Examination of the implementation determinants of skin-to-skin care in the pediatric cardiac Intensive Care Unit

Introduction

Skin-to-skin care (SSC), where parents hold their unclothed baby directly on their bare chest, is regarded as best practice for hospitalized infants. SSC is not routine for infants with complex congenital heart disease (cCHD) in the Pediatric Cardiac Intensive Care Unit (PCICU). SSC is understudied and the contextual factors influencing its implementation in the PCICU are unknown. This multisite, multi-methods study using the Tailored Implementation for Chronic Diseases implementation determinants framework aimed to identify the contextual factors influencing the implementation of SSC in the PCICU.

Methods

We interviewed stakeholders across two US PCICUs, one with previous implementation experience of SSC and one with little to no implementation experience. We used purposive snowball sampling, representing the interdisciplinary team of clinicians (n = 25) and parents (n = 21) at each site, until we reached thematic saturation. Clinicians completed a suite of valid and reliable surveys of acceptability, feasibility, and appropriateness. Descriptive statistics were calculated for the acceptability, feasibility, and appropriateness measures, with comparative analysis across clinician characteristics. Cross-cutting key themes were generated from a combined inductive and deductive approach to content analysis.

Results

On a five-point Likert scale, clinicians rated their acceptability (mean = 4.7, SD = 0.4), feasibility (mean = 4.2, SD = 0.7), and appropriateness (mean = 4.5, SD = 0.5) of SSC in the PCICU within the agree/completely agree range. Cross-cutting themes included knowledge, communication, role clarity, resources, and safety.

Conclusions

Findings will be the foundation for implementation mapping, where identified barriers and facilitators are linked with evidence-based implementation strategies that can be tested to enhance the implementation of SSC in the PCICU.