KANGAROO MOTHER CARE IN SWEDEN – Results of a trial on facilitation support for guideline...
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KANGAROO MOTHER CARE IN SWEDEN –Results of a trial on facilitation support for guideline implementation
Lars Wallin RN, PhDWomen health and pediatric divisionUppsala University Hospital
KU05 Melbourne
Lars Wallin KU05
Aim of the study
To investigate the effect of external facilitation in the implementation of KMC guidelines on patient outcomes
Lars Wallin KU05
Intervention I: KMC guidelines
Continuous and prolonged skin-to-skin contact between the parents and the infant
Promotion of breastfeeding Supporting the family Humanization of neonatal
care
WHO 2003
Lars Wallin KU05
Intervention II: Facilitation
Guiding model from Royal College of Nursing Institute (UK)
Appointed role Helping and enabling Support change and
learning Flexible structure and
focus
Harvey et al, Journal of Advanced Nursing, 2002
Lars Wallin KU05
Study overview
Intervention2 sites
Control2 sites
Dissemination of KMC guidelines – all units
Start of group focused facilitation – intervention
Pre-intervention6 months
Intervention8 months
Post-intervention6 months
End of facilitation
Start of Data collection
April 2001
Participants recruited throughout the whole study period
November 2002
447 infants/368 mothers
Lars Wallin KU05
Patient outcomes
duration skin-to-skin first time skin–to-skin length of stay infant growth incidence of
breastfeeding
parental satisfaction with care
parental experience of interaction with their infant
parental stress
Lars Wallin KU05
Skin-to-skin contact all study phases
Mean minutes skin-to-skin contact per infant per day over hospital stay
60
70
80
90
100
110
120
130
140
150
pre-intervention intervention post-intervention
Facilitation
blue and green
Lars Wallin KU05
Effects (after accounting for covariates)
Guidelines 1.37 0.0003 Facilitation 0.97 0.821 “Post-facilitation” 0.99 0.928 Guidelines + facilitation 1.34 0.010
Multiplicative effect P-value
Lars Wallin KU05
Skin-to-skin contact all study phases
Mean minutes skin-to-skin contact per infant per day over hospital stay
60
70
80
90
100
110
120
130
140
150
pre-intervention intervention post-intervention
“Co-care”
blue and red
Lars Wallin KU05
Interaction effect guidelines and co-care
Because of the steep increase of the time s-t-s in units with “co-care” we developed a model with interaction effects
Guidelines without co-care 1.15 0.225 Guidelines with co-care 1.51 0.018
Multiplicative effect P-value
Lars Wallin KU05
Conclusion
Guidelines increased duration skin-to-skin Facilitation no additional effect Only two units continue to improve during post-
intervention - the “co-care” units with best facilities for parents
Guidelines and unit design prominent impacting factors on time skin-to-skin
Lars Wallin KU05
Context measurement
Intervention2 sites
Control2 sites
QWC 2001
Baseline 16 months
Baseline 28 months
Baseline 36 months
QWC 2002
Focus groups
Lars Wallin KU05
Skin-to-skin contact all study phases
Mean minutes skin-to-skin contact per infant per day over hospital stay
60
70
80
90
100
110
120
130
140
150
pre-intervention intervention post-intervention
“Co-care”
blue and red
Lars Wallin KU05
Outcomes on each unit 2001 and 2002
0
10
20
30
40
50
60
70
80
90
100
Men
tal e
nerg
y
Work
clim
ate
Work-
relat
ed e
xhau
stion
Work
tem
po
Perfo
rmanc
e feed
back
Partic
ipato
ry m
anage
men
t
Skills
deve
lopment
Goal c
larity
Organ
isatio
nal e
fficacy
Lead
ersh
ip
Dynam
ic Foc
us S
core
Unit A 2001
Unit A 2002
Unit B 2001
Unit B 2002
Unit C 2001
Unit C 2002
Unit D 2001
Unit D 2002
Outcomes on each unit 2001 and 2002