2

these infants impose critical thinking skills and safest interventions for them

to survive. However, mothers may experience a higher incidence of

distress during the neonatal period as a result of their infants’ prematurity.

(Tilokskulchai et al., 2002). In order to manage their fears and anxiety, Staff

nurses in Neonatal Intensive Care Unit (NICU) play a very significant role in

assisting mothers during the course of kangaroo mother care by providing

with them adequate knowledge and emotional support.

Consequently, nurses may not be able to provide adequate care and

assistance to mothers in providing Kangaroo Mother Care due to the lack

of staff in NICU. Mothers may face difficulties during KMC in NICU that may

affect them to provide KMC successfully. These factors include staff’s

attitude, inadequate assistance to position the infant on a mother’s chest

and inadequate information about this method (Seidman G, 2015).

The aim of the present study is to investigate and explore mother’s

experiences of the Kangaroo Mother Care procedure (KMC). Specifically,

their experiences towards the staff nurses who are the primary educators

of KMC. Furthermore, this study seeks to discern mother’s perspective on

what could be possibly improved regarding KMC procedure. With this, the

findings of the study can serve as a starting point for researchers and

program implementers looking to improve KMC programs and possible

improvement of the quality of care from nurses.

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Statement of the Problem

Prematurity is the most common cause of neonatal deaths globally.

Of these, about 2.6 million died within the first month (Muhe, 2018). For this

problem to be dealt with, an alternative model of care was developed as

one of the measures to reduce this dilemma. KMC can shorten the infant’s

length of hospital stay and improve mother-infant bonding. In connection

with this, NICU nurses have the responsibility to render adequate

information and build effective communication to mothers to teach them

KMC method. This qualitative study will explore and describe mother’s

experiences of educative and action care from NICU nurses and

determines how it affects them of providing Kangaroo mother care to their

preterm babies.

Research Questions

The aim of this study is to explore and describe mother’s experiences

on proving KMC to their hospitalized preterm babies to help healthcare

providers especially nurses to improve the quality of care in Neonatal

Intensive Care Units. Therefore, the purpose of this study can be fulfilled

through answering the following research questions:

1. What are the mothers’ experiences as they deal with staff nurses

about KMC at NICU?

2. How do their experiences from NICU nurses affect them on

providing KMC to their preterm infants?

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Research Objectives

The general objective of this study is to explore and describe

mother’s experiences on providing KMC to their hospitalized preterm

babies in provincial hospitals of Maramag Bukidnon. Specifically, the

objectives of this study are:

1. To describe mothers’ experiences on information and

communication given by staff nurses about KMC at NICU.

2. To explore the experiences of mothers who provide KMC to their

preterm babies.
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RESEARCHER’S PRESUPPOSITION, BIAS AND THEORETICAL

STANCE

Researcher’s Bias

The researcher had come up with this study because of her interest

of determining how the nurses render care and education to patients’

significant others. By obtaining each participant’s account, the researcher

will be able to gather experiences from mothers that could be a help to the

researcher of how to improve the quality of care and how to be an effective

nurse in the near future. The researcher is a third year college student,

currently studying at Central Mindanao University, College of Nursing, who

aims to finish her course with adequate knowledge, skills and attitude of an

effective nurse. Through the researcher’s experiences in clinical duty which

deals with different patients rendering them utmost services, the researcher

is able to relate in the study. Way back in second year level, the researcher

together with her colleague, were able to monitor infants in NICU including

those premature ones. The researcher had seen the struggles of mothers

in NICU caring for their babies who were admitted due to prematurity.

During also in her childhood days, the researcher visits her mother most

often in the NICU area who was a staff nurse before. She was amazed of

how noble a nurse is, who provides care not only to the patients but also to

their significant others. Upon observation, a nurse who maintains patience

and calm voice fosters good relationship to her patient. And thus, facilitates

openness to their concerns and difficulties.

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Presupposition

The baby's extensive period of hospitalization in the Neonatal

Intensive Care Unit (NICU) may impair the establishment of maternal

bonding and attachment. Mothers may have insecurity and guilt for

delivering a vulnerable infant. Most preterm infants are born ill and the

mother may experience several feelings, like fear, uncertainty, and

anguish. In addition, mothers may have an increased fear of the neonatal

environment that may cause delayed development of the relationship

between mothers and their babies. Nurses, in this context, have an

important role in the moments of interaction and care of the mother-child.

Nurses should give support at all times and assist mothers in providing

kangaroo mother care to their babies. Nurses should build rapport, trust

and observe effective communication. Furthermore, staff nurses should

supply adequate education to mothers regarding this procedure with full

patience. Hence, the personalities and qualities of nursing staff are

considered to be of great importance for their interactions and nursing

relationships with the mothers that may also influence their experiences on

KMC. Adequate staff support of mothers while providing care to their

preterm babies is highly crucial during this crisis for them to cope with their

difficulties and challenges.

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Theoretical Stance

Holistic care in the NICU dictates that the nurse develops an

understanding of each mother-infant dyad and what is important to the

mother. Such understanding cannot acquire from demographic information

in a chart or from the pages of neonatal nursing books and journals, rather

it comes only from being truly present with the mother, listening carefully to

what she is and is not saying, and providing a safe environment in which

the mother will feel comfortable in trusting nurses. Positive attitudes and

communication from nurses provides support and encouragement to them

during this crisis. Thus, nurses and physicians need to understand the

mother’s experience to provide the support they need and expect.

The concept of this study is anchored on the theory of Interpersonal

Relations by Hildegard Peplau. Her theory explains that the purpose of

nursing is to help others identify their felt difficulties and that nurses should

apply principles of human relations to the problems that arise at all levels of

experience. A professional and planned relationship between client and

nurse that focuses on the client’s needs, feelings, problems, and ideas. It

involves interaction between two or more individuals with a common goal.

The attainment of this goal, or any goal, is achieved through a series of

steps following a sequential pattern.

The assumptions of Peplau’s Interpersonal Relations Theory are: (1)

Nurse and patient can interact. (2) Peplau emphasized that both the patient

and nurse mature as the result of the therapeutic interaction. (3)

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Communication and interviewing skills remain fundamental nursing tools.

And lastly, (4) Peplau believed that nurses must clearly understand

themselves to promote their client’s growth and to avoid limiting client’s

choices to those that nurses value.

Her concepts also discussed the four Phases of the therapeutic

nurse-patient relationship which includes: 1. Orientation Phase 2.

Identification Phase 3. Exploitation Phase 4. Resolution Phase.

In the orientation phase, the nurse engaged the client in providing

explanations and information, and answering questions. Followed by

identification phase wherein the client works interdependently with the

nurse, expresses feelings, and begins to feel stronger. The client makes

full use of the services offered that is define in the exploitation phase. And

lastly the resolution phase, which the client no longer needs professional

services and gives up dependent behavior.

The concept of this study is supported on the theory of maternal

attainment role by Ramona T. Mercer. Her theory is significantly relevant to

how nurses should work with mothers and their children. The theory of

Maternal Role Attainment uses many concepts that makes its use practical

among the different academic disciplines but more importantly to the

nursing profession and nursing practice. Thus, this theory was developed

to function a framework for nurses to produce applicable health care

interventions for mothers in order for them to develop a powerful maternal

identity.
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Maternal role attainment is defined as “an interactional and

developmental process occurring over a period of time, during which the

mother becomes attached to her infant, acquires competence in the care-

taking tasks involved in the role, and expresses pleasure and gratification

in the role”. According to her, secure attachment of the infant to his mother

or her surrogate is crucial to normal growth and development and an

integral part of a child’s ability to develop a sense of mastery, identity and

self-worth. The work of nurse scientists, such as Ramona Mercer’s

Maternal Role Attainment Theory, can be an invaluable resource for new

and experienced nurses, helping them to learn how they can foster the

mother-child bond most effectively within the parameters determined by

current health care practice and provider constraints. Advanced practice

nurses who work in obstetric services or with pediatric patients can benefit

from knowing Mercer’s work as they care for their patients. Thus, their

added clinical knowledge and experience may help to identify women or

mothers with postpartum depression and be in need of intervention.

Applying the nursing process to any of the factors that influence the

new mother’s adaptive processes is one of the profession’s most enduring

challenges and one of the most important. There is no doubt that one of the

most crucial relationships in human dynamics is the relationship between a

mother and her child and a great responsibility comes from nurses to foster

the essential bond between mother and child.

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Scope and Delimitations of the Study

The study focuses in exploring and investigating mothers’

experiences of providing Kangaroo Mother Care to their premature babies

admitted in Neonatal Intensive Care Unit specifically the educative and

action care of NICU nurses of the provincial hospital of Maramag Bukidnon

for the first semester, school year 2018-2019. The study is limited only in

describing and understanding the focused phenomenon. Due to the lack of

work force and limited amount of time given to conduct the research, the

researcher imposed several limitations for this study. The proponent will

have at least 4 research participants that will be selected through inclusion

criteria and until data saturation will be achieved. Moreover, the study is

limited only to each participant’s accounts, thus the researcher’s biases,

assumptions and presuppositions will be excluded in the process of data

gathering and analysis in order to maintain objectivity throughout the study.

Lastly, it will be based on the primary data sources which information are

from mothers as participants and secondary data sources coming from

published or unpublished journals and articles.

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Significance of the Study

By investigating the experiences of mothers who provide KMC to

their preterm babies specifically educative and action care of NICU nurses,

the researcher believes that the present study can make several

contributions to the society. The results thereof will be beneficial to the

following:

Mothers

Since they are the main participants of the study, the researcher

believes that it will provide knowledge and awareness to the mothers about

KMC that will help them to fully understand and appreciate the importance

of providing Kangaroo Mother Care to their preterm babies. Through this,

mothers’ experiences will be heard, appreciated and understood. This

study will also serve as their voice to the society specifically to the health

care professionals in raising their problems and concerns throughout the

course of providing KMC in NICU environment. Furthermore, this paper will

help the mothers to further understand the nature of being a mother to her

baby.

Students

As a future nurse, this will provide cognizance and will guidance to

the student nurses as to what the experiences are faced by mothers who

are providing KMC to their preterm babies. Thus, student nurses will be

able to acquire knowledge and understanding on how to communicate

effectively and on how to be a therapeutic nurse to mothers in the near

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future. Furthermore, they will be able to appreciate the role of being a

health educator to their patients and will enable them to understand the

importance of providing adequate information about the purpose and

benefits of KMC and in demonstrating the proper procedure to the mothers.

Lastly, this will be a help as they encounter the challenges of being a nurse

in the near future.

Department of Health

This study will provide a comprehensive overview of what are the

experiences of mothers in the NICU environment while providing KMC to

their babies. This paper will give a great contribution of awareness to the

said office. Through this, the DOH will be aware and be able to manage in

order to improve effectively not only the standards of caring but most of all

to address the concerns, hindrances and problems encountered by

mothers who provide KMC to their baby.

NICU nurses

Since the NICU nurses play a very crucial role in the care of preterm

babies and in assisting the mothers to provide KMC, this study will provide

new knowledge to them about possible barriers, problems and concerns of

mother towards the NICU nurses. Thus, it will raise awareness to them and

shall provide insights to evaluate their own selves regarding the quality of

care they render to their patients and a way to improve their nursing

performance. Furthermore, this paper will help the nurses to further

understand the nature of their profession.

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Hospital administration

This research will have a significant impact not only in raising

awareness to the administrators, but also will give them a hint on what

other areas could be further improve regarding Kangaroo Mother Care. By

knowing the experiences of mothers, administrators will look for another

ways as to what they can do to enhance KMC implementation and the

quality of care that is to be rendered.

Hospital Institutions

The research findings can be beneficial to other hospitals which do

not implement Kangaroo Mother Care. The findings will be an eye opener

to them as to how KMC operates at the NICU level.

Future researchers

This study will serve as a basis for further research study about

mother’s experiences of providing KMC to their hospitalized preterm

babies. This will be a help to them especially if they are interested in doing

a research study related to this. The study will help the researcher to know

what are the other areas or issues regarding this certain phenomenon that

are needed to be discovered and for them to further look into more.
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OPERATIONAL DEFINITION OF TERMS

Care: It is a genuine attention given by a person to another through way of

careful actions. It is a means of protecting someone or something and

providing what that person needs.

Premature: is the term used to describe infants born before 37 weeks of

gestational age. This is also referred as preterm. Preterm babies are

vulnerable to susceptibility and immediately admitted to NICU after birth.

Kangaroo mother care (KMC): is a method, which involves the mother

and baby wherein the infant is placed in an upright position under the

mother’s clothes on her naked skin specifically on the mother’s chest

between her breasts.

Skin-to-skin contact (SSC): is the practice of placing an infant only in a

diaper and a hat on his head chest-to-chest on the parent’s bare skin.

NICU: Neonatal Intensive Care Unit is a unit in the hospital which caters

newborn infants with medical or critical condition and needs specialized

care.

Experience: A direct personal participation that gives knowledge, skills

and learnings to the person. It is one’s personal story of your life whether

these are significant or insignificant past happenings, a particular incident

and feeling.