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Skin-to-Skin Contact in the Operating Room
A study was conducted in 2016 and published in 2018 by Billner-Garcia, Spilker and Goyal that sought to examine the direct effects of skin-to-skin contact, or SSC, in the operating room after an elective cesarean section. The study was conducted over the course of a year and concluded that out of the 91 mother-infant dyads, 56% were able to maintain or increase their temperatures (Billner-Garcia, Spilker & Goyal, 2018. p. 161). This led the researchers to support the use of SSC in the operating room. The purpose of this paper is to critique the quantitative research design of the study performed and examine if the design was appropriate.
The study conducted by Billner-Garcia, Spilker and Goyal published in 2018 took a look at the effects of skin-to-skin contact in the delivery room after an elective cesarean section. It was non-experimental as there were no variables that could be manipulated by the researchers. The specific design used is described by the authors as “a quantitative, descriptive, retrospective design (Billner-Garcia, Spilker & Goyal, 2018. p. 160).” The use of a descriptive design is appropriate due to the fact that the study seeks to describe the effects of skin-to-skin contact, or SSC, on infant temperature regulation.
This study is cause-probing as it does seek to find if infant temperature can be maintained as a result of SSC directly after delivery (Polit and Beck, 2018. p. 11). The question that is aimed to be answered in this study is: “What is the change in temperature pre and post SSC among infants born via elective cesarean section (Billner-Garcia, Spilker & Goyal, 2018. p. 159)?” Given the nature of this study being observational and that it did not require the researchers to intervene, the most rigorous design was used to collect data.
This research study sought to compare the temperatures of newborn infants measured immediately before performing SSC in the operating room after a cesarean section, versus the temperature measured immediately after SSC was performed (Billner-Garcia, Spilker & Goyal, 2018. p 158). The comparison strategy was effective in illumination a key relationship between SSC and regulating infant temperature without the use of a radiant warmer. The result of the comparison was that 56% of infants either maintained or increased their axillary temperatures after SSC, while 44% lowered, thus leading the researchers to conclude that SSC is a successful tool to utilize in the operating room (Billner-Garcia, Spilker & Goyal, 2018. p. 161).
This study did not involve any intervention to control conditions because it was not experimental, and did not use blinding. Blinding is described by Polit and Beck (2018) as a process of preventing the participants of a study from having information that could sway the study, or lead to bias (p. 60). The process of blinding would not be applicable because in order to have full participation from mothers in the delivery room to perform SSC, they must be aware of how to do it properly and be explained the supposed benefits before performing it.
Since this study was non-experimental the researcher decided not to intervene because it would not have been an appropriate measure of information. Since the study was cause-probing, the criteria for inferring causality was potentially compromised by the length of time spent performing SSC, and the unavailability of several ways to monitor infant temperature. According to the authors of this study, a retrospective design was used (Billner-Garcia, Spilker & Goyal, 2018. p. 160). Polit and Beck (2018) describe the retrospective design as being a study design that begins with an outcome variable and a search for a presumed cause (p. 137). The study sought to see if the SSC caused the temperature to stay the same, increase or decrease, so the retrospective design was appropriate.
Type of Study
The study is cross-sectional. Cross-sectional studies are designed to collect data at one period in time, versus longitudinal studies that will collect information several times over a long period (Polit and Beck, 2018. p. 149). Data analysis was collected on 91 mother-infant dyads in this study over a period of a year ( Billner-Garcia, Spilker & Goyal, 2018. p. 161). Only 398 births at this particular hospital were cesarean sections out of the entire year. The timing of the collection was directly before and directly after SSC was implemented. The number and timing of data collection points are appropriate for what the study was trying to accomplish.
The characteristics of the participants were women aged 23-49 and an average of 39 weeks and four days gestation (Billner-Garcia, Spilker & Goyal, 2018. p. 161). Of the 91 births, 58% of the babies were Caucasian males with weights between 2,720 grams to 4,670 grams. Participation in the study lasted between three minutes and twenty-five minutes. The representation of participants is not confounding and the procedure of SSC was effective in maintaining the temperature of 56% of the infants.
A threat to the internal validity of the study would be the selection bias of mainly Caucasian males. Although this particular demographic would be unavoidable in this study, a better representation would include a wider variety of ethnicity. The study also focuses on elective cesarean sections which would not give a full range of participants that may include non-elective cesareans.
The relationship between the independent variable, the effect of SSC in the operating room, and the outcome, temperature regulation, was enabled by the design chosen and drew causal inferences because the cause preceded the effect (Polit and Beck, 2018. p. 153).
Major Limitations of the Study
The major limitation of this study was the reliance on electronic medical record entries (Billner-Garcia, Spilker & Goyal, 2018. p. 162). The authors stated that they believed the limitations were due to this design because even though the employees were trained to be able to enter information into the record, 50% of eligible participants could not be used because the post SSC temperatures were not recorded. Another limitation to the study was the fact that other means of evaluating the temperatures of the infants were unavailable (Billner-Garcia, Spilker & Goyal, 2018. p. 161).
The external validity of this study is that it can be applied to most healthy delivery situations to keep the infant warm. The benefits of SSC have been recommended by the Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN), and now many hospitals around the United States are starting to push for SSC to be performed after every birth as long as the baby is healthy (Billner-Garcia, Spilker & Goyal, 2018. p. 159). If using the same demographic of infants at each hospital, the results would more than likely be similar to this study’s findings.
- Billner-Garcia, R., Spilker, A., & Goyal, D. (2018). Skin to Skin Contact. MCN, The American Journal of Maternal/Child Nursing, 43(3), 158–163. doi: 10.1097/nmc.0000000000000430
- Polit, D. F., & Beck, C. T. (2018). Essentials of nursing research: Appraising evidence for nursing practice (8th ed.) Philadelphia, PA: Wolters Kluwer Health.
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