Abstract The authors (Chiu, Anderson, & Burkhammer, 2005) of the article present all the essential components of the research study. There will be a decrease in temperature in the newborn if having difficulties breastfeeding while having skin-to-skin contact with the mother. That was the inferred hypothesis. The method used to gather the information was a pretest-test-post test study design and the sample consisted of 48 full-term infants. The key findings showed most infants reached and maintained temperatures between 36. 5 and 37.

6 degrees Celsius, the thermo neutral range, with only rare exceptions. Problem Statement The research problem is thermo regulation in newborn infants. The purpose of the research study is to find out if Kangaroo, or skin-to-skin contact, facilitates safe temperatures in newborn infants during the first few minutes and hours after birth, specifically during breastfeeding. In this article the problem statement is written clearly and it expresses a relationship between two or more variables, specifically temperature and skin-to-skin contact. In this study the problem statement is testable and states a specific population being studied (full-term newborns). The significance to nursing is apparent in the problem statement.

It is important for newborns to maintain a body temperature within a normal range so that "caloric expenditure and oxygen consumption are minimal. If excessive effort is needed to produce heat when cold stress persists, newborn infants may experience adverse metabolic events such as, acidosis, and hypoglycemia" (Chiu et al. , 2005. p. 115 as cited in Kenner, 2003). Literature Review The literature review is comprehensive and makes explicit the relationship among the variables and discusses the relevant concepts.

All sources are relevant to the study topic and are critically appraised. Both classic and current sources are included ranging in date from 1977 to 2004. Most sources are primary sources but only supporting research is presented. Chiu et al states that one gap in knowledge about the problem identified is that "temperature has not been reported in studies of skin-to-skin contact with a focus on the breastfeeding process." This study intends to fill the gaps by studying mothers and newborns that are having trouble breastfeeding between 12 and 24 hours after birth. Theoretical/Conceptual Framework The conceptual framework is clearly identified and based on a nursing theory and is appropriate for the study. The concepts and relationships between the concepts are clearly stated.

The researcher does not provide a schematic diagram of the proposed relationships. There is sufficient literature to support the study and a propositional statement is identified in the abstract that will guide the hypothesis. Chiu et al states this as, "Concern persists that infants will become cold while breastfeeding, however, especially if in skin-to-skin contact with the mother." Hypothesis/Research Question The hypothesis is not directly stated in the article. The inferred hypothesis is the temperature of the newborn will decrease during skin-to-skin contact while experiencing difficulties breastfeeding.

The dependent variable is temperature and the independent variable is skin-to-skin contact. The hypothesis is testable. Sample The sample was selected by recruiting from the University MacDonald's Women's Hospital between February and October of 2002. Convenience sampling was used and was appropriate to the design of the study. But Chiu et al states that because most infants were appropriate for gestational age and "most mothers were 28 years old on average, married, and had delivered virginally... it may not be possible to generalize [these] results to other populations." The sample size was appropriate and the sample was ethnically diverse.

The demographic characteristics of the sample are listed in a table. Two couples withdrew from the study. One because of too many interruptions and the other because the infant had an anatomical defect. Design A pretest-test-post test study design was used for this study and seemed to flow from the problem statement. The threat to internal validity comes from having no control group. The researcher does not attempt to use any method of control and therefore the design does not have controls at an acceptable level for the threats to internal validity.

The study used only full-term infants with no significant anomalies and that was a limitation to in terms of external validly. Data Collection Methods A one-group pretest-test-post test design was used to measure temperature. Chiu et al states the newborn's temperature was "taken just before skin-to-skin contact, 30 minutes into skin-to-skin contact, and just before the end of skin-to-skin contact." These procedures were similar for all subjects. Instruments A temporal scanner (TAT-5000) was used to measure temperature (Chiu et al. , 2005). This scanner is highly correlated with rectal and esophageal temperatures (Chiu et al.

, 2005). As She au-Huey et al states, "the researchers were shown how to use the thermometer and, because of its simplicity, inter rater reliability was easily achieved." Teaching the researchers the proper use of the thermometer was the only provision made to maintain accuracy. Reliability & Validity Inter rater reliability was reported for the temperature scanner but the level was not reported. Content validity was achieved because the thermometer was highly correlated with rectal and esophageal temperatures. Legal/Ethical The Institutional Review Board approved the study and informed consent was obtained from the mothers of the newborns. No information about provisions for anonymity or confidentiality was mentioned.

Vulnerable subjects were used but protection was not addressed. Analysis of Data Descriptive statistics were reported in the study including the mean, standard deviation, and range. These statistics were reported in the results section of the article and were appropriate to the level of measurement for each variable. The standard deviation was reported with the mean and the temperature was reported as an interval. The author does not state the level of significance for the results.

The tables used in the article supplemented and economized the text. They were easy to read with precise titles and headings and were not overly repetitive of the text. Conclusions, Implications, and Recommendations The null hypothesis was not supported because there was no decrease in the temperature of the infants. The results of the study were interpreted in the discussion section of the article. According to Chiu et al (2005), the "sample was ethnically diverse, surprisingly little variation was seen on other demographic or clinical variables, such as infant birth weight, gestational age, maternal age, parity, and delivery methods" (p. 119).

The study had some limitations such as; the majority of the newborns were appropriate for gestational age, most mothers were 28 years old and married, and most babies were born vaginally. Therefore "it may not be possible to generalize [the] results to other populations" (Chiu et al. , 2005. p. 119).

One problem identified in the study related to the lack of researchers available at night to record the third intervention temperature. According to Chiu et al (2005), "These data suggest that mothers may have the ability to modulate their infant's temperature during skin-to-skin contact, if given the opportunity" (p. 119). Some nursing interventions identified from this study include placing a cap on the newborn's head after birth and changing the cap when it becomes damp. Also a blanket can be placed across the infant's back, but never between mother and baby, if additional warmth is needed. Generalizations are made according to Chiu et al (2005) that, "Hospital staff and parents can be reassured that, with or without breastfeeding difficulties, may safely breastfeed in skin-to-skin contact with their mothers" (p.

120). These generalizations are made within the scope of the findings of this study. Several recommendations were made for future studies. "First, additional research staff are needed to cover evening shifts" (Chiu et al. , 2005.

p. 120). The second recommendation was to recruit the couples sooner so that all four interventions could be completed before discharge. A third recommendation was made for a greater amount of temperature readings. And the last recommendation was for a training session for hospital staff on correct skin-to-skin positioning for mother and baby.

Application and Utilization for Nursing Practice The temperature results provide solid evidence that this study is valid. According to Chiu et al (2005), "When mother-infant couples breastfeed skin-to-skin using a safe technique, concern for hypothermia is unfounded" (p. 120). Patients benefit from the research findings because, "healthy full-term infants, with or without breastfeeding difficulties, could safely breastfeed in skin-to-skin contact with their mothers" (Chiu et al.

, 2005. p. 120). Direct application of the research findings is feasible in terms of time, money, and legal / ethical risks. These findings indicate that nurses no longer need to worry that infants will become cold during skin-to-skin contact especially during breastfeeding. The results of this study should be applied to nursing practice because skin-to-skin contact facilitates a bond between mother and baby and because it helps regulate baby's temperature.

References Chiu, S. , Anderson, G. C. , & Burkhammer, M. D. (2005).

Newborn Temperature During Skin-to-Skin Breastfeeding in Couples Having Breastfeeding Difficulties. BIRTH, 32 (2), p 115-121.