Kangaroo Care, Research Paper Example

Introduction

Kangaroo care is the type of critical care suggested for premature infants that involves skin-to-skin contact with either the mother or a nurse in the hospital after birth and up until the infant reaches 41 weeks gestational age. Premature infants are sometimes admitted to the neonatal intensive care unit or NICU, where the focus in on the physiological well being of the premature infant and not on the parent-infant bonding (Chia et al., 2005; Bialoskurski et al 1999); however, studies have indicated that the use of Kangaroo care on premature infants have shown stability in normal ranges of heart rates, respiration levels and oxygen levels (Chia et al 2005; Messmer et al 1997; Legault and Goulet 1995). Previous studies have also indicated that neonatal nurses are focused more on the medical needs on the premature infant instead of encouraging the interaction between the infants and their parents and skin-to-skin contact. (Fenwick et al 2001a, 1999)  Although nurses are focused on the main issues, it is suggested that the critical care nurses play an important role in helping promote Kangaroo Care with premature infants and their parents in the NICU.

Kangaroo Care in the NICU

The bonding and skin-to-skin contact of the premature infant and the parent was overlooked for twenty years. The primary goal was to treat the premature infant with main issues or problem and focus on their growth and development. The use of Kangaroo Care in the NICU was first prompted in Bogota, Columbia, where it was suggested as an alternative to incubator care for the premature newborns who overcame the main issues and were staying in the NICU for feeding and growth issues only. Through this suggestion, it was realized that the premature infants exposed to Kangaroo Care were exhibiting thermal regulation, weight gain and increase in health from clinical issues. (Blackwell and Catteneo 2007). In addition, studies showed that Kangaroo Care was a safe practice even for premature infants who were receiving ventilation (Ludington-Hoe et al 1998; Gale et al 1993) and who had low birth weights (Bauer et al 1996; Bosques et al 1995). The only problem has been implementing this practice into the NICU and placing it as a standard protocol for the NICU nurses.

Previous literature on NICU nurses provided with Kangaroo Care training indicated that the nurses exhibited positive attitudes towards the implementation of Kangaroo Care for premature infants (Chia et al 2005); however, there were some concerns about the skin-to skin contact with very premature infants, especially infants who weighed below 1000 grams or the infants who were placed on ventilators (Bell and McGrath 1996; Gale et al 1993).  In addition, nurses were concerned about premature infants undergoing apnoeic spells or oxygen depletion. Furthermore, nurses were concerned about the intravenous lines becoming tangled, loose or dislodged leading to extubation (Chia et al 2005; Victor and Persoon 1994; Drosten-Brooks 1993; Gale et al 1993). However, it has been shown that Kangaroo Care is a safe practice and nurses feel more comfortable supporting this method once properly trained. (Chia et al 2005).

The support of Kangaroo Care in the NICU comes mainly from the NICU nurses. The nurses are the staff that interacts most with the parents. Premature infant hospitalization can cause major stress on the parent which reduces the mother-infant skin-skin contact. In addition, when the mother is not able to be at the hospital, the nurses can step in and provide the skin-to-skin contact to the premature infant. Previous studies have shown that nurse-mother interaction with psychosocial and communication support of Kangaroo Care results in positive and trusting relationships between the mother and nurse, in addition to the positive physiological responses in the infant. Additional studies also indicated that Kangaroo care increased infant attachment and early development in premature infants (Kearvell and Grant 2008). Furthermore, studies where nurses in the NICU encouraged Kangaroo care and physically showed parents how to conduct the skin-to-skin method, resulted in positive feedback from mothers. (Kearvell and Grant 2008)

Conclusion    

Studies conducted on premature infants who are admitted to the neonatal intensive care unit have shown a decrease in the natural bonding between the mother and infant. Studies have also shown that with the introduction of Kangaroo Care from critical care nurses show an increase in the mother-infant bonding, as well as the stabilization of vitals in premature infants. In addition, Kangaroo Care has shown to exhibit a positive interaction and communication between the nurse and parent. (Kearvell and Grant 2008)  Kangaroo Care, therefore, offers multiple positive outlooks for NICU nurses. There were some concerns in regard to the safety of the infant; however, with the proper training and supervision, Kangaroo Care does not show any safety concerns.

Kangaroo care is currently not a standard procedure in every hospital, especially in the United States. (Kearvell and Grant 2008) The introduction of educational seminars and training sessions should be offered to nurses nationwide in order for this procedure to be implemented properly into our health systems.  It is important for NICU nurses to be aware of this Kangaroo care and all of the positive outcomes that can result from this care, such as parent-infant bonding and overall stable health of the premature infant.

References

Bauer, J., Sontheimer, D., Fischer, C. and Linderkamp, O. 1996. Metabolic rate and energy balance in very low birth weight infants during kangaroo holding by their mothers and fathers. The Journal of Pediatrics. 129(4): 608-611.

Bell, R.P. and McGrath, J.M. 1996. Implementing a research-based kangaroo care program in the NICU. Nursing Clinics of North America. 31(2): 387-403.

Bialoskurski, M., Cox, C.L. and Hayes, J.A. 1999. The nature of attachment in a neonatal intensive care.  Journal of Perinatal Neonatal Nursing. 13(1): 66-77.

Blackwell, K. and Catteneo L. May 2007.  What is the evidence for kangaroo mother care of the very low birth weight baby? International Child Health Review Collaboration  www.ich.org.

Bosque, E.M., Brady, J.P., Affonso, D.D. and Wahlberg, V. 1995. Physiologic measures of kangaroo versus incubator care in a tertiary-level nursery. Journal of Obstetric, Gynecologic, and Neonatal Nursing. 24(3): 219-226.

Drosten-Brooks, F. 1993. Kangaroo care: skin-to-skin contact in the NICU. American Journal of Maternal Child Nursing. 18(5): 250-253.

Fenwick, J., Barclay, L. and Schmied, V. 1999. Activities and interactions in level 2 nurseries: a report of an ethnographic study.  Journal of Perinatal and Neonatal Nursing. 13(1): 53-65.

Fenwick, J., Barclay, L. and Schmied, V. 2001a. Struggling to mother: a consequence of inhibitive nursing interactions in the neonatal nursery. Journal of Perinatal and Neonatal Nursing. 15(2): 49-64.

Gale, G. and Franck, L.S. 1998. Neonataology: toward a standard of care for parents of infants in the neonatal intensive care unit. Critical Care Nurse. 18(5): 62-74.

Ludington-Hoe, S.M., Ferreira, C.N. and Goldstein, M.R. 1998. Kangaroo care with a ventilated preterm infant. Acta Paediatrica. 87(6): 711-713.

Kearvell, H. and Grant, J. 2008. Getting connected: How nurses can support mother/infant attachment in the neonatal intensive care unit. Australian Journal of Advanced Nursing. (27):3.

Victor, L. and Persoon, J. 1994. Implementation of kangaroo care: a parenthealth care team approach to practice change. Critical Care Nursing Clinics of North America. 6(4): 891-895.

World Health Organization Department of Reproductive Health and Research. Kangaroo Mother Care A Practical Guide.Geneva, Switzerland. 48pp. http://www.ichrc.org/pdf/kangaroo.pdf