title: Evidence utilization project: implementation of kangaroo care at neonatal ICU.
abstract: BACKGROUND
  Kangaroo care is no longer performed for the initial purpose of maintaining a small baby's body temperature in the developed countries where there are now sufficient medical equipments to keep babies warm. The objectives of kangaroo care in advanced neonatal ICUs have changed to provide benefits such as bonding and attachment, physiologic stability of newborn babies, successful breastfeeding and positive effects on infant development. Kangaroo care is not new to many neonatal nurses, but not every neonatal center is routinely practicing kangaroo care in Singapore. Inadequate nurses' knowledge and lack of guidelines on kangaroo care hinder its practice.
  
  
  OBJECTIVE
  The aim of this project was to implement kangaroo care in very low birth weight babies in a systematic and structured approach.
  
  
  METHODS
  The team followed Larrabee's The Model For Evidence-Based Practice Change, used the available evidence on kangaroo care to develop guideline that was specific and suitable for the local setting. The team organized kangaroo care road shows for nurses and parents to create and enhance awareness. Evaluation of the project was done through two audits. The audit tool consisted of correct baby positioning and nursing documentation, with a sample size of 30 episodes.
  
  
  RESULTS
  The ages of the babies audited were from 24 to 34 weeks of gestation with their weight ranging from 850 to 1500 g. The compliance rate for correct baby positioning during kangaroo care was 100% for both audits. The compliance rate for nursing documentation improved from 93% in the first post-implementation audit to 96.7% in the second post-implementation audit.
  
  
  CONCLUSIONS
  The systematic and structured approach in kangaroo care implementation has created awareness among nurses and led to improvements in their knowledge and practices of kangaroo care. The implementation process of kangaroo care has also aided in training the ward Evidence-Based Nursing Unit team members to engage in critical thinking, which ultimately benefited the babies and parents.
authors.affiliation: 1Khoo Teck Phuat - National University Children's Medical Institute 2National University Hospital, Centre for Evidence-Based Nursing: A Collaborating Centre of the Joanna Briggs Institute, Singapore.
authors.forename: Su He
authors.initials: SH
authors.lastname: Zhang
authors.forename: Wai Kin
authors.initials: WK
authors.lastname: Yip
authors.forename: Priscilla Fong Chien
authors.initials: PF
authors.lastname: Lim
authors.forename: Micki Zhen Yi
authors.initials: MZ
authors.lastname: Goh
mesh_terms: D001942:Breast Feeding; D055318:Evidence-Based Nursing / Q000379:methods* / Q000592:standards; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal / Q000592:standards*; D060127:Kangaroo-Mother Care Method / Q000379:methods* / Q000592:standards; D017283:Neonatal Nursing / Q000193:education / Q000379:methods* / Q000592:standards; D009769:Object Attachment; D010290:Parents / Q000193:education; D012846:Singapore