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Running head: QUALITY IMPROVEMENT PROJECT 1 Quality Improvement Project: Delay Newborn Bathing Jane G. Watson NUR 4144: Professional Role Development Servant Leadership Dr. Ellcessor March 27, 2018 Honor Code- I pledge QUALITY IMPROVEMENT PROJECT
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  Running head: QUALITY IMPROVEMENT PROJECT 1 Quality Improvement Project: Delay Newborn Bathing Jane G. Watson  NUR 4144: Professional Role Development Servant Leadership Dr. Ellcessor March 27, 2018 Honor Code- I pledge  QUALITY IMPROVEMENT PROJECT 2 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, “t he 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.  QUALITY IMPROVEMENT PROJECT 3 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 disruptiv e 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  QUALITY IMPROVEMENT PROJECT 4 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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