Quality Improvement Project: The Critical Role of Provider Knowledge in The Golden Hour

Degree Name

Nursing Practice, DNP

Publication Date

4-20-2026

First Advisor

Sandy King

Second Advisor

Randi McCoy

Abstract

Maternal and infant mortality rates in the Southern United States remain disproportionately high, and inconsistent implementation of the Golden Hour, defined as uninterrupted skin to skin contact for at least the first hour after birth, continues to limit its evidence based maternal and neonatal benefits. The aim of this Doctor of Nursing Practice (DNP) quality improvement project was to evaluate the impact of a structured provider education intervention on Golden Hour compliance and provider confidence. Guided by Benner’s Novice to Expert Theory and implemented using Kotter’s 8-Step Change Model, a quantitative, quasi experimental pre-post design was used. The project was conducted in a 15 bed Level IV labor and delivery unit within a large urban hospital in Memphis, Tennessee. A nonprobability convenience sample of 12 obstetric providers (physicians, resident physicians, and certified nurse midwives) completed both pre and post intervention assessments. Provider confidence was measured using the validated Grundy Confidence Scale (C Scale), and Golden Hour compliance was evaluated through electronic health record audits of eligible vaginal births. Results demonstrated a statistically significant improvement in provider confidence following the intervention, t(11) = -19.29, p < .001, with a large effect size (Cohen’s d = 5.57). In contrast, Golden Hour compliance increased minimally, from 22.4% to 22.6% during the three month monitoring period. These findings suggest that while targeted education effectively strengthens provider confidence, education alone is insufficient to achieve practice change, underscoring the need for multicomponent, interdisciplinary strategies to improve Golden Hour implementation and maternal-infant outcomes.

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