UMKC Dose of Skin to Skin Contact and Techniques Research i’m working on group project and this is my part. THIS IS MY PART: Recommendations (5 points). P

UMKC Dose of Skin to Skin Contact and Techniques Research i’m working on group project and this is my part.

THIS IS MY PART: Recommendations (5 points). Provide a recommendation for next steps.

If you believe there is enough evidence to support a practice change: Describe the quality improvement project that you would recommend. Include the patient population and the outcomes that you would measure to ensure that the change is an improvement.

If you believe we need more research on this topic: Describe the research question(s) that remain unanswered, and discuss the type of research study that you would implement to answer the question. It is fine to replicate one of the studies that you reviewed, with a plan to vary the study to capture the gap in knowledge. Many students automatically choose ‘more research’; however, your decision should consider the potential risks of the intervention coupled with potential benefits to patients.

-I upload other group members work so you can understand the project well and write the recommendations.

Also I upload other fields about the project that I did with the group. INTRODUCTION (10 points) – Iyanla
Begin with a 1 paragraph introduction. In the introduction discuss your rationale for undertaking
this project. Discuss the background of the topic, including what makes this topic important to
the health of persons, families, or communities. Include data to support the need for the project
(prevalence rates, implications if untreated, population affected, etc.). Basically, why is this topic
important?
STATE OF THE SCIENCE SUMMARY (40 points)
Interventions and Outcomes (10 points): In a paragraph discuss the interventions that you
encountered in the studies that you reviewed. Speak to the amount of variation in the
intervention delivered. For example, if you are studying the impact of an exercise intervention,
did some studies require more time, longer sessions? Or were the studies fairly consistent in
how the intervention was implemented. Iyanla
In a second paragraph, speak to the types of outcomes that were studied, and generally
address the amount of variance in the outcomes that were studied across the studies. For both
Interventions and outcomes, use appropriate citations to link the reader back to the article. For
example, if you say “Six studies measured mortality rates (provide six citations) and four studies
measured length of stay (provide four citations).” This citation method should be used in all
sections of the paper. Payton
As specified by the research question, the studies measured physiological outcomes of
mother and infant. There were five studies that measured the cardio-respiratory function of the
infants (Chi Luong et al., 2016; Kristoffersen et al., 2016; Lorenz et al, 2017; Mitchell et al.,
2013; Moore et al., 2016; Shattnawi & Al-Ali, 2019). Variance in the measurement of cardiorespiratory function included measuring oxygen saturation, number of apneas, regional cerebral
oxygenation, heart rate, or the use of the Stability of Cardio-Respiratory System in Premature
Infants (SCRIP) scale. Three studies measured temperature as an outcome (Kristoffersen et al.,
2016; Lorenz et al, 2017; Moore et al., 2016). Variance of the measurement in temperature
ranged from one study that specifically looked at hypothermia to the other two that analyzed the
temperatures collected during vital signs. Two studies measured pain outcomes of infants using
reliable pain scales (Hatfield et al., 2019; Johnston et al., 2017). A measurement of physiological
stress was studied by Cooijmans et al. (2017) that measured the cortisol levels in both infants and
mothers.
Findings (10 points): In this section analyze the findings. Your paragraph style synthesis
should answer the following questions: Ashley
•What findings are supported by more than one study/report?
•What findings are supported by just one study, but are compelling? Why are they compelling?
•What findings are out right contradictory across the studies?
•Describe the practical significance of the research findings?
Do not include the questions in your synthesis; rather use them as a guide.
Skin-to-skin contact (sometimes referred to as kangaroo care) has become a standard practice to
assist in the physiological development and stability of preterm infants in the neonatal intensive
care units. Infants in the NICU are often put in incubators to receive oxygen, medications, and to
be warmed. Studies performed by Chi Luong et al and Mitchell et al measured the cardiorespiratory functions of preterm infants and supported the common practice that skin-to-skin
time between infants and parents reduces respiratory issues such as oxygen desaturation as well
as a slow heart rate(Chi Luong et al., 2016; Mitchell et al., 2013
). Temperature regulation is supported by skin-to-skin contact with a parent. If an infant is
struggling to regulate body heat, they use more energy and consume more oxygen which may
then become fatal (Kristoffersen et al., 2016; Moore et al., 2016). Coojimans’ study was one of a
kind and compelling in the fact that kangaroo care showed an increase in mental stability in the
mother. This study looked at maternal health as well as the infants which tends to get looked
over when discussing the benefits of skin-to-skin contact (Coojimans et al., 2017). However,
Lorenz’s study examined cerebral oxygenation, heart rate, oxygen saturation, and temperature
for preterm infants that were able to do skin-to-skin care versus incubator care. This study
disagreed and said that infants that received incubator care in comparison to skin-to-skin contact
did not differ in any physiological measures (Lorenz et al., 2017). Many research studies suggest
that skin-to-skin contact achieves better physiological stability in preterm infants than previously
used incubators. Infants have less need for respiratory support, grow quicker and healthier, are
able to breastfeed, cry less, and sleep better.
Level of Evidence (5 points): Provide a summary/analysis of the strength of evidence that you
found. Use Melnyk & Fineout’s hierarchy to describe the overall validity and strength of
evidence available to answer your question. Discuss the level of evidence in terms of the PICOT
question. For example, if there are not many random controlled trials, does this surprise you? Or
would you expect it because randomization may not be ethical given the nature of your
question. Marchelle
The level of evidence found ranged from level Ia to level IV. The evidence displayed in
this state of the science was strengthened as the research included a meta-analysis study
conducted by Moore et al. (2016), a level Ia ranking of Melnyk & Fineout’s hierarchy. There
were two systematic reviews of RCTs, a level IB ranking (Hatfield et al., 2019; Johnston et al.,
2017). The inclusion of both level Ia and level Ib evidence provides confidence in the data
collected, as these study designs are able to synthesize data from many other studies. There were
four studies that ranked as a level II, a randomized control trial (Cooijmans et al., 2017; Chi
Luong et al., 2016; Kristoffersen et al., (2016); Mitchell et al., 2013). The study conducted by
Shattnawi & Al-Ali (2019) was a quasi-experimental study that did not use randomized control
trial. This ranks as a level III. The weakest piece of evidence was a cohort study conducted by
Lorenz et al. (2017), which ranked as a level IV. The majority of the analyzed studies were
randomized control trials. Thus, the level of evidence is strong in supporting the conclusions
found.
Conclusion Regarding Available Evidence (5 points). Do you believe the evidence picture is
sufficiently complete? Do you believe enough is known about benefits, risks, burdens,
underlying mechanisms, and specifics of administration to support a change in practice that
would be safe and likely beneficial to patients. Why or Why not? Lauren
Next Step Recommendations (5 points). Provide a recommendation for next steps. THIS IS
MY PART, JUST DO THIS PART
If you believe there is enough evidence to support a practice change: Describe the quality
improvement project that you would recommend. Include the patient population and the
outcomes that you would measure to ensure that the change is an improvement.
If you believe we need more research on this topic: Describe the research question(s) that
remain unanswered, and discuss the type of research study that you would implement to
answer the question. It is fine to replicate one of the studies that you reviewed, with a plan to
vary the study to capture the gap in knowledge. Many students automatically choose ‘more
research’; however, your decision should consider the potential risks of the intervention coupled
with potential benefits to patients.
Findings Table
PICOT Question: In neonates, what are the effects of skin to skin contact after birth compared to typical care on physiological outcomes
Author(s) and Date
(Year)
Purpose or
Research question(s)
Research Design and
Evidence Ranking*
Sample Size
Moore, E. R.,
Bergman, N.,
Anderson, G. C., &
Medley, N. (2016).
To assess the effects of early
skin to skin contact for
healthy infants compared to
standard contact on starting
and continuance of
breastfeeding, well-being of
the infant, and the attachment
of mom and baby.
randomized controlled trials
meta-analysis. Level 1a
Databases used were
Cochrane Pregnancy
and Childbirth
Group’s Trials
Register,Central
Medline, Embase,
CINAHL, about 30
journals in person,
monthly BioMed
Central email
messages.
Sample size was
large, including 46
trials that contained
3850 mom and
babies sets, only 38
of those trials were
included in the data
analysis which
included 3472 moms
and their infants.
Women with early skin-to-skin
contact breastfed their babies longer
than those with standard contact,
higher effectiveness in breastfeeding
as well as doing well the first time
around.
In preterm infants, what effect
do behavioral and
environmental pain
management interventions
have on acute procedural
behavioral pain response?
Systematic Review of Multiple
RCTs
Level IB
Fourteen randomized
controlled trials from
a literature search of
PubMed and Medline
databases.
-across age groups facilitated
tucking was the most frequent
intervention and demonstrated
decreases in behavioral and
physiologic pain
-autonomic responses generated by
noxious stimuli were decreased
during sucrose, facilitative tucking,
Hatfield, L. A.,
Murphy, N., Karp, K., &
Polomano, R. C.
(2019).
Page 1 of 3
Findings
For Systematic
Reviews/Meta-analysis
include the databases
searched and number of
publications reviewed
infants had higher stability in heart
and respiratory systems, higher
blood sugars. however they have
similar body temperatures of those
with standard contact with their
mothers.
Cooijmans, K.,
Beijers, R., Rovers,
A. C., & de Weerth,
C. (2017).
Chi Luong, K., Long
Nguyen, T., Huynh
Thi, D. H., Carrara,
H. P., & Bergman, N.
J. (2016).
What is the effectiveness of
skin-to-skin contact versus
care-as-usual in mothers and
their full-term infants?
Do newly born low birthweight
infants stabilize better in skin‐
to‐skin contact than when
separated from their
mothers?
parallel group Randomized
Controlled Trial
Level ll
116 mothers and their
full-term infants
Randomized Controlled Trial
Level ll
Sample size was 100
randomized LBW
infants. 50 had
routine care. 50 had
skin to skin contact.
As of June 2016 27
very preterm infants
(28-31) weeks with
birth weight >1000
grams born in St.
Olav’s University
Hospital in Trondheim
Thirty-eight infants
27 to 30 weeks
gestational age.
Kristoffersen, L.,
Stoen, R., Rygh, H.,
Sognnaes, M.,
Follestad, T., Mohn,
H. S., Nissen, I., &
Bergseng, H. (2016).
To investigate whether skin to
skin care following delivery is
safe, and how it affects early
and late outcomes compared
to standard care for very
preterm infants.
Randomized Controlled Trial
Level II
Mitchell, A. J., Yates,
C., Williams, K., & Hall,
R. W. (2013).
To compare bradycardia and
oxygen desaturation events in
preterm infants in standard
incubator care versus
Kangaroo care.
Randomized Controlled Trial
Level II
Johnston, C.,
Campbell-Yeo, M.,
Disher, T., Benoit,
B., Fernandes, A.,
Streiner, D., Inglis,
D., & Zee, R. (2017).
To determine the effect of
SSC(skin to skin contact)
alone on pain from medical or
nursing procedures in
neonates compared to no
intervention.
Quasi Experimental
Level III
Page 2 of 3
2001 infants
Database: PubMed
and kangaroo care compared to
standard care.
-pain management interventions can
be used with preterm infants to
mitigate biobehavioral responses to
procedural pain.
-SSC has a positive effect on both
the mother and baby in the shortterm and long-term.
-SSC is simple, cost effective and
preventative.
-SSC is proven to help postpartum
depressed mothers
Skin to skin contact most likely
provides an optimal environment for
neonates.
-early skin to skin contact between
preterm infant and the mother could
contribute to a more gentle
adjustment to extrauterine life with
improved physiological stability.
The KC group had fewer
bradycardia events per hour while
being held compared to time spent
in an incubator. Also they had
significantly fewer oxygen
desaturation events while being held
than while in the incubator and
significantly fewer desaturation
events than infants in standard care.
-No difference in heart rates during
pain procedures
-oxygen saturation at 30 and 60
seconds following the painful
procedure did not show a difference
-SSC appears to be effective.
Shattnawi, K. K., & AlAli, N. (2019).
Assess the effect of short
duration Skin to skin contact
(SSC) (5 days) on premature
infants’ short-term
physiological and behavioral
outcomes.
Systematic review
Level Ib
A sample size of 89
stable premature
infants, with 48 in the
intervention group
and 41 in the control
group.
In the SSC intervention group of
premature infants:
– increased weight gain
– increased likelihood of using mixed
feeding
– a significant decrease in the
incidence of apnea
– significant differences in the crying
patterns (less likely to cry in a
continuous pattern),
-more likely to have good quality
sleep and regulated sleep patterns.
Lorenz, L., Dawson,
J. A., Jones, H.,
Jacobs, S. E.,
Cheong, J. L.,
Donath, S. M.,
Davis, P. G., &
Kamlin, C. (2017).
To investigate whether the
Regional cerebral
oxygenation (rcO2), HR, &
SpO2 during skin-to-skin care
(SSC) would be similar to
standard care in preterm
infants receiving respiratory
support.
Cohort study
Level IV
Forty preterm infants
(26.0-28.9) weeks’
gestation)
– Regional cerebral oxygenation
(rcO2) was similar during SSC
compared with incubator care.
– No clinically important differences
in HR, SpO2, FiO2 or temperature
were observed in the whole cohort
and by mode of respiratory support.
*Use hierarchy adapted from Melnyk & Fineout-Overholt (2011)
(NOTE: Organize the table by the hierarchy of evidence, listing the highest level(s) of evidence first, and the least valid/reliable at the bottom. Be concise. Use
short phrases/bullets. The total table should be less than 3 pages (font size 10 or larger). Include each of these references in your APA reference list (organized
alphabetically by author).
Page 3 of 3
EBP Assignment: PICOT question and Review of Literature
PICOT Question
3 points
Search Terms
2 points
Search PubMed
5 points
In neonates, what are the effects of skin to skin contact after birth compared to typical care
on physiological outcomes?
Kangaroo care OR kangaroo mother care OR skin to skin contact AND physiological
outcomes
Complete the search in PubMed
Read the titles. If the article matches your PICOT question, check the box to the left of the
article.
In top right corner of screen click the drop down box labeled “Send to”
Select E-mail and email the results to yourself.
From your email, forward the search to Dr. Meyer (meyermn@umkc.edu )*
Describe your
PubMed search and
findings using
language provided
below**
10 points
The PubMed data base was searched using Kangaroo care or kangaroo mother care or skin
to skin contact and physiological outcomes. (((Kangaroo care) OR (kangaroo mother care))
OR (skin to skin contact)) AND (physiological outcomes). Publication dates were limited to
the last 10 years, 2010-2020. The article types were narrowed down to meta- analysis,
systematic review, and randomized controlled trial. 25 articles retrieved. The reviewer read
each abstract and eliminated those that were not aligned with the PICOT question. 7 articles
remained.
Search CINAHL
1. Complete the search in CINAHL.
2. Read the titles. For each article that matches your PICOT question, click the folder to add
the article to your folder.
3. Click “Go to Folder View”.
3. From here click “save as file”. You may save the file or copy/paste it into a word
document.
4. Do not email this document to Dr. Meyer, but save it in case she needs to see it.
5. Now click the folder and email the results to yourself.
Describe your CINAHL
search and findings
using language
provided below**
10 points
CINAHL was reviewed using similar search strategies and terms. CINAHL did not have an
option to filter article types, meta- analysis, systematic review and randomized controlled trial
were not an option.12 articles were retrieved, and 3 were eliminated because the
publication(s) did not align with the PICOT question. 7 were eliminated because they were
duplicates from the Pubmed Search, leaving 2 articles on CINAHL.There was one article
listed on both databases, but was chosen from CINAHL, being certain that it is not a
duplicate in the total number. That article is “Skin-to-skin care for procedural pain in
neonates.” In total 9 articles from PubMed and CINAHL were considered for review and will
be presented in the Findings table.
Total: 30 points
You may have more than 10 references, but for the purposes of this project, stay as close to
10 as you can. If you need assistance expanding or narrowing your searches, consult faculty.
** Important to forward your email to me; otherwise I cannot know who sent the email.
** Use this format to describe your literature search. The blue text is suggested language that you may borrow.
The PubMed data base was searched using [insert Mesh terms, MeSh headings, subject headings, or perhaps just
‘search terms’)
Now list your terms exactly as you entered them in the search engine: e.g. Nurse staffing OR “low staffing” OR hospital
nursing AND readmissions OR “low readmissions” AND “Congestive heart failure” AND “30-day readmissions” AND
“patient education”.
Next describe any limits that you set. NEVER limit by full text available: The results were limited by English language and
the past 10 years.
Now describe how many articles that you found: XX articles were retrieved.
Next describe your systematic process for eliminating any article that was not included in the review: The reviewer read
each abstract and eliminated those that were not aligned with the PICOT question. X articles remained.
Repeat the description for your CINAHL search:
CINAHL was reviewed using similar search strategies and terms. XX articles were retrieved, and X were eliminated
because the publication(s) did not align with the PICOT question. X were eliminated because they were duplicates from
the Pubmed Search. In total 10 articles from PubMed and CINAHL were considered for review and will be presented in
the Findings table.

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