1. Increasing Skin to Skin within five minutes of a Vaginal delivery though Systems Change, Education and Documentation Jenna K. Nagele RN. BSN.

2. SIGMA THETA TAU Maternal Child Leadership Academy This program is a partnership between Johnson & Johnson and Sigma Theta Tau The main goals are to… – Create influential leaders in the Maternal Child Nursing workspace ( NICU, L&D, Post-Pardum) – Develop a practice change that will make a positive impact on moms and babies for years to come in our healthcare field. – Design a project with a measurable outcome

3. HUP and Our Baby Friendly Journey “The Baby-friendly Hospital Initiative (BFHI) was launched by WHO and UNICEF in 1991, following the Innocenti Declaration of 1990. The initiative is a global effort to implement practices that protect, promote and support breastfeeding.” http://www.who.int/nutrition/topics/bfhi/en/ http://www.who.int/nutrition/topics/bfhi/en/ How will HUP achieve Baby Friendly Designation? – Develop a Baby Friendly Task Force – Apply for the designation, grants and submit projects to Sigma – Gather statistics to present to the Maternal Child Grant Companies such as WICC – Continue to hold meetings to keep up with our developments, improvements and measurable goals

4. What is Skin-to-Skin? After a vaginal delivery, the baby is dried off on mom’s stomach with warm baby blankets and then placed stomach down on moms chest, with head turned to the side. This creates a convection like atmosphere when a warm blanket is placed over the baby’s back. The benefits….. Baby will be more willing to breastfeed Regulation of blood sugar Regulation of Respiratory rate Baby will become soothed by mom and will not cry as much during medications and footprints, causing a decrease in vasoconstriction Within 10 minutes baby’s will become more alert and rooting reflex will start and the baby will also start messaging moms skin Temperature regulation (Dabrowski, 2007)

5. Where did I start? 1)Picked a theory to develop my project “ Theory of Planned Behavior”- Attitudes, Norms and Behaviors 2) Created a Survey for Labor & Delivery RNs 3) Gathered my findings from the survey to understand why Skin to Skin was not happening more after our Vaginal Deliveries. 4) Devised a plan with my team to tackle the issues that were presented to me through the results of the survey. 5) Implement systems change on the Labor & Delivery floor

6. Development of the “Theory of Planned Behavior” Ajzen &Fishbein Formulated the ”Theory of Reasoned Action” in 1975  They wanted to learn the discrepancy between attitudes and behaviors through voluntary behavior.  They discovered that behaviors are not always voluntary.  Due to this discovery the “Theory of Planned Behavior” was developed in 1988.  The new theory proposed a model that would be able to measure how human actions are guided.  The new theory would help them to predict the occurrence of a particular behavior through the intension of a person. (Ajzen, 1991)

7. Theory of Planned Behavior

8. Survey Questions and Answers Q) What are the reasons you feel as though Skin to Skin would not be able to be initiated within five minutes of a vaginal delivery ? (Barriers to Change) A)Mothers decline, baby requiring more resuscitation, not enough nursing help, Physicians asking for to many things at once Q) What are your fears or concerns about the systems change ? A)“ It is a great change, but needs to be brought up prior to delivery so that the RN, patient, OB team and NICU team can all be on the same page” Q) What action can the Skin to Skin task force do to help alleviate your concerns or fears about this system change? A)“We need to have two nurses in every delivery, it needs to be discussed with the stakeholders for this systems change. Having two RNs in a delivery will also help to decrease mistakes, and provide more help for the primary RN without her having to leader the LD room.”

9. The Sigma Method to Implement Change The KP Model… without these I could not start to implement a systems change – Model the way-> Set an example, finding your voice – Inspire the heart->Enlist others to act, envision the future – Challenge the Process->seizing initiatives, small wins – Enable others to act-> Foster collaboration, Facilitating relationships – Encourage the heart ->showing appreciation, celebrating values and victories by creating a spirit of community. (Kouzes & Posner, 2007)

10. M IDWAY P HASE RN A TTITUDES OF S KIN TO SKIN O PEN F ORUM WITH RN S I NTERVENTIONS FOR THE L ABOR & D ELIVERY U NIT C HANGING RN B EHAVIORS O UR N EXT S TEPS S URVEY FOR ALL RN S Action #1 Action # 2 Action # 3 S USTAINABILITY P HASE IMPLEMENTING S KIN TO S KIN IN RN S COPE Problems to Overcome ? *Change the Rn’s documentation system *Needing more Rns in Delivery *Reassuring RN baby assessment during Skin to Skin *Educating RN and patients of the importance for Skin to Skin post delivery Action #4 What did we implement? * A Task Force *Skin to Skin documentation with statistical questions *Huddles for education benefits to the nurses *Offering more education to patients in the form of a pamphlet *Development of Alghorhythem for Skin to Skin post delivery *Development of Skin to Skin Competency Check List * Pre and Pot Surveys What is to come ? Continuing to collect data for Baby Friendly Designation Surveying Rns and patients about Skin to Skin Implementing Competency Check List for safety measures Implement the Fetal Alghorhythm for deeper Assessment Skills * Discussing and exploring more options to assist nurses in vaginal deliveries with management * M ODEL THE WAY * INSPIRE A SHARED VISION * CHANGE THE PROCESS * E NABLE OTHERS TO ACT * E NCOURAGE THE HEART *

11. What Are We Currently Working On? Finalizing an education packet for our Moms and Dads for the outpatient setting Developing an alghorhythm for nurses to better asses babies post delivery for skin to skin application Monthly PDSA projects Education Huddles on the L&D floor to assist nurses with any questions about skin to skin or listen to their concerns or comments about the practice change. Just recently went live with our new documentation system on L&D that incorporates the new assessment questions for skin to skin as well as if skin to skin was accomplished within 5 min of a Vaginal delivery Currently in the process of gathering new statistics to see if our practice changes have made an impact on our Skin to Skin numbers each month.

12. References Ajzen, I. (1991). Organizational behavior & human decision making. Theories of Cognitive Self Regulation, 50(2), Dabrowski, G. (2007). Skin to skin: Giving birth back to mothers & babies. AWHONN : Nursing for Women's Health, 11(1), Kouzner, J., & Posner, B. (2007). The leadership challenge. (4 ed.).