KANGAROO METHOD:
KNOWLEDGE AND PRACTICES OF THE MULTIPROFESSIONAL TEAM
MÉTODO CANGURU: CONHECIMEN=
TOS
E PRÁTICAS DA EQUIPE MULTIPROFISSIONAL
Ana Maria de Souza Matozo[1] * Mayara Carolina
ABSTRACT
Objective:
Keywords:
Kangaroo-Mother
Care Method; Patient Care Team; Infant, Newborn; Neonatal nursing; Children=
's
Health Services.
RESUMO
Objetivo: Analisar o conhecimento e práticas=
dos
profissionais de saúde que atuam na linha pediátrica de um hospital de ensi=
no
de Campo Grande/Mato Grosso do Sul sobre o Método Canguru. Métodos: Estudo descritivo e transversal realizado com dad=
os
primários, por meio de questionário aplicado de agosto a setembro de 2020 e=
na
primeira quinzena de janeiro de 2021, com 98 profissionais de saúde da linha
pediátrica. Os dados coletados foram armazenados e calculados por meio do
programa Microsoft Office Excel. R=
esultados:
A maioria foi do sexo feminino, declarada de cor branca e escolaridade de
ensino superior com pós-graduação. Quanto aos aspectos profissionais, obtev=
e a
predominância de técnicos de enfermagem e tempo de serviço na instituição de
aproximadamente 12 an=
os. A pesquisa demonstrou um maior percentual de respostas
adequadas sobre o método, a Posição Canguru e sobre os seus benefícios nas
explicações dos profissionais da saúde que tinham o curso do Método Canguru,
mais tempo de serviço na linha pediátrica e que atuavam na unidade neonatal.
Além disso, a maioria tem conhecimento sobre o método e em quantas etapas se
divide. Entretanto, alguns participantes têm a opinião equivocada de que o
Método Canguru se restringe à Posição Canguru. Conclusões:
O estudo possibilitou a reflexão sobre o entendimento do método pelos
profissionais da saúde que realizam assistência aos recém-nascidos e seus
familiares. Tal fato pode contribuir para o aperfeiçoamento assistencial, a=
lém
de incentivar os gestores de saúde na inserção da educação permanente e
continuada dos profissionais da saúde sobre o Método Canguru.
Palavras-chave: Método Canguru; Equipe de Assistên=
cia
ao Paciente; Recém-nascido; Enfermagem Neonatal; Serviços de Saúde da Criança.
INTRODUCTION
The birth of a low birth weight preterm
newborn (LBWPTNB) causes an emotional impact on the families, due to t=
he
need for hospitalization and permanence in incubators(1). In
addition, a research study carried out at a regional hospital in Piauí, Bra=
zil,
with 125 records of newborns (NBs) hospitalized in a Neonatal Intensive Care
Unit (NICU) showed that births of preterm infants occurred even if the
pregnant women had complied with the number of prenatal consultations
recommended by the Ministry of Health(2).
Given the above, it becomes relevant to create
effective and regionalized health care networks (Redes de Atenção à Saúde, RAS) for neonatal care. In 1979,
“Kangaroo Mother” appeared in Colombia with the aim of placing the LBWPTNB =
in
continuous skin-to-skin contact against the mother's chest and thus improvi=
ng
the care provided. In Brazil, the Kangaroo Method (KM) gained national=
visibility
with the Pernambuco Maternal-Child Institute, currently Professor Fernando
Figueira Institute of Integral Medicine (IMIP), which was one of the
finalists in the social projects contest sponsored by the National Bank for
Economic and Social Development (Ba=
nco
Nacional de Desenvolvimento Econômico e Social, BNDES), with the n=
ame
of “Kangaroo Mother Ward”. Since then, several Brazilian hospitals have ado=
pted
the new care model for preterm newborns (PTNBs)(3).
In order to improve the quality of health care for
pregnant women, LBWPTNBs and their families, the KM in Brazil is divided in=
to
three stages. The first is developed in the prenatal period and during birt=
h,
accompanied by the NB's hospitalization in the NICU and/or in the Conventio=
nal
Neonatal Intermediate Care Unit (Un=
idade
de Cuidado Intermediário Neonatal Convencional<=
/i>, UCINCo).
The second is the parents' participation in neonatal care at the Kangaroo
Neonatal Intermediate Care Unit (Un=
idade
de Cuidado Intermediário Neonatal Canguru, UCINCa); and the last s=
tage
takes place at the family's home, with follow-ups shared between the outpat=
ient
consultations at the hospital of origin and Primary Health Care (PHC)<=
sup>(4,5).
This method contributes benefits for the LBWPTNBs,
parents/relatives and professionals, as well as it improves thermal control,
provides more effective breastfeeding (BF), weight gain and reduced
stress, among other factors. For the parents/relatives, it is the time to
establish a mother-child-father bond and to reduce insecurity. Health profe=
ssionals,
in turn, play the important role of guiding and encouraging the families to
care for their infants, establishing bonds and providing individualized and
humanized care for all NBs(4,5).
Thus, the health team that works in accordance with the KM paradigms=
is
more involved with the family, helps in coping with less traumatic
hospitalization and provides better guidelines in the care of PTNBs, in
addition to identifying the improvement in the NB's clinical evolution. The
multiprofessional team has a facilitating and motivating role for conductio=
n of
the KM, promoting its implementation in the health units(6).
A research study carried out with 22 health professionals from a
Neonatal and Pediatric Intensive Care Center, whose objective was to know t=
he benefits
and challenges experienced by them regarding the KM, showed that each
professional and institution with their unique particularities exert an
influence on the implementation of the method. In addition to that, the aut=
hors
reinforce that the KM requires commitment from the management and the acume=
n of
the service to analyze its environment, improve human resources and adapt i=
t,
in favor of the LBWPTNB and its family(7).
Given the above, this research is justified by the
scarcity of studies involving the perceptions and knowledge of the
multidisciplinary team about the KM(8). Thus, based on the
literature, the following research question was elaborated: What is the
knowledge and practices of the pediatric health care team about the KM?
Therefore, the objective of this study was to anal=
yze
the knowledge and practices of health professionals working in the pediatric
line of a teaching hospital in Campo Grande/Mato Grosso do Sul about the KM=
.
METHODS
This is an exploratory, descriptive and cross-sectional study, with a
quantitative methodological approach. It was carried out with professionals
working in the pediatric line of a teaching hospital located in Campo Grand=
e –
MS, which serves patients from the Unified Health System (Sistema Único de Saúde, SUS). In addition, since 2012, the
hospital has been accredited as a state reference for the KM and also as a
Baby-Friendly Hospital Initiative (BFHI).
The population consisted in the multiprofessional team of the pediat=
ric
line of that hospital. This team is made up of nurses, nursing technicians,
lactation technicians, nursing assistants, physicians (pediatrician,
neonatologist and pediatric intensive care specialist), physiotherapists,
occupational therapists, social workers, speech therapists and nutritionist=
s,
totaling 179 employees. Pediatric professionals who worked in the three shi=
fts
with at least six months of active performance were included in the researc=
h,
and 13 professionals who were on sick leave and six who were on vacation we=
re
excluded, thus leaving 160 eligible professionals.
The sample of the current study consisted of 98 professionals, based=
on
the simple probabilistic sampling technique with a 95% confidence level and=
a
5% sampling error. The sample was selected for convenience. The researchers
made previous personal contacts with the participants. Of these, six
professionals refused to answer the questionnaire; thus, another six who had
not yet been approached and who worked in the pediatric line were invited to
complete the sample.
This research used primary data through a questionnaire developed by=
the
authors after conducting the literature review. In addition to that, to test
the instrument's adequacy to the objectives of this research, the researche=
rs
applied a pre-test with one participant in August 2020, and this questionna=
ire
is part of the research.
Data collection was carried out from August to
September 2020 and, to achieve sample size calculation, data were also
collected in the first half of January 2021. Due to the Coronavirus pandemi=
c,
professionals from the pediatric line were relocated to the adult critical
patient line, which required this extension at the time of collection. The
questionnaires were applied at times previously scheduled with the particip=
ants
in order not to hinder development of their professional activities. The
quantitative variables were presented descriptively through means, percenta=
ges,
standard deviation and significance probability. All calculations were made
using the Microsoft Office Excel software.
This study was submitted to the Teaching, Research=
and
Institutional Quality Directorate of the teaching hospital and to the Commi=
ttee
of Ethics in Research with Human Beings of the University for the Developme=
nt
of the State and Pantanal Region (Comitê
de Ética em Pesquisa com Seres Humanos/Universidade para o Desenvolvimento =
do
Estado e da Região do Pantanal, CEP/UNIDERP). The project was appr=
oved
by CEP/UNIDERP with CAAE protocol No. 34288620.8.0000.5161, opinion
No. 4,179,030 and amendment 12/18/2020, opinion No. 4,476,263. Da=
ta
collection was preceded by the participants' authorization through the sign=
ed
Informed Consent Form. To ensure the participants' rights, all items presen=
t in
Resolution 466/12 of the National Health Council were observed.
RESULTS
Table 1 – Distributio=
n of
the sociodemographic information of the pediatric line professionals. Campo
Grande - MS, 2020/2021.
Key: n, number of employees; SD, Standard
Deviation.
Source: Prepared by the authors.
Regarding completion of the KM course, 69 (70%)
professionals reported having attended it and 29 (30%) did not. In relation=
to
the number of times the professionals performed it, 33 (34%) did not know or
did not answer; 18 (18%) implemented it more than three times; five (5%), t=
hree
times; 22 (22%) twice; and 20 (20%), only once.
As for the date of the last course taken by the
professionals, 56 (57%) did not know or did not answer; 15 (15%) attended t=
he
last course in 2017; eight (8%), before 2017; and six (6%), in 2018. In
addition to these data, 58 (59%) professionals answered that they were not
asked by the study hospital if they already attended a KM course when they
started working in the pediatric line; only nine (9%) stated having been as=
ked.
Twenty (20%) entered the institution before 2012, period in which the method
had not been implemented, and 11 (11%) do not remember.
Regarding the institution where the professionals
received the KM training, 53 attended it at the study hospital, 19 indicated
other intuitions and six did not report the location. As for the type of
course, 64 participants took the Hospital KM course; 49, the PHC KM course;
seven, PHC KM tutor; and only two, for Hospital KM tutor.
When the professionals were asked about their
knowledge about the KM, 48 (50%) of the answers were related to humanized c=
are
for the LBWPTNB and their family in the hospital environment, aiming at the
biopsychosocial aspects, and 39 (39%) described it as being skin-to-skin
contact of the NB with the mother and/or father. According to the responden=
ts'
opinion about what the Kangaroo Position (KP) is, 54 (55%) described i=
t as
“Skin-to-skin contact of the LBWPTNBs with their parents, next to the chest=
in
an upright position”; 35 (36%) as “skin-to-skin contact between the LBWPTBs=
and
their mother”; and nine (9%) did not answer or did not know.
In the answers about the care provided to the LBWP=
TNB
and their family according to the KM, 34 answered “Guidelines and welcoming=
for
parents on the care of the NB”; 22, “Decrease in environmental stimuli (noi=
se,
light, temperature); ten, “Stimulating the parents in carrying out the KP”;
nine, “Carrying out measures to control stress and pain (pharmacological and
non-pharmacological)”; eight, “Guidelines on the prevention of hospital
infection and hand hygiene”; and 25 did not answer or did not know.
As for the benefits of the KM, the three most
described, in order, by the health professionals were as follows: “It enhan=
ces
the family-infant bond” (n=3D70), “It stimulates/facilitates breastfeeding”
(n=3D40) and “It favors the neuropsychomotor development of the NB” (n=3D30=
), and
it was observed that some participants answered more than one item. In
addition, the study revealed a statistical difference (p=3D0.001) between t=
he
professionals who took the KM course and those who did not, when asked about
who benefited from the KM.
Table 2 presents the results related to the
questions about the KM, such as knowledge of the method and of the KP, crit=
eria
for the LBWPTNB to go to the UCINCa and care based on the Kangaroo methodol=
ogy,
evidencing that the professionals with the longest mean length of service in
the sector and that declared having attended the KM course answered correct=
ly
on how many stages the KM is divided (56 `[81%]), on the correct =
time
to start the KM (48 [70%]), and on the recommended time for
completion of the KM (30 [43%]). Of the 69 professionals who took=
the
KM course, 56 knew that the method is divided into three stages, but only 11
(20%) knew how to explain each of them.
Regarding the singular care centered on the NB and
their family, 64 (65%) of the professionals have already offered KM-based
assistance, noting that, among these, 53 (77%) have taken the KM course. Wi=
th
regard to the criteria for the LBWPTNB to participate in the second stage of
the KM, among the participants who have taken the course, 59 (86%) answered
that they know the conditions for the LBWPTNB to go to the UCINCa; however,
only 12.9 (22%) of them listed the criteria in their entirety. On the other
hand, of the 13 (45%) participants who declared being aware of the criteria=
but
not having taken the KM course, only 5.8 (15%) answered correctly the quest=
ions
about the necessary criteria for transferring the infant and its family to =
the
second stage.
Weaving a parallel between the answers to the ques=
tionnaire
and the sectors evaluated, it is noted that the professionals from the neon=
atal
unit have the highest level of knowledge related to the KM, which can be
related to the professional practice, as they are the professionals who most
welcome, assist and take care of the LBWPTNBs. This data shows the need for
training for the Pediatric Intensive Care Unit (PICU), for the pediatr=
ic
ward that serves LBWPTNBs, and for the milk bank, which serves the mothers =
of
the preterm infants. Table 3 presents the results related to the quest=
ions
about the KM according to the performance sector.
Table 2 – Knowledge of the pediatric line professionals a=
bout
the Kangaroo Method according to having attended the course and to mean len=
gth
of service. Campo Grande - MS, 2020/2021.
|
Knowledge of the pediatric line health professionals about the
Kangaroo Method |
Received training=
|
|
Mean length of service |
Total |
||
|
Yes (n =3D 69) |
No (n =3D 29) |
|
(n =3D 98) |
|||
|
n(%) |
n(%) |
p |
n(%) |
|||
|
Typ=
e of
contract |
CLT=
|
4(6=
) |
5(1=
7) |
0.5=
73 |
2.5=
|
9(9=
) |
|
Sta=
tutory |
64(=
93) |
18(=
62) |
|
9.8=
|
82(=
84) |
|
|
Oth=
ers |
1(1=
) |
5(1=
7) |
|
1.8=
|
6(6=
) |
|
|
Did=
not
answer |
0(0=
) |
1(3=
) |
|
3.0=
|
1(1=
) |
|
|
Len=
gth
of service in the pediatric line |
<=
; 1 year |
4(6) |
6(21) |
0.198 |
0.3 |
10(10) |
|
1 y=
ear <
time < 3 years |
8(12) |
10(34) |
|
1.4 |
18(18) |
|
|
3 y=
ears<
time < 5 years |
8(12) |
1(3) |
|
2.0 |
9(9) |
|
|
5 y=
ears
< time < 10 years |
16(23) |
6(14) |
|
10.3 |
22(22) |
|
|
>=
; 10
years |
31(45) |
6(21) |
|
22.1 |
37(38) |
|
|
|
Did=
not
answer |
2(3) |
0(0) |
|
0.0 |
2(2) |
|
Performance sector |
Pediatric ICU |
13(19) |
6(21) |
0.301 |
9.9 |
19(19) |
|
Neonatal Unit (=
UCINCa/UCINCo/Neonatal
ICU) |
40(58) |
12(41) |
|
10.0 |
52(53) |
|
|
Pediatrics |
13(19) |
9(31) |
|
13.2 |
22(22) |
|
|
Milk Back |
3(4) |
2(7) |
|
18.3 |
5(5) |
|
|
Kno=
wledge
about the number of stages in the Kangaroo Method |
Awa=
re |
56(=
81) |
14(=
48) |
0.506 |
11.3 |
70(=
71) |
|
Una=
ware |
7(1=
0) |
3(1=
0) |
|
5.7 |
10(=
10) |
|
|
Does
not Know/Did not answer |
6(9=
) |
12(=
41) |
|
10.1 |
18(=
18) |
|
|
Kno=
wledge
about the proper moment to initiate the Kangaroo Method |
Awa=
re |
48(=
70) |
10(=
34) |
0.362 |
11.6 |
58(=
59) |
|
Una=
ware |
21(=
30) |
19(=
66) |
|
8.0 |
40(=
41) |
|
|
Kno=
wledge
about the recommended time to perform the Kangaroo Position |
Cor=
rect |
30(=
43) |
10(=
34) |
0.124 |
11.2 |
40(=
41) |
|
Inc=
orrect |
27(=
39) |
5(1=
7) |
|
8.7 |
32(=
33) |
|
|
Does
not Know/Did not answer |
12(=
17) |
14(=
48) |
|
11.0 |
26(=
27) |
|
|
Con=
duction
of care for newborns and their families based on the Kangaroo Method |
Alr=
eady
performed KM care |
53(=
77) |
11(=
38) |
0.483 |
10.5 |
64(=
65) |
|
Nev=
er
performed KM care |
15(=
22) |
14(=
48) |
|
12.4 |
29(=
30) |
|
|
Does
not Know/Did not answer |
1(1=
) |
4(1=
4) |
|
11.8 |
5(5=
) |
|
|
Kno=
wledge
of the criteria for low birth weight newborns to go to the Kangaroo
Intermediate Neonatal Care Unit |
Kno=
ws
thee criteria |
59(=
86) |
13(=
45) |
0.564 |
11.0 |
72(=
73) |
|
Does
not Know/Did not answer |
10(=
14) |
16(=
55) |
|
11.4 |
26(=
27) |
Source: Prepared =
by
the authors.
Table 3 – Knowledge of the pediatric line health
professionals about the Kangaroo Method according to the performance sector=
.
Campo Grande - MS, 2020/2021.
|
Knowle=
dge
of the pediatric line health professionals about the Kangaroo Method |
Sector=
s |
||||||||
|
HMB |
NEONAT=
AL
ICU |
PEDIAT=
RICS |
PEDIAT=
RIC
ICU |
||||||
|
n |
(%) |
n |
(%) |
n |
(%) |
n |
(%) |
||
|
Knowledge about the number of
stages in the Kangaroo Method |
Aware |
4 |
(80) |
47 |
(90) |
9 |
(41) |
10 |
(53) |
|
Unaware |
1 |
(20) |
5 |
(10) |
3 |
(14) |
1 |
(5) |
|
|
Does not know/Did not answer |
0 |
(0) |
0 |
(0) |
10 |
(45) |
8 |
(42) |
|
|
Knowledge about the proper mom=
ent
to initiate the Kangaroo Method |
Aware |
3 |
(60) |
36 |
(69) |
11 |
(50) |
8 |
(42) |
|
Unaware |
2 |
(40) |
16 |
(31) |
11 |
(50) |
11 |
(58) |
|
|
Knowledge about the recommended
time to perform the Kangaroo Position |
Correct |
0 |
(0) |
29 |
(56) |
3 |
(14) |
8 |
(42) |
|
Incorrect |
5 |
(100) |
23 |
(44) |
19 |
(86) |
11 |
(58) |
|
|
Does not know/Did not answer |
0 |
(0) |
0 |
(0) |
0 |
(0) |
0 |
(0) |
|
|
Conduction of care for newborns
and their families based on the Kangaroo Method |
Already performed KM care |
0 |
(0) |
46 |
(88) |
7 |
(32) |
11 |
(58) |
|
Never performed KM care |
5 |
(100) |
6 |
(12) |
11 |
(50) |
7 |
(37) |
|
|
Does not know/Did not answer |
0 |
(0) |
0 |
(0) |
4 |
(18) |
1 |
(5) |
|
|
Knowledge of the criteria for =
low
birth weight newborns to go to the Kangaroo Intermediate Neonatal Care Un=
it |
Knows the criteria |
3 |
(60) |
49 |
(94) |
9 |
(41) |
11 |
(58) |
|
Does not know the criteria |
2 |
(40) |
3 |
(6) |
13 |
(59) |
8 |
(42) |
Source: <=
/b>Prepared
by the authors.
DISCUSSION
The participants were mostly women, nursing
technicians, over 40 years old, graduates and with approximately
12 years of service at the institution. The research showed a higher
percentage of correct answers about the method, about the Kangaroo
Position (KP) and about its benefits in the answers given by the health
professionals who had taken the Kangaroo Method course, with more time in t=
he
pediatric line and who worked in the neonatal unit. In addition to that, mo=
st
of the participants know about the method and how many stages it is divided=
into.
However, some are of the mistaken opinion that the KM is restricted to the
skin-to-skin contact of the mother/father with the infant.
The KM is a paradigm shift in perinatal care, where
humanization and quality of attention and care provided are fundamental
objectives, in addition to a commitment of every health professional to the
LBWPTNB and their family(3). In other words, the method involves=
the
reduction of environmental stimuli and pain control, in addition to
facilitating the NB's interaction with the family, guidance and support for
breastfeeding and the KP. In this way, skin-to-skin contact, which consists=
of
keeping the NB, only in diapers, in an upright position next to the parents'
chest with the support, guidance and monitoring of the health professional,=
is
one of the KM's care measures.(5,9). However, in this study, many
health professionals related the KM only to skin-to-skin contact and are
unaware of the method's scope.
A study carried out with 37 Nursing professionals =
from
the NICU of a hospital in Paraná revealed that the participants did not rel=
ate
the health care provided to NBs with the KM practice, as they understood it=
as
a work routine, which shows the need for appropriation of the KM with its d=
aily
applicability(10). On the other hand, a research study with a
qualitative approach involving eight nurses from the maternal-infant line o=
f a
hospital in Minas Gerais (MG), Brazil, showed that three of them knew =
the
KM in theory, although they did not have the opportunity to work with it in=
the
practice(11). Another study, also qualitative, with 15 Nursing
professionals who worked in a NICU in Porto Alegre (RS), pointed out t=
hat
the professionals describe the KM as a practice to ensure humanization of t=
he
NBs and strengthen the bond with their families(12). As well as,=
in
this research, which showed the lack of knowledge of some participants in
relation to the KM, its stages, which cover prenatal care, birth,
hospitalization of the LBWPTNB in the NICU and UCINCo and not only in the
UCINCa, as well as return appointments up to a weight of 2,500 grams. =
The KP contributes countless benefits both for the
LBWPTNB and for the parents. A study carried out with 86 newborns from a
hospital in Rondônia (RO) showed that those subjected to skin-to-skin =
contact
with their parents had greater weight gain and shorter hospital stays when
compared to NBs to whom the KP was not applied(13). The benefits=
of
skin-to-skin contact with LBWPTNBs are the same, whether performed by the
mother or the father(14). This fact corroborates the findings of
this research, which showed that most of the participants answered that the=
KP
is “skin-to-skin contact of the LBWPTNBs with their parents, next to the ch=
est
in a vertical position”.
Several benefits of the KM are pointed out by the
health professionals in the current research, and all approve the method. T=
he
three most mentioned benefits were as follows: “It enhances the family-baby
bond”, “It stimulates/facilitates breastfeeding” and “It favors the NB's
neuropsychomotor development”. An observational study developed through fil=
ming
showed that the longer time spent with the KP benefits the initial contact
exchanges between the preterm child and the mother, which suggests greater
alertness and better availability of the NB for interactions with the mother
during breastfeeding(15). A research study carried out with 37
Nursing professionals showed that 33.8% of them associate the KM with an
improvement in growth and development of the NB(16).
A quasi-experimental research study carried out in=
two
hospitals from Turkey, aimed at investigating the effect of the KM on the
breastfeeding rate and on the development of LBWPTNBs in the first six mont=
hs
of life, evidenced that the group that underwent the KP had a significantly
higher mean body weight than the control group in the third and sixth postn=
atal
month (p<0.05). In addition to that, the experimental group had higher
breast milk intake and breastfeeding rates than the control group during
transition to exclusive breastfeeding and at discharge, as well as in the
first, third and sixth postnatal months (p<0.05)(17).
Furthermore, 66 professionals argued that the KM
benefits the NB and 52 stated that the method benefits the mother. However,=
the
KM does not only benefit the NB, but also their parents, family members,
siblings and health professionals, as it reduces the separation time between
mother/father and child and facilitates the bond. The NB benefits from the
reduction of hospital infection, stress and pain, improvement of thermal and
neuropsychomotor control, and a better relationship and communication betwe=
en
the family and the health professionals. Another advantage is that siblings=
can
come to the health units to see the infant(5). In addition, when=
the
multidisciplinary team perceives the clinical improvement and evolution of =
the
LBWPTNB after KP performance, they start to believe in the method, they not=
ice
that it is not dogma but science and, thus, this practice continues to be
adopted in neonatal units(18).
An international survey carried out with 27
professionals from a tertiary-level hospital and three district hospitals in
Malawi evidenced that, in the participants' perception, as they are more
stable, infants in Kangaroo rooming have low care prioritization and inadeq=
uate
monitoring practices(19). Another survey also carried out in Mal=
awi
with 123 health professionals revealed their positive reactions in relation=
to
the care provided by family members to preterm infants during hospitalizati=
on,
as well as to skin-to-skin contact(20). This fact corroborates t=
he
findings of this study in which the professionals stated that they provide =
care
centered on the NB and their family. However, it should be emphasized that =
the
parents' participation should not interfere with the quality of care provid=
ed
by health professionals to the NB; on the contrary, inclusion of the parents
only offers contributions.
Regarding the care related to the KM applied by
professionals in the hospital environment, the most frequently mentioned by=
the
participants was: “Guidelines and welcoming to the parents about the care of
the NB”. In agreement with the results of this research, a qualitative study
conducted with Nursing professionals from an UCINCa in northeastern Brazil
highlighted the importance of the guidelines on the KM for parents/relative=
s,
which favors their adherence to the method(21). In addition to t=
hat,
by welcoming LBWPTNB families, mediating the first contact of parents with
their children, the health professionals are providing for the bonding betw=
een
them, interrupted due to premature birth and the need for hospitalization of
the child in the neonatal unit(5).
Furthermore, skin-to-skin contact should be initia=
ted
as soon as possible and during hospitalization of the LBWPTNB in the NICU a=
nd
UCINCo. Thus, a research study carried out in a university hospital from
Gambia, whose objective was to understand the effects of initial care with =
the
KM on the survival of unstable NBs weighing less than 2,000 g, evidenc=
ed a
reduction in mortality by half during the study implementation period and t=
he
importance of the KM-related interventions in unstable neonates in neonatal
units(22).
In this study, only two health professionals repor=
ted
having taken the Hospital KM tutor course, that is, with a license to be a
replicator and carry out training sessions. This fact shows the need to tra=
in
new tutors, as the hospital is the State's reference and responsible for
internal and external training, in addition to promoting awareness raising =
in
the health team about the KM.
Thus, knowledge acquisition is fundamental for the
development and implementation of the method's good practices in the health
units. Theoretical knowledge needs to be articulated with the team's behavi=
oral
change, working on the development of managerial strategies that facilitate
adherence to the KM in the care practice(23). Thus, the KM cours=
es
enable the professionals to acquire a scientific basis for their behavior a=
nd
improve the assistance provided to the LBWPTNBs and their families.
A qualitative study carried out in Kenya, which ai=
med
at understanding, from the point of view of family members and health
professionals, the barriers and facilitators for essential newborn care, sh=
owed
that the KM is widely accepted as a gold standard intervention to increase
LBWPTNB survival. In addition to that, this research included the views and
opinions of parents, family members, health professionals, policymakers and
non-governmental representatives in the context of NB care provision and the
development of a broader work program to develop an early warning score,
showing the importance of everyone's involvement for the effective
implementation of the KM(24).
Some factors can be mentioned as limitations to ca=
rry
out other analyses, reflections and notes. One of them refers to the
questionnaire, considered long and complex by some professionals, which did=
not
allow them to participate in the research; the other is that the hospital in
question is the only one in the state with KM and BFHI titles, which does n=
ot
reflect the reality of all hospitals. Even more important, this is an atypi=
cal
moment experienced all over the world, which are the limitations brought ab=
out
by the pandemic, causing several professionals to be relocated from the ped=
iatric
line to other sectors in order to provide care for patients of different age
groups.
CONCLUSIONS
This study showed that some participants have
theoretical knowledge about the KM, knowing how many stages it is divided i=
nto
and its main benefits. In addition, most of the professionals had taken the=
KM
course at the study hospital. However, the open-ended questions revealed th=
at
some participants are of the mistaken opinion that the KM is restricted to
skin-to-skin contact of the mother/father with the infant, whereas the Kang=
aroo
methodology is broad and involves a paradigm shift such as the importance of
exclusive breastfeeding (EBF), humanized assistance and inclusion of t=
he
family in care. On the other hand, the professionals were able to describe =
several
benefits of the method consistent with the guidelines and scientific studie=
s on
it, especially the participants who had training, that is, the research sho=
wed
that there is a statistical difference between the professionals who attend=
ed
the course and those who did not, when asked about who benefited from the K=
M.
The research made it possible to reflect on the
understanding of the KM by the health professionals who provide
assistance to LBWPTNBs and their families. Such fact can contribute =
to
the improvement of care, in addition to encouraging health managers to incl=
ude
permanent and continuing education for health professionals about the KM. T=
his
study is also important for Nursing, as nurses favor infant-parent-professi=
onal
bonding and must have qualified listening, including the parents in the care
provided to the newborns and propitiating interdisciplinary and humanized c=
are.
Based on the data from this research, it is clear that there is a need for
further studies on the perception and application of the KM to PTNBs and th=
eir
families by the multiprofessional health team, both in public and private
hospitals.
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Corresponding=
Author
Mayara Carol=
ina Cañedo, Rua: Casimiro de Abreu n. 135. Jardim dos
Submissão: 2021-09-19<=
span
style=3D'mso-spacerun:yes'>
Aprovado: 2021-12-05<= o:p>
[1]
Pós-graduada pelo Programa de Residência Multiprofissional Integrada em Saú=
de
Materno Infantil pelo Hospital Regional de Mato Grosso do Sul/Anhanguera
[2]
Mestre em enfermagem pela Universidade Federal de Mato Grosso do Sul.
Enfermeira do Núcleo Regional de Saúde de Dourados, Mato Grosso do Sul, Bra=
sil.
ORCID: http://orcid.org/00=
00-0002-7232-1431