Running head: QUALITY IMPROVEMENT PROJECT 1

Quality Improvement Project: Delay Newborn Bathing

Jane G. Watson

Bon Secours Memorial College of Nursing

NUR 4144: Professional Role Development Servant Leadership

Dr. Ellcessor

March 27, 2018

Honor Code- I pledge

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The medical profession is constantly evolving as new information is discovered to

support a change in practice. Over the years, there has been much debate as to when to give a

newborn baby its first bath. Until recently in the United States, it was a common practice to

bathe neonates immediately after birth. The misconception was that newborns were ‘dirty’ after

delivery. The bath enabled the nurse to introduce a ‘clean’ baby to its mother. However, current

evidence supports a delay in bathing. “The Neonatal Skin Care Evidence-Based Clinical

Practice Guideline, developed by the Association of Women's Health, Obstetric and Neonatal

Nurses (AWHONN), recommends giving the first bath when thermal and cardiorespiratory

stability has been achieved, proposing it ideal to wait at least 2 hours after delivery” (AWHONN,

2013). However, “the World Health Organization (WHO) recommends delaying the bath for 24

hours, or if this is not possible due to cultural reasons waiting at least 6 hours, in an effort to

prevent hypothermia” (WHO, 2013). Although there is some controversy as to the ideal amount

of time to wait for an initial newborn bath, the evidence overwhelmingly suggests that there is no

benefit to immediate bathing. In an effort to provide the most up-to-date care for patients based

on evidence that has been reinforced through clinical research, the Mother-Infant Unit at St

Mary’s hospital has adopted the policy to delay newborn bathing between 8 to 12 hours after

birth.

The purpose of this paper is to discuss how I would implement this quality improvement

project as a nurse manager utilizing the four domains and the five practices of exemplary

leadership, as well as explore the nursing implications and outcomes evaluation of such an

initiative.
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Four Domains of Leadership

In the book, Lead Like Jesus, four domains that influence servant leaders include the

heart, head, hands and habits (Blanchard & Hodges, 2005). The heart and the head represent

internal factors of the servant leader. The heart domain expresses the motivation, while the head

domain conveys the belief system or core values of the servant leader. As the nurse manager,

my goal would be to provide the safest care that promotes the best possible outcomes for our

patients. The hands and the habits represent external factors of the servant leader. The hands

domain is displayed through the daily work and policies observed on the unit, while the habits

domain is reflected in supportive relationships that keep the staff grounded and focused on

common goals. As the nurse manager, I would want to promote open communication and a safe

environment to collect honest feedback from the team regarding the quality improvement

initiative.

Five Practices of Exemplary Leaders

The five exemplars of servant leadership include model the way, inspire a shared vision,

challenge the process, enable others to act, and encourage the heart (Ellecessor, PPT, 2018).

As the nurse manager, I would model the way by endorsing the new policy in staff meetings and

morning huddle. I would be excited about the possibility of improving our patient outcomes. I

would also inspire a shared vision by establishing ‘buy-in’ from the entire staff. I would make

sure that everyone understands how to implement the new procedure and I would collect ongoing

feedback from the staff. I would enable others to act by encouraging open communication. I

would dig deeper if I feel resistance to the change in current policy. I would find out if delaying

the baths is disruptive to the nurses’ routine. If so, I would encourage feedback for ideas that

may streamline the procedure. On the other hand, I would find out if the nurses are seeing an
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improvement in the newborn’s ability to maintain adequate body temperature and

cardiorespiratory stability. If so, I would explore the nurses’ feelings on the efforts of providing

optimal care. I would also foster a conversation to reveal the added benefits the change in

practice has granted the nurse. Caring for a stable newborn means less monitoring and fewer

needed interventions, which is a time saver. Finally, I would encourage the heart by taking the

time to recognize the staff that have effectively executed the initiative, have shared in the

excitement of the policy change, or have helped other staff members incorporate the new policy

into their practice.

Professional Practice Implications

At times, change can be met with resistance. When making a change in policy, as the

nurse manager, I would like to establish buy-in from the staff to ensure the change is understood

from a performance perspective as well as a logical perspective. Everyone should understand the

new protocol and be adequately trained. At the same time, the staff should understand the

reasons for the change in policy, and hopefully agree with the benefits that support the change in

policy.

Since the initiative to delay newborn bathing had already been implemented at the

hospital where I am currently doing my immersion, I was able to discuss the process with the

staff. The transformation was smooth since staffing at multi-levels understood and agreed with

the change in policy. The change was relatively easy to understand, and little training was

necessary. As a result, the initiative to delay newborn bathing until 8-12 hours of life not only

benefited the newborn by promoting thermal and cardiorespiratory stability, it promoted mother-

infant attachment by allowing more time for skin-to-skin bonding. As an added benefit, the
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change in policy allowed nurses more time to perform other necessary tasks immediately after

birth.

Outcomes Evaluation

As the nurse manager investigating a change in practice, I would like to be able to

compare data from before the change in protocol to the data after implementation. In this

scenario, data parameters would include thermal regulation and cardiorespiratory stability of the

neonate. I would look at trends in the data and see if the change in policy actually produces the

expected findings. I would also check in with the staff for feedback and react accordingly.
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References

Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN). Neonatal Skin

Care: Evidence-based Clinical Practice Guideline. 3rd ed. Washington DC: AWHONN;

2013.

Blanchard, K. & Hodges, P. (2005). Lead like Jesus. Nashville, TN: Thomas Nelson.

Ellcessor, B. (2017). Five Practices of Exemplary Leadership [PPT].

World Health Organization, United Nations Population Fund, UNICEF, The World Bank.

Pregnancy, Childbirth, Postpartum and Newborn Care: A Guide for Essential Practice.

Geneva, Switzerland: WHO; 2013.