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

Lars Wallin KU05

Unit C (control)

A change team was established late. No significant activities were carried out during the study period.