Kangaroo Method: potentialities, barriers and difficulties in humanized care for newborns in the Neonatal ICU

Luz, Susian Cássia Liz; Backes, Marli Terezinha Stein; Rosa, Rosiane da; Schmit, Eudinéia Luz; Santos, Evangelia Kotzias Atherino dos

doi:10.1590/0034-7167-2020-1121

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Revista Brasileira de Enfermagem

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REVIEW • Rev. Bras. Enferm. 75 (02) • 2022 • https://doi.org/10.1590/0034-7167-2020-1121 copy

Kangaroo Method: potentialities, barriers and difficulties in humanized care for newborns in the Neonatal ICU

Método Madre-Canguro: potencialidades, barreras y dificultades en atención humanizada al recién nacido en la UCI Neonatal

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To identify the potentialities, barriers and difficulties for the implementation of humanized care from the perspective of the Kangaroo Method.

Methods:

Integrative literature review with a time cut from 02/01/2015 to 06/01/2019, totaling ten articles in the final sample.

Results:

The findings were categorized into two categories: Potentialities for humanized care from the perspective of the Kangaroo Method; Barriers or difficulties to the implementation of the Kangaroo Method. Several potentialities for humanized care allied to technology and continuing education were identified, as well as several barriers to the implementation of the Kangaroo Method, such as lack of physical space, lack of professionals and team training, lack of knowledge, lack of adherence and professional demotivation.

Final considerations:

There are still few studies that address the potentialities, barriers and difficulties for the implementation of humanized care from the perspective of the Kangaroo Method, and most of those included in this review were conducted in Brazil and present a qualitative approach.

Descriptors:
Nursing Care; Kangaroo Method; Nursing; Neonatal Infant; Newborn; Intensive Care Units; Neonatal

Database	Junctions
MEDLINE	(("Kangaroo-Mother Care Method"[Mesh] OR "Kangaroo Mother Care Method"[All Fields] OR ("kangaroo-mother care method"[MeSH Terms] OR ("kangaroo-mother"[All Fields] AND "care"[All Fields] AND "method"[All Fields]) OR "kangaroo-mother care method"[All Fields] OR ("kangaroo"[All Fields] AND "mother"[All Fields] AND "care"[All Fields] AND "methods"[All Fields])) OR "Kangaroo Mother Care"[All Fields] OR "Kangaroo-Mother Care"[All Fields] OR "Kangaroo method"[All Fields] OR ("macropodidae"[MeSH Terms] OR "macropodidae"[All Fields] OR "kangaroo"[All Fields])) AND ("Intensive Care Units, Neonatal"[Mesh] OR "Neonatal ICU"[All Fields] OR "Neonatal Intensive Care Units"[All Fields] OR "Newborn Intensive Care Units"[All Fields] OR "Newborn Intensive Care Units (NICU)"[All Fields] OR "NICU"[All Fields] OR "Neonatal ICUs"[All Fields] OR "Newborn ICU"[All Fields] OR "Newborn ICUs"[All Fields] OR "Infant, Premature"[Mesh] OR "Premature Infant"[All Fields] OR "Preterm Infants"[All Fields] OR "Preterm Infant"[All Fields] OR "Premature Infants"[All Fields] OR "Neonatal Prematurity"[All Fields])) AND (("2015/01/01"[PDAT] : "2019/06/01"[PDAT]) AND (English[lang] OR Portuguese[lang] OR Spanish[lang]))
Scopus	ALL ( ( "Kangaroo Mother Care Method" OR "Kangaroo-Mother Care Methods" OR "Kangaroo Mother Care" OR "Kangaroo-Mother Care" OR "Kangaroo method" OR kangaroo ) AND ( "Neonatal ICU" OR "Neonatal Intensive Care Units" OR "Newborn Intensive Care Units" OR "Newborn Intensive Care Units (NICU)" OR "NICU" OR "Neonatal ICUs" OR "Newborn ICU" OR "Newborn ICUs" OR "Premature Infant" OR "Preterm Infants" OR "Preterm Infant" OR "Premature Infants" OR "Neonatal Prematurity" ) ) AND ( LIMIT-TO ( PUBYEAR, 2019 ) OR LIMIT-TO ( PUBYEAR, 2018 ) OR LIMIT-TO ( PUBYEAR, 2017 ) OR LIMIT-TO ( PUBYEAR, 2016 ) OR LIMIT-TO ( PUBYEAR, 2015 ) ) AND ( LIMIT-TO ( LANGUAGE, "English" ) OR LIMIT-TO ( LANGUAGE, "Spanish" ) OR LIMIT-TO ( LANGUAGE, "Portuguese" ) ) AND ( LIMIT-TO ( DOCTYPE, "ar" ) OR LIMIT-TO ( DOCTYPE, "re" ) )
Web of Science	TS=(("Kangaroo Mother Care Method" OR "Kangaroo-Mother Care Methods" OR "Kangaroo Mother Care" OR "Kangaroo-Mother Care" OR "Kangaroo method" OR kangaroo) AND ("Neonatal ICU" OR "Neonatal Intensive Care Units" OR "Newborn Intensive Care Units" OR "Newborn Intensive Care Units (NICU)" OR "NICU" OR "Neonatal ICUs" OR "Newborn ICU" OR "Newborn ICUs" OR "Premature Infant" OR "Preterm Infants" OR "Preterm Infant" OR "Premature Infants" OR "Neonatal Prematurity")) ( 2019 OR 2018 OR 2017 OR 2016 OR 2015 ) AND ( ENGLISH OR PORTUGUESE OR SPANISH ) AND ( ARTICLE OR REVIEW )
SciELO	(("Kangaroo Mother Care Method" OR "Kangaroo-Mother Care Methods" OR "Kangaroo Mother Care" OR "Kangaroo-Mother Care" OR "Kangaroo method" OR kangaroo OR "Método Canguru" OR "Método Mãe-Canguru" OR "Método Mãe Canguru" OR "Mãe Canguru" OR "Projeto Mãe-Canguru" OR Canguru OR "Método Madre-Canguro" OR "Metodo canguro" OR canguro) AND ("Neonatal ICU" OR "Neonatal Intensive Care Units" OR "Newborn Intensive Care Units" OR "Newborn Intensive Care Units (NICU)" OR "NICU" OR "Neonatal ICUs" OR "Newborn ICU" OR "Newborn ICUs" OR "Premature Infant" OR "Preterm Infants" OR "Preterm Infant" OR "Premature Infants" OR "Neonatal Prematurity" OR "Unidades de Terapia Intensiva Neonatal" OR "Centros de Terapia Intensiva para Recém-Nascidos" OR "CTI Neonatal" OR "Unidade Neonatal de Cuidados Intensivos" OR "Unidade Neonatal de Terapia Intensiva" OR "Unidade Neonatal de Tratamento Intensivo" OR "Unidade de Terapia Intensiva do Tipo III" OR "Unidade de Terapia Intensiva Neonatal" OR "Unidade de Tratamento Intensivo Neonatal" OR "Unidades de Cuidados Intensivos Neonatais" OR "Unidades Neonatais de Cuidados Intensivos" OR "Unidades Neonatais de Terapia Intensiva" OR "Unidades de Tratamento Intensivo Neonatal" OR "Unidades de Terapia Intensiva para RecémNascidos" OR "UCI Neonatal" OR "UTI Neonatal" OR "Unidades de Cuidado Intensivo Neonatal" OR "Recém-Nascido Prematuro" OR "Bebê Prematuro" OR "Bebês Prematuros" OR "Lactente Nascido Prematuramente" OR "Lactente Nascido Pré-Termo" OR "Lactente Prematuro" OR "Lactente Pré-Termo" OR "Lactentes Nascidos Prematuramente" OR "Lactentes Nascidos Prematuros" OR "Lactentes Nascidos Pré-Termo" OR "Lactentes Prematuros" OR "Lactentes Pré-Termo" OR "Neonato Prematuro" OR "Neonato Pré-Termo" OR "Neonatos Prematuros" OR "Neonatos Pré-Termo" OR Prematuridade OR "Prematuridade Neonatal" OR Prematuro OR "Pré-Termo" OR Prematuros OR "Recém-Nascido Pré-Termo" OR "Recém-Nascidos Prematuros" OR "Recém-Nascidos Pré-Termo" OR "Recien Nacido Prematuro" OR "Lactante Prematuro"))
CINAHL	(("Kangaroo Mother Care Method" OR "Kangaroo-Mother Care Methods" OR "Kangaroo Mother Care" OR "Kangaroo-Mother Care" OR "Kangaroo method" OR kangaroo) AND ("Neonatal ICU" OR "Neonatal Intensive Care Units" OR "Newborn Intensive Care Units" OR "Newborn Intensive Care Units (NICU)" OR "NICU" OR "Neonatal ICUs" OR "Newborn ICU" OR "Newborn ICUs" OR "Premature Infant" OR "Preterm Infants" OR "Preterm Infant" OR "Premature Infants" OR "Neonatal Prematurity"))
LILACS e BDENF	(("Kangaroo Mother Care Method" OR "Kangaroo-Mother Care Methods" OR "Kangaroo Mother Care" OR "Kangaroo-Mother Care" OR "Kangaroo Method" OR Kangaroo OR "Método Canguru" OR "Método Mãe-Canguru" OR "Método Mãe Canguru" OR "Mãe Canguru" OR "Projeto Mãe-Canguru" OR Canguru OR "Método Madre-Canguro" OR "Metodo Canguro" OR Canguro) AND ("Neonatal ICU" OR "Neonatal Intensive Care Units" OR "Newborn Intensive Care Units" OR "Newborn Intensive Care Units (NICU)" OR "NICU" OR "Neonatal ICUs" OR "Newborn ICU" OR "Newborn ICUs" OR "Premature Infant" OR "Preterm Infants" OR "Preterm Infant" OR "Premature Infants" OR "Neonatal Prematurity" OR "Unidades de Terapia Intensiva Neonatal" OR "Centros de Terapia Intensiva para Recém-Nascidos" OR "CTI Neonatal" OR "Unidade Neonatal de Cuidados Intensivos" OR "Unidade Neonatal de Terapia Intensiva" OR "Unidade Neonatal de Tratamento Intensivo" OR "Unidade de Terapia Intensiva do Tipo III" OR "Unidade de Terapia Intensiva Neonatal" OR "Unidade de Tratamento Intensivo Neonatal" OR "Unidades de Cuidados Intensivos Neonatais" OR "Unidades Neonatais de Cuidados Intensivos" OR "Unidades Neonatais de Terapia Intensiva" OR "Unidades de Tratamento Intensivo Neonatal" OR "Unidades de Terapia Intensiva para RecémNascidos" OR "UCI Neonatal" OR "UTI Neonatal" OR "Unidades de Cuidado Intensivo Neonatal" OR "Recém-Nascido Prematuro" OR "Bebê Prematuro" OR "Bebês Prematuros" OR "Lactente Nascido Prematuramente" OR "Lactente Nascido Pré-Termo" OR "Lactente Prematuro" OR "Lactente Pré-Termo" OR "Lactentes Nascidos Prematuramente" OR "Lactentes Nascidos Prematuros" OR "Lactentes Nascidos Pré-Termo" OR "Lactentes Prematuros" OR "Lactentes PréTermo" OR "Neonato Prematuro" OR "Neonato Pré-Termo" OR "Neonatos Prematuros" OR "Neonatos Pré-Termo" OR Prematuridade OR "Prematuridade Neonatal" OR Prematuro OR "Pré-Termo" OR Prematuros OR "Recém-Nascido Pré-Termo" OR "Recém-Nascidos Prematuros" OR "Recém-Nascidos Pré-Termo" OR "Recien Nacido Prematuro" OR "Lactante Prematuro"))
Cochrane Library	("Kangaroo Mother Care Method" OR "Kangaroo-Mother Care Methods" OR "Kangaroo Mother Care" OR "Kangaroo-Mother Care" OR "Kangaroo method" OR kangaroo) in Title, Abstract, Keywords and ("Neonatal ICU" OR "Neonatal Intensive Care Units" OR "Newborn Intensive Care Units" OR "Newborn Intensive Care Units (NICU)" OR "NICU" OR "Neonatal ICUs" OR "Newborn ICU" OR "Newborn ICUs" OR "Premature Infant" OR "Preterm Infants" OR "Preterm Infant" OR "Premature Infants" OR "Neonatal Prematurity") in Title, Abstract, Keywords, Publication Year from 2015 to 2019 in Cochrane Reviews

Title, periodical and year	Study site and database	Type of study and sample size (n)	Results	Level of evidence
Management challenges for best practices of the Kangaroo Method in the Neonatal ICU⁽⁸8 Silva LJ, Leite JL, Silva TP, Silva IR, Mourão PP, Gomes TM. Management challenges for best practices of the Kangaroo Method in the Neonatal ICU. Rev Bras Enferm. 2018;71(suppl 6):2783-91. https://doi.org/10.1590/0034-7167-2018-0428 https://doi.org/10.1590/0034-7167-2018-0... ⁾. Brazilian Journal of Nursing. 2018.	Brazil CINAHL	Qualitative study n = 8	The nurses demonstrated that they had difficulty in implementing the Kangaroo Method, for various reasons, including: lack of institutional management combined with lack of human resources, adherence of some professionals, and professional autonomy.	VI
The nursing social practice in the promotion of maternal care to the premature in the neonatal unit⁽⁹9 Araújo BBM, Pacheco STA, Rodrigues BMRD, Silva LF, Rodrigues BRD, Arantes PCC. The nursing social practice in the promotion of maternal care to the premature in the neonatal unit. Texto Contexto Enferm. 2018;27(4):e2770017. https://doi.org/10.1590/0104-07072018002770017 https://doi.org/10.1590/0104-07072018002... ⁾. Text & Context Nursing. 2018.	Brazil SciELO	Critical discourse analysis n = 15	It is important that nurses also pay attention to maternal needs, favoring their potential to care for PTNB*.	VI
Nurses' adherence to the Kangaroo Care Method: support for nursing care management⁽¹⁰10 Silva LJ, Leite JL, Scochi CGS, Silva LR, Silva TP. Nurses' adherence to the kangaroo care method: support for nursing care management. Rev Latino-Am Enfermagem. 2015;23(3):483-90. http://dx.doi.org/10.1590/0104-1169.0339.2579 http://dx.doi.org/10.1590/0104-1169.0339... ⁾. Latin American Journal of Nursing. 2015.	Brazil Scopus	Qualitative research n = 8	The importance of each team member as a multiplier of care was evidenced. Each one can be influential or not in the recognition of the Kangaroo Method as a care model, and the nurse is the great protagonist in this process.	VI
The value attributed by nursing professionals to the care proposed by the canguru method⁽¹¹11 Stelmak AP, Mazza VA, Freire MHS. The value attributed by nursing professionals to the care proposed by the canguru method. Rev Enferm UFPE. 2017;11(9):3376-85. https://doi.org/10.5205/1981-8963-v11i9a110236p3376-3385-2017 https://doi.org/10.5205/1981-8963-v11i9a... ⁾. UFPE Journal of Nursing on. 2017.	Brazil BDENF	Descriptive study with a qualitative approach n = 37	The Kangaroo Method is compared to "life insurance" by nurses for providing care that balances biological, environmental, and family needs in low-birth-weight preterm newborns. The method aims to protect and preserve the NB from the sequelae of prematurity, which provides adequate infant neuropsychomotor development.	VI
Conceptions of humanization of health professionals in neonatal intensive therapy unit⁽¹²12 Roseiro CP, Paula KMP. Concepções de humanização de profissionais em Unidades de Terapia Intensiva Neonatal. Estud Psicol. 2016;32(1):109-19. https://doi.org/10.1590/0103-166x2015000100010 https://doi.org/10.1590/0103-166x2015000... ⁾. Psychology Studies. 2015.	Brazil Scopus	Qualitative research n = 29	The professionals are able to understand and work humanization, distancing themselves from the biomedical model. They know the importance of an adequate environment, free of noise and unnecessary lights, and they also understand the relevance of parents' participation in the care of their children. There is demotivation of professionals due to lack of professional recognition.	VI
Kangaroo care in the high-technology neonatal unit: exploring evidence-based practice, policy recommendations and education priorities in Northern Ireland⁽¹³13 Mcgowan JE, Naranian T, Johnston L. Kangaroo care in the high-technology neonatal unit: exploring evidence-based practice, policy recommendations and education priorities in Northern Ireland. J Neonatal Nurs. 2017;23(4):174-9. http://doi.org/10.1016/j.jnn.2017.03.001 http://doi.org/10.1016/j.jnn.2017.03.001... ⁾. Journal of Neonatal Nursing. 2017.	Northern Ireland Scopus	Quantitative Researchn = 78	Although nurses recognize the effects and benefits of the Kangaroo Method, there are still barriers to its implementation, such as inadequate environment and insecurity on the part of some professionals to start the method. However, professional experiences showed positive attitudes for the promotion of the method.	VI
Neonatal nurses' perceptions of supportive factors and barriers to the implementation of skin-to-skin care in extremely low birth weight (ELBW) infants - A qualitative study⁽¹⁴14 Lim S. Neonatal nurses’ perceptions of supportive factors and barriers to the implementation of skin-to-skin care in extremely low birth weight (ELBW) infants: a qualitative study. J Neonatal Nursing. 2017;24(1):39-43. https://doi.org/10.1016/j.jnn.2017.11.010 https://doi.org/10.1016/j.jnn.2017.11.01... ⁾. Journal of Neonatal Nursing. 2018.	England Scopus	Qualitative research n = 7	As a significant barrier to the implementation of the method, this study points to the unit, in addition to the lack of support from the medical team. On the other hand, nurses support the Kangaroo Method, skin-to-skin contact with restrictions for NB weighing less than 1,000 g.	VI
Knowledge and attitude of personnel, key factors in implementation of neonatal pain management in NICU⁽¹⁵15 Mehrnoush N, Ashktorab T, Heidarzadeh M, Momenzadeh S. Knowledge and attitude of personnel, key factors in implementation of neonatal pain management in NICU: a qualitative study. J Clin Diagn Res. 2017;11(11):SC05-9. https://doi.org/10.7860/JCDR/2017/26290.10851 https://doi.org/10.7860/JCDR/2017/26290.... ⁾. Journal of Clinical and Diagnostic Research. 2017.	Iran Scopus	Qualitative study n = 35	There is a lack of knowledge by doctors and nurses of non-pharmacological methods for the relief of pain in newborns, such as skin-to-skin contact, which can be performed by parents during painful procedures, but is little used.	VI
The experiences of professionals regarding involvement of parents in neonatal pain management⁽¹⁶16 Marfurt-Russenberger, K, Axelin A, Kesselring A, Franck LS, Cignacco E. The experiences of professionals regarding involvement of parents in neonatal pain management. J Obstet Gynecol Neonatal Nurs. 2016;45(5):671-83. https://doi.org/10.1016/j.jogn.2016.04.011 https://doi.org/10.1016/j.jogn.2016.04.0... ⁾. Journal of Obstetric, Gynecologic, and Neonatal Nursing. 2016.	Sweden PubMed	Qualitative study n = 23	For the parents' participation in pain management to be successful, the nurse's action in this process is important, stimulating skin-to-skin contact, non-nutritive sucking, and the use of sucrose. However, some factors hinder the parents' action: the conditions of the NB, lack of organization, space and staff.	VI
Kangaroo Care Education Effects on Nurses' Knowledge and Skills Confidence⁽¹⁷17 Almutairi WM, Ludington-Hoe SM. Kangaroo care education effects on nurses' knowledge and skills confidence. J Contin Educ Nurs. 2016;47(11):518-24. https://doi.org/10.3928/00220124-20161017-11 https://doi.org/10.3928/00220124-2016101... ⁾. Journal of Continuing Education in Nursing. 2016.	USA Scopus	Quasi-experimental design pre-test and post-test n = 57	Although nurses already knew the benefits of the Kangaroo Method, their practice was limited due to lack of knowledge and skills. After taking a course, the nurses felt more prepared, understood the importance of parents staying with the NB, the kangaroo position for as long as possible, and the presence of parents during painful procedures.	II

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[1] Corresponding author: Susian Cássia Liz Luz E-mail: susilizluz@hotmail.com