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12th Annual Kangaroo Care Certification Pre-conference On-line Lectures
June 2016
There are three power point presentations that follow. Please read the presentations and complete the questions following them. (Passing score 80%). Print your certificate of completion and bring it to the conference when you register.
KC for preterms was first studied in Cleveland, OH by Klaus & Kennell in 1970 and has spread around the world. It is now recommended for ALL newborns EVERY WHERE, as follows:(Klaus MH &Kennell JH (1970). Mothers separated from their newborn infants. Pediatr Clin North America, 17(4) 1015-1037).
“Kangaroo mother care is a basic right of the newborn and should be an integral part of the low birth weight and full term newborn’s care, in all settings, in all levels of care, and in all countries” (pg. 1140)
(Charpak N, de Calume, ZF, & Ruiz JG. (2000). “The Bogota Declaration on kangaroo mother care.” Conclusions of the second international workshop on the method. Second International Workshop of Kangaroo Mother Care. Acta Paediatrica 89 (9): 1137-1140. )
1) To gain understanding of the levels of science 2) To learn how evidence is rated3) To learn what the KC bib contains4) To understand how to find a topic in the KC bib5) To understand one’s responsibilities as a Certified Kangaroo Caregiver6) Impact of certification on practice and salary recognition7.) To increase awareness of and participation in the international Kangaroo Care Awareness Day May 15
All levels of health care are being challenged …
Our care practices must be “Evidenced-Based-Practice”
What is “Evidenced-Based Practice”?
How and where do we get the evidence?
Which sources are good sources of evidence?
These questions will be answered in following slides
Evidence used to be anything published but now evidence is classified by its strength, i.e. a commentary does not have the same strength as a randomized controlled clinical trial (RCT).
Thus, all evidence is not the same!
“Evidence-based practice” has evolved into recognition that evidence should be based on experimental studies (RCT) and meta-analyses.American Academy of Pediatrics, Section on Breastfeeding. 2005. Breastfeeding and the Use of Human Milk Policy Statement. Pediatrics 115(2), 496-506.
Strongest
Weakest
Publications and research studies are evaluated for their level of scientific rigor (design, and was there a control group for comparisons) and blindness (i.e. concealment – were the people collecting the data aware of the purpose of the study, aware of the desired outcomes aware of the research questions being answered and was the patient informed of what data was being collected. When the answer to these questions is NO, then a high level of concealment as occurred in the conduct of the study, making the results more valid and less biased.
Thus, a commentary is low level of evidence, a meta-analysis is high level of evidence (see previous table /graph)
•Cochrane means a systematic method of reviewing all articles and data (published and unpublished) that has been conducted by multiple researchers examining all data.
•Analysis means the data from all studies (published and unpublished) are analyzed together.
•Meta refers to “all, many” studies, not just a single study
THUS, meta-analysis says that the findings APPLY to everyone in the population, not just the subjects that were studied.
Meta-analysis results are generally INDISPUTABLE
Cochrane Meta-Analyses results are INDISPUTABLE and are the BEST EVIDENCE. So, when questioned or provided with contrary information, your reply should be: “I’ll SHOW YOU MY COCHRANE if YOU’LL SHOW ME YOURS”
US Preventive Services Task Force – grades evidence from studies; if evidence is graded:
A= merits application of the intervention B= suggests application of the intervention C= warrants consideration of applying the findings D= limited E= effectiveness is not established
The following slide depicts how the evidence for use of Kangaroo Care has been rated by the US Preventive Services Task force as of 2008. There are two findings, effect on Apnea and effect on Brain Maturation, which have 2 ratings; i.e. “C/B” and “C/A”. This indicates there has been research since 2008 and the evidence of KC’s effect on these criteria is now : “B” for apnea and “A” for brain maturation.All of the studies on Kangaroo Care can be found in the “Kangaroo Care Bibliography”.
KC Effects EvidenceRating
Physiological Heart Rate ARespiratory Rate AOxygen saturation ADesaturations BApnea- No change/ ↓ Apnea
A/ B
Temperature ACortisol B↑ Weight gain C↓ Infections A
Behavioral Improve Sleep A
↓Crying AAnalgesic / pain relief A
Breastfeeding ↑ Milk production A↑ Exclusivity A↑ Duration A↑ Initiation A
Neurobehavioral ↑ General development A↑ Mental/ Motor Scores A↑Brain Maturation C /A
Psychosocial ↓ Maternal Anxiety A↑ Maternal Satisfaction ABetter Attachment AMore positive interactionwith infant
B
Ludington, Morgan, and Abulfettoh. 2008. Clinical Guidelines for Implementation of Kangaroo Care with Premature Infants > 30 Weeks Postmenstrual Age. Advances in Neonatal Care NANN special supplement.
US Preventive Services Task Force Rating of all Preterm Evidence through March 1, 2008
Dr. Ludington maintains a bibliography for Kangaroo Care.The Bib contains all published reports available to Dr. Ludington, a list of videos, handouts, websites, and poetry about KC. The majority of citations are annotated. It is available on the USIKC website under “Resources” for your use. You can find any topic pertaining to KC in this bib.
IN the KC bib, all publications / reports are identified according to the type of evidence (clinical reports, commentary, review, studies) provided by the publication.
2016Kangaroo Care Annotated
Bibliography and References to Videos, Books, Webinars, Wraps,
Researchers, etc.
Cover of KC Bib found on USIKC website under Resources
In the KC bib, the entries are categorized as; • Review is called a “REVIEW”• Theory article that presents a theory is
called “THEORY”, • Policy reports are called “POLICY”• Recommendation reports are called
“GUIDELINES”• Research studies are identified
according to the type of study it was as listed on the slide ”Types of Studies from
Strongest to Weakest” level of evidence slide that came previously
• Check date of the KC Bib to see how current it is (it is updated twice /year)
• Find the current KC bib on USIKC website under “Resources”
• Alphabetical listing, not chronological – author(s) and year• Title of article and source of publication, with page
numbers• Type of publication identified in text and at end of each
citation• Preterm (PT) or Fullterm (FT) or Both identified at end of
each citation• Key terms and outcomes listed at end of each citation• Two examples of KC BIB citations follow
• Ludington-Hoe SM, Morgan K, & Abouelfettoh A. (2008). National evidence-based guidelines for Kangaroo Care with preterm infants > 30 weeks postmenstrual age. Advances in Neonatal Care.8 (3 Suppl): S3-S23. A review article of the evidence of KC on physiologic (cardiovascular –HR, blood pressure, bradycardia-, respiratory -RR, ,apnea, tachypnea, periodic breathing, desaturation events, SAO2 - temperature –hypo & hyperthermia, rewarming – pain and brain maturation), behavioral (crying, state, breastfeeding), and psychosocial (maternal feelings, maternal-infant interaction, paternal attachment, recovery from maternal stress) effects of KC. A sample protocol is included as is a Readiness for Kangaroo Care assessment guide that assesses infant, parent, staff, and institutional readiness for KC. Guidelines for monitoring and documenting the KC sessions are provided. Review, PT, guidelines, protocol, readiness for KC , pain. sleep
Bold print identifies Review Pre-term, Guidelines /Protocol, Key Words
Chiu, S-H, & Anderson GC. (2009). Effect of early skin-to-skin contact on mother-preterm infant interaction through 18 months: randomized controlled trial. International J. of Nursing Studies. 46(9), 1168-1180. RCT of 100 infants who started KC early after birth and then intermittently throughout the next five days (Amt of KC was very little – see Anderson, Chiu et al., 2003) vs. those preterms put in regular NICU without early KC. AT 6 (N= 69 infants) and 12 months (N=70 infants) NCAST feeding was videotaped and scored. No difference in feeding between groups. At 6,12, and 18 months (N=76) the NCAST teaching was videotaped. KC infants scored lower on the teaching at 6 months (negative outcome, more controlling mother). Authors conclude that the data is inconclusive due to low dose of KC, small sample size (but this is a good sample size in general, but I do not know what their actual power was for these outcomes), and insensitive measures of interaction (they suggest Parent-Child Early Relational Assessment and/or behavioral coding during play). PT, RCT, interaction, teaching, feeding, reports a negative effect
Bold print identifies Pre-term, Randomized Control Trial, key words
• The KC Bib is in WORD format
• Go to first page of the KC Bib
• Simultaneously click on “control” and “F” – this brings you to the FIND field in pre 2014 versions of WORD, or it takes you to NAVIGATE, a sign on the left side of the screen in WORD versions after 2012
*When you get to Navigate or Find screen
*Type in the key word, i.e pain, cesarean, birth KC, temperature, etc
*Click on FIND NEXT I pre 2012 versions or click on the arrow headed down beneath the Navigate Sign. The first article about this key word comes up. Read it and then
*Click on FIND NEXT again (or click on the down arrow again) and the next reference to this same topic will come up
Type Key word
OR
Click to advance
Everything related to becoming and being a Certified Kangaroo Caregiver (CKC) is in the first module of the Learner’s Manual. (Manual provided at conference)
We review here: responsibilities of being CKC- in module1 procedure for recertification- in module 1 initials to use to designate your certified status –in module 1
•1) Promote Kangaroo Care– • make consumers and professionals aware of KC after you
have learned the evidence base for the practice. • come up with creative solutions to KC implementation
issues,• focus on the health-driven quality outcomes of KC, • teach skills and content related to Kangaroo Care in their
area of expertise (either preterm or full term Kangaroo Care), • lead policy changes to enhance use of Kangaroo Care, • support and participate in quality improvement projects
and/or research studies related to Kangaroo Care • develop resources to enhance the implementation of
Kangaroo Care in a variety of settings. • The Certified Kangaroo Caregiver first and foremost becomes
an informed change-agent for non-separation of infant and mother
• 2) Provide Kangaroo Care – fulfill every infant’s right to receive KC
• 3) Preserve Kangaroo Care by creating a culture of consistent kangaroo caregiving -insure KC’s continuance by contributing to its evidence base through research and quality improvement programs and by contributing to its practice base by using KC in every appropriate situation and sharing your experiences with others engaging in the practice of KC
• 4) Protect Kangaroo Care- appropriate and safe use by using critical thinking skills when using KC and by REMAINING CURRENT WITH THE LITERATURE. Having mother and infant in skin-to-skin chest-to-chest contact is NATURAL, but we have moved so far away from permitting natural, instinctive phenomena to occur, that we often think we have to “help,” “guide,” “advise,” “order,” “permit,” and “support” KC with her infant. But, really, we need to “protect” KC’s natural occurrence and sustain this instinctual behavior.
• After you complete your KC Certification you may use the initials CKC after your name, i.e. Mary Smith, RN, IBCLC,CKC
• Certification is valid for TWO years, from July 1 - June 30 two years later
• From January through June you can complete recertification which is reviewing current KC articles, answering the questions, submitting your answers and paying the Recertification fee (now $50.00 but subject to change) to KC Certification Corporation.
• Your new certificate will be sent by email Certified Kangaroo Caregiver
Mary Smith, RN, IBCLC, CKC
Valid Dates: July 1, 2015 - June 30, 2017
•The initials you are entitled to use once you satisfactorily complete all requirements for Certification as a Kangaroo Caregiver are:
• CKC• Use the initials every time you professionally sign a
document. The more you use it, the sooner others will acknowledge it and become familiar with its value
• The study found that CKCs reported that they learned a lot in the certification course,
• That they increased use of KC in many ways, • That they are proud of their certification and it has meaning to
them,• Recognition of their expertise was slow in first six months but
then picked up,• The majority of attendees had registration paid by their
hospitals,• 4/67 CKCs received salary differential for this certification, and • CKC certification needs to recognized by USA certification
bodies so hospitals pay differential
• In 2010, the Kangaroo Care Awareness Day initiative began in recognition of a small ventilated male premature infant named Zak who survived the evacuation of a University NICU during a hurricane by being kept in KC when all electricity had failed and the unit was flooding
• Sample activities are having: Be Creative! • a contest to reward the mother conducting the most KC from May 1 to May 15• a wall of Kangaroo Care pictures or kangaroo cutouts acknowledging
each infant who receives KC• distribution of Kangaroo lollipops or cakes or brochure to advertise
the KC being done in the institution• international competition of which institution had the most KC hours
over a given period of time• Visit by a costumed Kangaroo who distributed stuffed Joeys, etc.
Kangaroo Care is the right of every newbornThe science supporting KC has been establishedThe Best evidence is found in Cochrane Meta-analysis The Randomization Clinical Trial is the strongest type of studyYour certification indicates that you will do your part to promote, provide, preserve and protect this right for all newborns, both FT and PTThe Kangaroo Care Bibliography contains references which provide the science for KC. Learn to use the KC Bib as it will help you as you proceed in carrying out your responsibilities as a Certified Kangaroo Caregiver
This is the end of the first pre-conference lectures. Proceed to the quiz for this power point.
