Date of Degree

Summer 2025

Document Type

DNP Scholarly Project

Academic Department

School of Nursing

Degree Type

Doctoral

Degree Name

Doctor of Nursing Practice

First Advisor

Cleveland, Sandra

Abstract

Problem: Cesarean deliveries often interrupt early mother-infant bonding, delaying the initiation of breastfeeding and limiting opportunities for skin-to-skin contact. Despite national guidelines promoting immediate postpartum contact, cesarean-born infants receive kangaroo care (KC) at significantly lower rates than those born vaginally. Prior to this project, only 2% of cesarean births at the project site received KC, highlighting a significant gap in care delivery.

Aim of the Project: The aim was to evaluate the feasibility and impact of implementing kangaroo care during cesarean deliveries in a community hospital to improve neonatal outcomes and adherence to evidence-based postpartum practices.

Review of the Evidence: Research shows KC improves thermoregulation, breastfeeding success, and bonding while reducing neonatal morbidity. Meta-analyses and systematic reviews support KC as a standard intervention for all delivery types, yet barriers in surgical settings hinder implementation.

Project Design: This quality improvement initiative followed the Plan-Do-Study-Act (PDSA) cycle within the Organizational Health Change Model (OHCM) framework. A pre-post implementation design assessed outcomes over eight weeks, comparing vaginal and cesarean deliveries. Measures included KC initiation within 10 minutes, breastfeeding within 60 minutes, and neonatal temperature regulation within 30 minutes.

Intervention: The intervention involved staff education, workflow modifications, and EHR documentation enhancements to support immediate KC in the operating room. Interprofessional collaboration ensured safe integration without disrupting surgical protocols.

Significant Findings/Outcomes: Post-implementation, cesarean KC rates increased from 2% to 71.8%. The majority of infants achieved timely breastfeeding and stable temperatures. These findings demonstrate the feasibility of KC in surgical settings and reflect alignment with national standards promoting equitable neonatal care.

Implications for Nursing: Nurses play a pivotal role in implementing and sustaining KC practices. This project highlights how nursing-led initiatives, supported by institutional policies and continuous education, can overcome systemic barriers and advance equitable, evidence-based maternal-infant care across all delivery settings.

Rights

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