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Close to Me

Enhancing Kangaroo Care Practice for NICU Staff and Parents

Cooper, Liza LMSW; Morrill, Allison JD, PhD; Russell, Rebecca B. MSPH; Gooding, Judith S. BA; Miller, Laura BME; Berns, Scott D. MPH, MD

Section Editor(s): Dowling, Donna

doi: 10.1097/ANC.0000000000000144
Original Research

PURPOSE: The benefits of kangaroo care (KC) are well supported by previously published studies, yet KC is offered inconsistently and faces obstacles in the neonatal intensive care unit (NICU). The March of Dimes designed Close to Me to facilitate and increase KC in NICUs. The program incorporates KC education for nurses and parents, as well as awareness and comfort components. The purpose of this study was to assess whether Close to Me increased favorable attitudes toward KC among nurses and parents, and changed nurse and parent behaviors to implement KC earlier, more often and for longer duration.

SUBJECTS AND DESIGN: This study took place in 5 NICUs with 48 nurse participants and 101 parent participants. It used a pre-/postprogram implementation design for nurses and a nonequivalent comparison versus intervention group design for parents.

METHODS: Nurses and parents were surveyed on knowledge, attitudes, perceived behavioral control, and behavior. Comparisons were made pre- and postprogram implementation for nurses and between intervention and comparison groups for parents. Nurse focus groups were conducted pre- and postimplementation and analyzed using a constant comparative analysis method. Parents recorded care behaviors and satisfaction in journals, which were analyzed similarly.

MAIN OUTCOME MEASURES/PRINCIPAL RESULTS: After the Close to Me intervention, nurses reported more positive attitudes toward KC (P = .04), increased transfer of ventilated babies from incubators to parents (P = .01), and more parents requesting KC. Parents who received Close to Me had greater knowledge about KC (P = .03) compared with those who did not. With the Close to Me intervention, all babies born at less than 28 weeks' gestation had KC by the age of 12 days, whereas without the intervention, some did not have KC until the age of 31 days (P < .05).

CONCLUSIONS: March of Dimes Close to Me improved knowledge and behavior regarding KC in NICUs. By offering KC education to parents, providing KC awareness and comfort components, and providing information and encouragement on the benefits and feasibility of KC to nurses, hospitals can potentially promote earlier and more frequent use of KC, particularly with infants born less than 28 weeks' gestation.

Child and Family Education, the Center for Child and Family Experience, Sala Institute for Child and Family-Centered Care at NYU Langone Medical Center, New York (Ms Cooper); Perinatal Data Center, Program Resource Development and Evaluation Department (Ms Russell), Signature Programs, Chapter Programs Department (Ms Gooding), NICU Initiatives, Chapter Programs Department (Ms Miller), and Chapter Programs Department (Dr Berns), March of Dimes Foundation, White Plains, New York; and School of Community and Population Health, University of New England, Portland, Maine (Dr Morrill).

Correspondence: Judith S. Gooding, BA, March of Dimes, 1275 Mamaroneck Ave, White Plains, NY 10605 (

At the time this article was accepted for publication, Liza Cooper was the director of Family-Centered Care and Family Engagement, March of Dimes, White Plains, New York. The authors could not have conducted this research without the assistance of our 5 hospital partners, their administrators, NICU nurses and NICU parents, and March of Dimes NICU family support specialists Kelly Cover, Jennifer Horner, and Jeanne Lattanzio, and the March of Dimes chapters in Delaware, Oregon, Connecticut, and Texas. They also thank Sarah Rand for her assistance with this manuscript, and especially Dr Jennifer L. Howse, President, March of Dimes, for her vision and leadership to provide education and comfort to NICU families.

Vida Health Communications, Inc, was funded by the March of Dimes to conduct this original research study.

The implementation, evaluation, and refinement of Close to Me were supported in part by a grant from the former Picker Institute, Inc, a nonprofit organization that supported research and education in the field of patient-centered care. The views presented here are those of the authors and not necessarily those of the Picker Institute, Inc. Liza Cooper was the principal investigator for this grant (AE9).

The authors declare no conflict of interest.

© 2014 by The National Association of Neonatal Nurses