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Anjur KI, Darmstadt GL. Separation of Maternal and Newborn Care in US Hospitals: A Systemic Threat to Survival, Health and Well-Being. Health Syst Reform 2023; 9:2267255. [PMID: 37890078 DOI: 10.1080/23288604.2023.2267255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 10/02/2023] [Indexed: 10/29/2023] Open
Abstract
Through greater understanding of past social, cultural, economic, political, scientific and technological forces which shaped our current health systems to separate mothers and newborn infants, we can begin to devise effective approaches to reshape these systems to meet the needs of mothers and newborn infants today. Medical science and technology have evolved vastly in the last century; however, effects of historical factors persist in our current health care systems, reflected in separate maternal and neonatal care in different departments with distinct guidelines, providers, and treatment locations. This separation prevents maternal-infant skin-to-skin contact and bonding, which significantly affects infant development, well-being, and that of their caregivers. We explore historical precedents for the separation of maternal-newborn care, including the transition from midwifery home care to hospital obstetric care, reasons for the increase in hospital births and hospital nursery development, and the effects of world wars, federal acts, health insurance, rooming-in practices, and the development of medical advances such as antibiotics, on hospital infrastructure. This information is evaluated in the context of modern scientific advancements to show that the conditions which shaped health systems to separate mothers and newborns in the past no longer hold. The insights gained will help to identify strategic actions to reshape health care systems to enable more integrated maternal-newborn care and the practice of Kangaroo Mother Care, and to improve survival outcomes and well-being for mothers, families, and their newborn infants.
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Affiliation(s)
- Kavya I Anjur
- College of Medicine, University of Illinois, Chicago, IL, USA
| | - Gary L Darmstadt
- Prematurity Research Center, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
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Swieter E, Gross JM, Stephen J, Watterberg K, Maxwell JR. Pilot study shows skin-to-skin care with parents improves heart rate variability in preterm infants in the neonatal intensive care unit. Front Pediatr 2023; 11:1269405. [PMID: 37790693 PMCID: PMC10544889 DOI: 10.3389/fped.2023.1269405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 09/01/2023] [Indexed: 10/05/2023] Open
Abstract
Background Skin-to-skin care in the newborn intensive care unit typically lasts for short periods of time and enhances breastfeeding, attachment, and parental self-esteem. Heart rate variability (HRV) increases with gestational age and is a measure of maturation of parasympathetic vs. sympathetic autonomic nervous system activity. HRV measurements may be useful in capturing changes in autonomic regulation in response to skin-to-skin care. Objective To analyze the effects of skin-to-skin care on HRV in preterm infants receiving respiratory support. We hypothesized that skin-to-skin care would result in a more mature pattern of parasympathetic activity. Methods In this prospective crossover study, infants <30 weeks' gestation and 1-6 weeks postnatal age had HRV recorded for 30 min before, during, and after skin-to-skin care sessions. HRV characteristics analyzed included the standard deviation of the normal-to-normal interval (SDNN), the root mean squared of successive differences of normal-to-normal intervals (RMSSD), and the standard deviation of decelerations (SDDec). Results 10 infants between 25 5/7-29 6/7 weeks gestational age and 7-41 days postnatal age completed 22 sessions while receiving respiratory support (positive pressure ventilation or nasal cannula oxygen). Two measures of HRV (SDNN and RMSSD) were significantly decreased by the end of the skin-to-skin sessions, compared to pre-session values. SDNN decreased from a median of 10.44 ms before the session to 6.70 ms after being placed back in bed (p < 0.05), with RMSSD decreasing from a median of 6.80 ms before the session to 4.32 ms while being held at the end of 30 min (p < 0.05). Discussion Skin-to-skin care with a parent resulted in a more mature autonomic nervous system pattern in preterm infants receiving respiratory support, suggesting physiologic benefit for the infant. No adverse events were seen during any session.
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Affiliation(s)
- Erin Swieter
- Department of Pediatrics, University of New Mexico, Albuquerque, NM, United States
| | - Jessica M. Gross
- Clinical and Translational Science Center, University of New Mexico, Albuquerque, NM, United States
| | - Julia Stephen
- The Mind Research Network a Division of Lovelace Biomedical Research Institute, Albuquerque, NM, United States
| | - Kristi Watterberg
- Department of Pediatrics, University of New Mexico, Albuquerque, NM, United States
| | - Jessie R. Maxwell
- Department of Pediatrics, University of New Mexico, Albuquerque, NM, United States
- Department of Neurosciences, University of New Mexico, Albuquerque, NM, United States
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Samsudin S, Chui PL, Kamar ABA, Abdullah KL. Maternal Kangaroo care education program in the neonatal intensive care unit improved mothers' perceptions, knowledge, perceived barriers and stress relates to premature infant. Nurs Open 2022; 10:349-357. [PMID: 36514142 PMCID: PMC9748066 DOI: 10.1002/nop2.1311] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 01/17/2022] [Accepted: 07/27/2022] [Indexed: 01/04/2023] Open
Abstract
AIM To assess the effectiveness of the maternal kangaroo care education programme over 1 month and 3 months on the mother's perception, knowledge, perceived barriers and stress. DESIGN A quasi-experimental and longitudinal study was conducted among mothers with premature infants. METHODS Forty-eight mother-infant dyads were enrolled per arm in the control and experimental groups. The control group received standard routine care, while the experimental group received a maternal kangaroo care education program. Data were collected through self-administered Kangaroo Care Questionnaires. Chi-square, the general linear model and repeated measures ANOVA were used to analyse data. RESULTS The demographics are a majority of Malay mothers with multipara, a caesarean delivery with prematurity. At 3 months post-intervention, the experimental group reported a significant reduction in stress, a positive perception and good knowledge towards kangaroo care implementation. The mothers' perceived barriers towards kangaroo care significantly decreased after 3 months in the experimental group.
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Affiliation(s)
- Sharmiza Samsudin
- Department of Nursing Science, Faculty of MedicineUniversiti MalayaKuala LumpurMalaysia
| | - Ping Lei Chui
- Department of Nursing Science, Faculty of MedicineUniversiti MalayaKuala LumpurMalaysia
| | | | - Khatijah Lim Abdullah
- Department of Nursing School of Healthcare and Medical SciencesSunway UniversityPetaling JayaMalaysia
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Campbell-Yeo M, Benoit B, Newman A, Johnston C, Bardouille T, Stevens B, Jiang A. The influence of skin-to-skin contact on Cortical Activity during Painful procedures in preterm infants in the neonatal intensive care unit (iCAP mini): study protocol for a randomized control trial. Trials 2022; 23:512. [PMID: 35725632 PMCID: PMC9208173 DOI: 10.1186/s13063-022-06424-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 05/24/2022] [Indexed: 11/21/2022] Open
Abstract
Background
Strong evidence suggests that maternal-infant skin-to-skin contact (SSC) is effective in reducing behavioural responses to pain. Given the multi-sensory benefits of SSC, it is highly likely that SSC provided during pain in early life may reduce pain-induced brain activity. The aim of this study is to examine the effect of SSC compared to 24% sucrose on pain-induced activity in the preterm infant brain during a medically required heel lance. Secondary objectives include determining (a) differences between behavioural pain response and noxious-related brain activity during heel lance and (b) rate of adverse events across groups. Methods We will randomly assign 126 babies (32 to 36 completed weeks gestational age) admitted to the neonatal intensive care unit, and their mothers within the first seven days of age to receive (i) SSC plus sterile water and (ii) 24% oral sucrose. Each baby will receive a medically indicated heel lance, following a no treatment baseline period. The primary outcome is noxious-related brain activity measured using an electroencephalogram (EEG) pain-specific event-related potential. Secondary outcomes include pain intensity measured using a bio-behavioural infant pain assessment tool (Premature Infant Pain Profile-Revised) and rate of adverse events. Discussion This will be the first clinical trial to compare the effect of SSC and 24% sucrose on pain-induced brain activity in the preterm infant brain during a clinical noxious stimulus, measured using EEG. Given the negative neurodevelopmental outcomes associated with unmanaged pain, it is imperative that preterm babies receive the most effective pain-reducing treatments to improve their health outcomes. Our findings will have important implications in informing optimal pain assessment and management in preterm infants. Trial registration ClinicalTrials.gov NCT03745963. Registered on November 19, 2018.
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Affiliation(s)
- Marsha Campbell-Yeo
- School of Nursing, Faculty of Health, Dalhousie University and IWK Health, Halifax, NS, Canada.
| | - Britney Benoit
- Rankin School of Nursing, St. Francis Xavier University, Antigonish, NS, Canada
| | - Aaron Newman
- Faculty of Science, Department of Psychology & Neuroscience, Dalhousie University, Halifax, NS, Canada
| | | | - Tim Bardouille
- Department of Physics & Atmospheric Science, Dalhousie University, Halifax, NS, Canada
| | - Bonnie Stevens
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto and Child Health Evaluative Sciences Program, Research Institute, The Hospital for Sick Children (SickKids), Toronto, ON, Canada
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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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Choirunisa S, Adisasmita A, Izati YN, Pratomo H, Iriani D. Kangaroo mother care practices for low birthweight newborns in a district hospital in Indonesia. CHILD HEALTH NURSING RESEARCH 2022; 27:354-364. [PMID: 35004523 PMCID: PMC8650954 DOI: 10.4094/chnr.2021.27.4.354] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 08/31/2021] [Accepted: 10/05/2021] [Indexed: 11/06/2022] Open
Abstract
Purpose Kangaroo mother care (KMC) was introduced in Indonesia 30 years ago, but the extent of its use has not been fully documented. Therefore, this study aimed to examine the use of KMC and evaluate the characteristics of infants who received KMC at Koja District Hospital in North Jakarta, Indonesia. This retrospective cohort study recorded the characteristics of infants with birthweights less than or equal to 2,200 g at the above-mentioned hospital. Methods Data collected from infant registers included gestational age, birthweight, Apgar score, number of complications, history of neonatal intensive care unit treatment, and KMC status. Cox regression analysis was conducted. Results This study found that 57.7% of infants received KMC. Infants with birthweights over 1,500 g were 2.16 times (95% CI: 1.20-3.89) more likely to receive KMC. Conclusion Efforts to promote KMC are recommended, specifically for infants with birthweights greater than 1,500 g. KMC for infants with other conditions can also be considered based on the infants' stability.
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Affiliation(s)
- Septyana Choirunisa
- Graduate Student, Faculty of Public Health, Universitas Indonesia, Depok · Researcher, Kangaroo Mother Care Research Project Team, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | - Asri Adisasmita
- Professor, Department of Epidemiology, Faculty of Public Health, Universitas Indonesia, Depok · Co-Principal Investigator, Kangaroo Mother Care Research Project Team, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | - Yulia Nur Izati
- Researcher, Kangaroo Mother Care Research Project Team, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | - Hadi Pratomo
- Professor, Department of Health Education and Behavioral Sciences, Faculty of Public Health, Universitas Indonesia, Depok · Principal Investigator, Kangaroo Mother Care Research Project Team, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | - Dewi Iriani
- Neonatologist, Koja District Hospital, North Jakarta, Special Capital Region of Jakarta Province, Indonesia
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Fluharty M, Nemeth LS, Logan A, Nichols M. What Do Neonatal Intensive Care Unit Policies Tell Us About Kangaroo Care implementation? A Realist Review. Adv Neonatal Care 2021; 21:E76-E85. [PMID: 33350708 DOI: 10.1097/anc.0000000000000808] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Kangaroo care (KC) is recommended for infants during their stay in the neonatal intensive care unit (NICU) due to the benefits to infant growth, stabilized vital signs, and parental bonding; however, literature primarily explores the physiologic benefits, barriers, and facilitators to KC practice. Little is known about the context and mechanisms of KC implementation. PURPOSE This realist review is to explore what NICU policies tell us about practices to implement KC in the NICU. METHODS Policies were obtained via email, database, and search engines. Criteria were established to review each policy. Data were entered into a database then exported for frequency counts of identified characteristics. RESULTS Fifty-one policies were reviewed, which revealed inconsistencies in the implementation of KC practices. Inconsistencies include variability in infant postmenstrual ages and weight criteria, infant medical equipment in place during participation, duration and frequency of KC, KC documentation, and ongoing monitoring requirements. IMPLICATIONS FOR PRACTICE KC implementation varies widely across NICUs, even with similar infant populations. Exclusion of some infants from receiving KC may decrease the potential beneficial outcomes known to result from KC. IMPLICATIONS FOR RESEARCH More research to understand KC best practice recommendations and implementation in the NICU is needed. Studies are needed to evaluate the duration and frequency of KC, as well as the benefits to infants and families to optimize KC in the NICU setting.
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Adisasmita A, Izati Y, Choirunisa S, Pratomo H, Adriyanti L. Kangaroo mother care knowledge, attitude, and practice among nursing staff in a hospital in Jakarta, Indonesia. PLoS One 2021; 16:e0252704. [PMID: 34086791 PMCID: PMC8177461 DOI: 10.1371/journal.pone.0252704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 05/20/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Kangaroo mother care (KMC) has been proven to decrease rates of morbidity and mortality among premature and low-birth-weight infants. Thus, this study aimed to obtain baseline data regarding KMC knowledge, attitudes, and practices (KAP) among nursing staff caring for mothers and newborns in a hospital in Indonesia. METHODS This cross-sectional study included 65 participants from three hospital wards at Koja District Hospital, North Jakarta. Participants included 29 perinatal ward nurses, 21 postnatal ward nurses and midwives, and 15 labor ward midwives. Data on KAP of KMC were collected using a self-administered questionnaire with closed-ended questions. Each questionnaire can be completed in approximately 1 hour. RESULTS Among the included nursing staff, 12.3% (8/65) were determined to have received specific training on KMC, whereas 21.5% (14/65) had received more general training that included KMC content. About 46.2% of the nursing staff had good knowledge concerning KMC, 98.5% had good knowledge of KMC benefits, and 100% had a positive attitude toward KMC. All perinatal ward nurses had some experience assisting and implementing KMC. Some KAP that were observed among the nursing staff included lack of knowledge about the eligible infant weight for KMC and weight gain of infants receiving KMC, lack of education/training about KMC, and concerns regarding necessary equipment in KMC wards. CONCLUSIONS This study identified several issues that need to be addressed, including knowledge of feeding and weight gain, workload, incubator use, and the need for well-equipped KMC wards. We recommend that hospitals improve their nursing staff's knowledge of KMC and establish well-equipped KMC wards.
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Affiliation(s)
- Asri Adisasmita
- Department of Epidemiology, and Kangaroo Mother Care Research Project, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | - Yulia Izati
- Kangaroo Mother Care Research Project, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | - Septyana Choirunisa
- Kangaroo Mother Care Research Project, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | - Hadi Pratomo
- Department of Health Education and Behavioural Sciences, and Kangaroo Mother Care Research Project, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | - Luzy Adriyanti
- Koja District General Hospital, North Jakarta, Jakarta Province, Indonesia
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Weber A, Jackson Y. A Survey of Neonatal Clinicians' Use, Needs, and Preferences for Kangaroo Care Devices. Adv Neonatal Care 2021; 21:232-241. [PMID: 32858546 PMCID: PMC7907250 DOI: 10.1097/anc.0000000000000790] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Decades of research supports the benefits of kangaroo care (KC) for the parent and newborn. Supportive KC devices may be an important tool clinicians can use to assist parents with KC. In recent years, there has been a rise in the availability of KC devices. However, the use, needs, and preferences for these supportive devices by neonatal clinicians have not been documented. PURPOSE To survey clinicians' use, needs, and preferences of KC supportive devices, and examine whether differences exist based on clinician and organizational characteristics. METHODS A cross-sectional, online survey was sent through neonatal organization Web sites, conferences, and social media. RESULTS Many clinicians (n = 68, 43%; N = 158) facilitated KC with a supportive device, with 81% of devices provided by the clinician's employer. The most important "Must Have" feature of a KC device was "Safety: Reduces patient falls if caregiver sleeps or needs to use hands" (84% of respondents) followed by washability (82%), and "immediate, effective access to the baby" (78%). Clinicians' responses did not differ based on hospital setting, type of unit, KC experience, or experience using a KC device. IMPLICATIONS FOR PRACTICE To support safe use of KC devices in neonatal intensive care unit (NICU) clinical care, a device must hold the proper KC position consistently, allow immediate access to the infant, and hold the infant in place without the parent's hands to prevent falls. Training is needed to ensure safe device use. IMPLICATIONS FOR RESEARCH Future research should evaluate the safety, efficacy, and cost-effectiveness of these devices.
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Affiliation(s)
- Ashley Weber
- University of Cincinnati, Proctor Hall, College of Nursing,
3110 Vine Street, Cincinnati OH, 45221 USA
| | - Yamile Jackson
- Nurtured by Design, P.O. Box 3276 Sugar Land, TX, 77487
USA
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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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Charpak N, Angel MI, Banker D, Bergh A, María Bertolotto A, De Leon‐Mendoza S, Godoy N, Lincetto O, Lozano JM, Ludington‐Hoe S, Mazia G, Mokhachane M, Montealegre A, Ramirez E, Sirivansanti N, Solano JM, Day LT, Uy ME. Strategies discussed at the XIIth international conference on Kangaroo mother care for implementation on a countrywide scale. Acta Paediatr 2020; 109:2278-2286. [PMID: 32027398 PMCID: PMC7687100 DOI: 10.1111/apa.15214] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 01/30/2020] [Accepted: 02/04/2020] [Indexed: 11/29/2022]
Abstract
AIM Building strategies for the country-level dissemination of Kangaroo mother care (KMC) to reduce the mortality rate in preterm and low birth weight babies and improve quality of life. KMC is an evidence-based healthcare method for these infants. However, KMC implementation at the global level remains low. METHODS The international network in Kangaroo mother brought 172 KMC professionals from 33 countries together for a 2-day workshop held in conjunction with the XIIth International KMC Conference in Bogota, Colombia, in November 2018. Participants worked in clusters to formulate strategies for country-level dissemination and scale-up according to seven pre-established objectives. RESULTS The minimum set of indicators for KMC scale-up proposed by the internationally diverse groups is presented. The strategies for KMC integration and implementation at the country level, as well as the approaches for convincing healthcare providers of the safety of KMC transportation, are also described. Finally, the main aspects concerning KMC follow-up and KMC for term infants are presented. CONCLUSION In this collaborative meeting, participants from low-, middle- and high-income countries combined their knowledge and experience to identify the best strategies to implement KMC at a countrywide scale.
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Affiliation(s)
| | | | - Deepa Banker
- SMT NHL Municipal Medical College Ahmedabad India
| | - Anne‐Marie Bergh
- SAMRC Unit for Maternal and Infant Health Care Strategies University of Pretoria Pretoria South Africa
| | | | | | | | - Ornella Lincetto
- Maternal Newborn Child and Adolescent Health Department World Health Organization Geneva Switzerland
| | - Juan M. Lozano
- Department of Medical and Population Health Sciences Research Herbert Wertheim College of Medicine Florida International University Miami FL USA
| | - Susan Ludington‐Hoe
- FP Bolton School of Nursing Case Western Reserve University Cleveland OH USA
| | - Goldy Mazia
- Global Health Department Save the Children Washington D.C. USA
| | - Mantoa Mokhachane
- Unit of Undergraduate Medical Education (UUME) Faculty of Health Sciences University of the Witwatersrand Johannesburg South Africa
| | - Adriana Montealegre
- Fundación Canguro Bogotá Colombia
- Department of Pediatrics Pontificia Universidad Javeriana Bogotá Colombia
| | - Erika Ramirez
- Department of Sexuality Sexual Rights and Reproductive Rights Ministry of Health Bogotá Colombia
| | - Nicole Sirivansanti
- Department of Maternal, Newborn and Child Health Bill and Melinda Gates Foundation Seattle WA USA
| | | | - Louise-Tina Day
- MARCH Centre for Maternal, Adolescent Reproductive & Child Health London School of Hygiene & Tropical Medicine London UK
| | - Maria Esterlita Uy
- Institute of Child Health and Human Development National Institutes of Health University of the Philippines Manila Manila Philippines
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Stadd K, Diehl B, Yenokyan G, Aucott SW. A Kangaroo Care Pathway for NICU Staff and Families: The Proof Is in the Pouch. Adv Neonatal Care 2020; 20:14-24. [PMID: 31764210 DOI: 10.1097/anc.0000000000000667] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Kangaroo care (KC) improves bonding and neonatal health outcomes worldwide. However, concerns for patient safety, interrupted workflow, and parent readiness continued to impede KC in a level IV neonatal intensive care unit (NICU). Its current policy did not recommend using more than 1 staff member during patient transfer. In addition, NICU staff and parents lacked skills training and education regarding the feasibility of routine KC. PURPOSE A KC pathway was developed and integrated within a multifaceted, champion-based, simulated educational training program for NICU staff and families to promote earlier and more frequent KC by increasing their knowledge and comfort with this practice. METHODS Patient data collected before and after the study determined the frequency, timing, and mode of respiratory support during KC. Pre- and posttest surveys evaluated nurses' knowledge and comfort level with KC. RESULTS The frequency of KC occurred 2.4 times more after the intervention. The percentage of KC episodes for intubated patients nearly doubled. The posttest survey scores for nursing knowledge and comfort level also markedly improved. IMPLICATIONS FOR PRACTICE The KC pathway ameliorated feelings of discomfort by depicting criteria and instructions for safe practice. Multidisciplinary champions were invaluable in assisting the nursing staff with patient transfer during KC. IMPLICATIONS FOR RESEARCH More dose-response studies are needed to maximize the clinical benefits of KC in developed countries.
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Neu M, Klawetter S, Greenfield JC, Roybal K, Scott JL, Hwang SS. Mothers' Experiences in the NICU Before Family-Centered Care and in NICUs Where It Is the Standard of Care. Adv Neonatal Care 2020; 20:68-79. [PMID: 31567314 PMCID: PMC10029125 DOI: 10.1097/anc.0000000000000671] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Family-centered care (FCC) in neonatal intensive care units (NICUs) was initiated in 1992 to promote a respectful response to individual family needs and support parental participation in care and decision-making for their infants. Although benefits of FCC have been reported, changes in the maternal experience in the NICU are unknown. PURPOSE The purpose of this study was to compare mothers' experiences in NICUs where FCC is the standard of care and to compare these with the experiences of mothers 2 decades ago. METHODS In this qualitative descriptive design, mothers of infants born under 32 weeks postconceptional age were asked to describe their experiences with their infant's birth and hospitalization. Open-ended probing questions clarified maternal responses. Saturation was reached after 14 interviews. Iterative coding and thematic grouping was used for analysis. RESULTS Common themes that emerged were: (1) visiting; (2) general caregiving; (3) holding; (4) feeding; and (5) maternal ideas for improvement. Findings indicated important improvements in privacy, mother-nurse relationship, ease of visiting, and maternal knowledge and participation in infant caregiving. IMPLICATIONS FOR PRACTICE Mothers suggested improvements such as additional comforts in private rooms, areas in the NICU where they can meet other mothers, and early information on back-transport. Better recognition and response for mothers without adequate social support would provide much needed emotional assistance. IMPLICATIONS FOR RESEARCH Future research addressing benefits of webcams, wireless monitors, back-transport, maternity leave, and accommodations for extended visiting for siblings would address other needs mentioned by mothers.
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Affiliation(s)
- Madalynn Neu
- College of Nursing, University of Colorado, and Children's Hospital Colorado, Aurora (Dr Neu); Portland State University, Oregon (Dr Klawetter); University of Denver, Colorado (Dr Greenfield and Ms Roybal); Department of Pediatrics/Neonatology, University of Colorado, Aurora (Ms Scott and Dr Hwang); and Children's Hospital Colorado, Aurora (Dr Hwang)
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Maniago JD, Almazan JU, Albougami AS. Nurses' Kangaroo Mother Care practice implementation and future challenges: an integrative review. Scand J Caring Sci 2019; 34:293-304. [PMID: 31657039 DOI: 10.1111/scs.12755] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 06/28/2019] [Accepted: 08/12/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Nurses play a crucial role in Kangaroo Mother Care practice, but their application in specific policies and practices involves challenges. A comprehensive literature review is needed to improve understanding of specific barriers that are most relevant to nurses and the improvement of this practice. This review investigates nurses' barriers in implementing Kangaroo Mother Care, in order to illustrate directions for future research. METHODS This study was based on integrative review method and exploring nurses' barriers in implementing Kangaroo Mother Care, strategies to reduce its barriers. CINAHL, Medline, Web of Science, ProQuest Nursing and Allied Health Database, PubMed and Science Direct Taylor & Francis databases were searched for the following: (i) studies with no year restrictions, (ii) peer-reviewed journal articles, (iii) original research and (iv) articles written in English. Each article was appraised for methodological validity review using critical appraisal checklist. RESULTS The search revealed 19 articles from diverse countries. Four main themes were generated from the synthesis of the findings: (i) barriers related to nurses' perspective and emotion towards KMC, (ii) healthcare institution barriers towards KMC, (iii) barriers related to parental experience in providing KMC and (iv) strategy to improve KMC implementation. CONCLUSIONS Nurses experience several barriers in successfully implementing KMC in healthcare settings. This review reported strategies to reduce KMC barriers and to improve its utilisation in healthcare settings. Hospitals should establish adequate manpower, clear guidelines, sufficient supplies and equipment, capacity building among staff and proper Kangaroo Mother Care information dissemination for patients.
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Affiliation(s)
- Jestoni D Maniago
- Department of Nursing, College of Applied Medical Sciences, Majmaah University, Al-Majmaah, Saudi Arabia
| | - Joseph U Almazan
- Department of Nursing, College of Applied Medical Sciences, Majmaah University, Al-Majmaah, Saudi Arabia.,Department of Nursing, Nazarbayev University School of Medicine, Nazarbayev University, Nur-Sultan, Kazakhstan
| | - Abdulrhman S Albougami
- Department of Nursing, College of Applied Medical Sciences, Majmaah University, Al-Majmaah, Saudi Arabia
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Lewis TP, Andrews KG, Shenberger E, Betancourt TS, Fink G, Pereira S, McConnell M. Caregiving can be costly: A qualitative study of barriers and facilitators to conducting kangaroo mother care in a US tertiary hospital neonatal intensive care unit. BMC Pregnancy Childbirth 2019; 19:227. [PMID: 31272398 PMCID: PMC6610951 DOI: 10.1186/s12884-019-2363-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 06/14/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Preterm birth is a leading cause of morbidity and mortality in children under five and often requires a newborn to have an extended stay in a neonatal intensive care unit (NICU). Maternal engagement, such as visiting the NICU to provide kangaroo mother care (KMC), can improve outcomes for preterm infants but requires significant investment of time and resources. This study sought to understand barriers and facilitators to provision of KMC in the NICU. METHODS We conducted semi-structured in-depth interviews with mothers of preterm infants (N = 20) at a large academic medical center in Massachusetts. A series of open-ended interview questions were designed to elicit all aspects of mothers' experiences and to understand how these experiences influence provision of KMC. All interviews were recorded and transcribed verbatim. We conducted an inductive thematic analysis to identify themes in the data with a focus on the barriers and facilitators of KMC provision in the NICU. RESULTS Findings show that engaging in KMC is heavily influenced by the mental, emotional, and physical effects of preterm birth on the birth mother, such as stress around preterm birth and difficulty recovering from birth. These challenges are compounded by structural barriers such as costly accommodations, unreliable transportation, lack of child care, and inadequate maternity leave policies that limit the frequency and duration of KMC and parental ability to provide care. CONCLUSIONS A complex array of mental, emotional, physical, and structural factors determine a mother's ability to visit the NICU and provide kangaroo mother care. Providing social supports, such as improved maternity leave policies and reliable hospital access through child care, accommodation, and transportation services, may address the structural barriers that inhibit KMC, reduce burdensome costs, and improve the health of mothers and their preterm infants.
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Affiliation(s)
- Todd P Lewis
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Ave., Building 1, 11th Floor, Boston, MA, 02115, USA.
| | - Kathryn G Andrews
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Ave., Building 1, 11th Floor, Boston, MA, 02115, USA
| | | | | | - Günther Fink
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | | | - Margaret McConnell
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Ave., Building 1, 11th Floor, Boston, MA, 02115, USA
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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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Nurse Decision Making and Attitudes About Circuit Disconnection During Ventilator Therapy at a Swedish Neonatal Intensive Care Unit. Adv Neonatal Care 2018; 18:E13-E20. [PMID: 30299284 DOI: 10.1097/anc.0000000000000564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND There are many challenges to providing care to infants in need of ventilator therapy. Yet, few studies describe the practical handling of the ventilator circuit during nursing care. PURPOSE To describe neonatal intensive care unit (NICU) nurses' decision making regarding whether or not to disconnect the ventilator circuit when changing the infant's position and to investigate the grounds for their decisions. METHODS A descriptive questionnaire study with both quantitative and qualitative elements was conducted. In 2015, a convenience sample of nurses working in an NICU completed a questionnaire including both closed-ended and open-ended, free-text questions. Answers to the closed-ended questions were analyzed with descriptive statistics, whereas answers to the free-text questions were analyzed using qualitative content analysis. RESULTS Nurses' decisions on whether to disconnect or keep the ventilator circuit closed were based on the infant's needs for ventilator support. The nurses gave several reasons and motivations both for why they disconnected the circuit and for why they did not. The handling of the circuit and the reasons and motivations given were inconsistent among the nurses. IMPLICATIONS FOR PRACTICE This study highlights the need for continuous, repetitive education and training for NICU nurses, as well as demonstrating the importance of clear and distinct guidelines and working methods regarding the care of infants on ventilator support. IMPLICATIONS FOR RESEARCH Future research should continue to find ways of working and handling an infant on ventilator support that are least harmful to the infant.
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18
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McCarley RM, Dowling DA, Dolansky MA, Bieda A. Implementing a Systematic Process for Consistent Nursing Care in a NICU: A Quality Improvement Project. Neonatal Netw 2018; 37:96-104. [PMID: 29615157 DOI: 10.1891/0730-0832.37.2.96] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIM The global aim of this quality improvement project was to develop and implement a systematic process to assign and maintain consistent bedside nurses for infants and families. METHODS A systematic process based on a primary care nursing model was implemented to assign consistent care for a 48-bed, single-family room NICU. RESULTS Four PDSA cycles were necessary to obtain agreement from the nursing staff as to the best process for assigning primary nurses. Post-intervention data revealed a 9.5 percent decrease of consistent caregivers for infants in the NICU ≤ 28 days and a 2.3 percent increase of consistent caregivers for infants in the NICU ≥ 29 days. CONCLUSION Although these findings did not meet the goal of the specific aim, a systematic process was created to assign bedside nurses to infants. Further PDSAs will be needed to refine the process to reach the aim.
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19
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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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Marulli A, Kamlin COF, Dawson JA, Donath SM, Davis PG, Lorenz L. The effect of skin-to-skin care on cerebral oxygenation during nasogastric feeding of preterm infants. Acta Paediatr 2018; 107:430-435. [PMID: 29168250 DOI: 10.1111/apa.14158] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 11/09/2017] [Accepted: 11/17/2017] [Indexed: 11/28/2022]
Abstract
AIM To describe cerebral oxygenation during gavage feeding of preterm infants during incubator and skin-to-skin care. METHODS Further analysis of data from two crossover studies comparing cerebral oxygenation, heart rate and oxygen saturation during skin-to-skin care with incubator care. Data were analysed in three epochs; 10 minutes prefeed, during-feed and 10 minutes postfeed. Measurements from infants fed during incubator care were compared with those obtained during skin-to-skin care. RESULTS In 39 infants [median (IQR) 27.8 (26.1-30.0) weeks' gestation], there was no difference in cerebral oxygenation between pre-, during- and postfeed. Heart rate increased by three beats per minute postfeed compared with during-feed. Twenty infants received two gavage feeds, one feed in the incubator and another during skin-to-skin care. There was no difference in cerebral oxygenation and heart rate; peripheral oxygen saturation decreased by 3% during feeding whilst skin-to-skin care compared with feeding in the incubator. CONCLUSION Cerebral oxygenation remained stable before, during and after gavage feeding in an incubator and during skin-to-skin care. The small decrease in oxygen saturation whilst receiving gavage feeding during skin-to-skin care is unlikely to be clinically important, providing reassurance that preterm infants maintain physiological stability during skin-to-skin care.
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Affiliation(s)
- A Marulli
- Newborn Research Centre and Neonatal Services; The Royal Women's Hospital; Melbourne Vic. Australia
- University of Melbourne; Melbourne Vic. Australia
| | - COF Kamlin
- Newborn Research Centre and Neonatal Services; The Royal Women's Hospital; Melbourne Vic. Australia
- University of Melbourne; Melbourne Vic. Australia
- Murdoch Childrens Research Institute; Melbourne Vic. Australia
| | - JA Dawson
- Newborn Research Centre and Neonatal Services; The Royal Women's Hospital; Melbourne Vic. Australia
- University of Melbourne; Melbourne Vic. Australia
- Murdoch Childrens Research Institute; Melbourne Vic. Australia
| | - SM Donath
- University of Melbourne; Melbourne Vic. Australia
- Murdoch Childrens Research Institute; Melbourne Vic. Australia
| | - PG Davis
- Newborn Research Centre and Neonatal Services; The Royal Women's Hospital; Melbourne Vic. Australia
- University of Melbourne; Melbourne Vic. Australia
- Murdoch Childrens Research Institute; Melbourne Vic. Australia
| | - L Lorenz
- Newborn Research Centre and Neonatal Services; The Royal Women's Hospital; Melbourne Vic. Australia
- Department of Neonatology; University Children's Hospital of Tübingen; Tübingen Germany
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Maastrup R, Weis J, Engsig AB, Johannsen KL, Zoffmann V. ‘Now she has become my daughter’: parents’ early experiences of skin-to-skin contact with extremely preterm infants. Scand J Caring Sci 2017; 32:545-553. [DOI: 10.1111/scs.12478] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 04/23/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Ragnhild Maastrup
- Department of Neonatology and The Research Unit for Women's and Children's Health; The Juliane Marie Centre; Copenhagen University Hospital; Rigshospitalet; Copenhagen Denmark
| | - Janne Weis
- Department of Neonatology and The Research Unit for Women's and Children's Health; The Juliane Marie Centre; Copenhagen University Hospital; Rigshospitalet; Copenhagen Denmark
| | - Anne B. Engsig
- Public Health; University of Copenhagen; Copenhagen Denmark
| | | | - Vibeke Zoffmann
- The Research Unit for Women's and Children's Health; The Juliane Marie Centre; Copenhagen University Hospital; Rigshospitalet; Copenhagen Denmark
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McGowan JE, Naranian T, Johnston L. Kangaroo Care in the high-technology neonatal unit: Exploring evidence-based practice, policy recommendations and education priorities in Northern Ireland. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.jnn.2017.03.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Impact of kangaroo care on parental anxiety level and parenting skills for preterm infants in the neonatal intensive care unit. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.jnn.2016.09.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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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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Abstract
Kangaroo care (KC), also known as skin-to-skin contact, saves lives, but fewer than 50% of newborns and mothers in U.S. hospitals receive KC because of lack of knowledge and skill competency. Because nurses can increase knowledge and skill competency through a certification course, the value of certification as a kangaroo caregiver and administrative incentives for certification as a kangaroo caregiver were evaluated in 71 neonatal intensive care and maternal-newborn unit nurses who completed an electronic questionnaire and the Perceived Value of Certification Tool. Nurses highly valued their KC certification, agreeing with 17 of 18 positive value statements. KC certification increased salary for a few, but institution-based incentives for KC certification are still limited and recognition of KC certification is needed.
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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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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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Solomons N, Rosant C. Knowledge and attitudes of nursing staff and mothers towards kangaroo mother care in the eastern sub-district of Cape Town. SOUTH AFRICAN JOURNAL OF CLINICAL NUTRITION 2016. [DOI: 10.1080/16070658.2012.11734400] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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31
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Mooney-Leber SM, Brummelte S. Neonatal pain and reduced maternal care: Early-life stressors interacting to impact brain and behavioral development. Neuroscience 2016; 342:21-36. [PMID: 27167085 DOI: 10.1016/j.neuroscience.2016.05.001] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 03/22/2016] [Accepted: 05/02/2016] [Indexed: 12/21/2022]
Abstract
Advances in neonatal intensive care units (NICUs) have drastically increased the survival chances of preterm infants. However, preterm infants are still exposed to a wide range of stressors during their stay in the NICU, which include painful procedures and reduced maternal contact. The activation of the hypothalamic-pituitary-adrenal (HPA) axis, in response to these stressors during this critical period of brain development, has been associated with many acute and long-term adverse biobehavioral outcomes. Recent research has shown that Kangaroo care, a non-pharmacological analgesic based on increased skin-to-skin contact between the neonate and the mother, negates the adverse outcomes associated with neonatal pain and reduced maternal care, however the biological mechanism remains widely unknown. This review summarizes findings from both human and rodent literature investigating neonatal pain and reduced maternal care independently, primarily focusing on the role of the HPA axis and biobehavioral outcomes. The physiological and positive outcomes of Kangaroo care will also be discussed in terms of how dampening of the HPA axis response to neonatal pain and increased maternal care may account for positive outcomes associated with Kangaroo care.
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Affiliation(s)
- Sean M Mooney-Leber
- Department of Psychology, Wayne State University, Detroit, MI, United States
| | - Susanne Brummelte
- Department of Psychology, Wayne State University, Detroit, MI, United States.
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Perception of kangaroo care in German neonatology—A nationwide survey. Eur J Integr Med 2016. [DOI: 10.1016/j.eujim.2015.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Koopman I, Callaghan-Koru JA, Alaofin O, Argani CH, Farzin A. Early skin-to-skin contact for healthy full-term infants after vaginal and caesarean delivery: a qualitative study on clinician perspectives. J Clin Nurs 2016; 25:1367-76. [DOI: 10.1111/jocn.13227] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Inez Koopman
- Selective Utrecht Medical Master; Utrecht University; Utrecht The Netherlands
| | | | - Oluwatope Alaofin
- Department of Gynecology and Obstetrics; Johns Hopkins Bayview Medical Center; Baltimore MD USA
| | - Cynthia H. Argani
- Labor and Delivery at Johns Hopkins Bayview Medical Center; Baltimore MD USA
- The Johns Hopkins University School of Medicine; Baltimore MD USA
| | - Azadeh Farzin
- Department of International
Health; International Center for Maternal and Newborn Health; Johns Hopkins Bloomberg School of Public Health; Baltimore MD USA
- Division of Neonatology; Department of Pediatrics; The Johns Hopkins University School of Medicine; Baltimore MD USA
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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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Tully KP, Holditch-Davis D, White-Traut RC, David R, O'Shea TM, Geraldo V. A Test of Kangaroo Care on Preterm Infant Breastfeeding. J Obstet Gynecol Neonatal Nurs 2016; 45:45-61. [PMID: 26815798 PMCID: PMC4730116 DOI: 10.1016/j.jogn.2015.10.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To test the effects of kangaroo care (KC) on breastfeeding outcomes in preterm infants compared with two control groups and to explore whether maternal-infant characteristics and the mother's choice to use KC were related to breastfeeding measures. DESIGN Secondary analysis of a multisite, stratified, randomized three-arm trial. The treatment groups used KC, auditory-tactile-visual-vestibular (ATVV) intervention, or received preterm infant care information. SETTING Neonatal intensive care units from 4 hospitals in the United States from 2006 to 2011. PARTICIPANTS Racially diverse mothers (N = 231) and their preterm infants born weighing less than 1,750 g. METHODS Mothers and their infants were enrolled once the infants were no longer critically ill, weighed at least 1,000 g, and could be safely held outside the incubator by parents. Participants were instructed by study nurses; those allocated to the KC or ATVV groups were asked to engage in these interactions with their infants for a minimum of 3 times a week in the hospital and at home until their infants reached age 2 months adjusted for prematurity. RESULTS Feeding at the breast during hospitalization, the duration of postdischarge breastfeeding, and breastfeeding exclusivity after hospital discharge did not differ statistically among the treatment groups. Regardless of group assignment, married, older, and more educated women were more likely to feed at the breast during hospitalization. Mothers who practiced KC, regardless of randomly allocated group, were more likely to provide their milk than those who did not practice KC. Breastfeeding duration was greatest among more educated women. CONCLUSION As implemented in this study, assignment to the KC group did not appear to influence the measured breastfeeding outcomes.
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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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Vesel L, Bergh AM, Kerber KJ, Valsangkar B, Mazia G, Moxon SG, Blencowe H, Darmstadt GL, de Graft Johnson J, Dickson KE, Ruiz Peláez JG, von Xylander SR, Lawn JE. Kangaroo mother care: a multi-country analysis of health system bottlenecks and potential solutions. BMC Pregnancy Childbirth 2015; 15 Suppl 2:S5. [PMID: 26391115 PMCID: PMC4577801 DOI: 10.1186/1471-2393-15-s2-s5] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Preterm birth is now the leading cause of under-five child deaths worldwide with one million direct deaths plus approximately another million where preterm is a risk factor for neonatal deaths due to other causes. There is strong evidence that kangaroo mother care (KMC) reduces mortality among babies with birth weight <2000 g (mostly preterm). KMC involves continuous skin-to-skin contact, breastfeeding support, and promotion of early hospital discharge with follow-up. The World Health Organization has endorsed KMC for stabilised newborns in health facilities in both high-income and low-resource settings. The objectives of this paper are to: (1) use a 12-country analysis to explore health system bottlenecks affecting the scale-up of KMC; (2) propose solutions to the most significant bottlenecks; and (3) outline priority actions for scale-up. METHODS The bottleneck analysis tool was applied in 12 countries in Africa and Asia as part of the Every Newborn Action Plan process. Country workshops involved technical experts to complete the survey tool, which is designed to synthesise and grade health system "bottlenecks", factors that hinder the scale-up, of maternal-newborn intervention packages. We used quantitative and qualitative methods to analyse the bottleneck data, combined with literature review, to present priority bottlenecks and actions relevant to different health system building blocks for KMC. RESULTS Marked differences were found in the perceived severity of health system bottlenecks between Asian and African countries, with the former reporting more significant or very major bottlenecks for KMC with respect to all the health system building blocks. Community ownership and health financing bottlenecks were significant or very major bottlenecks for KMC in both low and high mortality contexts, particularly in South Asia. Significant bottlenecks were also reported for leadership and governance and health workforce building blocks. CONCLUSIONS There are at least a dozen countries worldwide with national KMC programmes, and we identify three pathways to scale: (1) champion-led; (2) project-initiated; and (3) health systems designed. The combination of all three pathways may lead to more rapid scale-up. KMC has the potential to save lives, and change the face of facility-based newborn care, whilst empowering women to care for their preterm newborns.
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Affiliation(s)
- Linda Vesel
- Innovations for Maternal, Newborn and Child Health, Concern Worldwide US, 355 Lexington Avenue, New York, NY 10017, USA
- Health Section, Programme Division, UNICEF Headquarters, 3 United Nations Plaza, New York, NY 10017, USA
| | - Anne-Marie Bergh
- MRC Unit for Maternal and Infant Health Care Strategies, University of Pretoria, Private Bag X323, Arcadia 0007, Pretoria, South Africa
| | - Kate J Kerber
- Saving Newborn Lives, Save the Children, 2000 L Street NW, Suite 500, Washington, DC 20036, USA
| | - Bina Valsangkar
- Saving Newborn Lives, Save the Children, 2000 L Street NW, Suite 500, Washington, DC 20036, USA
| | - Goldy Mazia
- USAID's Maternal and Child Survival Program, 455 Massachusetts Avenue NW, Suite 1000, Washington, DC 20001, USA
| | - Sarah G Moxon
- Saving Newborn Lives, Save the Children, 2000 L Street NW, Suite 500, Washington, DC 20036, USA
- Maternal, Adolescent, Reproductive and Child Health (MARCH) Centre, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Hannah Blencowe
- Saving Newborn Lives, Save the Children, 2000 L Street NW, Suite 500, Washington, DC 20036, USA
- Maternal, Adolescent, Reproductive and Child Health (MARCH) Centre, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Gary L Darmstadt
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Joseph de Graft Johnson
- Saving Newborn Lives, Save the Children, 2000 L Street NW, Suite 500, Washington, DC 20036, USA
- USAID's Maternal and Child Survival Program, 455 Massachusetts Avenue NW, Suite 1000, Washington, DC 20001, USA
| | - Kim E Dickson
- Health Section, Programme Division, UNICEF Headquarters, 3 United Nations Plaza, New York, NY 10017, USA
| | - Juan Gabriel Ruiz Peláez
- School of Medicine, Pontificia Universidad Javeriana, Carrera 7 No 40-62, Bogotá, Colombia
- Fundación Canguro, Calle 56A No 50-36 - Bloque A13, Apto 416, Pablo VI Azul, Bogotá, Colombia
- Hospital Universitario San Ignacio, Carrera 7 No 40-62, Bogotá, Colombia
| | - Severin Ritter von Xylander
- Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland
| | - Joy E Lawn
- Saving Newborn Lives, Save the Children, 2000 L Street NW, Suite 500, Washington, DC 20036, USA
- Maternal, Adolescent, Reproductive and Child Health (MARCH) Centre, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
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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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Mörelius E, Anderson GC. Neonatal nurses’ beliefs about almost continuous parent-infant skin-to-skin contact in neonatal intensive care. J Clin Nurs 2015; 24:2620-7. [DOI: 10.1111/jocn.12877] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2015] [Indexed: 12/01/2022]
Affiliation(s)
- Evalotte Mörelius
- Department of Social and Welfare Studies; Division of Health, Activity, and Care; Linköping University; Linköping Sweden
| | - Gene Cranston Anderson
- Emeritus and Courtesy Faculty; University of Florida; Gainesville FL USA
- Case Western Reserve University; Cleveland OH USA
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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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Campbell-Yeo ML, Disher TC, Benoit BL, Johnston CC. Understanding kangaroo care and its benefits to preterm infants. Pediatric Health Med Ther 2015; 6:15-32. [PMID: 29388613 PMCID: PMC5683265 DOI: 10.2147/phmt.s51869] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The holding of an infant with ventral skin-to-skin contact typically in an upright position with the swaddled infant on the chest of the parent, is commonly referred to as kangaroo care (KC), due to its simulation of marsupial care. It is recommended that KC, as a feasible, natural, and cost-effective intervention, should be standard of care in the delivery of quality health care for all infants, regardless of geographic location or economic status. Numerous benefits of its use have been reported related to mortality, physiological (thermoregulation, cardiorespiratory stability), behavioral (sleep, breastfeeding duration, and degree of exclusivity) domains, as an effective therapy to relieve procedural pain, and improved neurodevelopment. Yet despite these recommendations and a lack of negative research findings, adoption of KC as a routine clinical practice remains variable and underutilized. Furthermore, uncertainty remains as to whether continuous KC should be recommended in all settings or if there is a critical period of initiation, dose, or duration that is optimal. This review synthesizes current knowledge about the benefits of KC for infants born preterm, highlighting differences and similarities across low and higher resource countries and in a non-pain and pain context. Additionally, implementation considerations and unanswered questions for future research are addressed.
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Affiliation(s)
- Marsha L Campbell-Yeo
- School of Nursing, Dalhousie University
- Department of Pediatrics, IWK Health Centre
- Department of Psychology and Neuroscience, Dalhousie University
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS
| | | | | | - C Celeste Johnston
- Department of Pediatrics, IWK Health Centre
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS
- Ingram School of Nursing, McGill University, Montréal, QC, Canada
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Bergh AM, Kerber K, Abwao S, de-Graft Johnson J, Aliganyira P, Davy K, Gamache N, Kante M, Ligowe R, Luhanga R, Mukarugwiro B, Ngabo F, Rawlins B, Sayinzoga F, Sengendo NH, Sylla M, Taylor R, van Rooyen E, Zoungrana J. Implementing facility-based kangaroo mother care services: lessons from a multi-country study in Africa. BMC Health Serv Res 2014; 14:293. [PMID: 25001366 PMCID: PMC4104737 DOI: 10.1186/1472-6963-14-293] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 07/03/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Some countries have undertaken programs that included scaling up kangaroo mother care. The aim of this study was to systematically evaluate the implementation status of facility-based kangaroo mother care services in four African countries: Malawi, Mali, Rwanda and Uganda. METHODS A cross-sectional, mixed-method research design was used. Stakeholders provided background information at national meetings and in individual interviews. Facilities were assessed by means of a standardized tool previously applied in other settings, employing semi-structured key-informant interviews and observations in 39 health care facilities in the four countries. Each facility received a score out of a total of 30 according to six stages of implementation progress. RESULTS Across the four countries 95 per cent of health facilities assessed demonstrated some evidence of kangaroo mother care practice. Institutions that fared better had a longer history of kangaroo mother care implementation or had been developed as centres of excellence or had strong leaders championing the implementation process. Variation existed in the quality of implementation between facilities and across countries. Important factors identified in implementation are: training and orientation; supportive supervision; integrating kangaroo mother care into quality improvement; continuity of care; high-level buy in and support for kangaroo mother care implementation; and client-oriented care. CONCLUSION The integration of kangaroo mother care into routine newborn care services should be part of all maternal and newborn care initiatives and packages. Engaging ministries of health and other implementing partners from the outset may promote buy in and assist with the mobilization of resources for scaling up kangaroo mother care services. Mechanisms for monitoring these services should be integrated into existing health management information systems.
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Affiliation(s)
- Anne-Marie Bergh
- MRC Unit for Maternal and Infant Health Care Strategies, University of Pretoria, Private Bag X323, Arcadia 0007, South Africa
| | | | - Stella Abwao
- Save the Children, Washington, DC, USA
- Maternal and Child Health Integrated Program (MCHIP), Washington, DC, USA
| | - Joseph de-Graft Johnson
- Save the Children, Washington, DC, USA
- Maternal and Child Health Integrated Program (MCHIP), Washington, DC, USA
| | | | - Karen Davy
- MRC Unit for Maternal and Infant Health Care Strategies, University of Pretoria, Private Bag X323, Arcadia 0007, South Africa
| | | | | | | | | | - Béata Mukarugwiro
- Maternal and Child Health Integrated Program (MCHIP), Kigali, Rwanda
- Jhpiego, Washington, DC, USA
| | | | - Barbara Rawlins
- Maternal and Child Health Integrated Program (MCHIP), Washington, DC, USA
- Jhpiego, Washington, DC, USA
| | | | | | - Mariam Sylla
- Department of Paediatrics, Gabriel Toure Teaching Hospital, Bamako, Mali
| | - Rachel Taylor
- Save the Children, Washington, DC, USA
- Maternal and Child Health Integrated Program (MCHIP), Washington, DC, USA
| | - Elise van Rooyen
- MRC Unit for Maternal and Infant Health Care Strategies, University of Pretoria, Private Bag X323, Arcadia 0007, South Africa
| | - Jeremie Zoungrana
- Maternal and Child Health Integrated Program (MCHIP), Kigali, Rwanda
- Jhpiego, Washington, DC, USA
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Abstract
Prematurity is a complication of pregnancy for 1 in 8 families in the United States. The focus of care after preterm birth shifts to the fragile newborn, while the needs of the woman and her family may be overlooked. There are many challenges for parents, including impaired parent-newborn attachment, difficulties with breastfeeding, postpartum mental health, and family disruption. Premature birth may even risk the developing relationship between parents and their child. Comprehensive care is recommended for parents who have experienced a preterm birth, including support of effective lactation, promotion of skin-to-skin care, reflection on the birth experience, support and evaluation of postpartum mental health, and provision of family-centered care. Preconception care after preterm birth needs to include guidance about the recurrence risk for preterm birth as well as recommendations for risk reduction.
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McNair C, Campbell Yeo M, Johnston C, Taddio A. Nonpharmacological management of pain during common needle puncture procedures in infants: current research evidence and practical considerations. Clin Perinatol 2013; 40:493-508. [PMID: 23972753 DOI: 10.1016/j.clp.2013.05.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
All infants undergo painful procedures involving skin puncture as part of routine medical care. Pain from needle puncture procedures is suboptimally managed. Numerous nonpharmacologic interventions are available for these painful procedures, including swaddling, holding, skin-to-skin care, pacifier, sweet-tasting solutions, and breast-feeding. Adoption of nonpharmacologic pain-relieving interventions into routine clinical practice is feasible and should be a standard of care in the delivery of quality health care for infants. This review summarizes current knowledge about the epidemiology of pain from common needle puncture procedures in infants, the effectiveness of nonpharmacologic interventions, implementation considerations, and unanswered questions for future research.
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Affiliation(s)
- Carol McNair
- Nursing, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada
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Safety and effectiveness of skin-to-skin contact in the NICU to support neurodevelopment in vulnerable preterm infants. J Perinat Neonatal Nurs 2013; 27:255-62. [PMID: 23899805 DOI: 10.1097/jpn.0b013e31829dc349] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Skin-to-skin contact (SSC) is a cornerstone of neurodevelopmentally supportive and family-oriented care for very low-birth-weight preterm infants (VPIs). However, performing SSC with unstable and/or ventilated VPIs remains challenging for caregiving teams and/or controversial in the literature. We first aimed to assess the safety and effectiveness of SSC with vulnerable VPIs in a neonatal intensive care unit over 12 months. Our second aim was to evaluate the impact of the respiratory support (intubation or not) and of the infant's weight (above or below 1000 g) on the effects of SSC. Vital signs, body temperature, and oxygen requirement data were prospectively recorded by each infant's nurse before (baseline), during (3 time points), and after their first or first 2 SSC episodes. We compared the variations of each parameter from baseline (analysis of variance for repeated measures with post hoc analysis when appropriate). We studied 141 SSCs in 96 VPIs of 28 (24-33) weeks' gestational age, at 12 (0-55) days of postnatal age, and at a postmenstrual age of 30.5 (±1.5) weeks. During SSC, there were statistically significant increases in oxygen saturation (Sao2) (P < .001) with decreases in oxygen requirement (P = .043), a decrease in heart rate toward stability (P < .01) but a transient and moderate decrease in mean axillary temperature following the transfer from bed to mother (P < .05). Apneas/bradycardias requiring minor intervention occurred in 19 (13%) SSCs, without need for SSC termination. These variations were similar for intubated newborns (18%) as compared with newborns on nasal continuous positive airway pressure (52%) or breathing room air (30%). However, ventilated infants exhibited a significant increase in transcutaneous partial pressure of carbon dioxide (TcPco2) (P = .01), although remaining in a clinically acceptable range, and a greater decrease in oxygen requirements during SSC (P < .001) than nonventilated infants. Skin-to-skin contact in the neonatal intensive care unit seems safe and effective even in ventilated VPIs. Recording physiologic data of infants before, during, and after SCC provides data needed to secure changes of practice in SCC.
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Gonya J, Nelin LD. Factors associated with maternal visitation and participation in skin-to-skin care in an all referral level IIIc NICU. Acta Paediatr 2013; 102:e53-6. [PMID: 23088567 DOI: 10.1111/apa.12064] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Revised: 10/09/2012] [Accepted: 10/18/2012] [Indexed: 11/28/2022]
Abstract
AIM To identify variables associated with maternal visitation and participation in skin-to-skin care (SSC) with their extremely premature (<27 weeks) neonate. METHODS In an all referral level IIIc, 32 extremely premature neonates and their mothers were studied. Standardized instruments were the Parental Stressor Scale: NICU and the Parent-Staff Communication Rating Scale. Unstandardized Tools included a self-report demographics sheet and a self-report parent SSC log. RESULTS Using regression analysis, two factors were identified that were significantly associated with the amount of time that mothers visit and participate in SSC: the amount and type of stress that mothers experience and their perceived level of communication with medical staff. CONCLUSION Future interventions for increasing SSC should involve education about the NICU environment and neonatal behaviour along with methods for enhancing communication between mothers and healthcare providers.
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Affiliation(s)
- Jenn Gonya
- Ohio Perinatal Research Network; Center for Perinatal Research; The Research Institute at Nationwide Children's Hospital; Columbus; OH; USA
| | - Leif D. Nelin
- Ohio Perinatal Research Network; Center for Perinatal Research; The Research Institute at Nationwide Children's Hospital; Columbus; OH; USA
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47
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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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Olsson E, Andersen RD, Axelin A, Jonsdottir RB, Maastrup R, Eriksson M. Skin-to-skin care in neonatal intensive care units in the Nordic countries: a survey of attitudes and practices. Acta Paediatr 2012; 101:1140-6. [PMID: 22849363 DOI: 10.1111/j.1651-2227.2012.02802.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To investigate the application of skin-to-skin care (SSC) in the Nordic countries, the existence of guidelines for SSC and the attitudes of neonatal staff towards SSC. METHODS One questionnaire was distributed at unit level and one at staff level in all Nordic neonatal intensive care units (n = 109). RESULTS The unit questionnaire was answered by 95 (87%) units and the staff questionnaire by 1446 staff members (72%). All units offered SSC to various degrees, but guidelines only existed at 47% of them. Units in Denmark, Norway and Sweden seemed to use SSC earlier, longer and in more medically complicated situations than units in Finland and Iceland. Seventy-seven per cent of the units had private rooms where parents and infants could stay together, still the physical environment of the units limited the use of SSC. Medical risks were considered the main barrier for further implementation of SSC, while general development and early interaction were the most frequently mentioned benefits. CONCLUSION Skin-to-skin care is implemented in all Nordic neonatal units, but offered to various degrees, to various populations and to varying extents. Danish, Norwegian and Swedish units are offering SSC more extensively than units in Finland and Iceland.
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Affiliation(s)
- Emma Olsson
- Department of Paediatrics, Örebro University Hospital, Sweden.
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Skene C, Franck L, Curtis P, Gerrish K. Parental Involvement in Neonatal Comfort Care. J Obstet Gynecol Neonatal Nurs 2012; 41:786-97. [DOI: 10.1111/j.1552-6909.2012.01393.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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