With the increase in technology and research in the labor and delivery unit, it has become indubitably clear that promoting a baby friendly hospital is one of the most essential objective that each and every hospitably should focus on in the current and contemporary world.

Introduction
With the increase in technology and research in the labor and delivery unit, it has become indubitably clear that promoting a baby friendly hospital is one of the most essential objective that each and every hospitably should focus on in the current and contemporary world. In addition to stabilizing the infant’s heartbeat, temperature, and breathing, myriad benefits have also been identified such as the breasting feeding success with increase in milk supply among mothers using kangaroo care (Hoe & Golant, 2009). In fact, this has even necessitated my working place to lay essential strategies to ensure a friendly environment for the baby. For instance, we recently began administering newborn vitamin K and erythromycin ointment within the first hour of delivery. We also have been implementing skin to skin or kangaroo care immediate post delivery for the first hour of life with the goal to increase bonding and improving newborn thermoregulation. Further, we are also in the process of implementing mother and baby being transferred at the same time to the postpartum unit. Therefore, the significance of promoting a baby friendly environment is evident and should be taken seriously across the globe. In this regard, this capstone project focuses on developing an educational model for nurses and doctors on how to safely provide skin to skin or kangaroo care on labor and delivery within the first hour of live.
Problem statement
A focused and clear transitional process from the previous procedures to the new current procedures is one of the greatest problems leading to hesitant to change (Colling & York, 2010). There have been some barriers to promoting skin to skin post c-section delivery. For many years physicians have performed Cesarean sections in a certain way and therefore it becomes difficult when changing the way they practice this procedure. Hospital procedures are written and followed for many years and physicians can be very reluctant to change the way they practice. Additionally, there have been near-miss incidences that have raised concern for changers to our skin to skin practice (Stone & Eddleman, 2009). Fortunately there have been no fatal incidences but near-miss events that are enough to warrant changes in our practices. Hence, this has always led to a series of arguments against the changes with little facts presented to support this. Therefore, in order to achieve this objective, this project will begin with explanation on the importance of skin to skin time to the mother and baby and then proceed to develop an educational module on how to safely provide this.
Project idea and purpose
The purpose of the capstone is to develop an educational model for nurses and doctors on how to safely provide skin to skin or kangaroo care on labor and delivery within the first hour of live. This project will start with an explanation of what skin to skin or Kangaroo care is from a nursing as well as general perspective to enable the society, composing of non-medical and medical people, to understand what it entails. Further, it will proceed with an exploratory explanation on the benefits to the nurses for gaining the educational program. It will then finalize with an explanation on the benefits to the baby and mother and why it is essentially important to implement it.
Project significance
Training the nurses on safe handling and caring of pregnant mothers and the new born babies has proved to be very essential and have some benefits to the individual and to the community as a whole. As mentioned earlier, the benefits of this surrounds within and around enhancing the health of both the child and mother. Stabilizing the infant’s heartbeat, temperature, and breathing is among reasons for involvement in this project. Researchers have found that mothers who use kangaroo care often have more success with breastfeeding and also improve their milk supply. Further, researchers have found that infants who experience kangaroo care have longer periods of sleep, gain more weight, decrease their crying, have longer periods of alertness, and earlier hospital discharge (Kangaroo Care, 2010). The benefits to mom are “enhanced maternal-infant attachment & bonding increased maternal self-confidence, increased maternal affectionate behavior, enhanced relaxation and experience less anxiety, less breast engorgement, and more rapid involution (uterus returning to pre-pregnant size)” (Kangaroo Care, 2010).
The benefits of this project could be shown to the physicians and nurses during grand-rounds to learn how safely providing skin to skin improves mother’s birth experience, increase breast feeding rate, and accomplish facility baby friendly goals. It could also raise hospital scores which can improve reimbursement rates in the future. Also showing the nurses and physicians that they can continue to do their jobs without the skin to skin contact causing major disruptions there is a better possibility for change. A protocol could be devised and discussed in staff meetings, then possibly have a “mock cesarean surgery” to show how it would work if the protocol was to be implemented. This allows the nurses and doctors a way to see it in action, see how it would impact their job duties, while also coming up with other interventions if needed.

Theoretical framework.
With respect to ongoing technological changes in labor and delivery department, therefore, continuous training for nurses is an ongoing exercise for ensuring efficient service delivery. For nurses to perform efficiently, promotion of critical questioning together with reflection and inquiry process should be implemented upon. Development of the critical thinking can be put into action by supporting the nurses in the labor and delivery department so that the maternity outcomes will be improved.
The purpose of the capstone being to develop an educational model for nurses and doctors on safe provision of skin to skin or kangaroo care on labor and delivery within the first hour of live, the three domains of training and learning are ability to recognize, effectiveness and psychometrics should be applied in this educational model. Strategies employed should be learner-centered and participatory.
Being learner-centered, means the participation of the Nurses and encouraging discussions on different viewpoints. This also ensures working so much practically rather than using theories. This educational model also provides that the Labor and Delivery model should encourage the use of reflective thinking and so as to enable them achieve the clear understanding of the maternity settings and enhances the quality mother and babies care.
This educational model also should aim at training nurses on ability to transfer what they think to the labor and delivery task via dialog and critical thinking. Trainers in this scenario should then guide on how and why some of the special actions should be done in the maternity during delivery. This will ensure that the nurses recall what they have been trained on and there to apply the newly acquired technique for handling the expectant mothers and their newborn.
Practical sessions that should be conducted include the use of manikins to teach the nurses on ensuring the action of skin to skin care by the mother to the newborn baby. This demonstrates to the nurses the procedures to be followed in carrying out such task and then monitoring on the same. The dialogue should also be held between the trainer and the nurse being trained. Use of dialog during training is essential since it encourage the participants to understand better and to justify their actions during the practice.
The persons also whom should be carrying out the training should be experienced so as to impart skills and knowledge to the new and existing nurses in the maternity department. This will also build the confidence of the nurses and act with the capability to serve the expectant women. The use of competent trainers also ensures that the nurses adopt the concepts taught in there. Trainers aims at training the nurses on caring for new born babies and the women yet to deliver and ensuring better service offering.
This educational model uses educational approaches like using the robust overarching theoretical framework to support what the nurses have been trained on with regards to safe handling of both the pregnant women and the newborn babies. The use of critical thinking is critical as it is used to evaluate and develop the educational model for the labor and delivery as a basis of the model content. Moreover, the provision of the support network to the nurses and opportunities to practice with discussion and feedback in the labor and delivery department is adopted to reinforce the positive application of the new techniques.
Literature review
Nurse trainers are oftenly faced with a lot of challenges on handling the training exercise to the nurses in labor and delivery departments. The fact arises from dynamic technology which affects them and thus a need to update their skills constantly. The educational training to nurses will involve integrative teaching and a lot more of learning processes. By doing this, the nurses will be able to put into practice on the theories taught (Tanner & Hubber, 2007). Furthermore, nurses will be able to make decisions accordingly without too much consultation.
The nurses being the key players in the labor and delivery unit, their services should be accountable for safety and quality for the ongoing effectiveness of the mother and child care. Organizational culture which promotes development skills and regular reviewing of practices within the labor and delivery department ensures high standards of practice. Also, education for nurses should be continuous so as to fit to technological labor and delivery changes within the facility (Levett Jonnes 2005).
Application of processes like ongoing education, labor & delivery supervision and service effectiveness ensures women and their newborn babies receive the best possible quality care. Labor and delivery efficiency involves nurses regularly reviewing and auditing practice processes and maintaining conversancy with changes in both national and international standards. Nurse trainers play a pivotal role in supporting the professional development of nurse in the maternity department (Spark & Rowe, 2004). Positive responses can be facilitated to implement changes in the current turbulent healthcare environment. Because nurses are present most continuously with mothers and their newborns, they play a significant part in patient safety and error reduction in the delivery process. Trainers are well placed to act as potential change agents for the incorporation of safe, evidence-based practice knowledge.
Rapid turnover of nursing staff in hospitals and continually changing practices and procedures necessitate that educational activities relating to labor and delivery care. These activities need to accommodate all generational cohorts to best support and enhance their lifelong learning experiences. Continuous education is regarded as an imperative for the maintenance of professional competence because it positively influences nursing practice behaviors and patient outcomes (Jarvis, 2005).
Learners actively engaged in educational initiatives that encourage the use of critical thinking, reflection and clinical reasoning processes are better able to draw on diverse perspectives to resolve issues in the labor and delivery setting. Multi-modal teaching strategies recognize that different generations have divergent learning needs. Development of an understanding of the educational issues inherent in a multigenerational nursing workforce can foster a collaborative and cohesive workplace.
The findings of a comprehensive and systematic review of the literature associated with the process and content of labor and delivery nurses continuing training are described in this chapter. A skin to skin strategy is used to enhance the development of the baby. Mother and newborn baby’s safety has emerged as an important issue in health care receiving unprecedented attention from nurses. Expectant mother’s expectations of delivery quality and increasing litigation have reinforced the need for healthcare organizations to comply with national accreditation guidelines and the nursing profession to maintain high standards of patient care. Rapid technological changes combined with a major focus on hospital stay related adverse events have put pressure on all healthcare professionals to demonstrate best practice. Amid increasing labor and delivery, changing demographics and higher public information literacy, the development of complex systems and processes has potentially increased the scope for mother and newborn harm (Billings 2008).
Gaining and maintaining competence is especially important given the regular changes in procedures, systems, and products in present day healthcare institutions. Trainers should, therefore, make nurses aware that life-long learning is required to maintain competence. Competence in the nursing context is defined as the combination of knowledge, skills and personal attributes which enables nurses to provide nursing services of a standard acceptable to others in the profession of similar background and experience (Cheetham and Chivers 1996).
The value of appropriate theoretical education and critical thinking to the practical application of capability and competent nursing care is exemplified by the comments of an experienced nurse, however, there is ambivalence in the literature reflecting differing views regarding the use of competency based testing and assessment credentialing in nursing Training. Contemporary clinical practice needs to demonstrate clearly sound physiological knowledge as competent
Psychometric skills and professional standards of practice. They emphasize on critical thinking and nurses reasoning processes as well as interdisciplinary decision making. Competence is much more than an array of skills attained by the nurse. The interplay of technical skills with knowledge, attitudes and values integrates the cognitive, affective and psychometric domains of nursing practice (Axley, 2008).
On some circumstances, pulse Oximeter was introduced to the baby during the skin to skin session with the mother. This was done I order to measure the oxygen content and volume in the new born. Also, it was observed that the baby turned blue. The result seen had to be investigated so that the new born will be healthy. The cause of the color change should be investigated and then addressed. The new born should also be put into pulse Oximeter to enable thorough analysis. Babies born trough the cesarean section and post vaginal delivery should be put into tests. The changes of colors should be observed then recorded and reported for diagnosis.

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