Introduction
There are many ways for nurses to stabilize preterm newborns’ conditions, and skin-to-skin care (SSC) is a commonly offered approach for parents in neonatal intensive care units (NICUs). Patients might have current and developmental needs, and the task is to recognize which human need plays a more critical role in making the right decision at the moment. Kymre and Bondas (2013) developed a phenomenological study specifying the ideas of Husserl, Heidegger, Merleau-Ponty, and Gadamer to examine the effectiveness of SSC for patients and their parents in NICUs. The researchers focused on nurses’ experiences and introduced a descriptive analysis of their findings. The project by Kymre and Bondas contributed to a better understanding of infants’ development through the prism of touching practice and parent-child relationships.
Summary
Research Question and Hypothesis
SSC approaches have already been integrated into many NICUs, achieving different purposes. Kymre and Bondas (2013) were interested in articulating the essence of SSC from the perspective of nurses and their experiences in the chosen unit. The authors did not have a specific hypothesis to test. Still, they mentioned the application of the Newborn Individualized Developmental Care and Assessment Program (NIDCAP) education program theory among some participants (Kymre & Bondas, 2013). The central research question addressed the constituents of nurses’ experiences who enact SSC in NICUs to support preterm newborns and their parents.
Participants
Although it was expected to examine the impact of the SSC approach on parents and children, 18 nurses were selected as participants for the study. The researchers collaborated with unit leaders to select nurses who worked in NICUs at Scandinavian hospitals, including those in Sweden, Norway, and Denmark, and met the inclusion criteria. Nurses who were willing to participate in interviews on two days and afternoons had to have at least five years of NICU practical experience. The median age of participants’ practice was between 11 and 13 years, and one nurse had less than five years of experience due to her maternity leave (Kymre & Bondas, 2013). The regional medical and health research ethics committee approved the study, and each participant signed an informed consent form after receiving information about the project’s goals in a letter.
Data Collection
Data collection was organized correctly and described in the study. All participants were invited to silent rooms for interviews, during which they described their experiences related to SSC. Open-dialogue interviews with probing questions were conducted in November and December 2009 to obtain some facts about real-life situations and clarify every detail (Kymre & Bondas, 2013). All information was digitally recorded for further verbatim transcription and analysis, and nurses were informed correctly.
Method
A phenomenological method was employed to analyze the material, where interview texts were thoroughly read, meaning units were identified, and the SSC phenomenon was presented in terms of its essence and constituents. Primary measurement tools included the signs of comfort, stability, emotions, and confidence (Kymre & Bondas, 2013). Attention was paid to nurses’ awareness of the conditions under which newborns were placed in incubators and when they could be closer to their parents. The responsibility of caring for newborns who spent a significant amount of time with their parents (as part of an SSC approach) was shared among nurses.
Interpretation of Results
The results of the study were explained from the perspectives of Scandinavian NICU nurses and included the primary meanings of SSC enactment. Nurses should find a balance between the current and developmental needs of preterm newborns and parental readiness for SSC, underlining their roles with “double-focused steady attention” (Kymre & Bondas, 2013, p. 4). They described situations in which children were more comfortable with SSC compared to situations when they stayed alone for a while.
It was also clarified that not all parents were equally ready for the first close contact, and nurses needed to encourage parents and explain that they were the most significant caregivers for their children (Kymre & Bondas, 2013). It was found that most parents shared their interest in providing their babies with SSC, which resulted in further harmony and stable child-parent relationships. Interviews with nurses proved to be an essential step in changing the history of NICU SSC, demonstrating the value of touch and proximity in further child development and fostering supportive parental attitudes.
Conclusion
At the conclusion of the study, the researchers successfully achieved their desired goal and answered their research question. They described the essence of SSC enactment as the nurse’s double focus with steady attention to parents’ and newborns’ signals (Kymre & Bondas, 2013). It could be challenging for some mothers experiencing postpartum depression or health complications to participate in long SSC sessions. At the same time, most parents believed it was natural to spend a lot of time with their children.
Limitations
In the study, the authors did not mention any limitations or strengths. To improve their findings, Kymre and Bondas (2013) recommended additional research to specify parental willingness to spend time with children, the developmental aspects of SSC, and the impact of this knowledge on the care of preterm newborns. These future research suggestions could be applicable within an improved sample size and in more countries where nurses have similar practical experiences.
Critique
The study conducted by Kymre and Bondas was practical in terms of clarifying the essence of SSC practice from nurses’ standpoints and attitudes. The sample was properly introduced and explained, representing the role of nurses in SSC. The chosen article has a clearly defined goal and intention to demonstrate that nurses’ experiences reveal SSC constituents and help parents prepare for their first contact with their children in NICUs.
One of the strengths of the study is the identification of measurements, including personal emotions (such as fears and happiness) and attitudes (readiness or hesitation) toward SSC and newborns’ current and developmental needs. There was no discussion of the reliability and validity of measurement instruments, as the study adopted a phenomenological approach. However, the authors correctly admitted the application of the NIDCAP theory among NICU nurses. A possible extraneous confounding variable that could influence the findings was the level of nurse education and personal attitudes toward their practice with preterm newborns and their parents.
The authors’ conclusions were supported by the data obtained from nurses. They demonstrated that nurses must be knowledgeable about how to convey the necessary information about SSC to parents and observe any changes in children and their parents triggered by touch and proximity. The absence of study limitations that researchers develop on their own should be considered a weakness of the project.
However, it is also possible to acknowledge the size of the chosen sample and the fact that all interviews were based on nurses’ experiences, which may lead to biases. The findings are generalizable in that they help nurses and parents identify the main elements of SSC in NICUs and apply the offered approach effectively. Future research studies based on the current results should examine parental awareness and attitudes toward SSC to improve newborns’ conditions and infant development.
Conclusion
The authors of the chosen study made a significant contribution to understanding the essence of SSC and the importance of balancing the current and developmental needs of infants with their parents’ readiness for proximity. The role of nurses in this process cannot be ignored, as these healthcare providers can make observations and determine the impact that SSC has on preterm newborns and their parents. The study has specific strengths and weaknesses, but its conclusions were meaningful in highlighting the necessity of new research projects related to SSC and NICU practice.
Reference
Kymre, I. G., & Bondas, T. (2013). Balancing preterm infants’ developmental needs with parents’ readiness for skin-to-skin care: A phenomenological study. International Journal of Qualitative Studies on Health and Well-Being, 8, pp. 1-9.