Skin-to-skin holding in the NPICU : midwives' and nurses' perspectives

Abstract

Skin-to-Skin holding is based on skin-to-skin contact between the infant and parents. This physical contact after birth enhances parent-infant attachment. However, infants admitted to the Neonatal Paediatric Intensive Care Unit (NPICU), due to prematurity or high risks of complications, are initially separated from their parents and thus the initial close contact is often limited. The neonatal nurses and midwives have direct contact with these infants, and their attitudes and practices greatly influence the parents. These neonatal health professionals are in a position to either promote or discourage the practice of Skin-to-Skin Care (SSC) in the NPICU. In view of this, a quantitative study was carried out, using a self-designed questionnaire, to explore the nurses' and midwives' views on SSC practice in the local NPICU. A sample of 40 Maltese midwives and nurses was selected by convenience sampling from the NPICU at the Local General Hospital. The objectives of this study were to identify the neonatal staff's awareness of the benefits of SSC, to identify the possible concerns with promoting SSC in the NPICU and to explore the attitudes and practices of the neonatal staff towards the use of SSC in the NPICU. The response rate was 100% (n = 40). The findings of this study revealed that Maltese neonatal midwives and nurses were knowledgeable about the beneficial effects of SSC. The neonatal staff exhibited resistance when it came to assisting parents of low-birth-weight (LBW) and intubated infants with SSC, mainly due to concerns regarding the infant's safety. Also, most of the respondents never participated in educational sessions concerning the practice of SSC. The importance of providing more training and education amongst the staff in order to improve SSC practice in the NPICU also emerged. The provision of written guidelines and increase in opportunities for supervised practice would be greatly beneficial for the neonatal staff. Also, educational programs would provide them with invaluable evidence-based research about effective SSC with vulnerable infants. Added to these recommendations, longitudinal large-scale studies which explore the views of neonatal staff on SSC were found to be required. Furthermore, qualitative studies as well as studies, which explore the mothers' or parents' views on the practice and attitudes of the neonatal staff on SSC, are also recommended to be carried out locally.