Going Bare for Better Care

Objective: Evidence supports the use of Kangaroo Care (KC); therefore, our standard of care supported all vaginal births to complete at least 2 hours of KC.  However, we did not have a process in place to allow cesarean mothers to perform KC.  These mothers were also separated from their newborns during recovery. The aim of this project was to implement a process to support KC for cesarean sections and to decrease the mother-newborn separation time.

Design: The World Health Organization recommends kangaroo care for all newborns; therefore, evidence was translated with a quality improvement design using LEAN methodology.

Sample: Ninety-five women and their newborns who delivered via cesarean section between January 1 and July 30, 2013 were included.

Methods: This study was conducted at a northeastern, 76 bed Pathway to Excellence community hospital. Key stakeholders were included to transition to providing KC in the operating room. A swim chart of the current condition identified potential problems including: need for warm room, privacy for KC, stakeholder roles and responsibilities, and parents understanding of KC.

Implementation Strategies: A policy for KC after cesarean section was communicated to stakeholders that included: operating room temperature of 73 degrees, a safe location for mother-newborn recovery, clear roles and responsibilities for stakeholders, access for newborn assessment and physical examination, and essential equipment. In addition, education regarding KC benefits was initiated during mothers’ pre-admission testing. KC after cesarean section was piloted in April/May upon mother’s request. It was fully implemented in June for all scheduled cesarean sections.

Results: Data were collected to measure total time of KC (provided either by the mother or the significant other) and time of mother-newborn separation before and after implementation of KC after cesarean sections. Between January and July, the average amount of KC a newborn received increased from 30 minutes to 2 ½ hours.  Between January and April, mother/newborn separation time averaged 2 hours.  Following the shift to encouraging KC, the average separation time decreased to 1 hour and 20 minutes.  In July, the separation time further decreased to about 20 minutes.

Conclusion/Implications for nursing practice: There has been a decrease in the time mothers and newborns are separated after cesarean sections, with a corresponding increase in the time KC is provided. Support from stakeholders to implement KC in the operating room using LEAN methodology was successful in translating evidence into clinical practice.

Keywords: kangaroo care, skin to skin care, cesarean section, separation time