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Evidence utilization project: implementation of kangaroo care at neonatal ICU

Zhang, Su He BHs(N), Adv Dip Nsg (Pediatrics), RN; Yip, Wai Kin BHs(N), RN; Lim, Priscilla Fong Chien BHs(N), RN; Goh, Micki Zhen Yi BSc (Nursing), RN

International Journal of Evidence-Based Healthcare: June 2014 - Volume 12 - Issue 2 - p 142–150
doi: 10.1097/XEB.0000000000000009
Evidence Utilization

Background: Kangaroo care is no longer performed for the initial purpose of maintaining a small baby's body temperature in the developed countries where there are now sufficient medical equipments to keep babies warm. The objectives of kangaroo care in advanced neonatal ICUs have changed to provide benefits such as bonding and attachment, physiologic stability of newborn babies, successful breastfeeding and positive effects on infant development. Kangaroo care is not new to many neonatal nurses, but not every neonatal center is routinely practicing kangaroo care in Singapore. Inadequate nurses’ knowledge and lack of guidelines on kangaroo care hinder its practice.

Aim: The aim of this project was to implement kangaroo care in very low birth weight babies in a systematic and structured approach.

Methods: The team followed Larrabee's The Model For Evidence-Based Practice Change, used the available evidence on kangaroo care to develop guideline that was specific and suitable for the local setting. The team organized kangaroo care road shows for nurses and parents to create and enhance awareness. Evaluation of the project was done through two audits. The audit tool consisted of correct baby positioning and nursing documentation, with a sample size of 30 episodes.

Results: The ages of the babies audited were from 24 to 34 weeks of gestation with their weight ranging from 850 to 1500 g. The compliance rate for correct baby positioning during kangaroo care was 100% for both audits. The compliance rate for nursing documentation improved from 93% in the first post-implementation audit to 96.7% in the second post-implementation audit.

Conclusion: The systematic and structured approach in kangaroo care implementation has created awareness among nurses and led to improvements in their knowledge and practices of kangaroo care. The implementation process of kangaroo care has also aided in training the ward Evidence-Based Nursing Unit team members to engage in critical thinking, which ultimately benefited the babies and parents.

1Khoo Teck Phuat - National University Children's Medical Institute

2National University Hospital, Centre for Evidence-Based Nursing: A Collaborating Centre of the Joanna Briggs Institute, Singapore

Correspondence: S. H. Zhang, Khoo Teck Phuat - National University Children's Medical Institute, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074, Singapore. E-mail:

International Journal of Evidence-Based Healthcare © 2014 The Joanna Briggs Institute
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