Education of Immersion Swaddle Bathing Increase Knowledge and Nurse Satisfaction

Subject: Nursing
Pages: 18
Words: 6125
Reading time:
24 min
Study level: Master

Executive summary

Annually, pregnant women and their children are at a higher risk of developing illnesses and even dying due to pregnancy and delivery difficulties. As a result, there is a need to create preventative, diagnostic, and prompt treatment strategies to address this issue. According to AHWONN and WHO, a healthy newborn infant should be washed at least every two hours and no more than every twenty-four hours. It is preferable, however, to postpone a Healthy Newborn Infant’s wash for its benefit. This QI study aims to boost nurse knowledge and satisfaction via education to break down obstacles and facilitate ISB at a Level II postpartum hospital. The John Hopkins Nursing Evidence-Based Practice Model (JHNEBP) was used in the study, a robust problem-solving method for clinical decision-making. Moreover, a purposive and conceptual survey was applied in the study. An evaluation form administered three times during the study was also essential at determining the essence of education to satisfaction levels. It was observed that the following schooling, there was more excellent nursing by the children among the forty mother-infant pairs that completed the study. Furthermore, the youngsters were comfortable and did not scream much. The twenty nurses who answered the poll agreed on the importance of swaddling bathing for children since the moms smiled when the children were given their first wash. Among the forty mother-infant couples hospitalized, the newborn’s hospitalization was likewise kept to a minimum. Thus the study concluded that Swaddle bathing education is a safe and enjoyable method of keeping healthy infants in the newborn nursery. Future studies ought to focus on comprehensive and broader data.


Every year, expecting women and their children are exposed to a greater risk of contracting diseases and even suffering death due to pregnancy- and delivery-related complications. However, there is always a chance to avoid these deaths using better maternity care. Thus, there is the need to develop preventive, diagnostic, and timely therapeutic interventions for this problem (Peahl et al., 2020). Enhancing health professionals and improving knowledge and skills related to maternity care requires research and even better recommendation. The research ought to be based on the conceptualization of the problem and the practicability of the problem, and its translation into the current world. There is a need for a study to enhance the pregnancy, labor, birth, and postpartum period, which may only be achieved through better management and appropriate intervention. Even though there has been appliance of changes that have been adopted in the recent past, several interventions have been considered adequate (Speroni et al., 2020: Taşdemir & Efe, 2019). As it is, the problem does not only concern the newborn or their mother alone. There is a need to expand knowledge to families of pregnant women and even healthcare providers to understand how to care for expecting women and their newborns.

From the perspective of general care and knowledge, this study coins down to bathing the newborn. Bathing of often considered part of standardized care of healthy newborn infants (HNIs). History draws this standardized care from most community-based hospitals CBH), which had initial bathing of newborns within two hours after birth. It was done using a sponge on a heating unit in a bassinet. The units were located in the comfort of the mothers since it was conducted at their bedside. According to Ceylan and Bolւşւk, the initial bathing reduces the chances of transmissible diseases that can be possible through the body fluid and blood contact (Ceylan & Bolւşւk, 2018). Oliveira et al. (2020) confirm the scholars mentioned above’ idea stating that early bathing significantly impacts the extrauterine transition and be stressful for new parents and infants (Oliveira et al., 2020). Thus, this shows that the first bath that a child ever receives impacts his or her perspective of the world.

The evolution of the community-based health facilities to implement the evidence-based practices (EBP) of delayed bathing that aligns with the association of women’s Health, Obstetric and Neonatal Nurses (AHWONN) and the World Health Organization (WHO) guidelines to minimize the morbidity of infants and end the extrauterine transition. The recommendations AHWONN and WHO directs that a healthy Newborn baby needs to be bathed at least after two hours and at most, after twenty-four hours (World Health Organization 2017: 2020). It is preferred, however, that a Healthy Newborn Infant’s bath be delayed for its benefit. Other types of bathing have significantly impacted the families and parents since there are usually prolonged Hospitalization cases.

The Evidence-Based Practice (EBP) applied in the nursing intervention is Immersion Swaddle Bathing. It helps to improve the outcomes of the Healthy Newborn Infants. Even though a well-established EBP eludes many hospital facilities and the nurses’ population in general, it is essential to help disseminate its knowledge. It alludes to the established EBP creating barriers, including education and even resistance to change (Alatawi et al., 2020). Thus, understanding these barriers is essential as it will help the nurses hold most of the significant percentage within a healthcare system (Alatawi et al., 2020). Thus this research evaluates the Immersion Swaddle Bathing for a Healthy Newborn infant in a postpartum unit, thereby recommending areas that may need quality improvements.

The International Organization for migration also avers to the Swaddle bathing of the newborn. In essence, IOM confirms that the Swaddle Immersion baths help the newborn calm down and intrigue the happy hormone (Tobah et al., 2019). During this bath, the infant is loosely swaddled in a blanket given in the hospital or the mother’s favorite soft receiving blanket. The infant and his or her blanket are immersed into a warm water tub up to the baby’s shoulders. The limbs are loosely un-swaddled and washed, rinsed, and re-swaddled before other body parts. Educating nurses and even parents about swaddle bathing is essential as it enhances satisfaction levels.

PICOT Question

Among Postpartum Nurses (P), would education on immersion swaddle bathing (I) compared to no education on immersion swaddle bathing (C) increase current knowledge and nurse satisfaction (O) over four weeks (T)? PPNs, LDNs, and staff are among the people of interest. This demographic is defined as persons within the organization who have the knowledge and abilities required to educate and provide immersion swaddling bathing to new parent (s). PPNs will be utilized exclusively throughout the remainder of this article.

EBP Model

The John Hopkins Nursing Evidence-Based Practice Model (JHNEBP) is a solid problem-solving strategy for clinical decision-making. It is supported with tools to assist users in producing correct documents (Melnyk & Fineout-overholt, 2018). It is expressly developed to fulfill the demands of working nurses. It employs a three-step approach known as PET: practice question, evidence, and translation, to guarantee that the newest research and best practices are quickly and appropriately integrated into patient care (Melnyk et al., 2020: Migliore et al., 2020). JHNEBP has been chosen for this project and will assist in directing the project implementation by serving as a foundation and structuring the project’s flow. Melnyk and Fineout-overholt (2018) provide the following information:

P: The PICOT framework was used in the practice question phase. These questions aid in the direction of the literature survey. It provides a thorough overview of the project’s duties and obligations (Kelley et al., 2018). The Principal Investigator (PI), the women’s center instructor, and the director each have unique roles and duties within this scenario.

E: The JHNEBP model includes tools for retrieving, evaluating, and synthesizing papers under consideration. One of these tools is a research evidence appraisal tool, which aids in assessing the article’s degree of evidence and quality rating. Before making suggestions, including changes in practice, a synthesis method and recommendation tool (Appendix B) assist in critically thinking about each article. Current publications were found using the search keywords “thermoregulation,” “temperature,” “swaddle bathing,” “immersion swaddles bathing,” “infant bathing,” “newborn tub bathing,” “infant swaddle,” and “interactive newborn bath” “infant care,” “infant,” “newborn.” in online databases (CINAHL EBSCO, Google Scholar, and PubMed). Articles limited to English language papers and those less than five years.

T: Finally, the translation phase examines the possibility of putting the findings into practice and performing searches, reviews, and appraisals of literature using the JHNEBP rating scale to guarantee quality (appendix B). The ultimate aim is to demonstrate that immersion swaddles bathing enhances numerous physiological characteristics, including newborn thermoregulation, and conduct a pilot study for ISB in the postpartum unit to enhance infant temperature regulation. This study is divided into two phases: pre-educational surveys and course materials on immersion swaddle bathing, followed by a post-educational and project completion survey among PPNs.

Theoretical Framework

Every day, nursing ideas interweave and frequently overlap. Betty Neuman’s systems model, or holistic care, makes significant contributions to nursing practice theories via intrapersonal stresses (Zakieh & Sadeghi, 2017). On the other hand, Dorothea Orem’s grand theory employs holistic care concepts to detect patients’ needs or weaknesses. While these theoretical models share certain commonalities, their functions in nursing practice differ. Neuman’s idea follows several aspects of a human and their surroundings.

There are five major components: physiological (the body and it is functioning), cognitive (dealings with people), socio-cultural (sociological factors and cultural background), developmental (learning experiences), and spiritual (religious views in the coherent framework) (Zakieh & Sadeghi, 2017). In this study, PPNs sustain HNI suitable physiological demands during the infant’s bathing experience, demonstrating each element in Neuman’s idea. PPNs communicate with parents while training them on performing ISB, which gives parental comfort and support in HNI supportive therapy. PPNs, of course, recognize and respect family traditions, religious practices, and preferences over whether or not to have the bathing experience, thereby satisfying Neuman’s socio-cultural and spiritual factors (American Nurses Credentialing Centers, 2021). As PPNs undergo parents ’ education, the developmental component is visible before ISB deployment. Furthermore, before the implementation, PPNs will get a variety of teaching resources through email and video to assist them in improving their nursing expertise and sharing it with HNI parents.

Whereas Orem’s physiological model is comparable to Neuman’s, Orem stresses patient aggressiveness, such as self-care (universal, developmental, and health deviation), self-care deficiency (wholly or partially), and healthcare systems (supporting and educational) (Khademian et al., 2020; Mcleod, 2020; Malekzadeh et al., 2018; Shah et al., 2015; Smith, 2019). Using Orem’s nursing methods within the framework of this project is both helpful and informative for PPNs as they acquire correct procedures and parental education. Overall, these ideas underpin this academic effort, which strives to improve nurse knowledge and satisfaction via education.

Purpose and scope

This quality improvement (QI) project seeks to increase nurse knowledge and satisfaction via education to break down barriers and enable ISB at a Level II postpartum facility. Healthcare providers (Director of Nursing, nurses, technicians), parents, and HNI are among the stakeholders participating in this quality improvement. Several unit champions (Clinical Nurse Coordinators (CNC) and charge nurses) are on hand to assist with any questions or issues that may arise throughout the project, support the continuance of ISB, and smooth the transition from sponge bathing to ISB.

According to studies, unit advocates enhance the success rates of adopting, transferring, and sustaining EBPs like ISB (Miech et al., 2018). ISB is one method of delivering high-quality treatment to HNIs throughout their stay in the hospital. With postponed bathing encounters, ISB contributes to creating feelings of security and positional support among HNIs to facilitate a pleasant washing life experience (Anderson, 2021). Another goal of this research is to comply with AWHONN and WHO recommendations, which favor ISB over sponge bathing (Anderson, 2021). The objective is for HNI and bath-givers to experience and realize the benefits of converting to ISB, overcoming obstacles, and altering the current standardized baby care system.

This study focuses on the Application of ISB per global and national norms that will result in optimum healthcare provision during the showering session. Gather all bathing items before beginning the bathing experience (washcloth, baby sponge, shampoo, cleanser, and towels). Following that, ensure that the water temperature remains between 99.9-100.3 degrees Fahrenheit or comfortably warm within the bathing recipient’s arm (Oliveira et al., 2020). PPNs, LDNs, or staff wrap newborns loosely up to the shoulders in a light blanket, ideally a fleece blanket, before slowly submerging them in warm water. Methodically cleanse the eyes, ears, and face before exposing one body region at the moment to wash, rinse, and re-swaddle. Finally, gently rinse and cleanse the head (Oliveira et al., 2020). The procedure may require five to ten minutes and will assist newborns in maintaining temperature regulation. The premise behind this approach is that it mimics an embryonic microenvironment, enabling HNI to adapt smoothly to life outside the womb (Ceylan & Bolşk, 2018). Following the above steps in cleaning the child not only proves to be satisfactory to the infants, but also the mothers.

Conceptualization of the project

Even though bathing is good for the infant, this short bath may expose him or her to greater danger. For this reason, knowledge about Swaddle bathing is essential to the nurse’s practice and even a practical concept for the mothers and their families. As introduced above, bathing first reduces infectious diseases. It also supports a smooth extrauterine transition. In the contemporary world, nursing practices that are meant to be mandatory never allow for smooth transitions, something that may intrigue undesirable behaviors and psychological responses (Lubkowska et al., 2019). As also introduced above, several types of bathing could be given to a child. These include a swaddle, immersion bathing, sponge bathing, and tub bathing.

Consequently, sponge bathing causes adverse effects to the infants, including adverse stress and signs of insecurity. The insecurity signs in a child may be read by behaviors such as crying and back arching. Moreover, the child may also depict extreme fluctuations such as increased heart rate, thermoregulation, and respiration. When the stressors during the first bathing are not addressed, the child may posit delayed HNI discharge and also unnecessary Neonatal Intensive Care Unit (NICU) admission respectively (Ceylan & Bolւşւk, 2018; Yang & Meng, 2020). It is essential for the nurses to adopt a better bathing technique that may reduce parents’ stay in the hospitals after giving the bath.

PPNs, LDNs, and staff must notice and assist baby difficulties, including transitions to extrauterine life, in order to prevent HNI concerns. Immersion Swaddle Bathing (ISB) is an essential Evidence-Based Practice (EBP) nursing practice that improves HNI outcomes (Anderson, 2021). Unfortunately, many hospital facilities and registered nurse populations cannot use this well-proven EBP due to hurdles such as a lack of knowledge or opposition to change (Alatawi et al., 2020). The importance of recognizing these hurdles is highlighted because the nursing profession accounts for the majority of the workforce in healthcare systems (Alatawi et al., 2020). Ideally, it is the responsibility of the healthcare practitioners to help the baby in transiting from the womb environment to this world.

Because their work entails advocating and delivering excellent patient care, their resistance significantly impacts patient-centered care, resulting in either excellent or adverse patient outcomes (Alatawi et al., 2020). As a result, teaching on EBPs such as ISB and breaking down barriers would improve nurses’ knowledge, provide optimal patient care, and successfully implement ISB through effective education.

Appropriate temperature regulation occurs when a newborn achieves a balanced temperature condition in which the fetus’s metabolism is low, oxygen uptake is low, and the newborn is flourishing. Even though there is a more excellent knowledge of the necessity of newborns regulating body temperature, there is still room for improvement in preventing hypothermia in newborn babies (Bairoliya & Fink, 2018). Giving newborns in the neonatal nursery a swaddling bath can help minimize heat loss during a regular newborn wash and facilitate a smooth transition to intra-uterine existence.

Change Agents and Champions

The agents of change in this project are seen to be the nurse leaders and the nursing body in general because they are the ones on whom the education mainly focuses. Ideally, the nurses are the ones who provide care to parents after they have given a bath. Moreover, the nurses are the champions of change because their knowledge about swaddle bathing may impact the general hospital performance.

Option Leaders

The option leaders in this project are basically the Principal investigator. The PI will be assisted by another research team, but the decisions greatly rely on his view. Besides, the PI will be in charge of the budget that the project will cause, including the legal fee.

Stakeholders and Project Team

In this research, the stakeholders will be analyzed differently depending on their chores and tasks. Ideally, the nurses constitute one category of the stakeholders. The nurses’ reaction to swaddling bathing education is essential to determining the type of bath that a patient is given. Another group of stakeholders in the management team. The management team in the hospital is essential in making critical decisions within the hospital, including the determination of the type of bath given. Lastly, the patients are the other group who form part of the larger society.

Market/Risk Analysis

Swaddle bathing is a technique that helps reduce psychological conditions in the future. Ideally, when the first bath that the child is given is swaddle bathing, it means that the child is satisfied psychologically, thus minimizing his or her chance of getting psychological conditions. This, in turn, helps raise a future generation that has low psychological conditions, including a reduced level of stress among the children.

Babies who cannot maintain appropriate temperature regulation and then become hypothermic may be referred to the Neonatal Intensive Care Unit (NICU) for further assessment. These newborns are subjected to numerous blood tests, medications, extended hospitalization, and family attachment in the NICU (Gadson et al., 2017). In 2005, a preterm newborn’s estimated first-year healthcare expenditure (less than 370/7 weeks gestation) was $32,325, compared to $3,325 for a term infant (Gadson et al., 2017). This shows thus how essential the first environment is to the infants.

The choice of bathing always has an effect on NICU. Thirty-eight states in the United States of America reported that about half of the NICU admissions are HNI (Yang & Meng, 2020: Yoo et al., 2019). In 2020, for instance, there will be more than 3 600 000 births in the United States (Hamilton et al., 2021). These numbers made it possible for the NICU admissions substantially. Apart from containing VICUs, the infants’ prenatal bonding and increased financial burden on families were experienced (Yang & Meng, 2020). Thus this implies that for perfect bonding and reducing NICU, better education about bathing ought to be given.

The stability of the infant, therefore, is a field that ought to be considered. It occurs after the birth of the child. As seen above, it is possible to attain instability since the infants are removed from their previous environment in the uterus to an even colder environment when delivered. Lubkowsak et al. (2019) aver that there is a possibility of the infants losing about 20 Celsius several seconds after being born (Lubkowska et al., 2019). This, in turn, poses the risk of hypothermia several minutes after being brought into the world. Thus, to minimize the risk, the Postpartum Nurses (PPNs), Labor and Delivery Nurses (DNS), techs working, and the delivery staff need to educate the parent on how to care for their infants once they are discharged.

Literature review

Psychological Impacts of Swaddle bathing on the mother

Washing the child is necessary after delivery; nevertheless, bathing can cause heat imbalance and distress. Newborn newborns are more likely to suffer hypothermia because of their enormous surface area, lower thermal insulation of brown adipose tissue, higher body water content, and undeveloped metabolic systems for reacting to thermal stress. When a late preterm infant (340/7 – 366/7 weeks gestation) is admitted to the neonatal nursery, he or she is at increased risk for heat transfer characteristics due to lower levels of brown adipose tissue than a term newborn, although they are cared for similarly to term newborns Chowdhury et al., 2018). Indeed the first environment is essential for the infants. Thus, Chowdhury et al., (2018) article gives a contextual scene through which the current study may draw its argument.

Traditional washing has been shown to stress infants, as demonstrated by behavioral indicators like screaming, back-arching, stretched limbs, and spread fingers, as well as physiological symptoms such as temperature instability, apnea, hypoglycemia, and hypoxia (McKim, 2020). This article proves to be essential in the current study as it offers the basis for swaddle bathing. It helps the current study in the conceptualization of the essence of Swaddle bathing. The current study devours to evaluate the impact of the education about swaddle bathing, which McKims does not address.

Importance of staff education in Swaddle bathing

McKim’s 2020 continues to affirm that Staff education may have contributed to the unanticipated swaddle-bathing post-bath temperature; post-intervention temperatures are more in line with what was predicted (McKim, 2020). Adopting an evidence-based practice modification at an academic medical institution gives swaddled immerses bathing to tremendous expansion and late-preterm babies in the well-baby nursery (McKim, 2020). It is essential, however, to understand the impact of staff education. Once again, this article creates a standing ground when arguing about the essence of staff education and its impact. The current study, however, helps unravel the individual satisfaction as an impact of staff education.

Swaddling a baby blends information regarding confinement and postural assistance with research for immerse tub washing to give the most evidence-based bathing technique for infants born (Chowdhury et al., 2018). Cleaning a newborn while swaddled in a flexed, midline posture is known as swaddle bathing. The swaddled newborn is submerged in water up to the standard of the child’s neck in a tub. Each limb is unwrapped separately, gently cleaned, cleaned, and swaddled while the child remains in a confined posture during the bath.

MacDowell (2021), on the other hand, avers

Education/procedure demos on swaddling bathing were held on the unit, and pre-and post-survey results were compared. Following the re-education in swaddle bathing, the unit’s swaddle bathing rate increased by 42.6 percent. Furthermore, the post-survey data revealed a decrease in the total number of stress signals present while bathing. Because only a small number of babies on respiratory assistance were studied, it was difficult to establish a relationship between respiratory state and FIO2 need and bath type. In the post-implementation group, infants who got swaddling baths had a higher overall temperature than those who received sponge baths, with no neonates experiencing a temperature below 36.4oC (MacDowell, 2021).

The article is essential to the current study as it focuses on future policymaking. Ideally, the essence of the current study is to critically advise on the impact of nurse education about swaddle bathing on the general satisfaction at the healthcare facilities. Thus, MacDowell’s work will be significant to the current study when addressing the research’s sustainability concept.

Nurse resistance to change

Resistance to change management in the nursing industry has generally been associated with negative connotations. Resistance to change, for example, is regarded as stubborn and non-compliant in Swaddle bathing. Nevertheless, the opposition is not always a bad thing. The mothers have the last decision on the sort of bath that their child requires. Perhaps change cannot occur unless there is some amount of opposition. Adoption of swaddling bathing instruction in hospitals may not be successful unless there is some type of opposition. Critics offer an inside perspective on organizational challenges, resources, and the psychological impact of a particular action on both the mother and the newborn.

The unanticipated swaddle-bathing post-bath temperature may have been due to staff education; post-intervention temps are more in line with expectations (Barmore, 2020). Consequently, this article is essential in the current study as it gives the essence and adaptability of the environment to the newborns. Without those environments, satisfaction levels cannot be possible. Thus, a deep scope into the post-bath environment and its essence to the well-being of the infants gives voice to the current study.

The implication of Swaddle bathing to NICU

As seen above, swaddled bathing has a psychological effect on the child. Given the benefits of swaddled bathing in terms of physiological condition and stress reduction, it can be utilized as an acceptable bathing strategy in the NICU (SUN et al., 2021: Malekzadeh et al., 2018). This reduction may be interpreted through various activities and reactions of the baby during birth. Renfeng et al. (2018) confirm that swaddle bathing can increase newborn behavioral state throughout the bathing procedure and minimize neonatal dread. Furthermore, it may aid in keeping warm more efficiently (Renfeng et al., 2018). The two articles are critical in the current study since they offer a base for analyzing the findings that the current study will unravel. The psychological reactions are the basis that shows satisfaction in both the parents and the infants.

There are two different types of bathing there are always adopted that every expecting woman, together with the nurses, have to be trained on. This prepares them for actual clinical-based practice, thus reaching satisfaction and catering to the newborn’s behavioral and psychological needs. The two methods are Swaddle bathing and Tub bathing (Brennan et al., 2020). Ideally, the mother always has control over and decides what type of bathing the child should undergo. Both these bathing are aimed at and satisfying both the mother and the newborn; in essence, swaddle bathing, and tub bathing, are aimed at temperature, heart rate, oxygen saturation, respiration rate, crying times, and stress corrections. The parents using Swaddle bathing feel safer against the injuries and other hazards arising from this first bath (Brennan et al., 2020). Besides, the uneasiness of newborns and fear of slipping down from the hands may be curbed by the swaddle bathing. Thus, this shows the essence of the education about swaddle bathing.

The environmental aspect in Swaddle bathing

The environment in the uterus is always neutral and thermal. Thus, after an infant has spent about nine months in this environment, it calls for temperature regulation to help the baby survive in the outer world (Ritchie, 2019). Often, the room environment is always colder, together with the delivery equipment being used. Such a sudden change can expose the newborn to an even greater risk like hypothermia during the first hour of life. In the scope of the World Health Organization’s directions, the average body temperature is usually 36.5-37.50C. However, hypothermia is a condition that makes the body be less than 36.50C (Brennan et al., 2020). Hypothermia is not only an issue in Europe or the Americas alone but a worldwide issue that requires global intervention.


Ethical Considerations

Before implementing the project, the Institutional Review Board (IRB) at the facility where the project was to be conducted and the IRB at Rocky Mountain University of Health Profession (RMUoHP) conducted a formal ethics review. Both IRBs determined that the project was not classified as research (Appendices XX, XXX). Additionally, approval of the project was obtained from the women’s center director. Protecting participant rights included a consent form was provided and signed by participants (Appendix XXXX). Storage for collected data will be on Project Investigator (PI’s) USB flash drive that is password protected. Electronic data will be deleted unless needed for review or audits once the PI’s project is completed and data analyzed. The approximate timeframe of completion is spring of 2022.

Participants Protection

In June 2021, the PI completed the Collaborative Institutional Training Institution (CITI) for behavioral and social sciences (appendix) to understand how to protect participants and secure any data collection. The PI will only engage PPNs, LDNs, and staff. The inclusion of staff is because of their active everyday role on the units. Participation is voluntary and will not experience discomfort or harm during this project. Participants will be educated on the time required and expectations for this project. The educational in-service meeting will be approximately 30 minutes, with educational emails before the meeting. Pre, post and completion surveys will take approximately 5 minutes.

Participants and Inclusion/Exclusion Criteria

Inclusion criteria included licensure as a registered nurse and current employees of a community-based hospital. Exclusion criteria included disciplines outside of nursing and those elected not to participate, such as registered nurses who float to the postpartum or labor and delivery unit. Participant selection was based upon convenience.

Data Collection and Implementation Strategies

The John Hopkins Evidence-Based Model (JHEBP) initiates an inquiry generated by curiosity and identifies whether current practice mirrors the best evidence for a specific problem or a particular patient population (Dang & Dearholt, 2017). The PI selected this model to guide the QI project and generate systems change in postpartum and Labor and Delivery (L&D) units. Additionally, the evidence-based tool is ISB, which increases HNI outcomes before discharge. Appreciating ISB provides parent(s) the confidence and tools to become more confident once home from the hospital. Educating and Implementing ISB will enhance nurse knowledge and satisfaction to educate new parents on ISB for positive outcomes.

The JHEBP model has many working parts. During the “P” step and its subparts, the PI assessed the need for practice change. The identified problem was current practices of sponge bathing were not as beneficial as ISB for NHI because of increased risks of vital sign instability. Through step “P,” there were multiple discussions with several interprofessional teams, including stakeholders, to examine the current practice. The significance of these discussions was to gain support from the stakeholders to increase the chances of achieving a successful project outcome. During step “E” and its subparts, studies were examined and appraised studies by using many of the model’s tools to complete a literature review, appraise the evidence, and utilize an evidence table. The last step, “T,” and its subparts, helped assess the quality of the literature, which is significant for credibility. During this step, many studies were produced and used in this project.

Evidence of Collaboration

The interdisciplinary approach was used to meet the objectives of the systems change. Collaboration occurred throughout the project between PI, participants, the content expert, and the faculty chair.

Outcome Measures

The collected data were analyzed to measure the effects of education on HNI among babies in the newborn nursery and how education has dramatically improved the swaddle bathing techniques. Additionally, the analysis was to determine if infant swaddle baths improved the babies and children’s temperature regulation, parental involvement, and parental satisfaction regarding an infant bath.

Interview and Survey

A survey (see Appendix A) and an evaluation form were used to gather information (see Appendix B). This survey was administered at the start of the data collection stage, and the analysis form was distributed three times during the data collecting period. The study collected data on the sort of bath given by the caregiver the majority of the time. The assessment form evaluated the actual knowledge about bathing and the impact of education on swaddling bathing techniques.


Limitations may include a small sample size because this project was conducted at one hospital. Environmental stimuli may impact newborn temperature, especially if PPNs do not do temperature via axillary and air room temperatures are not measured. Lastly, all newborns are unique, and their temperature may vary to some degree, which may affect the results of the project.

Conflict of Interest

There is a potential conflict of interest as the PI is a full-time employee of the hospital. Although the DNP student will continue to be an employee, the PI and administration understand that during data collecting, education, or other aspects of this project, the PI will not be working at that time. There will be no participation compensation for this project. However, the PI will send thank you cards after completing the project as a show of gratitude.


Participant privacy of personal information is protected through de-identifiers consisting of survey monkey’s anonymous link and is password protected. All data collection is de-identified and non-traceable to any specific participant. All collected data is entered and saved in a password-protected computer owned by the PI.

Other Data Collection Privacy

Storage for collected data will be on PI’s USB flash drive that is password protected. Unless needed for review or audits, all electronic data will be deleted once the PI’s project is completed and data analyzed. The approximate timeframe of completion is spring of 2022.



About 50 mother-infant pairs who were admitted to the Mother-baby unit were among the participants. The infants could not have been more than a week old (Appendix C). Furthermore, the poll only included healthy newborns who were not visibly distressed. Convenience and purposeful sampling were often used. Furthermore, community-based hospitals with unit levels 2 and 3 were targeted.


Out of the forty mother-infant pairs who completed the survey, it was discovered that there was increased breastfeeding by the children after education. Besides, the children seemed relaxed and did not frequently cry. The twenty nurses who also completed the survey affirmed the essence of swaddle bathing to the children since the mothers also smiled when given their first bath. The prolonged hospitalization of the newborn also was minimized among the forty mother-infant pairs admitted.

Impact on the system

It is critical to understand all of the health advantages that breastfeeding provides for babies, particularly those in the NICU. Breastfeeding is proven to reduce a baby’s chance of allergies and infections, which are benefits NICU newborns require when they face so many other obstacles (Lubkowska et al., 2019). For infants, the NICU is a stressful environment. The stress of everyday routines might have a detrimental impact on the newborn’s well-being, including his or her readiness to nurse. Bathing is unavoidable in the NICU since the baby’s skin must be maintained clean. The findings show that improved breastfeeding participation immediately after a bath when stress levels are maintained as low as possible confirms the essence of education. The education about swaddle bathing indirectly helps to reduce the stress levels among the children.

Swaddle-bathed infants exhibited lower physiological and motor stress, more significant energy conservation and state regulation, and less crying and restlessness – overall fewer stress symptoms, according to clinical data. In the NICU, less stress enhances the likelihood of successful breastfeeding.

Psychologist attests that a smile is a sign of happiness. When the babies and their mothers smiled during the bath, they were relaxed and happy. According to Dr. Isha Gupta, a neurologist at IGEA Brain and Spine, a smile causes a chemical response in the brain, releasing chemicals such as dopamine and serotonin. “Dopamine boosts our happiness levels. Stress reduction is linked to serotonin release. Thus, education proves that the nurses, infants, and mothers were satisfied with the technique. The primary goal of nurses is to ensure that the patients are satisfied with the services provided. Ideally, the fact that the result points at patient satisfaction show that education enhances satisfaction.

Unintended consequences

Unintended consequence during the research process includes a breakthrough of finding a way to increase hospital admissions of expectant mothers and those who are about to deliver. As asserted above, swaddle bathing not only satisfies the infant’s psychology but also the mother is satisfied. When parents are satisfied with the services offered in the facility, more referrals will be attracted and thus more admissions.


As per the findings of this performance improvement assessment, swaddle bathing training is a safe and pleasant way to keep healthy newborns in the newborn nursery. Swaddle bathing seems to be more successful than other forms of bathing in regulating baby temperature and avoiding heat loss in newborn newborns, which promotes the intrauterine adaption process. Parental engagement and satisfaction influence the kind of bathing, so the results show that they are satisfied when swaddle bathing is used. Swaddle bathing may be done more simply at the bedside without using extra heating equipment, allowing parents to witness the initial bath and engage in parental bonding through skin-to-skin care and nursing right after the newborn bath. The influence of the project is felt by the parents and addresses the healthcare problem about patients’ satisfaction in the NICU.

The project will impact the healthcare facility since when the parents are satisfied, more admissions may be felt in the facility. This shows that the healthcare facility will be on its way to satisfying the patients. Ideally, patient satisfaction is the primary goal as to why healthcare facilities are set. Moreover, when stress levels are reduced among the newborns, the surety of a healthy and safer future generation is affirmed. Even though the parents will remain accountable for the type of bath they want their children to have, nurses’ responsibility is to educate the parents on better bathing techniques.

Future works need to point at a more comprehensive impact of education on satisfaction in healthcare facilities. Ideally, this research was only limited to about fifty mother-infant pairs and twenty nurses. However, when more compressive research is done, a better recommendation may be drawn.


American Nurses Credentialing Centers. (2021). Magnet model- Creating a magnet culture. ANCC.

Anderson, H. (2021). An organization-wide initiative to implement parent-performed, delayed immersion bathing. Nursing for Women’s Health, 25(1), 63-70. Web.

Bairoliya N., & Fink G. (2018) Causes of death and infant mortality rates among full-term births in the United States between 2010 and 2012: An observational study. PLoS Med, 15(3), e1002531.

Barmore, L., Muller, J., Pavsic, J., & Sangillo, J. (2020). Swaddled Immersion Bathing for Healthy Full-Term and Late-Preterm Newborns. Journal of Obstetric, Gynecologic & Neonatal Nursing, 49(6), S78-S79.

Brennan, R. A., Obrist, M., & Olson, K. (2020). Implementation of Newborn Delayed-Immersion Swaddle Bathing in a Mother-Baby Unit. Journal of Obstetric, Gynecologic & Neonatal Nursing, 49(6), S75.

Ceylan, S. S., & Bolւşւk, B. (2018). Effects of swaddled and sponge bathing methods on signs of stress and pain in premature newborns: Implications for evidence-based practice. Worldviews on Evidence-Based Nursing, 15(4), 296-303.

Chowdhury, M. A. K., Billah, S., Karim, F., Khan, A. N. S., Islam, S., & Arifeen, S. E. (2018). Report on Demographic profiling and needs assessment of maternal and child health (MCH) care for the Rohingya refugee population in Cox’s Bazar, Bangladesh.

Gadson, A., Akpovi, E., & Mehta, P. K. (2017). Exploring the social determinants of racial/ethnic disparities in prenatal care utilization and maternal outcome. In Seminars in perinatology (Vol. 41, No. 5, pp. 308-317). WB Saunders. Web.

Hamilton, B. E., Martin, J. A., & Osterman, M. J. K. (2021). Births: Provisional data for 2020. Centers for Disease Control and Prevention (12).

Kelley, P. A., Classen, K. A., Crandall, C. G., Crenshaw, J. T., Schaefer, S. A., Wade, D. A., Cramer., M. N., Arval, S., Fossee, K. A. (2018). Effects of timing of the first bath on a healthy newborn’s temperature. Journal of Obstetric, Gynecologic & Neonatal Nursing. 47(5): 608-619.

Lubkowska, A., Szymański, S., & Chudecka, M. (2019). Surface body temperature of Full-Term healthy newborns immediately after Birth-Pilot Study. International journal of environmental research and public health. 16(8),1312.

MacDowell, C. (2021). The Effect of a Swaddle Bathing Policy in the NICU on the Prevention of Hypothermia and Stress in the Premature Neonate. Web.

Malekzadeh, J., Amouzeshi, Z., & Mazlom, S. R. (2018). A quasi-experimental study of the effect of teaching Orem’s self-care model on nursing students’ clinical performance and patient satisfaction. Nursing Open. 5(3). 370-375.

McKim, M. (2020). Swaddle Bathing in the NICU. Journal of Obstetric, Gynecologic & Neonatal Nursing, 49(6), S78.

Melnyk B. M., & Fineout-overholt E. (2018). Evidence-Based Practice in Nursing & Healthcare. [VitalSource Bookshelf]. Web.

Melnyk B.M., Zellefrow, C., and Tan, A. (2020). There are differences between the magnet and non-Magnet-Designate hospitals in nurses’ evidence-based practice knowledge, competencies, mentoring, and culture. World views. 17(5) 337-347.

Migliore, L., Chouinard, H., & Woodlee, R. (2020). Clinical Research and Practice Collaborative: An Evidence-Based Nursing Clinical Inquiry Expansion. Military Medicine.

Oliveira R.O., Estevam L.D., Leite F.M., Almeida M.V., Mascimento, L., Amorim M.H.C., Bringuente M.E. (2020). Nursing intervention-first bath of the NB: a randomized study on neonatal behavior. Acta Paul Enferm. 33: 1-10.e-APE20190031

Peahl, A. F., Smith, R. D., & Moniz, M. H. (2020). Prenatal care redesign: creating flexible maternity care models through virtual care. American journal of obstetrics and gynecology, 223(3), 389-e1.

Renfeng, X. U., Cao, J., Zheng, W., Zhang, J., & Yuhua, W. U. (2018). Effects of swaddle and tub bathing methods on behavioral responses in preterm neonates. Chinese Journal of Practical Nursing, 34(27), 2138-2141. Web.

Ritchie, H. (2019). How many people die, and how many are born each year? Our world in data.

Speroni, K. G., McLaughlin, M. K., & Friesen, M. A. (2020). Using evidence‐based practice models and research findings in Magnet-designated hospitals across the United States: National survey results. Worldviews on Evidence-Based Nursing, 17(2), 98–107.

Sun, L., Yang, J. H., Chen, Y., Wu, Q. Q., & Cao, Y. R. (2021). Comparison of the effects of swaddle bathing and tub bathing on physiological parameters and stress of mid-late preterm infants during bathing. Chinese Journal of Child Health Care, 29(5), 497.

Taşdemir, H. İ., & Efe, E. (2019). Tub bathing and sponge bathing effect on neonatal comfort and physiological parameters in late preterm infants: A randomized controlled trial. International Journal of Nursing Studies. 99:103377.

Tobah, Y. S. B., LeBlanc, A., Branda, M. E., Inselman, J. W., Morris, M. A., Ridgeway, J. L.,… & Famuyide, A. (2019). Randomized comparison of a reduced-visit prenatal care model enhanced with remote monitoring. American journal of obstetrics and gynecology, 221(6), 638-e1.

World Health Organization (2020). Newborns: improving survival and well-being.

World Health Organization (2017). WHO recommendations on newborn health: guidelines approved by the WHO Guidelines Review Committee. Geneva (WHO/MCA/17.07).

Yang X, & Meng T. (2020). Admission of full-term infants to the neonatal intensive care unit: a 9.5-year review in a tertiary teaching hospital. J Matern Fetal Neonatal Med. 33(17). 3003-3009. doi: 10.1080/14767058.2019.1566901. Epub. PMID: 30624998.

Yoo, J.Y., Kim, J.H., Kim, J.S., Kim, H.L. & Ki, J.S. (2019). Clinical nurses’ beliefs, knowledge, organizational readiness and level of implementation of evidence-based practice: The first step to creating an evidence-based practice culture. PLoS One. 14(12): e0226742. doi: 10.1371/journal.pone.0226742. PMID: 31877147; PMCID: PMC6932768.


Appendix A: Bath assessment form

  1. What bathing technique was used?
    1. Sponge bath.
    2. Immersion tub bath.
    3. Swaddle bath.
  2. What was the temperature of the bath?
  3. If the bath technique was swaddling, what prompted you to use it?
    1. Self-knowledge.
    2. Personally attitude.
    3. Education attained.
  4. What was the reaction of the following towards the swaddle bath?
    1. Parent.
    2. Baby.
  5. Can you advise any other person to use the swaddle bath technique? If so, why?

Appendix B: Parent Satisfaction Scale

  1. How satisfied are you with the swaddle bath technique taught?
    1. Very satisfied.
    2. Fairly satisfied.
    3. Not satisfied.
    4. confused.

Appendix C: Demographic assessment

  1. What is the admission unit of the baby
    1. General Maternity Unit.
    2. Mother-baby unit.
    3. Intensive Care Unit.
  2. How old was the baby when admitted to the respective unit?
    1. Less than one week old.
    2. Two weeks old.
    3. One month old.
    4. Not sure.
  3. Did the admitted child have other underlying conditions
    1. Yes.
    2. No.
  4. What type of bath was the child given?
    1. Swaddle Bathing.
    2. Tube Immersion Bathing.
    3. Not Sure.
  5. How long did it take the child to be discharged out of the unit?
    1. One week.
    2. Less two weeks.
    3. One month.
    4. Three months.