Bowie State Kangaroo Care South Korean Based Nursing Article Critique This is a nursing research assignment. In this assignment, I am asked to critique an

Bowie State Kangaroo Care South Korean Based Nursing Article Critique This is a nursing research assignment. In this assignment, I am asked to critique an experimental research article which I will attach below using the rubric I will also attach. Journal of Pediatric Nursing (2016) 31, 430–438
The Effects of Kangaroo Care in the Neonatal
Intensive Care Unit on the Physiological
Functions of Preterm Infants, Maternal–Infant
Attachment, and Maternal Stress
Eun-Sook Cho MPH, RN a , Shin-Jeong Kim PhD, RN b , Myung Soon Kwon PhD, RN b,?,
Haeryun Cho PhD, RN c , Eun Hye Kim MSN, RN, CPNP-PC d ,
Eun Mi Jun PhD, RN e , Sunhee Lee PhD, RN f
a
Kangnam Sacred Heart Hospital, 1, Singil-ro, Yeongdeungpo-gu, Seoul, South Korea
Hallym University, College of Medicine, Div. of Nursing, Chuncheon, Gangwon-do, South Korea
c
Wonkwang University, Department of Nursing, Jeonbuk, South Korea
d
Goyang Foreign Language High School, Tongil-ro, Deogyang-gu, Goyang-si, Gyeonggi-do, South Korea
e
Pai Chai University, Department of Nursing, Baejae-ro(Doma-Dong) Seo-Gu, Daejeon, South Korea
f
Gimcheon University, Department of Nursing, Gyungbuk, South Korea
b
Received 28 October 2015; revised 12 February 2016; accepted 16 February 2016
Key words:
Infant;
Kangaroo care;
Object attachment;
Premature;
Stress
Purpose: This study was conducted to identify the effects of kangaroo care on the physiological functions of
preterm infants, maternal–infant attachment, and maternal stress.
Design and Methods: For this study, a quasi-experiment design was used with a nonequivalent control
group, and a pre- and post-test. Data were collected from preterm infants with corrected gestational ages of
? 33 weeks who were hospitalized between May and October 2011. Twenty infants were assigned to the
experimental group and 20 to the control group. As an intervention, kangaroo care was provided in 30-min
sessions conducted thrice a week for a total of 10 times. The collected data were analyzed by using the t test,
repeated-measures ANOVA, and the ANCOVA test.
Results: After kangaroo care, the respiration rate significantly differed between the two groups (F = 5.701,
p = .020). The experimental group had higher maternal–infant attachment scores (F = 25.881, p b .001)
and lower maternal stress scores (F = 47.320, p b .001) than the control group after the test. In other words,
kangaroo care showed significantly positive effects on stabilizing infant physiological functions such as
respiration rate, increasing maternal–infant attachment, and reducing maternal stress.
Conclusion: This study suggests that kangaroo care can be used to promote emotional bonding and support
between mothers and their babies, and to stabilize the physiological functions of premature babies.
Practice Implications: Kangaroo care may be one of the most effective nursing interventions in the neonatal
intensive care unit for the care of preterm infants and their mothers.
© 2016 Elsevier Inc. All rights reserved.
Background
? Corresponding author: Myung Soon Kwon, PhD, RN.
E-mail addresses: kwon1314@hallym.ac.kr, kwon1314@hanmail.net.
http://dx.doi.org/10.1016/j.pedn.2016.02.007
0882-5963/© 2016 Elsevier Inc. All rights reserved.
A preterm infant is an infant born prior to 37 weeks of
gestation or 259 days before the mother’s last menstruation
Kangaroo Care in the Neonatal Intensive Care Unit
period (Ahn, 2012). According to Statistics Korea (2012),
the number of premature babies born between January 1,
2012, and December 31, 2012, was 30,376 (6.3%) of the
484,550 total births for that year. In addition, regardless of
gestational age, the number of low-birth-weight infants who
weighed b 2500 g at birth was 25,870 (5.3%). Furthermore,
3037 (0.6%) of the low-birth-weight infants weighed b 1500 g
at birth (Statistics Korea, 2012). The percentage of premature
births increased steadily from 3.8% in 2000 to 4.9% in 2012.
Premature babies are well known to have many health
problems. They commonly have poor body temperature
control and can have cardiovascular and respiration
complications. In addition, intracranial hemorrhage is a
possible problem in premature babies (Bera et al., 2014).
Further disadvantages of hospitalization occur in the
neonatal intensive care unit (NICU). In the NICU, premature
infants are exposed to stressors such as noise from medical
machines, bright light, and invasive medical procedures
(Cho & Lee, 2010). It is important to note that infants’
separation from their mothers and the NICU environment
itself limit the visual, acoustic, and tactile interactions
between mothers and babies. This limitation causes anxiety
in mothers, affects maternal bonding, and leads mothers to a
negative understanding of their maternal role (Bang, Kang,
& Kwon, 2015).
In addition, having a preterm infant is a stressful
experience for mothers. They tend to feel guilty because
they believe that the premature birth was caused by their
carelessness or ignorance, and is an unexpected event in their
lives, so the hospitalization of their babies is extremely
stressful (Bang et al., 2015; Hwang, Kim, Yoo, & Shin,
2013). Thus, such events could result in a crisis that disturbs
the normal living patterns of the family (Jang, 2009). The
birth and hospitalization of a premature baby increase the
mother’s emotional vulnerability, thereby contributing to the
increases in stress and anxiety related to the infant, the risk of
possible complications, and the need for long-term separation. Although both parents of premature babies have this
level of stress, a study by Jeon (2011) demonstrated that
mothers have greater stress than fathers and other family
members. Long-term hospitalization of premature babies
leads to limited contact with parents and difficulty bonding
with mothers. These issues can produce developmental
delay, developmental disorders, and personality disorders, as
well as interrupt the natural attachment between mothers and
infants (Jang, 2009; Lee, 2008). In the care of preterm
infants, perceiving and interpreting their needs, and
providing appropriate stimulation, experienced nursing
interventions are needed to eliminate these barriers. Moreover,
providing an optimal environment for these infants is crucial
for their later development (Head, 2014).
Many research studies have identified the positive effects
of skin-to-skin contact such as sense stimulation on the
growth and behavioral development of preterm infants (Bera
et al., 2014; Head, 2014; Jang, 2009; Samra, Taweel, &
Cadwell, 2013). In fact, a study by Lee (2009) showed that
431
kangaroo care leads to greater preterm infant growth
development, and physiological and behavioral stability through
positive and consistent skin-to-skin contact with mothers.
Therefore, skin-to-skin care, called kangaroo care, can be effective
for reducing the possible complications in preterm infants.
Kangaroo care was developed in Columbia in the 1970s
to maintain infant body temperature. The position used in
kangaroo care is similar to the position of baby kangaroos
with their mothers, where the human infant has skin-to-skin
contact by being positioned between the mother’s clothes
and her skin (Samra et al., 2013). The World Health
Organization (WHO) in 2003 indicated that kangaroo care is
the most effective method for body temperature maintenance, infection prevention, sense stimulation, and offering
maternal love for the baby’s well-being. In addition,
kangaroo care is beneficial to preterm infants for maintaining
their regular breathing and reducing energy consumption,
thereby providing the needed weight gain in infants. Furthermore, a regular sleeping pattern with kangaroo care helps brain
development, allows for smoother delivery of oxygen supply to
the brain and better secretion of gastric hormones, reduces the
risk of infection, and reduces pain (Bera et al., 2014). Kangaroo
care is a safe, effective, and feasible method for premature
infant care, and thus designated as an effective and comprehensive intervention in the NICU setting (Samra et al., 2013).
This study was conducted to identify the effects of kangaroo
care on preterm infants’ physiological functions, maternal–
infant attachment, and maternal stress in South Korea.
Purpose
This study aimed to analyze the physiological effects (weight,
heart and respiration rates, oxygen saturation, and body temperature) of kangaroo care in two groups, one provided with kangaroo
care and the other not provided with kangaroo care. In particular,
the study was conducted with the following objectives:
1. To determine the effects of kangaroo care on the
physiological functions of premature infants
2. To analyze the difference in maternal–infant attachment between the two aforementioned groups
3. To analyze the difference in maternal stress between
the two groups
Methods
Design
In this study, a nonequivalent comparison group design
was used with both a pre- and a post-test (Figure 1).
Setting and Sample
The participants included in this study were preterm infants
with corrected gestational ages ? 33 weeks who completed
ventilator care in a general hospital in Seoul, South Korea. The
reason for using 33 weeks as the gestational age cutoff was that
premature babies aged b 33 weeks are more prone to health
problems such as respiration distress syndrome, apnea, and
infection. Preterm babies without sepsis, eating disorders, and
432
E.-S. Cho et al.
Corrected GA ? 33weeks
P a r t ic i p a n t s
Pre
test
T ime
Pos t
tes t
On s e t
EG
( n= 20)
Routine care with Kangaroo care
for 10 t imes , 30min/ t ime
( 3 t imes / week)
Group
CG
( n= 20)
Routine care
P h y s i o lo g ic a l f u n c t io n s
Phys iological functions
Variables
•
Body we ight
•
•
•
Heart rate
Res piration rate
Oxygen s aturation
•
•
•
•
Bo d y w e i g h t
He a r t r a t e
Re s p ir a t io n r a t e
Ox y ge n s a t u r a t ion
•
Body t emperature
•
Bo d y t e m p e r a t u r e
Maternal- infant attachment
M a t e r n a l – in f a n t a t t a c h m e n t
Maternal s tres s
Ma t e r n a l s t r e s s
*Note
EG : Experimental group, CG : Control age, min : minutes, GA : Gestational age
Figure 1
congenital deformity were included. The exclusion criteria
were as follows: 1) receiving respiration therapy with a
ventilator and E-tube insertion; 2) receiving medicines that
could influence sleeping patterns; 3) having a possible risk of
infection and skin disease; and 4) having a catheter inserted in
the artery and veins or the umbilical cord.
The maternal inclusion criteria were mothers without
infectious disease, epileptic illness, skin disease, or scars,
and the provision of informed consent for this study. Mothers
who did not want to participate in kangaroo care were
classified as the control group, while mothers who agreed to
participate in kangaroo care as an intervention were
classified as the experimental group.
To calculate the sample size, the G*Power 3.1.7 program
(Faul, Erdfelder, Lang, & Buchner, 2007) was used for the t
test. The result showed that 40 participants were required to
achieve a large effect size of 0.7, that is, two groups with 70%
power at a significance level of 0.05. Thus, 40 participants in
this study were acceptable for the sample size.
Accordingly, 40 participants (20 in the experimental
group and 20 in the control group) were included in this
study. None of these participants dropped out of the study.
Measurements
Physiological Functions
Physiological function is a phenomenon of the human body
that occurs in response to stimulation from the interaction
between humans and their environment (Bera et al., 2014).
Physiological functions are measured by determining the
Research design.
body weight, heart and respiration rates, oxygen saturation, and
body temperature.
•
Infant body weight was measured every morning at
a designated time (6:00 AM) after their baths, by using
a weighing machine (AD-15 T, CAS scale, Seoul,
South Korea).
• Infant heart rate, respiration rate, and oxygen saturation level were measured and recorded via a patient
monitor (IntelliVue MP 60, Philips, Eindhoven, the
Netherlands), 5 min before and after the intervention for
the experimental group and at a fixed time (3:00 PM) for
the control group.
• Infant body temperature was measured by using a
digital axillary body temperature monitor (MT200,
Microlife, NeiHu Taipei, Taiwan) and recorded 5 min
before and after the intervention for the experimental
group and at a fixed time (3:00 PM) for the control
group, on the same day of measurement as in the
experimental group.
The reasons for measuring the physiological functions at a
fixed time were possible fluctuations in biorhythms during the
daytime and for minimizing the measurement error by making
the situation as similar as possible with the experimental group.
The instruments used in this study were checked periodically by
the instruments company to ensure the accuracy of the scale. We
also carefully overhauled the instruments that were not working
or that had any error during the study period.
Kangaroo Care in the Neonatal Intensive Care Unit
Maternal–Infant Attachment
Maternal–infant attachment is the initial social relationship
between mothers and infants after birth. It is the emotional bond
established between mothers and their infants, and consistently
formed from early infancy to maturity (Bowlby, 1977). In this
study, a modified and corrected maternal–infant attachment
measurement tool was used. The tool was developed based on
Müller’s (1994) maternal attachment inventory and then adapted
by Han (2001). The questionnaire for this tool contained 24
questions. Each question included a scale from 1 point for
“strongly disagree” to 5 points for “strongly agree.” Higher
points indicated stronger maternal–infant attachment. The
reliability test yielded a Cronbach ? = .83 in the study by Han
(2001) and a Cronbach ? = .96 in the present study. We also
tested the validity of the tool and confirmed from experts that
this modified tool was acceptable for this study.
Maternal Stress
The stress level of a mother with a preterm infant is defined as
the maternal perception of stress factors that are related to
experiences within the physical and psychological environments
of preterm infant birth and hospitalization in a NICU (Miles,
Funk, & Carlson, 1993). In this study, the maternal stress level
related to stress factors in the NICU was measured by using the
Parental Stress Scale that Miles et al. (1993) initially developed
and Jeon (2011) modified. This questionnaire contained 20
questions, and points ranging from 1 point for “never worried”
to 5 points for “most worried” were given to each answer. A
score of 5 indicated “most stressful,” and a score of 1 point
indicated “least stressful.” A higher score indicated a higher
level of maternal stress. The Cronbach ? for this study and in
that by Jeon (2011) was .91. A validity test was performed by 7
experts, including two child health nursing professors, three
women’s health nursing professors, and two head nurses who
had a master’s degree in nursing and were working at the
postpartum ward of their respective general hospitals.
Training Procedure
Three nurses (including the first author of this study) who
were working in the NICU and had N over 10 years of clinical
experience were selected as trainees to collect high-quality data.
The first author explained the purpose and method of this study,
the protocols of kangaroo care, and the method of data
collection to the other trainees by using two presentations. After
that, each trainee gave two demonstrations that were recorded
via a video camera, and the trainee was evaluated, given
feedback, and asked to modify the process as per the results of
the feedback in order to provide kangaroo care of equal quality.
In addition, the first author observed them periodically to make
sure that they were measuring and recording the physiological
functions consistently throughout the study.
Experimental Intervention
Kangaroo care (skin-to-skin contact) is a method of
contact between parents and infants such that parents hold
infants upright and position them directly on the chest
433
(WHO, 2003). In this study, a modified skin-to-skin contact
method was used as a practical guide, based on the care
provided by kangaroo mothers to their babies.
At the beginning of the intervention, mothers with infants
receiving kangaroo care were educated individually for 10 min by
using brochures as follows: Mothers were recommended to take a
shower before kangaroo care and to wear clean placket shirts.
Mothers were prohibited to use perfume and makeup on days of
providing kangaroo care. They were recommended to wear
front-opening shirts that are easy to take them off before providing
kangaroo care. Before the study was initiated, the mothers were
asked about their willingness to continue kangaroo care until the
end and maintain a good health status without infection risk. They
were restricted from comforting their infants during the procedure,
for example, by singing and patting their backs.
Kangaroo care was conducted three times per week, on
Monday, Wednesday, and Friday, between 2:30 PM and
4:00 PM, with 30-min duration, for a total of 10 times. The
duration of 30 min was chosen as per the WHO (2003)
guidelines and the intervention used in the study by Moon and
Koo (2000). When the mothers arrived for the intervention at the
arranged time, they removed their shirts and sterilized their
chests, abdomens, and hands with 0.4% chlorohexidine and a
sterilized cotton ball, according to the contact precaution
protocol in the NICU. They were not permitted to wear any
accessories or put on body oil or lotion. The mothers changed
into a sterile gown and prepared for kangaroo care by rubbing
their hands to avoid being cold and sitting in a chair designated
only for kangaroo care. For performing kangaroo care, a monitor
and comforting chair were placed next to the incubator with a
curtain for privacy. Room temperature was maintained at 24 °C,
and noise was minimized to reduce any stress incurred from
hearing noise from phones ringing and workers’ conversation.
The mother held her infant to her bare chest in a vertical
position, holding the infant’s bottoms in one hand and letting the
other hand touch the infant’s head and back, with the infant wearing
only a diaper and hat. Both mother and infant touched each other’s
skin as closely as possible. At this time, the mother sat down in the
armchair and leaned her infant forward by 60°. The infant’s head
was turned to one side to touch the ear to the mother’s chest. The
infant’s mouth and nose were faced sideways to ensure open
breathing. At this time, the trainees helped both mother and infant
relax. The mother sat down and bent her legs. Periodic checks by
the first author were conducted to ensure that mothers administered
kangaroo care adequately and to answer questions and solve
problems regarding kangaroo care. We arranged the visiting time
for the experimental groups after the regular NICU visiting hours
(12:00 to 2:00 PM) so that the mothers of the infants in the control
group did not have to face any contamination.
Data Collection
Data were collected between May 1, 2011, and October
31, 2011. Physiological functions, including body weight,
heart rates, respiration rates, and oxygen saturation were
measured and recorded by the researchers. All the measurements were repeated twice. If the numerical values were not
434
the same, they were measured one more time, and the two
matching numerical values were used. A research assistant
collected the questionnaires to decrease the testing effect.
Ethical Considerations
This study was approved by the institutional review board of H
hospital, Seoul, South Korea (IRB No. 2011-05-41). After
providing information about the purpose of the study, guaranteeing anonymity and credibility, clarifying voluntary participation,
and indicating the benefits of the study, written consent was
obtained from all the participants who agreed to participate in th…
Purchase answer to see full
attachment