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Almutairi A, Gavine A, McFadden A. Parents' and healthcare providers' perceptions, experiences, knowledge of, and attitudes toward kangaroo care of preterm babies in hospital settings: Mixed-methods systematic review. Birth 2024. [PMID: 39140585 DOI: 10.1111/birt.12859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 05/04/2024] [Accepted: 07/24/2024] [Indexed: 08/15/2024]
Abstract
BACKGROUND Kangaroo care is an effective intervention to increase survival and improve the health and development of preterm infants. Despite this, implementation of kangaroo care globally remains low. The objectives of this review were to: (a) synthesize evidence on parents' and healthcare practitioners' perceptions, experiences, knowledge of, and attitudes toward kangaroo care of preterm babies in hospital settings; and (b) establish parents' satisfaction with kangaroo care. METHODS Studies of any design were included if they focused on parents' or healthcare practitioners' perceptions, experiences, knowledge of, and attitudes to kangaroo care of preterm babies, or reported parents' satisfaction, and were conducted in hospital settings. The search of seven electronic databases, African Journals Online, World Health Organization regional databases, and a gray literature search was conducted in April/May 2020, and updated in January 2024. Study selection was undertaken by two independent reviewers. Quality assessment using the Mixed Method Appraisal Tool and data extraction were completed by one reviewer with a 10% check by a second reviewer. Data were synthesized narratively using a parallel results convergent integrated design. RESULTS Thirty-seven studies, 19 quantitative, 16 qualitative, and 2 mixed methods, were included. The findings suggested that while healthcare practitioners generally demonstrated knowledge about kangaroo care, there was a notable minority with insufficient understanding among those who received training. Parents' knowledge, particularly among fathers, was limited. Both healthcare practitioners and parents appeared to have positive attitudes to kangaroo care. Little is known about parental satisfaction with kangaroo care. CONCLUSIONS Most healthcare practitioners were knowledgeable about kangaroo care, but parents had limited knowledge. This review findings suggest a need to enhance parental knowledge of kangaroo care before neonatal unit admission, and training is needed for HCPs to implement kangaroo care consistently.
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Affiliation(s)
- Amal Almutairi
- School of Health Sciences, University of Dundee, Dundee, UK
- King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Anna Gavine
- School of Health Sciences, University of Dundee, Dundee, UK
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Al Mutair A, Almutairi W, Aljarameez F, Kay E, Rabanal R, Abellar K, Napaod A, Hawsawi A, Saha C, Ahmed GY. Assessment of nurses' knowledge, attitude and implementation of skin-to-skin care within the perinatal setting in Saudi Arabia: Survey study. Nurs Open 2023; 10:2165-2171. [PMID: 36354110 PMCID: PMC10006611 DOI: 10.1002/nop2.1464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 05/12/2022] [Accepted: 10/22/2022] [Indexed: 11/11/2022] Open
Abstract
AIM To evaluate knowledge, attitude and implementation of Skin-to-Skin Care (SSC) among nurses and to assess the implementation of SSC in the perinatal setting. DESIGN A cross-sectional study design was implemented utilizing survey distributed among critical care paediatric and neonatal nurses. METHODS The data collection form was pre-structured validated tool consisted of two main sections; socio-demographic characteristics and Likert scale of 20 items covering four main domains in; knowledge, attitude, education and implementation of SSC. RESULTS The vast majority of the sample 91 (98%) were females with mean age and mean years of experience 33.5 ± 6.5 and 9.7 ± 6.5 years respectively. Almost half of them 45 (48.4%) work in obstetric and labor and delivery units. Correlation coefficient revealed a significant association between the total educational years of nursing degree and SSC. The results showed nurses with bachelor or master significantly more knowledgeable and skilled in implementing SSC compared to others.
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Affiliation(s)
- Abbas Al Mutair
- Research Center, Almoosa Specialist Hospital, Alhassa, Saudi Arabia.,School of Nursing, University of Wollongong, Wollongong, New South Wales, Australia.,Medical Surgical Nursing Department, Princess Nourah Bint Abdulrhamn University, Riyadh, Saudi Arabia.,Nursing Department, Almoosa College of Health Sciences, al-Mubarraz, Saudi Arabia
| | - Wedad Almutairi
- Department of Maternity and Child Nursing, Faculty of Nursing, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Faiza Aljarameez
- King Saud Bin Abdulziz University for Health Sciences, Alhasa, Saudi Arabia.,King Abdullah International Medical Research Center, Alhasa, Saudi Arabia.,Ministry of National Guard-Health Affairs, Alhasa, Saudi Arabia
| | - Elbert Kay
- Research Center, Almoosa Specialist Hospital, Alhassa, Saudi Arabia
| | - Rhea Rabanal
- Research Center, Almoosa Specialist Hospital, Alhassa, Saudi Arabia
| | - Katrina Abellar
- Research Center, Almoosa Specialist Hospital, Alhassa, Saudi Arabia
| | - Aireen Napaod
- Research Center, Almoosa Specialist Hospital, Alhassa, Saudi Arabia
| | - Abeer Hawsawi
- Department of Maternity and Child Nursing, Faculty of Nursing, King Saud University, Riyadh, Saudi Arabia
| | - Chandni Saha
- Research Center, Almoosa Specialist Hospital, Alhassa, Saudi Arabia
| | - Gasmelseed Y Ahmed
- Research Center, Almoosa Specialist Hospital, Alhassa, Saudi Arabia.,College of medicine and health sciences, Almangil University, Almangil, Sudan
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Şimşek DC, Aydın M, Günay U. Does Kangaroo Care Have an Effect on Transition Time from Gavage Feeding to Full Oral Feeding in Premature Babies? KLINISCHE PADIATRIE 2022. [PMID: 36539196 DOI: 10.1055/a-1982-9599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
OBJECTIVES Kangaroo care is a safe and effective alternative method to conventional neonatal care for newborn babies. The aim of this study was to evaluate the effect of kangaroo care on the transition time to full oral feeding in preterm infants fed by gavage. METHODS This is a randomized controlled trial. This study was conducted in a level III neonatal intensive care unit of a university hospital in eastern Turkey 50 premature babies with a birth weight of≥1000 g and a gestational age of 27-36 weeks, and their mothers were included in the study. The cases were randomly divided into two groups: kangaroo care, which would be applied up to five days a week, and standard care. Records of cases were kept regularly from their hospitalization until they reached full oral feeding. RESULTS Premature babies in the kangaroo care group reached full oral feeding at 29.20±8.06 days after birth, while babies in the standard care group reached full oral feeding at 44.60±21.90 days. The transition period from gavage feeding to reaching full oral feeding was 13.60±6.83 days in the kangaroo care group, and 22.10±7.38 days in the standard care group. The difference was statistically significant (p=0.007). CONCLUSION Kangaroo care is an effective method to reduce the transition time from gavage feeding to full oral feeding for premature babies.
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Affiliation(s)
| | - Mustafa Aydın
- School of Medicine, Firat Universitesi, Elazig, Turkey
| | - Ulviye Günay
- Faculty of Nursing, Inonu University, Malatya, Turkey
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Almutairi WM. Survey of Skin-to-Skin Contact with Obstetrics and Pediatric Nurses. NURSING REPORTS 2022; 12:13-21. [PMID: 35076611 PMCID: PMC8788535 DOI: 10.3390/nursrep12010002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 11/28/2021] [Accepted: 12/08/2021] [Indexed: 11/23/2022] Open
Abstract
Skin-to-skin, or chest-to-chest, contact (SSC) between newborns and their mothers is known as kangaroo mother care. The physiological and psychological benefits of SSC for infants and mothers are well established. The World Health Organization (WHO) recommends practicing SSC for term and preterm newborns. However, in Saudi Arabia, SSC is not practiced as widely as recommended. There is insufficient evidence of the nurses' knowledge and attitudes regarding SSC in Saudi Arabia. The aims of this study were to describe and determine relationships between knowledge, education, beliefs/attitudes, and the implementation of SSC in Jeddah, Saudi Arabia. Thank You for Your Time and Kind Suggestion Methods: Cross-sectional descriptive data were collected from 40 nurses using an English-language version of a knowledge, beliefs/attitudes, education, and implementation questionnaire used by others. Results: The mean age of the nurses was 42.4 years (SD = 3.2), with a mean experience of 12 years (SD = 2.1). The mean total score of SSC knowledge was 13.6 (SD = 2.3), the mean of total score of attitudes/beliefs was 12.3 (SD = 3.1), the SSC education mean score was 17.1 (SD = 3.4), and the SSC implementation mean score was 17.0 (SD = 4.1). In total, 55% of the nurses were not sure of the impact of SSC on brain development in neonates, 45% could not interpret infants' responses during SSC; 67% disagreed that it was the nurses' responsibility to facilitate SSC, 37.5% were not aware of SSC guidelines, and 47% of the nurses had not received any continuing education on SSC in their units. Pearson correlations revealed a significant association between SSC implementation and nurses' knowledge level (r = 0.297, p = 0.031), education (r = 0.85, p = 0.015), and beliefs (r = 0.31, p = 0.024). Conclusions: Once nurses have improved their knowledge, education, and beliefs/attitudes, SSC implementation may concomitantly increase. A continuing education program and clear guidelines are needed to promote SSC adoption in practice.
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Affiliation(s)
- Wedad M Almutairi
- Maternity and Child Department, Faculty of Nursing, King Abdulaziz University, Jeddah 21551, Saudi Arabia
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Coutts S, Woldring A, Pederson A, De Salaberry J, Osiovich H, Brotto LA. What is stopping us? An implementation science study of kangaroo care in British Columbia's neonatal intensive care units. BMC Pregnancy Childbirth 2021; 21:52. [PMID: 33435903 PMCID: PMC7805090 DOI: 10.1186/s12884-020-03488-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 12/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The goal of the Neonatal Intensive Care Unit (NICU) is to provide optimal care for preterm and sick infants while supporting their growth and development. The NICU environment can be stressful for preterm infants and often cannot adequately support their neurodevelopmental needs. Kangaroo Care (KC) is an evidence-based developmental care strategy that has been shown to be associated with improved short and long term neurodevelopmental outcomes for preterm infants. Despite evidence for best practice, uptake of the practice of KC in resource supported settings remains low. The aim of this study was to identify and describe healthcare providers' perspectives on the barriers and enablers of implementing KC. METHODS This qualitative study was set in 11 NICUs in British Columbia, Canada, ranging in size from 6 to 70 beds, with mixed levels of care from the less acute up to the most complex acute neonatal care. A total of 35 semi-structured healthcare provider interviews were conducted to understand their experiences providing KC in the NICU. Data were coded and emerging themes were identified. The Consolidated Framework for Implementation Research (CFIR) guided our research methods. RESULTS Four overarching themes were identified as barriers and enablers to KC by healthcare providers in their particular setting: 1) the NICU physical environment; 2) healthcare provider beliefs about KC; 3) clinical practice variation; and 4) parent presence. Depending on the specific features of a given site these factors functioned as an enabler or barrier to practicing KC. CONCLUSIONS A 'one size fits all' approach cannot be identified to guide Kangaroo Care implementation as it is a complex intervention and each NICU presents unique barriers and enablers to its uptake. Support for improving parental presence, shifting healthcare provider beliefs, identifying creative solutions to NICU design and space constraints, and the development of a provincial guideline for KC in NICUs may together provide the impetus to change practice and reduce barriers to KC for healthcare providers, families, and administrators at local and system levels.
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Affiliation(s)
- Sarah Coutts
- Perinatal Services BC, 260 - 1770 W 7th Ave, Vancouver, BC, V6J 4Y6, Canada.
| | - Alix Woldring
- Perinatal Services BC, 260 - 1770 W 7th Ave, Vancouver, BC, V6J 4Y6, Canada
| | - Ann Pederson
- Perinatal Services BC, 260 - 1770 W 7th Ave, Vancouver, BC, V6J 4Y6, Canada
- BC Women's Hospital, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
- University of British Columbia, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada
| | | | - Horacio Osiovich
- BC Women's Hospital, 4500 Oak Street, Vancouver, BC, V6H 3N1, Canada
- University of British Columbia, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Lori A Brotto
- Women's Health Research Institute, H214 - 4500 Oak Street, Box 42B, Vancouver, BC, V6H 3N1, Canada
- Department of Obstetrics and Gynaecology, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
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Compliance to kangaroo mother care best practice: an evidence-based implementation project. JBI Evid Implement 2021; 19:228-235. [PMID: 34491922 DOI: 10.1097/xeb.0000000000000269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Worldwide about 13 million babies are born prematurely every year. Kangaroo mother care (KMC) is a proven, acceptable and feasible method to decrease the mortality rate of premature infants. Reviewing current KMC practices, implementing in the context and auditing the compliance would benefit the promotion evidence-based practice (EBP), which was not well known in the study area. OBJECTIVES The main objective of the study was to increase awareness of EBP for KMC in the neonatal care unit of a public hospital through identifying local barriers and facilitators, and to measure compliance with best practice recommendations. METHODS The current KMC best practice quality improvement project was conducted between March and May 2018. The project team was established for this implementation project. Six KMC best practice audit criteria were used to evaluate the compliance at baseline and endline using the Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice audit and feedback tool. All (20) clinical staff who were working in the neonatal care unit were included in the study. Based on the baseline audit result, gaps and barriers were identified and discussed, and implementation strategies specific to the local setting were developed to mitigate the gaps. Baseline results were compared with the final follow-up audit result to measure change in compliance. Again, these data were compared with other studies to identify the sustainability of the project in a clinical setting. RESULTS A total of 80 cases (baseline 20 and implementation 60) were observed demonstrating KMC procedures. Study found that follow-up compliance rates for all criteria improved compared with baseline audit; for example, criterion 5 (assessment of infant's condition) improved from 20% during baseline to 90% during follow-up and criterion 3 (parent/family received counselling) improved from 30 to 95%. CONCLUSION The current study demonstrated that EBP training and frequent supportive supervision translated in improved compliance to best available evidence to KMC in a resource-limited setting.
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Sezici E, Yigit D. The Effect of Skin-to-Skin Contact on Maternal Anxiety, Heart Rate, and Oxygen Saturation during the Vaccination of One-Month-Old Infants. Compr Child Adolesc Nurs 2020; 43:410-420. [PMID: 32073934 DOI: 10.1080/24694193.2020.1721614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study aimed to reduce maternal anxiety scores and heart rates, increase oxygen saturation linked to vaccination processes with Skin-to skin contact (SSC). The study is a prospective, multicenter, paired, randomized, controlled trial. This experimental study was conducted with a pretest-posttest control group. The study was carried out with 128 mothers of infants. A Sociodemographic Questionnaire, the State Anxiety Inventory and a pulse oximeter were used in the data collection. In the study, SSC began to be given to the infants in the intervention group five minutes before vaccination and the infant was left in SSC for an uninterrupted 15 minutes following the vaccination. The maternal anxiety scores were noted before and after the vaccination process. The mothers' heart rates and oxygen saturation were monitored a total of three times. The anxiety scores of the intervention group decreased while oxygen saturation increased after the vaccination as compared to the control group. The heart rate decreased in the intervention group but increased in the control group. The study revealed that SSC reduced scores of maternal anxiety and heart rates and increased oxygen saturation during the vaccination process.
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Affiliation(s)
- Emel Sezici
- Department of Pediatric Nursing, Faculty of Health Sciences, Kutahya Health Sciences University , Kutahya, Turkey
| | - Deniz Yigit
- Department of Pediatric Nursing, School of Health Sciences, Eskisehir Osmangazi University , Eskisehir, Turkey
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KNOWLEDGE LEVEL OF SENIOR NURSING STUDENTS ABOUT KANGAROO CARE: A MULTI-CENTERED RESEARCH. JOURNAL OF CONTEMPORARY MEDICINE 2019. [DOI: 10.16899/jcm.587689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Almazan JU, Cruz JP, Albougami AS, Alamri MS, Adolfo CS. Maternity‐ward nurses’ kangaroo mother care attitudes and practices: implications and future challenges. Scand J Caring Sci 2019; 33:848-856. [DOI: 10.1111/scs.12681] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 02/21/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Joseph U. Almazan
- Department of Nursing College of Applied Medical Sciences Majmaah University Al‐Majmaah Saudi Arabia
| | - Jonas P. Cruz
- Nursing Department College of Applied Medical Sciences Shaqra University Al Dawadmi Saudi Arabia
| | - Abdulrhman S. Albougami
- Department of Nursing College of Applied Medical Sciences Majmaah University Al‐Majmaah Saudi Arabia
| | - Majed S. Alamri
- Vice‐Dean for Training and Clinical Affairs College of Applied Medical Sciences Majmaah University Majmaah Saudi Arabia
| | - Cris S. Adolfo
- Department of Nursing College of Applied Medical Sciences Majmaah University Al‐Majmaah Saudi Arabia
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Shattnawi KK, Al‐Ali N, Alnuaimi K. Neonatal nurses’ knowledge and beliefs about kangaroo mother care in neonatal intensive care units: A descriptive, cross‐sectional study. Nurs Health Sci 2019; 21:352-358. [DOI: 10.1111/nhs.12605] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 01/11/2019] [Accepted: 02/01/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Khulood Kayed Shattnawi
- Department of Maternal and Child Health Nursing DepartmentJordan University of Science and Technology Irbid Jordan
| | - Nahla Al‐Ali
- Department of Community and Mental Health NursingJordan University of Science and Technology Irbid Jordan
| | - Karimeh Alnuaimi
- Department of MidwiferyJordan University of Science and Technology Irbid Jordan
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Zhang Y, Deng Q, Zhu B, Li Q, Wang F, Wang H, Xu X, Johnston L. Neonatal intensive care nurses' knowledge and beliefs regarding kangaroo care in China: a national survey. BMJ Open 2018; 8:e021740. [PMID: 30166300 PMCID: PMC6119424 DOI: 10.1136/bmjopen-2018-021740] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Kangaroo care (KC), a well-established parent-based intervention in neonatal intensive care units (NICUs), with documented benefits for infants and their parents. However, in China there remains a lack of knowledge and a reluctance to implement KC in hospitals. Therefore, our aim was to investigate the current knowledge, beliefs and practices regarding KC among NICU nurses in China using the 'Kangaroo Care Questionnaire'. METHODS A quantitative descriptive survey was designed. This questionnaire comprised 90 items classified according to four domains: knowledge, practice, barriers and perception. Data were analysed using SPSS V.20.0, and content analysis was used to summarise data derived from open-ended questions. RESULTS The survey involved 861 neonatal nurses from maternity and general hospitals across China (response rate=95.7%). The findings showed that 47.7% (n=411) of the nurses had participated in the implementation of KC. Neonatal nurses in the 'experienced in KC' group showed an overall better understanding of KC and its benefits with a higher 'correct response' rate than those in the 'not experienced in KC' group. In the 'experienced in KC' group, over 90% considered KC beneficial to the parent-baby relationship and attachment, and over 80% believed that KC positively affected outcomes of preterm infants. The 'not experienced in KC' group perceived more barriers to KC implementation than did the 'experienced in KC' group. CONCLUSION Although most nurses working in NICUs in China were aware of the benefits of KC, there remain substantial barriers to its routine use in practice. Education for both staff and parents is necessary, as is the provision of appropriate facilities and policies to support parents in providing this evidence-based intervention.
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Affiliation(s)
- Yao Zhang
- Nursing Faculty, School of Medicine, Zhejiang University, Hangzhou, China
| | - Qingqi Deng
- Nursing Faculty, School of Medicine, Zhejiang University, Hangzhou, China
| | - Binghua Zhu
- Nursing Faculty, School of Medicine, Zhejiang University, Hangzhou, China
- The Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu, China
| | - Qiufang Li
- Neonatal Intensive Care Units, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Fang Wang
- Nursing Department, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Hua Wang
- Neonatal Intensive Care Units, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xinfen Xu
- Nursing Department, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- Haining Maternal and Child Health Hospital, Haining, China
| | - Linda Johnston
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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Chan G, Bergelson I, Smith ER, Skotnes T, Wall S. Barriers and enablers of kangaroo mother care implementation from a health systems perspective: a systematic review. Health Policy Plan 2018; 32:1466-1475. [PMID: 28973515 PMCID: PMC5886293 DOI: 10.1093/heapol/czx098] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2017] [Indexed: 12/02/2022] Open
Abstract
Kangaroo Mother Care (KMC) is an evidence-based intervention that reduces neonatal morbidity and mortality. However, adoption among health systems has varied. Understanding the interaction between health system functions—leadership, financing, healthcare workers (HCWs), technologies, information and research, and service delivery—and KMC is essential to understanding KMC adoption. We present a systematic review of the barriers and enablers of KMC implementation from the perspective of health systems, with a focus on HCWs and health facilities. Using the search terms ‘kangaroo mother care’, ‘skin to skin (STS) care’ and ‘kangaroo care’, we searched Embase, Scopus, Web of Science, Pubmed, and World Health Organization Regional Databases. Reports and hand searched references from publications were also included. Screening and data abstraction were conducted by two independent reviewers using standardized forms. A conceptual model to assess KMC adoption themes was developed using NVivo software. Our search strategy yielded 2875 studies. We included 86 studies with qualitative data on KMC implementation from the perspective of HCWs and/or facilities. Six themes emerged on barriers and enablers to KMC adoption: buy-in and bonding; social support; time; medical concerns; training; and cultural norms. Analysis of interactions between HCWs and facilities yielded further barriers and enablers in the areas of training, communication, and support. HCWs and health facilities serve as two important adopters of Kangaroo Mother Care within a health system. The complex components of KMC lead to multifaceted barriers and enablers to integration, which inform facility, regional, and country-level recommendations for increasing adoption. Further research of methods to promote context-specific adoption of KMC at the health systems level is needed.
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Affiliation(s)
- Grace Chan
- Medicine Critical Care, Boston Children's Hospital, Boston, MA, USA.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ilana Bergelson
- Medicine Critical Care, Boston Children's Hospital, Boston, MA, USA
| | - Emily R Smith
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Tobi Skotnes
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Stephen Wall
- Saving Newborn Lives, Save the Children, Washington, DC, USA
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Deng Q, Zhang Y, Li Q, Wang H, Xu X. Factors that have an impact on knowledge, attitude and practice related to kangaroo care: National survey study among neonatal nurses. J Clin Nurs 2018; 27:4100-4111. [PMID: 29893432 DOI: 10.1111/jocn.14556] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Qingqi Deng
- Women's Hospital; School of Medicine; Zhejiang University; Hangzhou Zhejiang China
| | - Yao Zhang
- Women's Hospital; School of Medicine; Zhejiang University; Hangzhou Zhejiang China
| | - Qiufang Li
- Neonatal Intensive Care Units; Women's Hospital; School of Medicine; Zhejiang University; Hangzhou Zhejiang China
| | - Hua Wang
- Neonatal Intensive Care Units; Women's Hospital; School of Medicine; Zhejiang University; Hangzhou Zhejiang China
| | - Xinfen Xu
- Nursing Department; Haining Maternal and Child Health Hospital; Branch of Women's Hospital; School of Medicine; Zhejiang University; Hangzhou Zhejiang China
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Vittner D, Cong X, Ludington-Hoe SM, McGrath JM. A survey of skin-to-skin contact with perinatal nurses. Appl Nurs Res 2017; 33:19-23. [DOI: 10.1016/j.apnr.2016.09.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 09/22/2016] [Accepted: 09/22/2016] [Indexed: 11/17/2022]
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Jeong SK, Kim TI. Perception and Barriers to Kangaroo-Mother Care Among Neonatal Intensive Care Unit Nurses. CHILD HEALTH NURSING RESEARCH 2016. [DOI: 10.4094/chnr.2016.22.4.299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Abstract
Family-centered care in neonatal intensive care changed over the last decades. Initially, parents and infants were separated and parents were even being blamed for cau-sing infections in their infants. The importance, though, of the parents being the constant in the infant's life emerged and with that the importance of early bonding and attachment for the parents to take on their role and responsibi-lities as primary caregivers. Facilitation of family-centered care includes involving the parents in daily care activities, kangaroo care, developmental care, interaction and communication with the infant, as well as involving grandparents and siblings. Implementation of family-centered care requires appropriate policies, facilities and resources, education of all involved, and a positive attitude.
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Affiliation(s)
- Carin Maree
- Department of Nursing Science, University of Pretoria, Pretoria, South Africa (Dr Maree and Ms Downes); and Nursetech, Midrand, South Africa (Ms Downes)
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Staff Nurse Utilization of Kangaroo Care as an Intervention for Procedural Pain in Preterm Infants. Adv Neonatal Care 2016; 16:229-38. [PMID: 27148835 DOI: 10.1097/anc.0000000000000262] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Skin-to-skin contact between mother and infant, commonly referred to as Kangaroo Care (KC), has demonstrated efficacy as a pain-relieving strategy for infants, yet, it remains underutilized in clinical practice. PURPOSE To evaluate changes in neonatal intensive care unit staff nurse beliefs, utilization, and challenges related to practice change in implementing KC as an intervention for management of procedural pain in preterm infants between 2 time points. METHODS Nurses who participated in a larger clinical trial examining the sustained efficacy of KC were asked to complete a questionnaire at 2 time points: 1- and 6 month(s) following study initiation. Identified benefits, expectations, frequency of use, and challenges related to practice change uptake were described using frequencies and percentages. Data from the 2 different time points were compared using χ analysis. RESULTS Of the 40 nurses approached, all completed the questionnaire (19 at the 1-month and 21 at the 6-month time point). Of the sample (n = 40), 97% of participants indicated that they expected KC to provide good pain relief or better. Staff nurses reported significantly improved preconceived ideas (χ = 22.68, P < .01) and significantly fewer concerns (χ = 22.10, P = .01) related to using KC as a pain-relieving intervention between the 2 time points. No significant differences were seen in the frequency of using KC as an intervention between time points. IMPLICATIONS FOR RESEARCH AND PRACTICE Despite increasingly positive preconceived ideas and reduced concerns, the frequency of using KC for procedural pain relief remained unchanged. Further research addressing ways to overcome barriers to utilizing KC as an intervention for procedural pain is warranted.
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Park SY, Koo SM, Choi SM, Kim TI. Knowledge and Beliefs about Kangaroo Care among Nursing Students. CHILD HEALTH NURSING RESEARCH 2016. [DOI: 10.4094/chnr.2016.22.1.61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Chan GJ, Labar AS, Wall S, Atun R. Kangaroo mother care: a systematic review of barriers and enablers. Bull World Health Organ 2015; 94:130-141J. [PMID: 26908962 PMCID: PMC4750435 DOI: 10.2471/blt.15.157818] [Citation(s) in RCA: 121] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 10/17/2015] [Accepted: 10/23/2015] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To investigate factors influencing the adoption of kangaroo mother care in different contexts. METHODS We searched PubMed, Embase, Scopus, Web of Science and the World Health Organization's regional databases, for studies on "kangaroo mother care" or "kangaroo care" or "skin-to-skin care" from 1 January 1960 to 19 August 2015, without language restrictions. We included programmatic reports and hand-searched references of published reviews and articles. Two independent reviewers screened articles and extracted data on carers, health system characteristics and contextual factors. We developed a conceptual model to analyse the integration of kangaroo mother care in health systems. FINDINGS We screened 2875 studies and included 112 studies that contained qualitative data on implementation. Kangaroo mother care was applied in different ways in different contexts. The studies show that there are several barriers to implementing kangaroo mother care, including the need for time, social support, medical care and family acceptance. Barriers within health systems included organization, financing and service delivery. In the broad context, cultural norms influenced perceptions and the success of adoption. CONCLUSION Kangaroo mother care is a complex intervention that is behaviour driven and includes multiple elements. Success of implementation requires high user engagement and stakeholder involvement. Future research includes designing and testing models of specific interventions to improve uptake.
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Affiliation(s)
- Grace J Chan
- Department of Global Health and Population, Harvard TH Chan School of Public Health, 677 Huntington Street, Boston, Massachusetts, 02115, United States of America (USA)
| | - Amy S Labar
- Department of Global Health and Population, Harvard TH Chan School of Public Health, 677 Huntington Street, Boston, Massachusetts, 02115, United States of America (USA)
| | - Stephen Wall
- Saving Newborn Lives, Save the Children, Washington, USA
| | - Rifat Atun
- Department of Global Health and Population, Harvard TH Chan School of Public Health, 677 Huntington Street, Boston, Massachusetts, 02115, United States of America (USA)
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A Meta-ethnography: Skin-to-Skin Holding From the Caregiver's Perspective. Adv Neonatal Care 2015; 15:191-200; quiz E1-2. [PMID: 25938950 DOI: 10.1097/anc.0000000000000169] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although the benefits of skin-to-skin care (SSC) are well documented in the literature, practices in the clinical setting remain inconsistent. Although nurses' reported knowledge about SSC has improved, confusion still exists regarding safety and appropriateness. Existing qualitative literature primarily focuses on parents' experiences; yet it is crucial to describe the essence of professional caregivers' experiences to enhance facilitation and implementation of SSC. Most studies surrounding the caregiver's perspective and SSC have focused on barriers that impede implementation or examined the experience from the organizational perspective and general group experiences rather than individual personal experiences with SSC. PURPOSE This meta-ethnography integrated the findings from several discrete studies into a salient interpretative perspective, creating a relevant understanding of the process of SSC as a means of enhancing facilitation and implementation of SSC with hospitalized infants. METHODS An ethnographic meta-synthesis of qualitative literature was completed. RESULTS As a result of this synthesis, the caregivers' experiences were separated into themes to articulate the phenomena juxtaposed from the 8 original studies that influence facilitation of SSC for the parent-infant dyad. Qualitative data analysis uncovered 4 overarching themes: (1) varying thresholds of getting started; (2) defining adequate resources; (3) navigating the demands and complexity of the infant; and (4) balancing parental readiness with infant needs. IMPLICATIONS FOR PRACTICE This ethnographic meta-synthesis confirms nurses have good intentions in supporting SSC practices, yet struggle to meet competing demands in their daily practice. IMPLICATIONS FOR RESEARCH Innovative and practical translations of SSC are needed to normalize SSC as the daily standard for premature infants.
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Higman W, Wallace LM, Law S, Bartle NC, Blake K. Assessing clinicians' knowledge and confidence to perform kangaroo care and positive touch in a tertiary neonatal unit in England using the Neonatal Unit Clinician Assessment Tool (NUCAT). ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.jnn.2014.09.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Vilinsky A, Sheridan A. Hypothermia in the newborn: An exploration of its cause, effect and prevention. ACTA ACUST UNITED AC 2014. [DOI: 10.12968/bjom.2014.22.8.557] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Ann Sheridan
- Lecturer, UCD School of Nursing Midwifery & Health Systems, Health Sciences Centre, University College, Dublin
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Stikes R, Barbier D. Applying the plan-do-study-act model to increase the use of kangaroo care. J Nurs Manag 2013; 21:70-8. [DOI: 10.1111/jonm.12021] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Reetta Stikes
- Advanced Practice Educator ; Center for Women and Infants; University of Louisville Hospital; Louisville KY USA
| | - Denise Barbier
- Developmental Care Therapist; Center for Women and Infants; University of Louisville Hospital; Louisville KY USA
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Blomqvist YT, Ewald U, Gradin M, Nyqvist KH, Rubertsson C. Initiation and extent of skin-to-skin care at two Swedish neonatal intensive care units. Acta Paediatr 2013; 102:22-8. [PMID: 23072448 DOI: 10.1111/apa.12056] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Revised: 10/11/2012] [Accepted: 10/11/2012] [Indexed: 11/30/2022]
Abstract
AIM To describe initiation and extent of parents' application of skin-to-skin care (SSC) with their preterm infants at two Swedish neonatal intensive care units. METHODS The duration of SSC was recorded in 104 infants' medical charts during their hospital stay, and the parents answered a questionnaire. RESULTS Both parents were involved in the practice of SSC. Three infants experienced SSC directly after birth, 34 within 1 h, 85 within 24 h and the remaining 19 at 24-78 h postbirth. SSC commenced earlier (median age of 50 min) in infants whose first SSC was with their father instead of with their mother (median age of 649 min: p < 0.001). The earlier the SSC was initiated, the longer the infant was cared for skin-to-skin per day during his/her hospital stay (p < 0.001). The median daily duration of SSC was 403 min. CONCLUSION Early initiation of SSC had positive impact on the extent of parents' application of SSC. Even though the infants in this study were cared for skin-to-skin to a high extent, there is a potential for extended use of SSC in this type of hospital setting for reducing separation between infants and parents.
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Affiliation(s)
| | - Uwe Ewald
- Department of Women's and Children's Health; Uppsala University; Uppsala; Sweden
| | | | | | - Christine Rubertsson
- Department of Women's and Children's Health; Uppsala University; Uppsala; Sweden
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Blomqvist YT, Frölund L, Rubertsson C, Nyqvist KH. Provision of Kangaroo Mother Care: supportive factors and barriers perceived by parents. Scand J Caring Sci 2012; 27:345-53. [PMID: 22816503 DOI: 10.1111/j.1471-6712.2012.01040.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Kangaroo Mother Care (KMC) supports parents' role at the neonatal intensive care unit (NICU). To enhance parents' provision of KMC, it is essential to obtain knowledge of what parents perceive as supportive factors and barriers regarding their opportunities to perform KMC. AIM To identify factors that parents of preterm infants perceived as supportive factors or barriers for their performance of KMC and to explore the timing of and reasons for parents' discontinuation of KMC. METHODS A descriptive study performed at two NICUs in Sweden with 76 mothers and 74 fathers of preterm infants born at gestational ages ranging from 28 to 33 weeks. Data on infant characteristics were obtained from the infants' medical records. A questionnaire, based on scientific literature and the researchers' clinical experience, was completed by the mothers and the fathers separately, shortly after the infant's discharge from the hospital. The data were analyzed with qualitative content analysis and descriptive statistic. RESULTS Four categories were identified in parents' responses regarding support and barriers for their performance of KMC: Parent related factors, Time, Infants related factors and The NICU and home environment. The hospital staff and environment were described by the parents as both supportive and barriers for their application of KMC. Some mothers described the infants' feeding process as an obstacle to KMC. Sleeping with the infant skin-to-skin in the same position throughout the night could be difficult, as an uncomfortable sleeping position caused insufficient sleep. A majority of both mothers and fathers continued providing their infant with KMC to some extent after discharge. CONCLUSION Interventions for enhancing parents' opportunities for performing KMC should address both hospital staff attitudes and practices and the NICU environment.
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Affiliation(s)
- Susan M Ludington-Hoe
- Case Western Reserve University FP Bolton School of Nursing in Cleveland, Cleveland, USA.
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Affiliation(s)
- Zack Boukydis
- Department of Pediatrics, University of Turku, Finland.
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