A Nursing Clinical Learning Module

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A Nursing Clinical Learning Module: How to Bathe Newborns :

A Nursing Clinical Learning Module: How to Bathe Newborns Rebecca McCray Franklin Pierce University

Lesson Objectives will promote::

Lesson Objectives will promote: Learning the physical psychomotor skill of newborn bathing Evidence based bathing practice Cultural and situational awareness around newborn bathing Confidence within nursing students while performing a newly learned skill.

Students will be able to::

Students will be able to: Practice newborn bathing in lab Apply psychomotor skill to clinical setting Synthesize current literature and recommendations about newborn bathing Create a procedural list of how to prepare and execute skill

Learning Style Friendly:

Learning Style Friendly Visual Kinesthetic Intrapersonal Interpersonal Auditory

Learning Module Design:

Learning Module Design For WhoM ? When? Full-time nursing students Bachelor’s of Nursing Master Entry Program for Nursing Program could be adapted for hybrid course Prior to or During Postpartum or Mother/Baby Unit Clinical Rotation

Literature Review:

Literature Review 99% of neonatal deaths world-wide occur in low and middle income countries and half of those deaths take place in the home after a home-birth I nappropriate Neonatal Care = high mortality level Correcting n eonatal care requires cultural understanding ( Pati et al., 2014).

Literature Review:

Literature Review Educating a whole culture on benefits of proper newborn care is a tough challenge, but not impossible.

Literature Review:

Literature Review WHAT IS VERNIx ? “Vernix unique to humans, is a cheesy white protective covering of the newborn skin in utero,” ( Kuller , 2014, p.166). Develops end of 2 nd trimester Thickest in weeks 36 -38 Protects baby from maceration of amniotic fluid and prevents chafing as baby moves in utero Protects baby’s skin from infection and promotes moisturizing and wound healing of skin.

Literature Review:

Literature Review Professional Recommendations: World Health Organization and Neonatal Skin Care Evidence-Based Clinical Practice Guidelines encourage leaving vernix on the skin until it wears off “with normal care and handling” ( Kuller , 2014, p.166). Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) advocates that the first bath be given 2-4 hours after birth as long as newborn vital signs and temperature are stable ( Kuller , 2014).

Literature Review:

Literature Review Most Recent Literature Explains positive attributes of vernix Clearly defines goals of first bath Discusses how to safely bathe newborn including the best cleansing agents.

Literature Review:

Literature Review Newborns have little insulating tissue and so their body temperature decreases through: Conduction Radiation Convection Evaporation (So et al., 2014)

Evidence Based or “Traditional” Nursing Practice?:

Evidence Based or “Traditional” Nursing Practice? Newborns in experimental group who were bathed trunk first and then head, returned to initial body temperature more rapidly than those bathed in the traditional “head-to-toe” nursing practice (So et al., 2014). Image from: https://i.ytimg.com/vi/2S_WCW3YJko/hqdefault.jpg

Learning Objectives:

Learning Objectives Students will be able to identify two types of newborn bathing currently practiced and the best practice to prevent hypothermia . Students will be able to list the steps of preparing to bathe a newborn . Student will be able to describe the benefits of vernix to the baby both in utero and after birth . Students will be able to demonstrate how to bathe a newborn while describing to another student or instructor what they are doing and why as if talking to parents of a newborn. Students will be able to identify cultural beliefs that differ from evidence based knowledge. Students will be able to analyze the impact cultural beliefs have on newborn health.

Learning How to Bathe a Baby:

Learning How to Bathe a Baby Students will read evidence based literature on newborn bathing. Students will make a step-by-step procedure list of how to prepare and bathe a baby that they can use in the lab setting to practice newborn bathing. Students will practice bathing newborns (using dolls) in the lab setting demonstrating verbally to their peers and instructor they are ready to bathe a baby. Students will then bathe a newborn in the clinical setting. Students will reflect in a post-experience journal about their first clinical experience giving a newborn bath.

Evidence Based Bathing Steps:

Evidence Based Bathing Steps Disinfect equipment. Supply room with appropriate heat, towels, warm water, and cleansing agent. Educate parents about water temperature, secure handling, and attention to newborn during bath. Hold baby securely. Undress baby. Place baby feet first into warm water supporting baby’s head while washing body ( Kuller , 2014). Wash head and neck using mild cleanser to massage out excess blood and birth product. Dry baby with warm towel and cover their head with a hat. Place baby skin to skin with mom or swaddle baby to be held to ensure warmth.

Cultural Considerations:

Cultural Considerations “Cultural issues, decision of family members and traditional beliefs still play a crucial role in shaping neonatal care practice in tribal communities,” ( Pati et al., 2014, p.238). Students will be guided through an activity and group discussion that will explore cultural beliefs and answer the following questions: How does the belief impact the newborn’s health? What might be the cultural purpose of the belief? What scientific evidence could help you explain what is most healthy for the baby? Do the ideas of how to handle the situation you wrote about apply to other cultural beliefs as well? Is there a universal way to honor a culture while improving the health of their newborn?

Conclusion:

Conclusion Learning module and literature review present evidence based practice information to promote student learning and application of the psychomotor skill of newborn bathing while addressing cultural beliefs that surround newborn care on labor and postpartum units as well as in the global health arena.

References:

References Johnson & Johnson Consumer Companies, Inc. (2015). JOHNSON'S® Baby HEAD-TO-TOE® Wash is Designed with AWHONN Standards in Mind. Retrieved from http://www.johnsonsprofessional.com/johnsons-baby/johnsons-meets-awhonn-standards . Kuller , J. M. (2014). Update on Newborn Bathing. Newborn and Infant Nursing Reviews , 14 (4), 166–170. http://doi.org/10.1053/j.nainr.2014.10.006 Pati , S., Chauhan , A. S., Panda, M., Swain, S., & Hussain , M. A. (2014). Neonatal care practices in a tribal community of Odisha , India: A cultural perspective. Journal of Tropical Pediatrics , 60 (3), 238–244. http://doi.org/10.1093/tropej/fmu005 Shamba , D., Schellenberg , J., Hildon , Z. J. L., Mashasi , I., Penfold , S., Tanner, M., ... & Hill, Z. (2014). Thermal care for newborn babies in rural southern Tanzania: a mixed-method study of barriers, facilitators and potential for behaviour change. BMC pregnancy and childbirth , 14 (1), 267. Retrieved from http://www.biomedcentral.com/1471-2393/14/267/ So, H.-S., You, M.-A., Mun , J.-Y., Hwang, M.-J., Kim, H.-K., Pyeon , S.-J., … Chang, B.-H. (2014). Effect of Trunk-to-Head Bathing on Physiological Responses in Newborns: Trunk-to-Head Bathing for Newborns. Journal of Obstetric, Gynecologic, & Neonatal Nursing , 43 (6), 742–751. http:// doi.org/10.1111/1552-6909.12496

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