FACTORS CONTRIBUTING TO THE INTRODUCTION OF THE KANGAROO METHOD INTO THE PRACTICE OF PERINATAL CENTERS OF THE REPUBLIC OF KAZAKHSTAN AND EXISTING BARRIERS
Relevance: Reducing infant mortality is one of the main tasks of the healthcare system of any country, as this indicator reflects the level of healthcare, the country's development, social orientation and commitment to universal human values. In the structure of infant mortality, more than 60% of losses occur in the neonatal period. One of the universally recognized and proven methods for reducing mortality and morbidity among preterm infants is the kangaroo method. This method, despite its effectiveness and availability, has numerous barriers to widespread use in the territory of the Republic of Kazakhstan. The identified barriers will allow the development of programs for the effective implementation of the daily practice of nursing premature newborns.
Objective: to study the awareness of the nursing staff about the beneficial properties of the kangaroo method, to identify existing barriers to its widespread introduction into the practice of neonatal departments of the Republic of Kazakhstan.
Materials and methods: The study was conducted by a survey method using a Google questionnaire and the republican professional chat of neonatologists on WhatsApp. 186 nurses participated in the survey, 5 of whom were excluded from the analysis due to the lack of answers to most questions. As a result, 110 nurses of neonatal intensive care and intensive care units (NICU) and 71 departments of preterm nursing and neonatal pathology (SCU/HDU) from 37 perinatal centers of the country were interviewed. Nurses participated in the survey, regardless of seniority and work experience. The respondents' answers were compared between these departments and the results obtained were processed by the statistical method [4]. The comparison of the average indicators between the groups was carried out using the Student's Criterion (t-test). For categorical data, the Fisher exact test was used (conjugacy tables for small samples). The difference between the groups was considered statistically significant with a p-value < 0.1. Linear regression and the stepwise regression method were used to predict the clinical outcome to improve the statistical model.
The results of the study: When analyzing the level of conditions created for the introduction of the kangaroo method (MC), knowledge and skills (indicators that depend on training), we found that the proportion of those who have been trained to conduct MC in neonatal intensive care unit (NICU)and Special Care/High Depency Unit (SCU/HDU) is not the same (significantly higher in SCU/HDU). However, the number of respondents who indicated at least 1 contraindication to MC does not depend on the number of trained, but depends on the type of unit. Moreover, untrained respondents noted more contraindications to MC than trained ones. In addition, the number of those who indicated at least one positive property of MK, as well as one contraindication to its implementation, was the same among both trained and untrained.
A comparative analysis of the organization of work of perinatal centers in the countries of the Organization for Economic Cooperation and Development of the OECD (using the example of the United Kingdom) and in the Republic of Kazakhstan revealed significant differences both in the structure of units and in the workload per nurse. It is shown that in the Republic of Kazakhstan, the bed fund in theSCU/HDU exceeds the bed fund in the NICU by 2.4 times. But, at the same time, the average number of nurses working day, night and on weekends in these units is about the same. When calculating the load (the number of beds served by 1 nurse) in the NICU and the SCU/HDU, it was revealed that the load in the SCU/HDU is significantly higher than in the NICU (p <0.001).
Conclusions:
1. In NICU and SCU/HDU, the level of knowledge, practical skills and conditions created for the introduction of MC into practice are statistically significantly higher among nurses who have been trained.
2. The load on one nurse in the SCU/HDUis significantly higher than in the NICU.
3. In the neonatal departments of the Republic of Kazakhstan, the estimated load per nurse corresponds to the established republican standard, but is significantly higher than in the OECD countries.
Bekturgan T. Karin1, https://orcid.org/0000-0002-8080-787X
Tamara K. Chuvakova1, https://orcid.org/0000-0001-5411-8061
Kulyash K. Jaxalykova1, https://orcid.org/0000-0001-5540-3331
Bagila K. Nurmagambetova2, Bakytzhan A. Alibekova3
1 NCJSC «Astana Medical University», Department of Neonatology, Nur-Sultan c., Republic of Kazakhstan;
2 NCJSC «Astana Medical University», Department of PediatricAnesthesiology and Resuscitation,
Nur-Sultan c., Republic of Kazakhstan;
3 NCJSC «Semey Medical University», Department of Pediatrics and Medical Rehabilitation named after D.M. Tusupova, Semey c., Republic of Kazakhstan.
1. Ann Bigelow, Michelle Power, Janis MacLellanвАРPeters, Marion Alex, Claudette McDonald. Effect of Mother/Infant Skin-to-Skin Contact on Postpartum Depressive Symptoms and Maternal Physiological Stress // JOGNN, 00, 1-14; 2012. DOI: 10.1111/j.1552-6909.2012.01350.x
2. Anderze´n-Carlsson A. et al. Parental experiences of providing skin-to-skin care to their newborn infant - Part 2: A qualitative meta-synthesis // Int J Qualitative Stud Health Well-being 2014, 9: 24907 - http://dx.doi.org/10.3402/qhw.v9.24907. (accessed: 22 May 2021).
3. Arshia Amiri, KatriVehvilainen-Julkunen, TyttiSolankallio-Vahteri, SirpaTuomi. Impact of nurse staffing on reducing infant, neonatal and perinatal mortality rates: Evidence from panel data analysis in 35 OECD countries. International Journal of Nursing Sciences 7 (2020) 161-169.
4. British association of perinatal medicine. Optimal Arrangements for Neonatal Intensive Care Units in the UK including guidance on their Medical Staffing A Framework for Practice. June 2014. (accessed: 09 Sertember, 2021).
5. Conde-Agudelo A., Díaz-Rossello J.L. Kangaroo mother care to reduce morbidity and mortality in low birthweight infants. Cochrane Database of Systematic Reviews 2016, Issue 8. Art. No.: CD002771. DOI: 10.1002/14651858.CD002771.pub4. https://www.cochrane.org/CD002771/NEONATAL_kangaroo-mother-care-reduce-morbidity-and-mortality-low-birthweight-infants (accessed: 09 Sertember, 2021).
6. Caryl Skene, Linda Franck, Penny Curtis, Kate Gerrish. Parental involvement in neonatal comfort care // J ObstetGynecol Neonatal Nurs. Nov-Dec 2012;41(6):786-97. doi: 10.1111/j.1552-6909.2012.01393.x.Epub 2012 Jul 12 . (accessed: 22 May 2021).
7. Calculating Unit Cot numbers and Nurse Staffing Establishment and Determining Cot Capacity October 2019. Supplementary guidance to BAPM Framework for Practice - Service Standards for Hospitals Providing Neonatal Care (3rd edition). 2010.
8. Debbie Webster, Katie Broadbent, Kellie Fraser, Kelly Harvey, Kylie Reid, Rachael Beagles, Neonatal nursing, 2020 Nov 8 https://www.rcn.org.uk/clinical-topics/children-and-young-people/neonatal-nursing (accessed: 22 May 2021).
9. Emma Olsson, Randi D Andersen, Anna Axelin, Rakel B Jonsdottir, Ragnhild Maastrup, Mats Erikson.Skin-to-skin care in neonatal intensive care units in the Nordic countries: a survey of attitudes and practices // Acta Paediatr.2012 Nov. 101(11):1140-6. doi: 10.1111/j.1651-2227.2012.02802.x. Epub 2012 Aug 23.
10. Grace Chan, Ilana Bergelson, Emily R Smith, Tobi Skotnes, Stephen Wall.Barriers and enablers of kangaroo mother care implementation from a health systems perspective: a systematic review // Health Policy Plan.2017 Dec. 32(10): 1466–1475. Published online 2017 Aug 24. doi: 10.1093/heapol/czx098
11. Joy E. Lawn, Judith Mwansa-Kambafwile, Bernardo L. Horta, Fernando C. Barros, Simon Cousens.‘Kangaroo mother care’ to prevent neonatal deaths due to preterm birth complications // International Journal of Epidemiology. 2010. 39:i144–i154 doi:10.1093/ije/dyq031
12. Levels & Trends in Child Mortality. Estimates developed by the the UN Inter-agency Group for Child Mortality Estimation. UNICEF, World Bank Group, WHO, UN. Report 2019.P36-39
13. Mallet I., Bomy H., Govaert N., Goudal I., Brasme C., Dubois A., Boudringhien S., Pierrat V. Skin to skin contact in neonatal care: knowledge and expectations of health professionals in 2 neonatal intensive care units // Arch Pediatr. 2007 Jul. 14(7):881-6. doi: 10.1016/j.arcped.2007.01.017. Epub 2007 May 8.
14. Neonatal Service Specification from Neonatal Clinical Reference Group of the National Commissioning Board, DH England 2013. С.109
15. NICU Service Specification https://www.england.nhs.uk/commissioning/spec-services/npccrg/group-e/e08/ (accessed: 09 Sertember, 2021).
16. Optimal Arrangements for Neonatal Intensive Care Units in the UK including guidance on their Medical Staffing A Framework for Practice Revised April. 2021.С122.
17. Paulina Chia, Ken Sellick, Sharon Gan.The attitudes and practices of neonatal nurses in the use of kangaroo care // Aust J Adv Nurs. Jun-Aug, 2006. 23(4):20-7.
18. Renée Flacking, Uwe Ewald, Lars Wallin. Positive Effect of Kangaroo Mother Care on Long‐Term Breastfeeding in Very Preterm Infants // JOGNN, 40, 190-197. 2011. DOI: 10.1111/j.1552-6909.2011.01226.x
19. Service Standards for Hospitals Providing Neonatal Care (3rd Edition) 2010 https://www.bapm.org/resources/32-service-standards-for-hospitals-providing-neonatal-care-3rdedition-2010 (accessed: 09 Sertember, 2021)
20. Toolkit for High Quality Neonatal Services 2009 https://webarchive.nationalarchives.gov.uk/20130123200735/http://www.dh.gov.uk/en/Publication sandstatistics/Pu blications/PublicationsPolicyAndGuidance/DH_107845 (accessed: 17 Sertember, 2021)
21. Tarnow‐Mordi W.O., Tucker J.S., Mc Cabeb C.J., Nicolson P., Parry G.J. The UK neonatal staffing study: A prospective evaluation of neonatal intensive care in the UK. Semin Neonat. 1997. 2.Pp.171–179.
22. Ylva Thernström Blomqvist, Christine Rubertsson, Elisabeth Kylberg, Karin Jöreskog, Kerstin Hedberg Nyqvist. Provision of Kangaroo Mother Care: supportive factors and barriers perceived by parents // Scandinavian Journal of Caring Sciences Volume 27, Issue 2. С.111.
23. DH Neonatal Toolkit. 2009. 25 c.
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Karin B.T., Chuvakova T.K., Jaxalykova K.К., Nurmagambetova B.K., Alibekova B.A. Factors contributing to the introduction of the kangaroo method into the practice of perinatal centers of the Republic of Kazakhstan and existing barriers// Nauka i Zdravookhranenie [Science & Healthcare]. 2022, (Vol.24) 1, pp. 90-97. doi 10.34689/SH.2022.21.1.011Related publications:
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