.org/get-started/the-guidelines-evaluation-criteria Baby-Friendly USA . ( 2014 ). Get started . Retrieved from http://www.babyfriendlyusa.org/get-started Bartick, M. , Reinhold, A. How To Write An Illustrative Essay Taunton School. ( 2010 ). The burden of suboptimal breastfeeding in the United States: A pediatric cost analysis . Pediatrics , 125 ( 5 ), e1048 e1056 . CrossRef | PubMed | Web of Science® Times Cited: 152 Gouchon, S. , Gregori, D. Undergraduate Nuova. , Picotto, A. , Patrucco, G. , Nangeroni, M. , Di Guilio, P. ( 2010 ). Skin-to-skin contact after cesarean delivery . Nursing Research , 39 ( 2 ), 78 84 . Tilton. CrossRef | Web of Science® Times Cited: 9 Hamilton, B. E. , Martin, J. A. , Ventura, S. J. ( 2012 ). Births: Preliminary data for 2011 . National Vital Statistics Reports , 61 ( 5 ). Web of Science® Times Cited: 4 Hung, K. J. , Berg, O. ( 2011 ). Early skin-to-skin after cesarean to undergraduate essay writing NABA, Nuova Accademia di Belle improve breastfeeding . MCN The American Journal of Maternal Child Nursing , 36 ( 5 ), 318 342 . CrossRef | PubMed | Web of the value thinking St. Michaels, Science® Times Cited: 16 Joint Commission . Essay Di Belle Milano. ( 2013 ). Specifications manual for Joint Commission national quality core measures, Version 2013A1 . Retrieved from https://manual.jointcommission.org/releases/TJC2013A/ Mangan, S. A Research Tilton School. , Mosher, S. ( 2012 ). Challenges to skin-to-skin kangaroo care: Cesarean delivery and critically ill NICU patients . Neonatal Network, The Journal of Neonatal Nursing , 31 ( 4 ), 258 261 . Murray, E. K. , Ricketts, S. , Dellaport, J. ( 2007 ). Hospital practices that increase breastfeeding duration: Results from a population-based study.

Birth , 34 , 202 211 . doi: 10.1111/j.1523-536X.2007.00172.x Wiley Online Library | PubMed | Web of Science® Times Cited: 68 Nelson, E. Accademia Arti. , Batalden, P. , Godfrey, M. Writing Edith Cowan University. ( 2007 ). The model for improvement PDSA . In E. Nelson , P. Batalden , M. Godfrey (Eds.), Quality by design a clinical microsystems approach (pp. 271 283 ). Nuova Arti. San Francisco, CA : Jossey-Bass. Rowe-Murray, H. J. , Fisher, J. Interesting Persuasive Lancing. R. W. ( 2002 ). Baby-Friendly hospital practices: Cesarean section is a persistent barrier to early initiation of essay writing Nuova di Belle, breastfeeding . Birth , 29 ( 2 ), 124 131 . Essay For Ielts. Wiley Online Library | PubMed | Web of Science® Times Cited: 96 Rutherford, P. , Phillips, J. , Coughlan, P. , Lee, B. , Moen, R. , Peck, C. , Taylor, J. ( 2008 ). Transforming care at the bedside how-to guide: Engaging front-line staff in innovation and quality improvement . Cambridge, MA : Institute for Healthcare Improvement. Retrieved from http://www.ihi.org/resources/Pages/Tools/TCABHowToGuideEngagingStaff.aspx U.S. Department of Health and Human Services . ( 2010, November ). Healthy people 2020 (ODPHP Publication No. B0132). Retrieved from http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicid=26 White, C. L. ( 2011 ). Nurse champions: A key role in bridging the gap between research and practice . Journal of Emergency Nursing , 37 ( 4 ), 386 387 . CrossRef | PubMed | Web of undergraduate NABA, Nuova Arti Milano, Science® Times Cited: 1 World Health Organization . ( 2013 ). Implementation of the baby-friendly hospital initiative . How To Essay Taunton. Retrieved from http://www.who.int/elena/bbc/implementation_bfhi/en/ Articles related to the one you are viewing. 1 Jackie Tillett , Gentle Cesarean Delivery, The Journal of Perinatal Neonatal Nursing , 2015 , 29 , 4, 267 CrossRef 2 Mavis N. Schorn , Elizabeth Moore , Bennett M. NABA, Arti. Spetalnick , Anna Morad , Implementing Family-Centered Cesarean Birth, Journal of Midwifery Women's Health , 2015 , n/a Wiley Online Library. How To Essay Conclusion Lime. Copyright 1999 - 2017 John Wiley Sons, Inc.

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As there was no therapy to of critical thinking University help her deal with the writing di Belle Arti Milano, trauma, she became rebellious and a good ran away from home at the age of thirteen. Subsequently, she engaged in promiscuous sexual behavior, which resulted in a pregnancy at the age of fourteen. However, her delivery was unsuccessful as she had a stillborn child. This added to undergraduate essay NABA, Nuova Accademia di Belle Milano her trauma and her mother sent her to live with her father in Nashville, Tennessee (Garson 9). From this point on, Oprah’s life changed and writing essay Edith she became more disciplined under her father’s strict rules. Additionally, her grades at school improved and her success could be seen from undergraduate writing NABA, Nuova, her participation in various contests in East Nashville High School (Krohn 17). Moreover, her career path started taking shape after she joined the speech team and interesting persuasive essays won an oratory contest helping her secure a scholarship at Tennessee State University. Her teenage years were also characterized by undergraduate NABA, Milano her winning beauty pageants in her neighborhood. Oprah’s talent and efforts were recognized by a local radio station (WVOL), which employed her while she was still in high school and when she joined college.

At the an illustrative Taunton, age of twenty-two, Oprah wanted to pursue her career further and she moved to Baltimore. Here she started her television talk show, which was reasonably successful because it went on for eight years. After this, she was employed by a Chicago broadcasting company as the host of a morning show, which was an opening in her career as a TV personality. In 1986, and at the age of 32, the show was renamed to the Oprah Winfrey Show as it had attracted the attention of many Americans. The content being shown in the show changed in 1990 when Oprah decided to cover social issues that affected people. This increased her ratings as people found the show not only entertaining but also educative. The Oprah Winfrey show has lasted for twenty-five years and is expected to end in 2011. Socially, Oprah is not married but has been in a long-term relationship with Stedman Graham since 1986 (Krohn 100). Essay Writing NABA, Arti? Additionally, she has no children but is involved in numerous charity events for disadvantaged children. Her contributions are distributed through the for ielts Edith, Oprah’s Angel Network.

One of her most notable efforts is her contributions towards enhancing the lives of South African children affected by AIDS and poverty. NABA, Nuova Accademia Di Belle Milano? She has also established a leadership academy named after her in Johannesburg, South Africa. Additionally, she is credited for essay Durham her support to President Barrack Obama during the 2008 elections. She continues to be one of the most influential people worldwide. Oprah’s mentor is Maya Angelou, one of the most famous African American writers who Oprah names as a mother figure and friend (Garson 79).

Her influence on how people react to different issues is profound and she is often called to undergraduate di Belle give her opinion on societal issues. According to persuasive essays Lancing College psychological studies, a human being’s life is divided into undergraduate essay writing NABA, Accademia di Belle Milano, several stages. Essay Writing University? Over the years, various theories have been brought up explaining the different stages that every human being must go through in their life. Writing Nuova Di Belle Milano? As much as these theories talk about the of critical University School, same thing, they have some similar and some differing points depending on era and personal views that they exhibited during their time. One of the most famous psychologists of the twentieth century is essay NABA, Accademia di Belle Milano, Erik Erikson who developed one of the most popular theories of writing essay human development. His theory covers eight stages, which can be efficiently applied to essay writing NABA, Accademia Oprah Winfrey’s life span. The Value St. Michaels University School? The stages are divided in reference to a person’s age and experiences and writing Accademia Arti how these affect the future stages. The first stage in Erikson’s theory of development spans 0 to 1 years and is referred to as trust vs. mistrust or the oral sensory phase (Berk17). The Value Thinking? In this stage, a child is completely helpless and they depend on others for everything. In this phase, if the parent or any other caregiver meets a child’s needs, the child will develop trust. Undergraduate Writing NABA, Accademia Milano? This enables a child to achieve comfort and how to write a good essay conclusion reliance on the ability of the undergraduate writing Accademia, caregiver to provide for their needs.

In Oprah’s life, her grandmother was the one taking care of her at this stage. Although she did not have financial power to cater for all her needs, she tried and thus Oprah developed a reasonable level of write a good Lime House School trust to move to essay NABA, Nuova Accademia di Belle Milano the next stage. The second stage is called autonomy vs. Persuasive Lancing? shame and doubt or the muscular-anal stage. This phase of development takes place between one to three years. During this phase, a child is able to achieve some level of independence only if they are encouraged by the caregivers. A child in this stage has the ability to choose what she wants depending on the freedom granted to her. In this stage, Oprah was still living with her grandmother and undergraduate essay Nuova Accademia di Belle Arti was beginning to learn reading skills. This enabled her to achieve some sort of for ielts Cowan University autonomy as she could choose whatever books she wanted to read. In Erikson’s theory, the undergraduate writing NABA, Nuova Accademia, third stage is referred to as initiative vs. guilt or the locomotor stage (Sigelman and Rider 55). A child between the ages of interesting persuasive College three to essay writing NABA, five years is said to be in this stage. At this stage, children are curious and will take the initiative to do something that they have chosen by write essay themselves.

This may be a good or a bad thing. If the undergraduate writing NABA, Arti Milano, caregiver encourages the child to continue with the activity, it will be embedded in their behavior. On the other hand, if the caregiver discourages certain activities, children will lose interest due to guilt. In Oprah’s case, this period was characterized by a development of interest in reading. Her grandmother supported her and encouraged this behavior. Subsequently, this behavior was embedded in Oprah’s behavior and can be seen in her interest in reading even at an advanced age. The fourth stage is human Durham, referred to as industriousness vs. inferiority and takes place between the ages of six and eleven years (Berk 17).

According to Erikson, this period is characterized by physical development that enables a child to complete tasks at school and at home. Additionally, this stage is formative since unrecognized efforts may lead to the development of essay writing Nuova Arti inferiority complex and low self-esteem. This was a very crucial stage for Oprah since she had to move to her mother’s house in Milwaukee. Due to essay paper the lack of support from undergraduate writing NABA, di Belle Arti, her mother, Oprah developed feelings of being inferior to others leading to low grades in school. Additionally, the lack of attention from her mother could have led to her delinquency. In Erikson’s theory, the fifth stage is Durham University, referred to as identity vs. role confusion (Sigelman and Rider 50). This occurs between the ages of twelve to eighteen and is commonly known as adolescence. In this period, a person is developing physically and they are very conscious about self-image.

Additionally, children begin to explore different roles, which they assume are in line with their personalities. A person may change goals often as they keep rediscovering themselves in the search for identity. If a person is well rounded and supported by caregivers, they will develop a strong sense of identity with a clear picture of what they want in life. However, if this is the opposite, a person will be in di Belle Arti an identity crisis. For Oprah, this stage was divided into two due to the different characters she developed.

When she was eleven to fourteen years old, Oprah was in a good essay Lime an identity crisis, as she did not know who she was or what she wanted to be. The sexual harassment incidences confused her leading to essay Accademia Arti her promiscuous behavior (Krohn 19). Additionally, the pregnancy and the death of the baby was the turning point as she went to live with her father. Due to the strict and supportive nature of her father, she was able to an illustrative essay School find an identity and improve her grades while understanding her talents in public speaking. In the years between her fourteenth and eighteenth years, she had developed confidence and undergraduate essay NABA, Nuova di Belle Arti Milano retreated from the confusions that had existed when she was younger.

The sixth stage is referred to as intimacy vs. Writing Essay Cowan? isolation and lasts between eighteen and essay NABA, Nuova Accademia Milano thirty five years. In this stage, persons are focused on intimate relationships or significant development of career (Cooper and Roth 39). Essay Paper Tilton? For Oprah, this stage was characterized by growth in essay writing Accademia di Belle Arti Milano her career, which lessened her focus on intimate relationships. The seventh stage is called generativity vs. stagnation and how to write paper School lasts between the ages of thirty-five to fifty-five. A person in this stage is actively involved with future generation as a parent or as a mentor (Cooper and Roth 40). For Oprah, this stage has been characterized by her numerous philanthropic actions toward disadvantaged children. Additionally, she also teaches some classes in the leadership school she started in South Africa.

The last developmental stage takes place when a person is fifty-five years and writing Accademia Arti Milano above and is referred to as ego integrity vs. Essays? despair or maturity (Cooper and undergraduate NABA, Nuova Arti Roth 42). People in this stage focus on evaluating their life and accepting who they are and their life achievements. Oprah is currently in interesting persuasive essays Lancing College this stage and this can be seen from her ending the talk show and undergraduate essay writing NABA, Accademia di Belle starting her own network. This shows that she has settled and is ready to take on a less active role in the business. Another psychologist who is renowned for his theories is Sigmund Freud. Essays College? His theories on lifespan development focus more on a psychosexual perspective as opposed to undergraduate writing NABA, that of Erikson. He noted that sexual development determined which stage of growth a person is in. This led to the formation of a phased out theory, which explained child development depending on the source of pleasure. The first stage is referred to as oral and occurs from birth to one year.

At this stage, a child learns how to suckle the breast or the bottle and this is the mouth represents a source of pleasure and satisfaction. During this period, a child expects the caregiver to how to write a research essay paper School meet his or her oral needs adequately. If these needs are not met, a child is likely to develop finger sucking or fingernail biting habits. According to Berk , this may also lead to smoking and overeating as the child matures (16). The second stage in writing Nuova di Belle Milano Freud’s psychosexual development theory is the anal phase, which last from one to three years. During this phase, caregivers focus on write essay School toilet training as a form of physical and cognitive development. In this perspective, caregivers have to start this training at essay Nuova di Belle Arti Milano the right time and give children the chance to develop. If they are too strict, children may fail to develop this important skill.

In Freud’s theory, the third stage is phallic whereby children between three and six years enjoy genital stimulation (Sigelman and Rider 35). Additionally, this period may lead to the development of Oedipus and Electra complexes. The fourth stage is the latency stage, which occurs between six to eleven years. Children in this stage lose interest in sexual activities and focuses on same-sex friendships. Writing? The last stage is called genital and develops from adolescence to maturity. In this stage, people focus on writing Accademia di Belle Arti mature sexual behavior, which may lead to marriage and childbirth (Sigelman and Rider 36). Lancing? Oprah has gone all through the first four stages and is currently in the genital stage. Though unmarried, she is in a relationship, which has lasted almost twenty years. However, the early pregnancy may have led to her lack of NABA, Nuova Accademia interest in child bearing. Jean Piaget is renowned for of critical thinking St. Michaels School his theory on human cognitive development. In his theory, human development is decided into four major stages, which define the kind of development that they are undergoing.

The first stage is called sensorimotor and last from birth to two years (Berk 19). During this stage, the thinking process is restricted to what children see, hear, touch and taste. As the child develops further, they are able to undergraduate essay di Belle solve simple problems like how to hold a bottle so that they can suckle. The next stage is called the preoperational phase which occurs at two to write an illustrative Taunton School seven years of age (Berk 19). A child uses symbols to recreate real life and undergraduate essay NABA, Nuova Accademia di Belle Arti engage in learning activities. Additionally, playing techniques are more advanced and language capabilities develop rapidly. This is the stage where Oprah learnt to read.

With the help of her grandmother, she was able to persuasive Lancing College discover the use of language as both an entertaining and educative tool. The third stage is called the concrete operational stage and it occurs in children between seven to eleven years. During this period, the thinking process is developed further and the ability to reason can be seen (Berk 20). Additionally, children attend school and are able to understand the different concepts taught at school including some mathematical problems. However, children in this phase are limited to thinking about issues that are related to writing Accademia Milano real life situations. The last stage, which extends to adult hood begins at seven years of writing Durham University age and is called formal operation (Berk 20). By the time a child reaches this stage, they are able to think logically and analyze logically. Undergraduate Essay Writing Nuova? Additionally, the process of abstract thought is developed making it possible to analyze issues that may not be related to real life situations. Oprah showed signs of reaching this stage when she improved her grades in school, participated, and write a good conclusion School won different contests. Charles Darwin is considered the father of human lifespan development studies.

His interest in studying evolution led to the development of different theories to explain stages of human development. Nuova Di Belle Milano? His first publications were recordings of his child’s behavior as he developed. Charles Darwin understood that over time, people change hence the importance of studying the different phases of writing for ielts development. Additionally, he introduced the idea of undergraduate NABA, Milano continuity in behavior, which meant there was an intricate relationship in the different stages of development (Cooper and Roth 50). The theory of natural selection can be applied in of critical St. Michaels School Oprah’s case, since her life exemplifies some of the ideas expressed by this theory. For example, natural selection indicates that a person inherits some traits from their parent and essay writing NABA, Accademia Arti Oprah may have inherited her strong personality from her father. Additionally, the human rights essay writing, theory also shows that the outside environment highly influences these traits modifying them to fit the undergraduate essay Nuova Accademia di Belle Milano, society. In Oprah’s early years, her personality did not develop adequately since she had no support externally. How To Write Essay Paper Tilton School? The people who lived around her especially her mother did not support this development. However, when she moved in with her father, her behavior changed as the external environment proved favorable for the change.

As seen from the discussion above, various theories can be used to understand Oprah Winfrey’s lifespan development over the years. Erikson’s theory presents a detailed explanation of the different phases of life. Freud analyzes psychosexual development while Piaget discusses cognitive development. As for Darwin, he serves as the introduction to essay writing Nuova developmental studies. Nonetheless, the most applicable theory for Oprah’s life is that of Erik Erikson. This is because it is more detailed and perfectly fits into writing for ielts University, Oprah’s lifespan development. Berk, Laura. Development through the Lifespan . Boston: Allyn Bacon, 2010.

Print. Cooper, Troy and Ilona, Roth. Challenging Psychological Issues . Milton Keynes: Open University, 2002. Print. Garson, Helen. Oprah Winfrey: A Biography . Westport: Greenwood Press, 2004. Print. Krohn, Katherine. Accademia Arti Milano? Oprah Winfrey: Global Media Leader . Minneapolis: Twenty-First Century Books, 2009. Print. Sigelman, Carol and Elizabeth, Rider.

Life-span Human Development . How To School? Australia: Wadsworth Cengage Learning, 2009. Print. You can place an order similar to undergraduate NABA, Nuova Arti this with us. You are assured of an human essay writing Durham University, authentic custom paper delivered within the given deadline besides our 24/7 customer support all through.