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06067 Topic: FINAL PICOT TEMPLATE
Number of Pages: 1 (Double Spaced)
Number of sources: 4
Writing Style: APA
Type of document: Coursework
Academic Level:Master
Category: Nursing
Language Style: English (U.S.)
Order Instructions: Attached
**** PLEASE JUST FILL IN INFO FROM STUDY ALREADY
DONE AND PAID FOR- I AM ATTACHING ALL PERTINENT
FILES. THANK YOU.
The purpose of this assignment is to create a final PICOT
question for your DPI Project.
General Requirements:
•
APA style is not required, but solid academic writing is
expected.
•
This assignment uses a rubric. Please review the rubric prior to
beginning the assignment to become familiar with the
expectations for successful completion.
•
Directions :
Using the "PICOT Question Template," submit your final
PICOT question
PICOT Question Template
Section 1: In this section provide one word to describe each
section of your proposed PICOT question
P
Population
I
Intervention
C
Comparison
O
Outcome
T
Timeline
Section 2: Write your PICOT question below using the words
listed above.
PICOT
Section 3: Use your PICOT to develop a formalized problem
statement. Use the example below to help formulate your
problem statement.
As you move through the program, you will be building your
project based on the PICOT question. Your problem statement,
purpose statement, and clinical question(s) will be derived from
the PICOT, though they are formatted differently. Use the
instructions below as an initial exercise in visualizing how your
problem and purpose statements might look. Read the
instructions and then develop your problem and purpose
statements in the designated fields below each instruction field
Problem Statement Format Instructions
A well-written problem statement begins with the big picture of
the issue (macro) and works to the small, narrower and more
specific problem (micro). It clearly communicates the
significance, magnitude, and importance of the problem and
transitions into the Purpose of the Project with a declarative
statement such as “It is not known if and to what
degree/extent...” or “It is not known how/why and…”.
Other examples are:
While the literature indicates ____________, it is not known in
_________. (organization/community) if __________.
It is not known how or to what extent ________________.
Problem Statement
Section 4: Based on your PICOT, create a declarative purpose
statement. Use the example below as a reference.
Purpose Statement Format Instructions
"The purpose of this project is....” Included in this statement are
also the project design, population, variables (quantitative) to
be studied, and the geographic location.
Creswell (2003) provided some sample templates for developing
purpose statements aligned with the different project methods as
follows:
The purpose of this quantitative ___________ (correlational,
descriptive, etc.) project is to ____________ (compare or see to
what degree a relationship exists) between/among
______________________ (independent variable) to
___________________ (dependent variable) for
________________ (participants) at ___________________
(project site/geographical location). The ________ (independent
variable) will be defined/measured as/by _______ (provide a
general definition). The (dependent variable) will be
defined/measured as/by ______ (provide a general definition).
Purpose Statement
Creswell, J. W. (2003). Research Design: Qualitative,
Quantitative, and Mixed Methods Approaches. Thousand Oaks:
Sage Publications.
© 2019. Grand Canyon University. All Rights Reserved.
Running Head: EMPIRICAL RESEARCH IDENTIFICATION
1
EMPIRICAL RESEARCH IDENTIFICATION
5
Summary Review
Student’s Name
Institution Affiliation
Article One: Early skin-to-skin contact for mothers and their
healthy newborn infants
Initial skin-to-skin contact refers to placing a undressed baby,
covering the head with warm blanket as well as dry cap
crosswise the back on the mother’s chest. After reading the
article, I expect to learn the special effects of early skin-to-skin
connection on psychological alteration, breastfeeding and
behaviour in healthy mother-newborn relation. The report
covers the relationship between mother and new-born baby
through early skin-to-skin contact. The rationale of the research
is to proof the effects of early skin to skin contact on
breastfeeding and other outcomes in mothers such as duration
and also mother’s healthy and late preterm newborn infants
(Moore et al., 2016). The article affirms that intimate contact at
early birth influence neurobehaviors, promoting the fulfilment
of basic biological needs.
The research was conducted in Cochrane Pregnancy and
Childbirth Group’s Trialist Registers, contacting trialist and the
bibliography on Kangaroo Mother Care. Randomised control
trials were used in the research. Trial quality was assessed
independently, and data extracted as well as more information
given by study authors. The main outcomes of the literature
found that there is an affirmative effect of SSC on breastfeeding
in the first four months after birth (Nagai et al., 2010). It was
also noted that the SSC increased the duration of breastfeeding.
Cardio-respiratory stability was noted in late preterm infants
(Neu & Robinson, 2010). The findings are supported by graphs
which illustrate that none of the studies met all the
methodological quality criteria. In conclusion, the authors
affirmed that intervention benefited breastfeeding outcomes,
decrease infant crying, and cardio-respiratory stability. The
response also was found to have no adverse effects. However,
further investigation is recommended. There are 66 references
included in the article review.
Article Two: Baby to Mother’s Skin or Baby to Radiant
Warmer; Which Practice Promotes the Best Outcome for a
Healthy, Term Newborn Delivery?
After reading the abstract, I expected to learn the benefits of
skin to skin contact for a newborn immediately after
spontaneous vaginal delivery as compared to radiant warmer. I
expected to learn how skin to skin contact promotes
stabilisation and promotion of newborn's well-being. The
literature review was made to examine the evidence regarding
which of the two practices promotes the best outcome for a
healthy newborn delivery. The research methods used in this
literature review include PubMed and CINAHL search engines
for Penn State Hershey George T. Harrell Health Science
Library. Surveys were also conducted on the current practices
of 3rd Floor Women’s Health RN’s in the labour and delivery
setting (Landis et al., 2013). The literature supports skin to skin
contact directly after vaginal delivery of a healthy newborn.
The benefit identified include mother-newborn bonding,
thermo-stabilization, initiation of breastfeeding, easier
transitions to extra-uterine life, pain reduction, stimulation of
oxytocin and promotion of antibodies (Weddig et al., 2011).
Surveys were conducted in the Labor and Delivery RN’s at
Hershey Medical Center which found that 90% prefer skin to
skin contact, while only 10% preferred warmer radiant
following delivery (Fleming, 2012). Pie chart and a graph were
used to present the findings of the literature. Radiant warmer
were said to cause complication such as infant pulmonary
distress, mental illness, newborn Hypoglycaemia and maternal
pain management challenges. In conclusion, baby to belly
directly following delivery was proven to be the best for mother
and baby stabilisation. However, the study should be conducted
on the level of education or policies on the practice, and staff
comfort in initiating breastfeeding. The literature used five
references to analyse the issue.
Article Three: Benefits of skin-to-skin during neonatal period:
Governed by Epigenetic Mechanism
The abstract of the article presents the importance of perinatal
experiences in the child’s later life psychology. The purpose of
the literature is to examine the current skin-to-skin practice and
the need for more studies discussed. The article emphasises the
contribution of skin-to-skin contact in establishing regular
breathing as well as maintaining healthy blood glucose and
blood temperature levels (Almgren, 2018). Also known as
Kangaroo mother care, SSC is appropriate care to stabilise low-
birth-weight infants.
In a Zimbabwe hospital where there was no equipment to care
for neonates was examined in the research. The literature was
weighing the survival of infants between 1000 and 1500 g.
Another randomised control study where stable neonates with
birth weight 1200 to 2199 g were examined got conducted. One
sample was assigned skin-to-skin and the other assigned
conventional care. Cardio-respiratory and temperature scores
were monitored within the 6 hours after birth (Carbasse et al.,
2013). The survival of infants had been as low as 10% in the
Zimbabwe hospital but improved dramatically to 50% for
infants with weight 1000 g-1500 g. In the second study found
that 100% of the sample assigned to SSC resulted in stability
scores as compared to the conventional care group 46%.
Graphical representation was used to show the findings of
Bergman et al. (1994) survival according to weights. Lastly,
there is a need for more studies and researches on the impact of
skin-to-skin on premature newborns. The article has used 18
references to examine the issue.
References
Almgren, M. (2018). Benefits of skin-to-skin contact during the
neonatal period: Governed by epigenetic mechanisms?. Genes &
diseases, 5(1), 24-26.
Carbasse, A., Kracher, S., Hausser, M., Langlet, C., Escande,
B., Donato, L., ... & Kuhn, P. (2013). Safety and effectiveness
of skin-to-skin contact in the NICU to support
neurodevelopment in vulnerable preterm infants. The Journal of
perinatal & neonatal nursing, 27(3), 255-262.
Fleming, P. J. (2012). Unexpected collapse of apparently
healthy newborn infants: the benefits and potential risks of
skin-to-skin contact.
Landis, E., Mueller, S., & Curcio, E., & Collins, M. (2013).
Baby to Mother's Skin or Baby to Radiant Warmer: Which
Practice Promotes the Best Outcome for a Healthy, Term
Newborn Directly Following Delivery?
Moore, E. R., Bergman, N., Anderson, G. C., & Medley, N.
(2016). Early skin‐to‐skin contact for mothers and their healthy
newborn infants. Cochrane database of systematic Reviews,
(11).
Nagai, S., Andrianarimanana, D., Rabesandratana, N.,
Yonemoto, N., Nakayama, T., & Mori, R. (2010). Earlier versus
later continuous Kangaroo Mother Care (KMC) for stable
low‐birth‐weight infants: a randomized controlled trial. Acta
Paediatrica, 99(6), 826-835.
Neu, M., & Robinson, J. (2010). Maternal holding of preterm
infants during the early weeks after birth and dyad interaction at
six months. Journal of Obstetric, Gynecologic & Neonatal
Nursing, 39(4), 401-414.
Weddig, J., Baker, S. S., & Auld, G. (2011). Perspectives of
hospital‐based nurses on breastfeeding initiation best
practices. Journal of Obstetric, Gynecologic & Neonatal
Nursing, 40(2), 166-178.
Rubic_Print_FormatCourse CodeClass CodeDNP-801DNP-801-
O501Final PICOT Question
Submission130.0CriteriaPercentageUnsatisfactory (0.00%)Less
than Satisfactory (74.00%)Satisfactory (79.00%)Good
(87.00%)Excellent (100.00%)CommentsPoints
EarnedContent100.0%Population12.0%A description of
population being assessed is not included.A description of
population being assessed is incomplete or incorrect.A
description of population being assessed is included but lacks a
link to direct practice improvements that could be measured
through patient and practice outcomes.A description of
population being assessed is complete and includes a direct link
to practice improvements that can be measured through patient
and practice outcomes.A description of population being
assessed can be linked to direct practice improvements and is
extremely thorough with substantial supporting
evidence.Intervention12.0%A description of the intervention is
not included.A description of the intervention is incomplete or
incorrect.A description of the intervention is included but lacks
a sufficient amount of evidence. A description of the
intervention is complete and includes a sufficient amount of
evidence and is supported by literature. A description of the
intervention is extremely thorough with substantial evidence
and supporting literature. Comparison12.0%A description of the
comparison information is not included.A description of the
comparison information is incomplete or incorrect.A description
of the comparison information is included but lacks evidence
and measurable outcomes.A description of the comparison
information is complete and includes a sufficient amount of
evidence and measurable outcomes.A description of the
comparison information is extremely thorough with substantial
evidence and measurable outcomes. Outcome12.0%A
description of the outcome is not included.A description of the
outcomes is incomplete or incorrect.A description of the
outcome is included but lacks evidence.A description of the
outcome is complete and includes a sufficient amount of
evidence.A description of the outcome is extremely thorough
with substantial evidence. Timeline12.0%A description of the
timeline is not included.A description of the timeline is
incomplete or incorrect.A description of the timeline is included
but lacks evidence.A description of the timelines is complete
and includes a sufficient amount of evidence.A description of
the timeline is extremely thorough with substantial evidence.
Purpose Statement7.0%A purpose statement for the selected
topic is not included.A purpose statement for the selected topic
is incomplete or incorrect.A purpose statement for the selected
topic is included but lacks evidence.A purpose statement for the
selected topic is complete and includes a sufficient amount of
evidence.A purpose statement for the selected topic is extremely
thorough with substantial evidence.Problem Statement8.0%A
problem statement rationale for the selected topic is not
includedA problem statement for the selected topic is
incomplete or incorrect.A problem statement for the selected
topic is included but lacks evidence.A problem statement for the
selected topic is complete and includes a sufficient amount of
evidence.A problem statement for the selected topic is
extremely thorough with substantial evidenceMechanics of
Writing (includes spelling, punctuation, grammar, language
use) 5.0%Surface errors are pervasive enough that they impede
communication of meaning. Inappropriate word choice or
sentence construction is used.Frequent and repetitive
mechanical errors distract the reader. Inconsistencies in
language choice (register), sentence structure, or word choice
are present.Some mechanical errors or typos are present, but are
not overly distracting to the reader. Correct sentence structure
and audience-appropriate language are used. Prose is largely
free of mechanical errors, although a few may be present. A
variety of sentence structures and effective figures of speech are
used. Writer is clearly in command of standard, written,
academic English.Paper Format (use of appropriate style for
the major and assignment)10.0%Template is not used
appropriately or documentation format is rarely followed
correctly.Appropriate template is used, but some elements are
missing or mistaken. A lack of control with formatting is
apparent.Appropriate template is used. Formatting is correct,
although some minor errors may be present.Appropriate
template is fully used. There are virtually no errors in
formatting styleAll format elements are correct. Documentation
of Sources (citations, footnotes, references, bibliography, etc.,
as appropriate to assignment and style)10.0%Sources are not
documented.Documentation of sources is inconsistent or
incorrect, as appropriate to assignment and style, with numerous
formatting errors.Sources are documented, as appropriate to
assignment and style, although some formatting errors may be
present.Sources are documented, as appropriate to assignment
and style, and format is mostly correct.Sources are completely
and correctly documented, as appropriate to assignment and
style, and format is free of error.Total Weightage100%
Rubic_Print_FormatCourse CodeClass CodeDNP-801DNP-801-
O501Final PICOT Question
Submission130.0CriteriaPercentageUnsatisfactory (0.00%)Less
than Satisfactory (74.00%)Satisfactory (79.00%)Good
(87.00%)Excellent (100.00%)CommentsPoints
EarnedContent100.0%Population12.0%A description of
population being assessed is not included.A description of
population being assessed is incomplete or incorrect.A
description of population being assessed is included but lacks a
link to direct practice improvements that could be measured
through patient and practice outcomes.A description of
population being assessed is complete and includes a direct link
to practice improvements that can be measured through patient
and practice outcomes.A description of population being
assessed can be linked to direct practice improvements and is
extremely thorough with substantial supporting
evidence.Intervention12.0%A description of the intervention is
not included.A description of the intervention is incomplete or
incorrect.A description of the intervention is included but lacks
a sufficient amount of evidence. A description of the
intervention is complete and includes a sufficient amount of
evidence and is supported by literature. A description of the
intervention is extremely thorough with substantial evidence
and supporting literature. Comparison12.0%A description of the
comparison information is not included.A description of the
comparison information is incomplete or incorrect.A description
of the comparison information is included but lacks evidence
and measurable outcomes.A description of the comparison
information is complete and includes a sufficient amount of
evidence and measurable outcomes.A description of the
comparison information is extremely thorough with substantial
evidence and measurable outcomes. Outcome12.0%A
description of the outcome is not included.A description of the
outcomes is incomplete or incorrect.A description of the
outcome is included but lacks evidence.A description of the
outcome is complete and includes a sufficient amount of
evidence.A description of the outcome is extremely thorough
with substantial evidence. Timeline12.0%A description of the
timeline is not included.A description of the timeline is
incomplete or incorrect.A description of the timeline is included
but lacks evidence.A description of the timelines is complete
and includes a sufficient amount of evidence.A description of
the timeline is extremely thorough with substantial evidence.
Purpose Statement7.0%A purpose statement for the selected
topic is not included.A purpose statement for the selected topic
is incomplete or incorrect.A purpose statement for the selected
topic is included but lacks evidence.A purpose statement for the
selected topic is complete and includes a sufficient amount of
evidence.A purpose statement for the selected topic is extremely
thorough with substantial evidence.Problem Statement8.0%A
problem statement rationale for the selected topic is not
includedA problem statement for the selected topic is
incomplete or incorrect.A problem statement for the selected
topic is included but lacks evidence.A problem statement for the
selected topic is complete and includes a sufficient amount of
evidence.A problem statement for the selected topic is
extremely thorough with substantial evidenceMechanics of
Writing (includes spelling, punctuation, grammar, language
use) 5.0%Surface errors are pervasive enough that they impede
communication of meaning. Inappropriate word choice or
sentence construction is used.Frequent and repetitive
mechanical errors distract the reader. Inconsistencies in
language choice (register), sentence structure, or word choice
are present.Some mechanical errors or typos are present, but are
not overly distracting to the reader. Correct sentence structure
and audience-appropriate language are used. Prose is largely
free of mechanical errors, although a few may be present. A
variety of sentence structures and effective figures of speech are
used. Writer is clearly in command of standard, written,
academic English.Paper Format (use of appropriate style for
the major and assignment)10.0%Template is not used
appropriately or documentation format is rarely followed
correctly.Appropriate template is used, but some elements are
missing or mistaken. A lack of control with formatting is
apparent.Appropriate template is used. Formatting is correct,
although some minor errors may be present.Appropriate
template is fully used. There are virtually no errors in
formatting styleAll format elements are correct. Documentation
of Sources (citations, footnotes, references, bibliography, etc.,
as appropriate to assignment and style)10.0%Sources are not
documented.Documentation of sources is inconsistent or
incorrect, as appropriate to assignment and style, with numerous
formatting errors.Sources are documented, as appropriate to
assignment and style, although some formatting errors may be
present.Sources are documented, as appropriate to assignment
and style, and format is mostly correct.Sources are completely
and correctly documented, as appropriate to assignment and
style, and format is free of error.Total Weightage100%
Running head: SKIN TO SKIN CONTACT
1
SKIN TO SKIN CONTACT
8
Skin to Skin Contact
Name:
University
May 7, 2019
Mothers and infant need to be close together during birth and
from the hours that follow. It is safe and essential to keep
mothers and babies together. Various evidence has supported
the need for constant skin care, after vaginal birth and during
and after caesarian surgeries for many stable mothers and other
babies. This text reviews various works of literature supporting
the need for skin to skin care during birth.
The best practice that supports safe and birth that is healthy is
to keep the mother and babies together and make sure that the
opportunities for the skin to skin care and breastfeeding are
unlimited. There is a need for psychological need between the
mother and babies the following birth since it helps to improve
maternally and the newborn outcome (Bergman, 2013).
According to World health organization and United Nations
children funds (2009), urge that every woman regardless of
feeding preferences and method of birth to have interrupted skin
to skin contact immediately after delivery for an hour until the
first feeding. Skin to skin care refers to placing a newborn
without clothes on the woman's bare chest with the only warm
dried and unclothed blanket covering the back of the newborn.
Other maternal care should take place during the skin to skin
care or postpone it until the skin to skin care has taken place
(Mark, 2010).
As stated by Buckley, (2014), the first hour after birth is very
sensitive and is greatly influenced by the elevated levels of the
maternal reproduction hormone, oxytocin which crosses the
placenta to the baby. Skin to skin contact helps to protect the
newborn baby from the negative effect of separation. Babies are
born to interact with their mothers. A mother and her newborn
baby are literal single biological organism until their umbilical
cord has been cut. Attachment between the mother and infant is
significant in the development of the new infant which helps to
self-regulate and maintain their homeostasis. The skin to skin
contact helps to control newborn exposure to the environment.
Therefore, it is evident babies who had skin to skin contact have
a higher survival during parents separation compared to those
who have experienced radiant warmer.
There is an increase in the oxytocin level during the skin to
skin care contact. It helps to promote mother to baby attachment
and regulates thermal temperature, reduces newborn stress and
helps faster transition to the postnatal life. (Dowell, 2012).
During this sensitive time which is always referred to ass, the
magical hour, golden hour or holy hour requires protection,
respect, and support. New innate protective behavior may be
suppressed due to delay or lack of skin to skin to skin care
which may lead to behavioral disorganization and make
attachment and breastfeeding to be more difficult. (More et al.,
2012).
According to Braun K. (2011) skin to skin contact helps for the
survival of the newborn baby. The surface to skin care contains
biochemical activators that prime the brain rewards circuitry
which increases the behavior of maternal care. The author also
argues that hormones are responsible for attachment behaviors
due to the skin to skin contact. This is very important to a
vulnerable new baby born; one of the hormones that are
generated due to the surface to skin contact is Oxytocin. This is
a love hormone that results in the bond between the child and
the mother. The hormone has shown to provide a relaxation
mood, attraction, and facial recognition. Mothers who have had
skin to skin contact with their newborn have a higher bond
compared to those who never had the skin to skin contact.
Early separation and denial of skin to skin to skin care may
disrupt maternal-infant bonding and reduce the dynamic
response of the mother to the baby. This will later hurt maternal
behavior (Dumas et al., 2013). According to Takashi (2011),
there is a heightened response of stimulations which meets the
new basic biological needs when the newborn is placed into the
skin to skin care with the mother. An immediate skin to skin
care helps in the colonization of the newborn maternal flora vs.
the hospital flora. This helps in protection against infection and
helps in breastfeeding of the infant (Sobel, 2011).
There is an increase in the neonatal hypothermia when skin to
skin care is interrupted, some of the benefits that are accrued
about skin to skin, are pleasant temperature, beneficial flora and
a prime opportunity to crawl to the breast which is the best
outcome between the mother and the baby.
How a baby is welcomed into the world in the first hours after
birth affects its health, the impact can be either positive or
negative. The article also emphasizes that healthy newborn
babies who are placed skin to skin with their mothers
immediately after delivery make a great transition from fatal
into a new life with excellent stability in respiration,
temperature, glucose, and less crying. This indicates that they
have a less amount of stress ( Chamberlain, 2013).
Safety measures
When a newborn is on a routine care practice, many infants are
exposed to various environments that are considered to be
painful such as heel lance procedure, blood sampling, and
intramuscular injections. Skin to skin care has shown neutralize
these responses to a painful stimulus inclusive a decrease in the
facial grimace, standard heartbeat and crying (Custardy, 2013).
According to WHO, not any person can perform skin to skin
contact care. He recommends that there need to be well-trained
healthcare personnel such as a registered, nurse, midwife or a
nurse practitioner or any physician to be in attendance for any
matter concerning skin to skin sessions (Moore et al., 2012).
There have been cases of a sudden relapse and postnatal
collapse infants which were unexpected because infants were
positioned prone when doing skin to skin contact (Morgan
2014). Despite having no evidence of sudden infant collapse in
various kinds of literature, there have been cases where infant
became apneic.
It is essential that healthcare personnel trained on ways to
manage skin to skin contact in postpartum and obstetric
settings. Various training should include things like proper
positioning, newborn and maternal safety measures and other
health indicators should be measured keenly when there is an
ongoing skin to skin contact (Stevens et al., 2014) even though
many stakeholders urge on the use of neonatal assessment tools
to monitor the wellbeing of infants, no means have been so far
approved at this time.
Recommendation.
It is recommended that all infants who are higher than 37 weeks
and 0 gestation should be placed in an immediate skin to skin
contact for at least for one hour only if either cesarean surgery
or vaginal delivery bore them. Additionally mothers of stable
infants who are more than 37 weeks of gestation should have a
choice to practice skin to skin care during their neonatal
procedure, e.g vaccination, sampling of blood and many more,
last but not least parents with healthy infant and greater than 37
weeks should be encouraged to have a frequent skin to skin
contact with their newborn while being in hospital and after
their discharge.
Conclusion
To Sum up, for a bay to adjust to the outside life of both skin
to skin contact is very necessary. The art is supported by much
organization who are responsible for the care and the wellbeing
of their infants, apart from being safe to the mother and the
babies it provides both short term and long-term benefits. From
various research, it is evident that new postpartum skin to skin
care tend to increase the psychological, stability and promotes
optimal psycho-emotional wellbeing and also supports the
structural and function of the newborn.
References
Chamberlain D. Babies remember the birth and other
extraordinary scientific discoveries about the mind and the
personality of your newborn. NY, New York: Ballantine Books.
Chen, J., Sadakata, M., Ishida, M., Sekizuka, N., and Sayam, M
(2011). Baby massage ameliorates neonatal jaundice in full-term
newborn infants. Tohoku Journal of Experimental Medicine.
2011; 223: 97–102
Kostandy, R., Anderson, G.C., (2013) and Good, M. Skin-to-
skin contact diminishes pain from hepatitis B vaccine injection
in healthy full-term neonates. Neonatal Network.; 32: 274–
280https://doi.org/10.1891/0730-0832.32.4.274
Ludington-Hoe SM, Lewis T, Morgan K, Cong X, Anderson L,
Reese S. (2016) Breast and infant temperatures with twins
during shared kangaroo care. J Obstet Gynecol Neonatal
Nurs.;35:223-231
Mason W, Berkson G. Effects of maternal mobility on the
development of rocking and other behaviors in Rhesus monkeys:
a study with artificial mothers. Dev Psychobilly. 1974; 8:197-
211.
Moore, E.R., Anderson, G.C., Bergman, N., and Doswell,
(2016) T. Early skin-to-skin contact for mothers and their
healthy newborn infants. Cochrane Database of Systematic
Reviews. CD003519
World Health Organization (WHO). (2017) Protecting,
Promoting and Supporting Breastfeeding in Facilities Providing
Maternity and Newborn Services 2017. Available from:
http://apps.who.int/iris/bitstream/
handle/10665/259386/9789241550086-eng.pdf?sequence=1. 2.
Moore ER, Bergman N, Anderson GC, Medley N. Early skin-to-
sky

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06067 Topic FINAL PICOT TEMPLATENumber of Pages 1 (Double Sp

  • 1. 06067 Topic: FINAL PICOT TEMPLATE Number of Pages: 1 (Double Spaced) Number of sources: 4 Writing Style: APA Type of document: Coursework Academic Level:Master Category: Nursing Language Style: English (U.S.) Order Instructions: Attached **** PLEASE JUST FILL IN INFO FROM STUDY ALREADY DONE AND PAID FOR- I AM ATTACHING ALL PERTINENT FILES. THANK YOU. The purpose of this assignment is to create a final PICOT question for your DPI Project. General Requirements: •
  • 2. APA style is not required, but solid academic writing is expected. • This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion. • Directions : Using the "PICOT Question Template," submit your final PICOT question PICOT Question Template Section 1: In this section provide one word to describe each section of your proposed PICOT question P Population I Intervention C Comparison O Outcome
  • 3. T Timeline Section 2: Write your PICOT question below using the words listed above. PICOT Section 3: Use your PICOT to develop a formalized problem statement. Use the example below to help formulate your problem statement. As you move through the program, you will be building your project based on the PICOT question. Your problem statement, purpose statement, and clinical question(s) will be derived from the PICOT, though they are formatted differently. Use the instructions below as an initial exercise in visualizing how your problem and purpose statements might look. Read the instructions and then develop your problem and purpose statements in the designated fields below each instruction field Problem Statement Format Instructions A well-written problem statement begins with the big picture of the issue (macro) and works to the small, narrower and more specific problem (micro). It clearly communicates the significance, magnitude, and importance of the problem and transitions into the Purpose of the Project with a declarative statement such as “It is not known if and to what degree/extent...” or “It is not known how/why and…”. Other examples are: While the literature indicates ____________, it is not known in _________. (organization/community) if __________. It is not known how or to what extent ________________. Problem Statement
  • 4. Section 4: Based on your PICOT, create a declarative purpose statement. Use the example below as a reference. Purpose Statement Format Instructions "The purpose of this project is....” Included in this statement are also the project design, population, variables (quantitative) to be studied, and the geographic location. Creswell (2003) provided some sample templates for developing purpose statements aligned with the different project methods as follows: The purpose of this quantitative ___________ (correlational, descriptive, etc.) project is to ____________ (compare or see to what degree a relationship exists) between/among ______________________ (independent variable) to ___________________ (dependent variable) for ________________ (participants) at ___________________ (project site/geographical location). The ________ (independent variable) will be defined/measured as/by _______ (provide a general definition). The (dependent variable) will be defined/measured as/by ______ (provide a general definition). Purpose Statement Creswell, J. W. (2003). Research Design: Qualitative, Quantitative, and Mixed Methods Approaches. Thousand Oaks: Sage Publications. © 2019. Grand Canyon University. All Rights Reserved. Running Head: EMPIRICAL RESEARCH IDENTIFICATION 1
  • 5. EMPIRICAL RESEARCH IDENTIFICATION 5 Summary Review Student’s Name Institution Affiliation Article One: Early skin-to-skin contact for mothers and their healthy newborn infants Initial skin-to-skin contact refers to placing a undressed baby, covering the head with warm blanket as well as dry cap crosswise the back on the mother’s chest. After reading the article, I expect to learn the special effects of early skin-to-skin connection on psychological alteration, breastfeeding and behaviour in healthy mother-newborn relation. The report covers the relationship between mother and new-born baby through early skin-to-skin contact. The rationale of the research is to proof the effects of early skin to skin contact on breastfeeding and other outcomes in mothers such as duration and also mother’s healthy and late preterm newborn infants (Moore et al., 2016). The article affirms that intimate contact at early birth influence neurobehaviors, promoting the fulfilment of basic biological needs. The research was conducted in Cochrane Pregnancy and Childbirth Group’s Trialist Registers, contacting trialist and the bibliography on Kangaroo Mother Care. Randomised control trials were used in the research. Trial quality was assessed independently, and data extracted as well as more information given by study authors. The main outcomes of the literature found that there is an affirmative effect of SSC on breastfeeding in the first four months after birth (Nagai et al., 2010). It was also noted that the SSC increased the duration of breastfeeding. Cardio-respiratory stability was noted in late preterm infants
  • 6. (Neu & Robinson, 2010). The findings are supported by graphs which illustrate that none of the studies met all the methodological quality criteria. In conclusion, the authors affirmed that intervention benefited breastfeeding outcomes, decrease infant crying, and cardio-respiratory stability. The response also was found to have no adverse effects. However, further investigation is recommended. There are 66 references included in the article review. Article Two: Baby to Mother’s Skin or Baby to Radiant Warmer; Which Practice Promotes the Best Outcome for a Healthy, Term Newborn Delivery? After reading the abstract, I expected to learn the benefits of skin to skin contact for a newborn immediately after spontaneous vaginal delivery as compared to radiant warmer. I expected to learn how skin to skin contact promotes stabilisation and promotion of newborn's well-being. The literature review was made to examine the evidence regarding which of the two practices promotes the best outcome for a healthy newborn delivery. The research methods used in this literature review include PubMed and CINAHL search engines for Penn State Hershey George T. Harrell Health Science Library. Surveys were also conducted on the current practices of 3rd Floor Women’s Health RN’s in the labour and delivery setting (Landis et al., 2013). The literature supports skin to skin contact directly after vaginal delivery of a healthy newborn. The benefit identified include mother-newborn bonding, thermo-stabilization, initiation of breastfeeding, easier transitions to extra-uterine life, pain reduction, stimulation of oxytocin and promotion of antibodies (Weddig et al., 2011). Surveys were conducted in the Labor and Delivery RN’s at Hershey Medical Center which found that 90% prefer skin to skin contact, while only 10% preferred warmer radiant following delivery (Fleming, 2012). Pie chart and a graph were
  • 7. used to present the findings of the literature. Radiant warmer were said to cause complication such as infant pulmonary distress, mental illness, newborn Hypoglycaemia and maternal pain management challenges. In conclusion, baby to belly directly following delivery was proven to be the best for mother and baby stabilisation. However, the study should be conducted on the level of education or policies on the practice, and staff comfort in initiating breastfeeding. The literature used five references to analyse the issue. Article Three: Benefits of skin-to-skin during neonatal period: Governed by Epigenetic Mechanism The abstract of the article presents the importance of perinatal experiences in the child’s later life psychology. The purpose of the literature is to examine the current skin-to-skin practice and the need for more studies discussed. The article emphasises the contribution of skin-to-skin contact in establishing regular breathing as well as maintaining healthy blood glucose and blood temperature levels (Almgren, 2018). Also known as Kangaroo mother care, SSC is appropriate care to stabilise low- birth-weight infants. In a Zimbabwe hospital where there was no equipment to care for neonates was examined in the research. The literature was weighing the survival of infants between 1000 and 1500 g. Another randomised control study where stable neonates with birth weight 1200 to 2199 g were examined got conducted. One sample was assigned skin-to-skin and the other assigned conventional care. Cardio-respiratory and temperature scores were monitored within the 6 hours after birth (Carbasse et al., 2013). The survival of infants had been as low as 10% in the Zimbabwe hospital but improved dramatically to 50% for infants with weight 1000 g-1500 g. In the second study found that 100% of the sample assigned to SSC resulted in stability scores as compared to the conventional care group 46%.
  • 8. Graphical representation was used to show the findings of Bergman et al. (1994) survival according to weights. Lastly, there is a need for more studies and researches on the impact of skin-to-skin on premature newborns. The article has used 18 references to examine the issue. References Almgren, M. (2018). Benefits of skin-to-skin contact during the neonatal period: Governed by epigenetic mechanisms?. Genes & diseases, 5(1), 24-26. Carbasse, A., Kracher, S., Hausser, M., Langlet, C., Escande, B., Donato, L., ... & Kuhn, P. (2013). Safety and effectiveness of skin-to-skin contact in the NICU to support neurodevelopment in vulnerable preterm infants. The Journal of perinatal & neonatal nursing, 27(3), 255-262. Fleming, P. J. (2012). Unexpected collapse of apparently healthy newborn infants: the benefits and potential risks of skin-to-skin contact. Landis, E., Mueller, S., & Curcio, E., & Collins, M. (2013). Baby to Mother's Skin or Baby to Radiant Warmer: Which Practice Promotes the Best Outcome for a Healthy, Term Newborn Directly Following Delivery? Moore, E. R., Bergman, N., Anderson, G. C., & Medley, N. (2016). Early skin‐to‐skin contact for mothers and their healthy newborn infants. Cochrane database of systematic Reviews, (11). Nagai, S., Andrianarimanana, D., Rabesandratana, N., Yonemoto, N., Nakayama, T., & Mori, R. (2010). Earlier versus later continuous Kangaroo Mother Care (KMC) for stable low‐birth‐weight infants: a randomized controlled trial. Acta Paediatrica, 99(6), 826-835. Neu, M., & Robinson, J. (2010). Maternal holding of preterm
  • 9. infants during the early weeks after birth and dyad interaction at six months. Journal of Obstetric, Gynecologic & Neonatal Nursing, 39(4), 401-414. Weddig, J., Baker, S. S., & Auld, G. (2011). Perspectives of hospital‐based nurses on breastfeeding initiation best practices. Journal of Obstetric, Gynecologic & Neonatal Nursing, 40(2), 166-178. Rubic_Print_FormatCourse CodeClass CodeDNP-801DNP-801- O501Final PICOT Question Submission130.0CriteriaPercentageUnsatisfactory (0.00%)Less than Satisfactory (74.00%)Satisfactory (79.00%)Good (87.00%)Excellent (100.00%)CommentsPoints EarnedContent100.0%Population12.0%A description of population being assessed is not included.A description of population being assessed is incomplete or incorrect.A description of population being assessed is included but lacks a link to direct practice improvements that could be measured through patient and practice outcomes.A description of population being assessed is complete and includes a direct link to practice improvements that can be measured through patient and practice outcomes.A description of population being assessed can be linked to direct practice improvements and is extremely thorough with substantial supporting evidence.Intervention12.0%A description of the intervention is not included.A description of the intervention is incomplete or incorrect.A description of the intervention is included but lacks a sufficient amount of evidence. A description of the intervention is complete and includes a sufficient amount of evidence and is supported by literature. A description of the intervention is extremely thorough with substantial evidence and supporting literature. Comparison12.0%A description of the comparison information is not included.A description of the comparison information is incomplete or incorrect.A description
  • 10. of the comparison information is included but lacks evidence and measurable outcomes.A description of the comparison information is complete and includes a sufficient amount of evidence and measurable outcomes.A description of the comparison information is extremely thorough with substantial evidence and measurable outcomes. Outcome12.0%A description of the outcome is not included.A description of the outcomes is incomplete or incorrect.A description of the outcome is included but lacks evidence.A description of the outcome is complete and includes a sufficient amount of evidence.A description of the outcome is extremely thorough with substantial evidence. Timeline12.0%A description of the timeline is not included.A description of the timeline is incomplete or incorrect.A description of the timeline is included but lacks evidence.A description of the timelines is complete and includes a sufficient amount of evidence.A description of the timeline is extremely thorough with substantial evidence. Purpose Statement7.0%A purpose statement for the selected topic is not included.A purpose statement for the selected topic is incomplete or incorrect.A purpose statement for the selected topic is included but lacks evidence.A purpose statement for the selected topic is complete and includes a sufficient amount of evidence.A purpose statement for the selected topic is extremely thorough with substantial evidence.Problem Statement8.0%A problem statement rationale for the selected topic is not includedA problem statement for the selected topic is incomplete or incorrect.A problem statement for the selected topic is included but lacks evidence.A problem statement for the selected topic is complete and includes a sufficient amount of evidence.A problem statement for the selected topic is extremely thorough with substantial evidenceMechanics of Writing (includes spelling, punctuation, grammar, language use) 5.0%Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice or sentence construction is used.Frequent and repetitive mechanical errors distract the reader. Inconsistencies in
  • 11. language choice (register), sentence structure, or word choice are present.Some mechanical errors or typos are present, but are not overly distracting to the reader. Correct sentence structure and audience-appropriate language are used. Prose is largely free of mechanical errors, although a few may be present. A variety of sentence structures and effective figures of speech are used. Writer is clearly in command of standard, written, academic English.Paper Format (use of appropriate style for the major and assignment)10.0%Template is not used appropriately or documentation format is rarely followed correctly.Appropriate template is used, but some elements are missing or mistaken. A lack of control with formatting is apparent.Appropriate template is used. Formatting is correct, although some minor errors may be present.Appropriate template is fully used. There are virtually no errors in formatting styleAll format elements are correct. Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style)10.0%Sources are not documented.Documentation of sources is inconsistent or incorrect, as appropriate to assignment and style, with numerous formatting errors.Sources are documented, as appropriate to assignment and style, although some formatting errors may be present.Sources are documented, as appropriate to assignment and style, and format is mostly correct.Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.Total Weightage100% Rubic_Print_FormatCourse CodeClass CodeDNP-801DNP-801- O501Final PICOT Question Submission130.0CriteriaPercentageUnsatisfactory (0.00%)Less than Satisfactory (74.00%)Satisfactory (79.00%)Good (87.00%)Excellent (100.00%)CommentsPoints EarnedContent100.0%Population12.0%A description of population being assessed is not included.A description of population being assessed is incomplete or incorrect.A description of population being assessed is included but lacks a
  • 12. link to direct practice improvements that could be measured through patient and practice outcomes.A description of population being assessed is complete and includes a direct link to practice improvements that can be measured through patient and practice outcomes.A description of population being assessed can be linked to direct practice improvements and is extremely thorough with substantial supporting evidence.Intervention12.0%A description of the intervention is not included.A description of the intervention is incomplete or incorrect.A description of the intervention is included but lacks a sufficient amount of evidence. A description of the intervention is complete and includes a sufficient amount of evidence and is supported by literature. A description of the intervention is extremely thorough with substantial evidence and supporting literature. Comparison12.0%A description of the comparison information is not included.A description of the comparison information is incomplete or incorrect.A description of the comparison information is included but lacks evidence and measurable outcomes.A description of the comparison information is complete and includes a sufficient amount of evidence and measurable outcomes.A description of the comparison information is extremely thorough with substantial evidence and measurable outcomes. Outcome12.0%A description of the outcome is not included.A description of the outcomes is incomplete or incorrect.A description of the outcome is included but lacks evidence.A description of the outcome is complete and includes a sufficient amount of evidence.A description of the outcome is extremely thorough with substantial evidence. Timeline12.0%A description of the timeline is not included.A description of the timeline is incomplete or incorrect.A description of the timeline is included but lacks evidence.A description of the timelines is complete and includes a sufficient amount of evidence.A description of the timeline is extremely thorough with substantial evidence. Purpose Statement7.0%A purpose statement for the selected topic is not included.A purpose statement for the selected topic
  • 13. is incomplete or incorrect.A purpose statement for the selected topic is included but lacks evidence.A purpose statement for the selected topic is complete and includes a sufficient amount of evidence.A purpose statement for the selected topic is extremely thorough with substantial evidence.Problem Statement8.0%A problem statement rationale for the selected topic is not includedA problem statement for the selected topic is incomplete or incorrect.A problem statement for the selected topic is included but lacks evidence.A problem statement for the selected topic is complete and includes a sufficient amount of evidence.A problem statement for the selected topic is extremely thorough with substantial evidenceMechanics of Writing (includes spelling, punctuation, grammar, language use) 5.0%Surface errors are pervasive enough that they impede communication of meaning. Inappropriate word choice or sentence construction is used.Frequent and repetitive mechanical errors distract the reader. Inconsistencies in language choice (register), sentence structure, or word choice are present.Some mechanical errors or typos are present, but are not overly distracting to the reader. Correct sentence structure and audience-appropriate language are used. Prose is largely free of mechanical errors, although a few may be present. A variety of sentence structures and effective figures of speech are used. Writer is clearly in command of standard, written, academic English.Paper Format (use of appropriate style for the major and assignment)10.0%Template is not used appropriately or documentation format is rarely followed correctly.Appropriate template is used, but some elements are missing or mistaken. A lack of control with formatting is apparent.Appropriate template is used. Formatting is correct, although some minor errors may be present.Appropriate template is fully used. There are virtually no errors in formatting styleAll format elements are correct. Documentation of Sources (citations, footnotes, references, bibliography, etc., as appropriate to assignment and style)10.0%Sources are not documented.Documentation of sources is inconsistent or
  • 14. incorrect, as appropriate to assignment and style, with numerous formatting errors.Sources are documented, as appropriate to assignment and style, although some formatting errors may be present.Sources are documented, as appropriate to assignment and style, and format is mostly correct.Sources are completely and correctly documented, as appropriate to assignment and style, and format is free of error.Total Weightage100% Running head: SKIN TO SKIN CONTACT 1 SKIN TO SKIN CONTACT 8 Skin to Skin Contact Name: University May 7, 2019 Mothers and infant need to be close together during birth and from the hours that follow. It is safe and essential to keep mothers and babies together. Various evidence has supported the need for constant skin care, after vaginal birth and during and after caesarian surgeries for many stable mothers and other babies. This text reviews various works of literature supporting the need for skin to skin care during birth. The best practice that supports safe and birth that is healthy is to keep the mother and babies together and make sure that the opportunities for the skin to skin care and breastfeeding are
  • 15. unlimited. There is a need for psychological need between the mother and babies the following birth since it helps to improve maternally and the newborn outcome (Bergman, 2013). According to World health organization and United Nations children funds (2009), urge that every woman regardless of feeding preferences and method of birth to have interrupted skin to skin contact immediately after delivery for an hour until the first feeding. Skin to skin care refers to placing a newborn without clothes on the woman's bare chest with the only warm dried and unclothed blanket covering the back of the newborn. Other maternal care should take place during the skin to skin care or postpone it until the skin to skin care has taken place (Mark, 2010). As stated by Buckley, (2014), the first hour after birth is very sensitive and is greatly influenced by the elevated levels of the maternal reproduction hormone, oxytocin which crosses the placenta to the baby. Skin to skin contact helps to protect the newborn baby from the negative effect of separation. Babies are born to interact with their mothers. A mother and her newborn baby are literal single biological organism until their umbilical cord has been cut. Attachment between the mother and infant is significant in the development of the new infant which helps to self-regulate and maintain their homeostasis. The skin to skin contact helps to control newborn exposure to the environment. Therefore, it is evident babies who had skin to skin contact have a higher survival during parents separation compared to those who have experienced radiant warmer. There is an increase in the oxytocin level during the skin to skin care contact. It helps to promote mother to baby attachment and regulates thermal temperature, reduces newborn stress and helps faster transition to the postnatal life. (Dowell, 2012). During this sensitive time which is always referred to ass, the magical hour, golden hour or holy hour requires protection, respect, and support. New innate protective behavior may be suppressed due to delay or lack of skin to skin to skin care which may lead to behavioral disorganization and make
  • 16. attachment and breastfeeding to be more difficult. (More et al., 2012). According to Braun K. (2011) skin to skin contact helps for the survival of the newborn baby. The surface to skin care contains biochemical activators that prime the brain rewards circuitry which increases the behavior of maternal care. The author also argues that hormones are responsible for attachment behaviors due to the skin to skin contact. This is very important to a vulnerable new baby born; one of the hormones that are generated due to the surface to skin contact is Oxytocin. This is a love hormone that results in the bond between the child and the mother. The hormone has shown to provide a relaxation mood, attraction, and facial recognition. Mothers who have had skin to skin contact with their newborn have a higher bond compared to those who never had the skin to skin contact. Early separation and denial of skin to skin to skin care may disrupt maternal-infant bonding and reduce the dynamic response of the mother to the baby. This will later hurt maternal behavior (Dumas et al., 2013). According to Takashi (2011), there is a heightened response of stimulations which meets the new basic biological needs when the newborn is placed into the skin to skin care with the mother. An immediate skin to skin care helps in the colonization of the newborn maternal flora vs. the hospital flora. This helps in protection against infection and helps in breastfeeding of the infant (Sobel, 2011). There is an increase in the neonatal hypothermia when skin to skin care is interrupted, some of the benefits that are accrued about skin to skin, are pleasant temperature, beneficial flora and a prime opportunity to crawl to the breast which is the best outcome between the mother and the baby. How a baby is welcomed into the world in the first hours after birth affects its health, the impact can be either positive or negative. The article also emphasizes that healthy newborn babies who are placed skin to skin with their mothers immediately after delivery make a great transition from fatal into a new life with excellent stability in respiration,
  • 17. temperature, glucose, and less crying. This indicates that they have a less amount of stress ( Chamberlain, 2013). Safety measures When a newborn is on a routine care practice, many infants are exposed to various environments that are considered to be painful such as heel lance procedure, blood sampling, and intramuscular injections. Skin to skin care has shown neutralize these responses to a painful stimulus inclusive a decrease in the facial grimace, standard heartbeat and crying (Custardy, 2013). According to WHO, not any person can perform skin to skin contact care. He recommends that there need to be well-trained healthcare personnel such as a registered, nurse, midwife or a nurse practitioner or any physician to be in attendance for any matter concerning skin to skin sessions (Moore et al., 2012). There have been cases of a sudden relapse and postnatal collapse infants which were unexpected because infants were positioned prone when doing skin to skin contact (Morgan 2014). Despite having no evidence of sudden infant collapse in various kinds of literature, there have been cases where infant became apneic. It is essential that healthcare personnel trained on ways to manage skin to skin contact in postpartum and obstetric settings. Various training should include things like proper positioning, newborn and maternal safety measures and other health indicators should be measured keenly when there is an ongoing skin to skin contact (Stevens et al., 2014) even though many stakeholders urge on the use of neonatal assessment tools to monitor the wellbeing of infants, no means have been so far approved at this time. Recommendation. It is recommended that all infants who are higher than 37 weeks and 0 gestation should be placed in an immediate skin to skin contact for at least for one hour only if either cesarean surgery or vaginal delivery bore them. Additionally mothers of stable infants who are more than 37 weeks of gestation should have a choice to practice skin to skin care during their neonatal
  • 18. procedure, e.g vaccination, sampling of blood and many more, last but not least parents with healthy infant and greater than 37 weeks should be encouraged to have a frequent skin to skin contact with their newborn while being in hospital and after their discharge. Conclusion To Sum up, for a bay to adjust to the outside life of both skin to skin contact is very necessary. The art is supported by much organization who are responsible for the care and the wellbeing of their infants, apart from being safe to the mother and the babies it provides both short term and long-term benefits. From various research, it is evident that new postpartum skin to skin care tend to increase the psychological, stability and promotes optimal psycho-emotional wellbeing and also supports the structural and function of the newborn. References Chamberlain D. Babies remember the birth and other extraordinary scientific discoveries about the mind and the
  • 19. personality of your newborn. NY, New York: Ballantine Books. Chen, J., Sadakata, M., Ishida, M., Sekizuka, N., and Sayam, M (2011). Baby massage ameliorates neonatal jaundice in full-term newborn infants. Tohoku Journal of Experimental Medicine. 2011; 223: 97–102 Kostandy, R., Anderson, G.C., (2013) and Good, M. Skin-to- skin contact diminishes pain from hepatitis B vaccine injection in healthy full-term neonates. Neonatal Network.; 32: 274– 280https://doi.org/10.1891/0730-0832.32.4.274 Ludington-Hoe SM, Lewis T, Morgan K, Cong X, Anderson L, Reese S. (2016) Breast and infant temperatures with twins during shared kangaroo care. J Obstet Gynecol Neonatal Nurs.;35:223-231 Mason W, Berkson G. Effects of maternal mobility on the development of rocking and other behaviors in Rhesus monkeys: a study with artificial mothers. Dev Psychobilly. 1974; 8:197- 211. Moore, E.R., Anderson, G.C., Bergman, N., and Doswell, (2016) T. Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database of Systematic Reviews. CD003519 World Health Organization (WHO). (2017) Protecting, Promoting and Supporting Breastfeeding in Facilities Providing Maternity and Newborn Services 2017. Available from: http://apps.who.int/iris/bitstream/ handle/10665/259386/9789241550086-eng.pdf?sequence=1. 2. Moore ER, Bergman N, Anderson GC, Medley N. Early skin-to- sky