Research Critiques and PICOT Question Guidelines: Final Draft.

Quantitative and Quantitative Studies

Background

Various arguments have been raised regarding the beginning of maternal-infant bonding. Lack of skin-to-skin care and early separation may disturb maternal-infant bonding, reduce the mother’s affective response to her baby, and have a negative effect on maternal behavior. Mazúchová et al. (2020) explore the bond between a mother and child during the post-partum period and factors that predict the different actions. It notes that the bond between a mother and child is reciprocal and emotional, and intended to maintain accessibility, proximity, and attachment.Research Critiques and PICOT Question Guidelines: Final Draft.

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It mentions Bowlbyʼs attachment theory, noting that it explains the relationship between a mother and child. The article specifically states that there are mother-infant bonding disorders and present a prediction model for these disorders. With this model, medical personnel would be better able to provide care to improve the relationship between the mother and child for the best outcomes. Research Critiques and PICOT Question Guidelines: Final Draft.

Secondly, Potgieter and Adams (2019) explore skin-to-skin contact’s influence on the bonding and touch between mother and child. It acknowledges that skin to skin contact is an acknowledged approach for providing care to preterm infants in settings with limited medical resources. In addition, it acknowledges that the practice is instrumental for initiating and maintaining breastfeeding. Still, it notes that skin-to-skin contact benefits are not well documented, with no clear evidence to support them. This has had a profound effect on high-risk groups who are not convinced about the need for skin-to-skin contact and the benefits to be expected. Given this awareness, the study sought to present evidence showing that early skin to skin contact helps in improving mother-infant bonding and touch.Research Critiques and PICOT Question Guidelines: Final Draft.

In another study, Maastrup et al. (2018) explore the experiences of parents who initiate early skin-to-skin contact for their preterm infants. It acknowledges that skin-to-skin connection has been determined as a critical neonatal care activity. However, there are questions about its actual value for preterm infants as its results for babies born to term cannot be generalized for preterm babies. Besides that, it raises concerns about parents’ readiness to use the activity and their experiences in using it since preterm babies are typically fragile with unique needs that may raise some fears among the parents, especially with handling them. In gaining knowledge about the concern that parents experience and express, nurses and other medical personnel can implement targeted interventions that would increase the adoption of skin-to-skin contact in neonatal care for extremely preterm infants (Maastrup et al., 2018).Research Critiques and PICOT Question Guidelines: Final Draft.

Finally, Anderzén-Carlsson et al. (2014) present the results of a secondary research study that explores the experiences of parents who use skin-to-skin contact for their newborn infants in neonatal care. It adopts a meta-synthesis approach that synthesizes and interprets qualitative research findings on the same subject. The authors highlight that skin-to-skin contact presents significant benefits for infants with discernible physiological and psychosocial outcomes. In conducting the research, the researchers sought to fill a knowledge gap that existed since no previous qualitative meta-synthesis was on the same research topic. The study is significant to nurses since it helps them support parents to engage in skin-to-skin contact activities with their infants, ensuring that the parents have a positive experience while facilitating the growth of the parents’ self-esteem and ensuring that they are ready to assume full parental care responsibilities (Anderzén-Carlsson et al., 2014).Research Critiques and PICOT Question Guidelines: Final Draft.

How do these four articles support the nurse practice issue you chose?

The chosen nurse practice issue is the need for skin-to-skin contact in maternal-infant bonding to develop the child better while improving maternal behavior. It is postulated that skin to skin contact presents significant benefits to the child, including regulating heart rate and breathing, calm and relaxation, stimulating digestion and interest in feeding, and better skin colonization. It positively influences maternal behavior by increasing the mother’s affective response to the baby and improving bonding. Mazúchová et al.Research Critiques and PICOT Question Guidelines: Final Draft. (2020) support the need for enhanced mother-infant bonding as it results in an insecure attachment that strengthens the child’s somatic and mental health. The article offers a predictive model of how each behavior influences both the mother and child, thereby helping nurse personnel better assess patients and determine when to apply preventive interventions. Potgieter and Adams (2019) similarly support the need for skin-to-skin contact, mentioning that longer communication would significantly promote initiation and duration of breastfeeding, and improve social-emotional, psychological, immunological, motor, and cognitive development.Research Critiques and PICOT Question Guidelines: Final Draft.

Additionally, Maastrup et al. (2018) answer the PICOT question by presenting some of the effects of skin-to-skin contact activities in neonatal care to include the physiological and psychosocial benefits. Still, the article makes a distinction from the PICOT question by focusing on preterm infants. This distinction is essential as the results may not be generalizable for all infants’ populations since preterm infants are immature and fragile, thereby making handling them in skin-to-skin activities a challenge. Overall, the article makes a valid claim in noting that unlike medical personnel trained to handle infants, parents do not receive professional training to handle infants, thus reducing their confidence in engaging in skin-to-skin contact and could even make the parents feel pressured.Research Critiques and PICOT Question Guidelines: Final Draft.

Lastly, Anderzén-Carlsson et al. (2014) have answered the PICOT question. Their study explores parental experiences with using skin-to-skin contact as indicators of the effects of applying this care approach. The article notes that parents who engage in the activity report a restorative and energy-draining activity.Research Critiques and PICOT Question Guidelines: Final Draft. It states that while it is targeted at the infant, it has significant effects on the parents. As such, it is important to present a supportive environment that would enable the parents to perceive the activity as a restorative experience while presenting an environment with obstacles would act to drain the parents of energy. In addition, the article focuses on the same patient population by simply identifying parents with infants, the same as the PICOT question. Overall, the study answers the PICOT question by showing that skin-to-skin contact significantly improves the bonding between parents and their infants, which is best achieved if the activities are conducted in a supportive environment.Research Critiques and PICOT Question Guidelines: Final Draft.

The four articles entail research studies that involve mothers and their infants. The interventions and comparison groups in the four articles are similar to the PICOT question as the focus remains on showing how skin to skin contact between the mothers and infants influence the newborns. Still, it is important to note that while the four studies explore the effects on both mothers and infants, the proposed study would only explore the effects on the infants.Research Critiques and PICOT Question Guidelines: Final Draft.

Method of Study:

Mazúchová et al. (2020) adopt a quantitative cross-sectional study methodology in which questionnaires are used to collect quantitative data from the population sample. The data is being used to make statistical inferences about the population of interest. A convenience population sample is recruited for the study. The study methodology has the benefit of not being costly to perform as it captures many variables at a specific point in time. Still, this methodology has the limitation of being unable to determine cause and effect relationships (Grove, Gray & Burns, 2015).Research Critiques and PICOT Question Guidelines: Final Draft.

Potgieter and Adams (2019) adopt a correlational study design that compares outcomes for groups that experienced skin to skin contact against groups that did not share skin to skin contact. The study applied a convenience sampling approach to recruit participants with questionnaires to collect data for the study. The research methodology (correlational study design) has the benefit of adopting a non-experimental approach that controls extraneous variables. Still, this methodology has the limitation of making it difficult to draw conclusions about the causal relationship between the variables being measured. Although the extraneous variables are controlled, conclusions cannot be drawn for the identified causal relationships (Grove, Gray & Burns, 2015). Research Critiques and PICOT Question Guidelines: Final Draft.

Maastrup et al. (2018) is presented as a qualitative study that adopts a primary research approach that uses thematic analysis to coalesce the recurrent themes and codes as demonstrated by a sample of the population of the interest concerning the topic of interest. The methodology made use of interviews with semi-structured interviews being issued to parents to explore their opinions. This research approach directly engages participants, thereby allowing the researchers to obtain original data that is current and highly specific to the research needs. Still, this research approach is faulted for being costly and time-consuming owing to the processes involved.Research Critiques and PICOT Question Guidelines: Final Draft.

Anderzén-Carlsson et al. (2014) similarly adopt a meta-synthesis methodology that relies on secondary information from previous publications on the same topic. The search for secondary data was conducted in four databases. This research approach does not directly engage the population of interest or other primary information sources as participants. Instead, it relies on systematic searches conducted on relevant publications. This research approach has the benefit of depending on existing data and infection from previous research, thus allowing the study to proceed speedily and at a lesser cost than if primary research approaches had been adopted. Still, it presents a concern regarding the difficulty in acquiring information specific to the research needs. Additionally, past publications may not necessarily have the current necessary to make them useful to the study.Research Critiques and PICOT Question Guidelines: Final Draft.

Results of Study

Mazúchová et al. (2020) report that among at-risk women, mother-infant bonding predictors include child planning, parity, and support after birth. It clarifies that there are predictors of the occurrence and quality of bonding between a mother and infant during the postpartum period. The significance of secure mother-infant bonding creates a need for nurse personnel to emphasize the bonding’s importance. As such, nurses need to identify the specific binding predictors and implications for each patient to develop and implement the appropriate interventions that improve the bonding and ultimately contribute to the proper development of mother and child. The results have implications for nursing practice by enabling nurses to use the predictors in creating secure bonds for the mother and child.Research Critiques and PICOT Question Guidelines: Final Draft.

Potgieter and Adams (2019) report that more extended mother-infant bonding is correlated with positive health outcomes for bothering the child and mother. It specifically notes that skin to skin contact at the earliest opportunity after birth is advisable to improve health outcomes. However, some of the results show significant variability in the significance and clinical effect, which is likely caused by the small study sample of 41 mother-infant dyads. Still, the study results have implications for nursing practice by supporting their involvement in interventions in advising mothers to engage in breastfeeding and other forms of skin-to-skin contact.Research Critiques and PICOT Question Guidelines: Final Draft.

Maastrup et al. (2018) report that parents’ experiences with skin-to-skin activities in neonatal care are directly related to the process. It is noted that parents who engage in the activities progressively moves through a process that shifts from ambivalence to appreciating the activities as beneficial to both them and their children. It involves parents going through a three-step process, beginning with overcoming ambivalence through leveraging the personal experience and professional support, moving to the proximity that creates parental feelings and an inner need to provide care, and ending with the feeling of being useful as a parent. This process has implications for nursing practice as it determines when and how nurses can intervene to support the use of skin-to-skin activities in neonatal care.Research Critiques and PICOT Question Guidelines: Final Draft.

Anderzén-Carlsson et al. (2014) report that parenting is an unfamiliar experience that is further complicated by engaging in skin-to-skin activities. Besides, it notes that skin-to-skin activities are essential health care interventions that are helpful for both the infant and parents. Besides that, it reports that the skin-to-skin actions are influenced by the environment, specifical interactions with other community members who include family and friends. The study results have implications for nursing practice by highlighting the need for skin-to-skin activities to be included as part of neonatal care packages.Research Critiques and PICOT Question Guidelines: Final Draft.

Ethical Considerations

Maastrup et al. (2018) report that ethical approval was sought for the study from the relevant ethical review bodies. Besides that, the participants were provided with verbal and written information on the research study to enable them to make informed decisions about whether or not to participate. The participation was voluntary, with a signed written consent form required before participation. In addition, the participants were assured of confidentiality and anonymity.Research Critiques and PICOT Question Guidelines: Final Draft.

Anderzén-Carlsson et al. (2014) does not present any ethical considerations made in the study. Still, two ethical considerations can be perceived. Firstly, the secondary sources of information are cited and references, thereby acknowledging the sources of information. Secondly, the use of the secondary information does not re-identify participants (or any specific sources of primary information), thereby ensuring their anonymity and confidentiality while protecting them from distress and damage that could result if they had been identified.Research Critiques and PICOT Question Guidelines: Final Draft.

Outcomes Comparison

The PICOT question is: “In newborns, what is the effect of kangaroo care (skin-to-skin contact) to no skin-to-skin contact on parental bonding in infants from birth to six months?” It is expected that the group exposed to the skin to skin contact will report better health outcomes for the infants to include increased touching and verbal interactions between the mother and child, better response to the mother’s body stimulation, and developing and progressing towards breastfeeding nutritional behaviors in the newborn. The contact is also expected to improve the social-emotional, psychological, immunological, motor, and cognitive development of the child. The PICOT question’s anticipated outcomes are comparable to the findings presented in the four articles as they indicate improved health outcomes for the child. Research Critiques and PICOT Question Guidelines: Final Draft.