Cooper Liza, Morrill Allison, Russell Rebecca B, Gooding Judith S, Miller Laura, Berns Scott D
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).
Adv Neonatal Care. 2014 Dec;14(6):410-23. doi: 10.1097/ANC.0000000000000144.
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.
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.
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).
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.
袋鼠式护理（KC）的益处已得到先前发表研究的充分支持，但在新生儿重症监护病房（NICU）中，袋鼠式护理的实施情况并不一致且面临诸多障碍。美国疾病控制与预防中心的“靠近我”项目旨在促进并增加新生儿重症监护病房中袋鼠式护理的实施。该项目包括对护士和家长进行袋鼠式护理教育，以及提高认知度和舒适度的内容。本研究的目的是评估“靠近我”项目是否能增强护士和家长对袋鼠式护理的积极态度，并改变护士和家长的行为，使其更早、更频繁且更长时间地实施袋鼠式护理。
本研究在5个新生儿重症监护病房开展，有48名护士参与者和101名家长参与者。对护士采用项目实施前/后的设计，对家长采用非等效比较组与干预组的设计。
对护士和家长进行了关于知识、态度、感知行为控制和行为的调查。对护士在项目实施前后进行比较，对家长在干预组和比较组之间进行比较。在实施前后对护士进行焦点小组访谈，并采用持续比较分析法进行分析。家长在日志中记录护理行为和满意度，分析方法类似。
主要结局指标/主要结果：在“靠近我”干预后，护士对袋鼠式护理的态度更为积极（P = 0.04），从暖箱向家长转移使用呼吸机婴儿的情况增加（P = 0.01），且更多家长要求进行袋鼠式护理。与未接受“靠近我”项目的家长相比，接受该项目的家长对袋鼠式护理的了解更多（P = 0.03）。通过“靠近我”干预，所有孕周小于28周出生的婴儿在12日龄时都接受了袋鼠式护理，而未进行干预时，一些婴儿直到31日龄才接受袋鼠式护理（P < 0.05）。
美国疾病控制与预防中心的“靠近我”项目改善了新生儿重症监护病房中关于袋鼠式护理的知识和行为。通过对家长进行袋鼠式护理教育，提供提高认知度和舒适度的内容，并向护士提供关于袋鼠式护理益处和可行性的信息及鼓励，医院有可能促进更早、更频繁地使用袋鼠式护理，尤其是对于孕周小于28周出生的婴儿。
