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Lars Wallin RN, PhD Women health and pediatric division Uppsala University Hospital

KANGAROO MOTHER CARE IN SWEDEN – Results of a trial on facilitation support for guideline implementation. Lars Wallin RN, PhD Women health and pediatric division Uppsala University Hospital KU05 Melbourne. Aim of the study.

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Lars Wallin RN, PhD Women health and pediatric division Uppsala University Hospital

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  1. KANGAROO MOTHER CARE IN SWEDEN –Results of a trial on facilitation support for guideline implementation Lars Wallin RN, PhD Women health and pediatric division Uppsala University Hospital KU05 Melbourne

  2. Aim of the study • To investigate the effect of external facilitation in the implementation of KMC guidelines on patient outcomes

  3. 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

  4. 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

  5. Study overview Dissemination of KMC guidelines – all units Start of group focused facilitation – intervention End of facilitation Intervention 2 sites Pre-intervention 6 months Intervention 8 months Post-intervention 6 months Control 2 sites Participants recruited throughout the whole study period November 2002 447 infants/368 mothers Start of Data collection April 2001

  6. 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 Patient outcomes

  7. Skin-to-skin contact all study phases Facilitation blue and green

  8. 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

  9. Skin-to-skin contact all study phases “Co-care” blue and red

  10. 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

  11. 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

  12. Context measurement QWC 2001 QWC 2002 Intervention 2 sites Baseline 1 6 months Baseline 2 8 months Baseline 3 6 months Control 2 sites Focus groups

  13. Skin-to-skin contact all study phases “Co-care” blue and red

  14. Outcomes on each unit 2001 and 2002

  15. Unit C (control) A change team was established late. No significant activities were carried out during the study period.

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