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Kangaroo Mother Care: Parents’ experiences and patterns of application in two Swedish neonatal intensive care units
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics. (Endokrinologi, Jan Gustafsson)
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Kangaroo Mother Care (KMC) is an alternative model of care that prevents parent-infant separation when preterm infants need neonatal intensive care by skin-to-skin contact between infants and their parents. KMC is also a strategy that involves parents in their infants’ care and enables them to assume the responsibility for the care. Furthermore, KMC promotes parent-infant bonding and attachment.

The overall aim of this thesis was to gain a deeper understanding and knowledge about parents’ capacity, willingness, and experiences of KMC and to which extent parents choose to use KMC throughout their infants' hospital stay. These studies were conducted in the NICUs at two Swedish university hospitals (NICU A and NICU B).

Mothers of infants cared for at NICU A (n=17) answered a questionnaire about their experiences of KMC (Paper I). Twenty parents of infants cared for at NICU A recorded the duration of each KMC session during a period of 24 hours and the identity the KMC provider (Paper II). Seven fathers were interviewed about their experiences of KMC (Paper III) and 76 mothers and 74 fathers completed a questionnaire about what facilitated or rendered it difficult to perform KMC (Paper IV). The time of initiation of KMC and duration in minutes, and the identity of the KMC providers was recorded continuously during the infants’ (n=104) hospital stay: 83 mothers and 80 fathers also completed a questionnaire during their infants’ hospital stay (Paper V).

This thesis provides new knowledge about parents’ practice of KMC, also continuously day and night, in a high tech NICU in an affluent society, with good resources for infant care in an incubator by trained staff. The accuracy of parents’ records of KMC were comparable to nurses’ records. The results indicate that parents want to be together with their infant in the NICU and be actively involved in the infants’ care. Although parents may experience KMC as exhausting and uncomfortable, they still prefer KMC to conventional neonatal intensive care as it supports their parental role. Early initiation of KMC after birth appears to result in a longer total duration of KMC during the infants’ hospital stay.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2012. , 73 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 804
Keyword [en]
Kangaroo Mother Care, Neonatal intensive care unit, Preterm infant, Nursing, Parenting
National Category
Pediatrics
Research subject
Pediatrics
Identifiers
URN: urn:nbn:se:uu:diva-180047ISBN: 978-91-554-8452-1 (print)OAI: oai:DiVA.org:uu-180047DiVA: diva2:547728
Public defence
2012-10-12, Rosensalen, Ing. 95/96, Akademiska Barnsjukhuset, Uppsala, 13:15 (Swedish)
Opponent
Supervisors
Available from: 2012-09-19 Created: 2012-08-28 Last updated: 2013-01-22
List of papers
1. Swedish mothers' experience of continuous Kangaroo Mother Care
Open this publication in new window or tab >>Swedish mothers' experience of continuous Kangaroo Mother Care
2011 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 20, no 9-10, 1472-1480 p.Article in journal (Refereed) Published
Abstract [en]

Aims. To characterise the first infants receiving continuous Kangaroo Mother Care from birth to discharge in a Swedish neonatal intensive care unit and to investigate their mothers' experiences of this model of care. Background.  Admission of a newborn infant to a neonatal intensive care unit commonly implies separation of the new mother from her infant. Kangaroo Mother Care is a model of neonatal care which supports the parental role as primary care-giver and contributes to minimising the separation between the infant and parents. Design. A retrospective survey design. Method. A purposive sample consisting of 23 mother-infant pairs. Relevant infant data were obtained from their medical records. A questionnaire with questions about the infant's care and regarding Kangaroo Mother Care was designed for this study. Results.  The infants were born at a gestational age of 31-41 weeks, birth weight ranging from 1715-3700 g. The mothers of these moderately preterm and ill newborn infants showed good acceptance of the idea of providing their infants with continuous Kangaroo Mother Care during their stay at the neonatal intensive care unit. The mothers' evaluations of this method were predominantly positive. Negative comments concerned lack of information about practical application of the method, and some mothers perceived their infants' care during the night as exhausting. No mother would have preferred not to perform continuous Kangaroo Mother Care or to terminate Kangaroo Mother Care earlier than they did. Conclusions. These mothers accepted this model of care very well, provided that they received the help and support they required. Relevance to clinical practice.  Mothers whose infants are admitted to an neonatal intensive care units in settings similar to the study setting should be offered opportunities to be present and provide Kangaroo Mother Care for their infants, to the extent that they are able and willing to do so and as permitted by the infant's medical condition and care.

Keyword
babies, midwifery, mothers, nurses, nursing, Sweden
National Category
Nursing
Identifiers
urn:nbn:se:uu:diva-140796 (URN)10.1111/j.1365-2702.2010.03369.x (DOI)000289630400029 ()21118321 (PubMedID)
Available from: 2011-01-10 Created: 2011-01-10 Last updated: 2017-12-11Bibliographically approved
2. Parent-infant skin-to-skin contact: how do parent records compare to nurse records?
Open this publication in new window or tab >>Parent-infant skin-to-skin contact: how do parent records compare to nurse records?
2011 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 100, no 5, 773-775 p.Article in journal (Refereed) Published
National Category
Nursing
Identifiers
urn:nbn:se:uu:diva-152867 (URN)10.1111/j.1651-2227.2011.02160.x (DOI)000289250200030 ()21375581 (PubMedID)
Available from: 2011-05-02 Created: 2011-05-02 Last updated: 2017-12-11Bibliographically approved
3. Kangaroo Mother Care helps fathers of preterm infants gain confidence in the paternal role
Open this publication in new window or tab >>Kangaroo Mother Care helps fathers of preterm infants gain confidence in the paternal role
Show others...
2012 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 68, no 9, 1988-1996 p.Article in journal (Refereed) Published
Abstract [en]

Aim. 

This article is a report on a descriptive study of fathers’ experiences of providing their preterm infants with Kangaroo Mother Care.

Background. 

During neonatal intensive care, fathers describe the incubator as a barrier and the separation from their infant as stressful. Fathers consider it important to be close to the infant, and performing Kangaroo Mother Care makes them feel an important participant in their infants’ care.

Method. 

Individual interviews conducted in 2009 with seven fathers who performed Kangaroo Mother Care were analysed using qualitative content analysis.

Results. 

The fathers’ opportunity for being close to their infants facilitated attainment of their paternal role in the neonatal intensive care unit. Kangaroo Mother Care allowed them to feel in control and that they were doing something good for their infant, although the infant’s care could be demanding and stressful. As active agents in their infant’s care, some fathers stayed with the infant during the whole hospital stay, others were at the neonatal intensive care unit all day long. Despite the un-wished-for situation, they adapted to their predicament and spent as much time as possible with their infants.

Conclusion. 

Fathers’ opportunities for Kangaroo Mother Care helped them to attain their paternal role and to cope with the unexpected situation. The physical environment and conflicting staff statements influenced their opportunity for, and experience of, caring for their preterm infants.

Keyword
father, infant, Kangaroo Mother Care, neonatal intensive care unit, nursing
National Category
Nursing
Identifiers
urn:nbn:se:uu:diva-164073 (URN)10.1111/j.1365-2648.2011.05886.x (DOI)000306806000009 ()22111919 (PubMedID)
Available from: 2011-12-15 Created: 2011-12-15 Last updated: 2017-12-08
4. Provision of Kangaroo Mother Care: supportive factors and barriers perceived by parents
Open this publication in new window or tab >>Provision of Kangaroo Mother Care: supportive factors and barriers perceived by parents
2013 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 27, no 2, 345-353 p.Article in journal (Refereed) Published
Abstract [en]

Background:

Kangaroo Mother Care supports parents’ role at the neonatal intensive care unit. To enhance parents’ provision of Kangaroo Mother Care, it is essential to obtain knowledge of what parents perceive as supportive factors and barriers regarding their opportunities to perform Kangaroo Mother Care.

Aim:

To identify factors that parents of preterm infants perceived as supportive factors or barriers for their performance of Kangaroo Mother Care and to explore the timing of and reasons for parents’ discontinuation of Kangaroo Mother Care.

Methods:

A descriptive study performed at two neonatal intensive care units in Sweden with 76 mothers and 74 fathers of preterm infants born at gestational ages ranging from 28 to 33 weeks. Data on infant characteristics were obtained from the infants’ medical records. A questionnaire, based on scientific literature and the researchers’ clinical experience, was completed by the mothers and the fathers separately, shortly after the infant’s discharge from the hospital. The data was analyzed with qualitative content analysis and descriptive statistic.

Results:

Four categories were identified in parents’ responses regarding support and barriers for their performance of KMC: Parent related factors, Time, Infants related factors and The NICU and home environment. The hospital staff and environment were described by the parents as both supportive and barriers for their application of Kangaroo Mother Care. Some mothers described the infants’ feeding process as an obstacle to Kangaroo Mother Care. Sleeping with the infant skin-to-skin in the same position throughout the night could be difficult, as an uncomfortable sleeping position caused insufficient sleep. A majority of both mothers and fathers continued providing their infant with Kangaroo Mother Care to some extent after discharge.

Keyword
Kangaroo Mother Care, Neonatal, Preterm Infants, Parents
National Category
Pediatrics
Research subject
Pediatrics
Identifiers
urn:nbn:se:uu:diva-179516 (URN)10.1111/j.1471-6712.2012.01040.x (DOI)000318815700018 ()22816503 (PubMedID)
Available from: 2012-08-17 Created: 2012-08-17 Last updated: 2017-12-07Bibliographically approved
5. Kangaroo Mother Care in two Swedish NICUs
Open this publication in new window or tab >>Kangaroo Mother Care in two Swedish NICUs
Show others...
2012 (English)Article in journal (Other academic) Submitted
Abstract [en]

Aim:

To describe initiation and the extent of parents’ application of Kangaroo Mother Care (KMC).

Methods:

The exact duration of which 104 preterm infants were cared for skin-to-skin was recorded in the infants’ medical charts during their hospital stay: the parents answered a questionnaire.

Results:

Both parents were involved in the practice of KMC. Three infants experienced KMC directly after birth, 34 within one hour, 85 within 24 hours, and the remaining 19 infants at 24 – 78 h post birth. KMC commenced earlier (median age of 50 minutes) in infants whose first KMC contact was with their father than with their mother (median age of 649 minutes: p < 0.000). The earlier KMC was initiated, the more the infant was cared for with KMC per day during his/her hospital stay (p < 0.000). The median daily duration of KMC was 403 minutes.

Conclusion:

Early initiation of KMC had a positive impact on the extent of parents’ application of the method. Even though the infants in this study were cared for with KMC to a high extent there is a potential for extended use of KMC in this type of hospital setting for reducing separation between infants and parents.

Keyword
Kangaro Mother Care, Parenting, Neonatal Intensive Care Unit
National Category
Pediatrics
Research subject
Pediatrics
Identifiers
urn:nbn:se:uu:diva-179517 (URN)
Available from: 2012-08-17 Created: 2012-08-17 Last updated: 2012-09-20Bibliographically approved

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