Critiques Paper on Skin-to-Skin Contact - Thesis Proposal Example

Critical Analysis of the study “skin-to-skin contact after cesarean delivery” by Gouchon et al. and Though the of the study is appropriate, it does not reflect the content of the study and also the methodology of the study. The first author and third author is a nursing coordinator, the second is a statistician and the fourth, an associate professor in the Department of Public Health and Microbiology. Hence the authors for this study are appropriate. Abstract The abstract is structured, short and to the point, summarizing the study and the main findings. Introduction The introduction clearly presents the background of the study. The authors have clearly stated the importance of skin-to-skin contact between the mother and the baby and the risk of hypothermia associated with such an intervention after Caesarean section. The purpose of the study is relevant and clearly stated. The latest articles discussing these issues, prior to the commencement of the study were studied and compared with. The research question asked in this study is "does skin-to-skin contact in cesarean section increase the risk of hypothermia in infants when compared to routine care?" Objectives and hypothesis The objectives are clearly stated. The intervention is skin-to-skin contact between mother and baby; the baby is positioned prone over the chest of the mother with minimal clothing. The hypothesis is skin-to-skin contact following cesarean does not increase of hypothermia of the baby when compared to those who received routine care. The study The study design is that of a randomized control trial. According to Lachin (1998), "RCTs are considered the most reliable form of scientific evidence in healthcare because they eliminate spurious causality and bias." This method of study design ensures that known and unknown confounding factors are evenly distributed between treatment groups. According to Beller et al (2002), it is important to randomize because, randomization aims to obviate the third possibility. Allocation of participants to specific treatment groups in a random fashion ensures that each group is, on average, as alike as possible to the other groups (Beller et al, 2002). This study is a randomized controlled trial that was conducted in Mother and Child Department of Pinerolo Hospital in 2006 after permissions from the Ethics Committee. 68 participants were enrolled in the study after taking consent. The sample size was decided after evaluating the power and significance and thus is appropriate. Randomization was done using envelopes and confidentiality was maintained. The main outcome measured were temperature in 2 hours time after mothers returned from the operating room. Other measured outcomes were minutes post-birth of first attachment, crying, breast feeding at discharge and after 3 months, maternal satisfaction after skin-to-skin contact and minutes post-birth after first attachment. Neither the mothers, nor the researchers were aware of group allocation. However, once the study started, the mothers were aware of their group allocation, but nor the researchers. It is extremely difficult to establish complete blinding to all parties. Equally important, however, is whether those doing the analysis were aware of the identity of either group. Somewhat typically these details are not given. The inclusion criteria for the study were Italian women scheduled for elective cesarean delivery with loco-regional anesthesia. Women who met the inclusion criteria were approached at 36- 37 weeks of gestation during their scheduled check-up. They were given detailed information about the study both verbally and in written format and asked to sign the consent form. Thus the inclusion criteria was appropriate for the study. The nurse opened the seal of the envelope on the day of surgery. After the baby was back from the operating room, the closest relative was informed about group allocation. The mother was informed after she returned from the operation theater. The main intervention in the study group was skin-to-skin contact. After the initial procedures in the operating room, the babies were shifted in an incubator to neonatal ward where they were given bath, dried and weighed. The average time from the birth to room was 51 minutes. Soon after the mothers arrived, the babies with only a diaper put in, were placed on the mothers skin between the breasts and then covered with a a blanket. Breast feeding was taught during this time. Those in the control group received regular care involving breast feeding advice and baby care. The observation period in both the groups was 2 hours. The skin temperature of the babies were measured after arrival from the operating room, after bath, after the mother returned from the operating room and every half an hour during the 2-hour period with infrared ray thermometer placed on the forehead. The intervention of the study is well defined and reproducible. The researchers following the methodology as determined in the beginning of the study. Potential source of bias Bias may be defined as delivery of opinions, values and views as if they were universal without looking at other points of view. Because the study was randomized, the chances of bias are very low. Construct validity Construct validity may be defined as the extent to which a scale measures a certain construct (Parahoo, 2006) in which the link between conceptual definitions and operational definitions is examined. There is clear definition as to what is the intervention studied. External Validity and Generalizability Generalizability is a measure of the applicability of study findings and conclusions to other similar settings and populations (Holloway & Wheeler 2002). This aspect is important to know in the study because it gives an idea as to what extent the suggested causality is likely to hold true in other settings. The study represented general population, thus the results can be generalized to all groups of people. However, the results can be extended only to loco-regional anesthesia patients and not to those who were given general anesthesia. Also, the safety of skin-to-skin contact immediately after cesarean section is not defined. Rigour and trustworthiness Rigour is the means to demonstrate integrity and competence and is determined by its truth value, applicability, consistency and neutrality (Holloway & Wheeler, 2002). It involves rigid adherence to research designs as mentioned in the methodology of studies and precise statistical analyses and can be influenced by poor observations and failure to utilise the available data (Burns & Grove, 1997). In this study, the authors maintained rigid adherence to the study design defined under methodology. The quality of data and the confidence of data display was gauged based on trustworthiness. Analysis and results Results were analyzed using appropriate statistical software. Data analysis was done on intention-to treat basis. Statistical analysis was done using Students t test. The study was performed on 34 mother-child couples, 17 in the study group and 17 in the control group. As far as general conditions, indications for surgery, intrapartum complications and post-operative pain management, both groups were comparable, thus decreasing the number of confounding factors. Even the babies in both the groups were comparable. From the statistical analysis, it was evident that there were no differences in the mean temperatures at each interval. Also, breast feeding and satisfaction levels were mush better in the study group. From the results, it was evident that temperature in skin-to-skin contact for 2 hours following cesarean section was similar to those with routine care. The analysis was done using appropriate statistical methods and hence the results of the study are valid. Conclusion The conclusion of the study is crisp and to the point. It gives an overview on the study conducted and the inferences which can be deducted from the study. Recommendations Infants who were subjected to skin-to-skin contact within one hour after delivery for 2 hours are not at risk of developing hypothermia as has been the common thought. Rather, it has many more benefits like early latching, exclusive breast feeding and increased maternal satisfaction. Since skin-to-skin contact immediately after delivery improves the chances of early breast feeding, it must be performed as and when possible. The risk of developing hypothermia following cesarean section is minimal and this should not be the preventing factor for skin-to-skin contact. Findings to Nursing theory and practice The inferences made from this study can be applied using Orems theory of Self Care. (Hartweg, 1990). Soon after cesarean section, mothers are not in a position to hold their babies and initiate breast feeding on time. They have low levels of satisfaction. Thus there is self-care deficit. Through application of Orems theory, nurses can help the mothers initiate early latching and breast feeding through skin-to-skin contact, thereby increasing the satisfaction levels of the mother. References Beller, E.M., Gebski, V., Keech, A.C., (2002). Randomization in clinical trials. MJA 2002, 177 (10): 565-567 Burns, N., Grove, S. K. (1997). The Practice of Nursing Research: Conduct, Critique and Utilisation. 3rd edition. Philadelphia: W. B. Saunders Co. Gouchon, S., Gregori, D., Picotto, A., et al. (2010). Skin-to-skin contact after ceserean delivery. Nursing Research, 59(2), 1-7. Hartweg, D.L. (1990). Health promotion self-care within Orems general theory of nursing. Journal of Advanced Nursing, 15, 35-41. Holloway, I., Wheeler, S. (2000). Qualitative Research in Nursing. New York: Wiley-Blackwell Lachin, J.M., Matts, J.P., Wei, L.J. (1988). Randomization in Clinical Trials: Conclusions and Recommendations. Controlled Clinical Trials, 9 (4): 365-74 Parahoo, L., 2006. Nursing research: Principles, Process, and Issues. London: Macmillan. Read More