Thematic Analysis of Kangaroo Mother Care Research - Thesis Example

Title: Thematic Analysis of Kangaroo Mother Care Research Name of Student: Registration No.: Institution Name: Professor’s Name: Date of Submission: TABLE OF CONTENTS Overview of Coding 1 1.Color Coded System 1 2.Relationship between Categories 6 2.1.Credibility 6 2.2.Conformability 7 2.3.Transferability 7 2.4.Dependability 8 3.Emerging themes from the study 9 3.1.Concepts of KMC 9 3.2.Benefits of KMC 10 3.3.Facilities 10 3.4.Challenges 11 4.Table of pattern Finding 11 5.Summary of the study 14 6.References 15 Overview of Coding This paper presents a thematic analysis of a study that was conducted in four hospitals where respondents were asked similar questions. The aim of the study was to know the views of respondents about kangaroo mother care and the benefits associated with KMC by recording the views of respondents about questions related to this topic. The thematic analysis involves identification of the emerging ideas, recurring statements and themes and phrases in the responses provided to each question by the respondents in the four hospitals. It also includes recording the list of recurring words in the responses towards the research question. This process is repeated until all the hospitals have been investigated and a compilation of high frequency words, phrases and ideas recorded. A tentative category of this list is made where the lists are categorized on the basis of credibility, conformability, transferability and dependability. This results into obtaining of the overarching themes that were obtained from the research. This study is mainly focused on the topic of mother to child contact within the context of Kangaroo Mother Care (KMC). 1. Color Coded System Qsn No. Research Question Initial Codes Hospital 1 Hospital 2 Hospital 3 Hospital 4 Example Quotes from the cases 1 What is your view about Kangaroo mother Care (KMC)? Source of information, bond, skin contact, approval, activity Warmth, contact, relationship, uncertainty, breastfeeding, activity Temperature, quiet and calm, breast feeding, security of baby, uncertainty Uncertainty, Source of information, contact Hospital 4: It’s a skin to skin contact between mother and baby during first mints of deliver is it correct? Hospital 2: I think KMC is high relationship, which mum can feel her baby emotionally. Hospital 3: stabilize the temperature. 2 Have you seen much KMC taking place? Experience, agreement, carries, mum, dress, action Approval, skin to skin contact, disapproval, You Tube, technology, source of information Disapproval, source of information, lectures Feeding, uncertainty, approval, disapproval Hospital 4: During feeding Hospital 2: You Tube Hospital 3: Only lectures Hospital 1: Mum carries her baby while she wears abaya and her dress. 3 What do you see as the benefits of KMC? Bonding, breastfeeding, quiet and calm, relationship, uncertainty Breast milk, emotional support, Bonding, breastfeeding, sleeping Relationship, breastfeeding, bonding, baby comfort Hospital 4: I think increased breastfeeding. Hospital 2: Its emotional support between child and mother Hospital 1: ummm I think Breast feeding and make baby quiet and calm, but I can’t tell you more as we did not try 4 What would you say was the most important benefit of KMC? Bond, baby, mum Bond, relation, role, time, warm and secure Uncertainty, apply, relation, workload Relationship, bond, agree Hospital 4: Strong relationship between mothers and baby. Hospital 2: I think bond between mum and child is the most important. Hospital 3: It’s hard to me to picture this thing that I haven’t done or seen by myself. Hospital 1: Strong bond between baby and his mum. 5 Could you explain please? Family, mortality and morbidity essential care, right , trust, deal with her baby Psychological Hospital 4: Ummm, as I say before psychological and physiological affect Hospital 2: I like it as the family they will have active role in the care of their baby Hospital 3: We need to trust each other mum and nurses, also mum she need to deal with her baby and well prepared when baby discharged. 6 What potential problems do you see? Anxious, uneducated, stable baby, support Privacy, crowded, monitor, criteria, security, Transferring, infant, manipulation, incubator, Hospital 2: At the beginning, baby attach to the monitor’s alarming frequently no quiet environment as well as the lack of screens made it lack with privacy, and as you know we are in a country that we should be covered, and the unit is almost always full and crowded. Hospital 3: Unstable infants with alarming monitors, I think, and some physicians think they need to stay in the incubator for the same reason. Hospital 1: Most of mothers anxious because their babies are in ICU. 7 Explain please? Culture, equipment, willing, parents, education program, benefit Hospital 2: we know our culture it prohibits for the women to expose they still not understood the benefit of KMC and how can positively help baby as well as mum. Hospital 3: I don’t think parents really want to hold baby with all connections to apply KMC, unless they provided them with education program to explain the benefit. 8 What would support nurses involved in KMC in a clinical environment? Education, implement, policy, extra support, Room, management, environment, Space, stay, policies, education, instructors Staff, nurses, information, private place for mothers, policies, training, promote KMC Hospital 4: We need training, more staff, family education, management support to implement this procedure, also evaluation. Hospital 3 : Policies provide us with standards of care we need specific police to promote KMC Hospital 1: We need help and extra support in order for us to implement this. 9 Could you explain more please? Prepared, education, knowledge, management, Recruit, management support, staffing, Hospital 2: personally, staff and education. Hospital 3: We need management support by recruit more staff to have adequate patient-nurse ratios and staffing to have the time to provide it. 10 Is it desirable to introduce KMC in other hospitals? Approval, yes, improve, positive attitude Approval, yes, important, Important, happy, willingness, doubt, evidence Approval, improve, Hospital 4: Of course we need to improve patient outcome. Hospital 2: She is right it’s important. Hospital 3: : I don’t know, I have some doubt about what I heard about KMC…..until I see the evidence with my own eyes, and then I believed it’s true. Hospital 1: Actually, yes we need to improve our care, I’m exits to take part of this discussion and I can’t wait till implement 2. Relationship between Categories 2.1. Credibility The credibility of this study is validated by the fact that it was conducted in our hospitals. Thus, the responses from all the hospitals were compared to provide an average understanding of the research topic: Kangaroo mother care (KMC) and the benefits associated with it. For instance, the views of respondents from hospital 1 were compared with those from hospital 2,3 and 4 and recurring words, phrases and themes were compared to determine whether they were similar or not. As a result, there was an improvement in credibility of the results. Since the study involved a number of research questions, it was possible to get views about various aspects of the research questions that resulted into improved credibility of the research. Another factor which improved credibility of the study is that the study involved an investigation of subjects that are relevant to this study. These included mothers who are breastfeeding and their children. It also involved the employees of hospitals where these mothers gave birth to babies. As a result, the responses were based on the experiences that hospital employees had undergone while attending to mothers in their hospitals. It also involved the observations that these employees had made on mothers when they gave birth to young ones who needed mother’s attention. For instance, it was possible for the employees to explain the benefits they had observed when mothers were in contact with their children compared with mothers whose children were placed in the incubators. Consequently, the responses provided could be relevant in answering the research topic: Kangaroo Mother Care (KMC) and the benefits associated with it. Another factor that enhanced credibility of the study is that all respondents were located in a single place during the interview (Charpak 2011). Thus, respondents ensured they provided accurate responses to avoid being disapproved by their colleagues. This ensured credibility of the results was achieved. 2.2. Conformability Conformability was determined by measuring the extent to which the results corroborated with other results (Chen, Oetomo and Feijs 2012). Various strategies were used to determine conformability of the results. An example of a strategy that was used is documentation of procedures for checking and rechecking the responses during the study. This involved checking responses to determine whether there similarity in responses such as by use of recurring words and phrases. For instance, in question 1, it was possible to observe that some of the common words included ‘breastfeeding’, ‘contact’ and ‘temperature’. This shows that there was conformity in the responses during the study. In addition, conformability was achieved by determining contrasting words or contrasts in responses. The higher the number of contrasting words, the lower the conformability (Donna 2010). In this study, there are various cases where respondents provided contrasting views thus affecting conformity of the research. For instance, in question 2 when respondents were asked to explain whether they had seen much KMC taking place, a respondent from Hospital 1 disagreed with the statement while another respondent from the same hospital agreed with the statement. There were also a number of individual opinions which were not common, thus affecting conformability of the responses to the research objectives. For instance, only a single respondent explained that the source of information about KMC could be learned from You Tube. Thus, it was not possible to know whether the responses of other participants could be similar to this response (Fitzpatrick and Kazer 2012). The strategy of determining conformability was to conduct data audit by examining data collection process and establishing where there was a potential bias or distortion of data. 2.3. Transferability There are various ways in which transferability could be achieved by the use of coded data during this thematic analysis. It is the extent to which a qualitative research can be used to create a general view about other settings or contexts (Guest, MacQueen and Namey 2012). For instance, in this study qualitative research results of the advantages of KMC in the four hospitals can be used as a general description of advantages of KMC in other hospitals. For instance, this study showed that one of the characteristics of KMC is where mothers breastfeed their children as well as being in contact with their children. Thus, it can be generalized that in all settings, the act of providing breastfeeding in other contexts is also an example of KMC (Lauwers and Swisher 2011). In addition, a response was given that there is a psychological effect associated with KMC. This implies that in other contexts where mothers are close to their children, they are likely to create a psychological effect of safety for their children. Another observation from the study that has a transferability facet is that KMC is more effective compared with the use of incubators. This is based on the fact that most respondents agreed that incubators do not provide a friendly condition for a child than KMC. Thus, it is concluded that in other contexts, the use of KMC strategy of taking care of young children should be implemented in hospitals than the use of incubators. There are also suggestions that hospitals should provide additional spaces for KMC as well as creating policies which enable implementation of KMC in hospitals. This implies that the suggestions can be transferred to other hospitals where studies were not conducted (Ludington-Hoe 2013). This is because the demands for implementation of KMC are common in all hospitals. 2.4. Dependability Dependability is where changing conditions are accounted for in the subject being studied in addition to the changes in design of the study that is required to understand the context of the study. In order to enhance dependability of this study, overlapping methods were used (Mills 2010). This included conducting interviews with the respondents as well as using observations to explain the research question. For instance, respondents were asked to explain whether they had observed KMC anywhere. It was found that observations were made in You Tube and lectures. Cross-validating was achieved by collecting data from a number of respondents for each question. For instance, it was possible to know respondents who agreed with a question, those who were not sure about the questions and those who opposed the questions. In addition, dependability was achieved by stepwise replication. This is where data was collected in multiple occasions (Moccia, Anthony and UNICEF 2008). For instance, after collecting data from hospital 1, data was collected in hospital 2, then hospital 3 and finally hospital 4. Thus, it was possible to compare the results from hospital 1, 2, 3 and 4 so that dependability could be determined. When the data had been collected, dependability was enhanced through inquiry audits. This is where outside help was sought in verification of consistency of the data collected with the research methods, research questions and interpretations (Mohrbacher, Kendall-Tackett and Newman 2010). Furthermore, the strategy of comparing recurring words in each case for each question enabled understanding of dependability of the data collected. For instance, in the fourth question, it was possible to determine dependability by comparing the recurrence of the word ‘bond’ which was observed in the 1st, 2nd and 4th hospitals. This implies that there was dependability of the data collected during the research. 3. Emerging themes from the study 3.1. Concepts of KMC Various ideas were contributed about the idea of KMC. For instance, there are respondents who believed that it is a process where the mother provides the child with breast milk while in other cases it was reported that it is a process where the mother and the child are in bodily contact with each other most of the time thus enjoying each other’s company. On the other hand, there are respondents who did not have an idea of the concept of KMC. For instance, some respondents based their understanding on imagination. A respondent from hospital 2 explained: I think KMC is high relationship, which mum can feel her baby emotionally. This shows that while the concept of KMC was known, there are respondents who had not observed the practice anywhere (Pope, Mays and Popay 2007). During the discussion of where respondents learned about KMC, it was found that the main sources of information were You Tube and lectures. This shows that most hospitals that implement KMC did not train their employees about the practice and they learned about the practice through their individual initiatives such as observing videos on You Tube and depending on what they learned about the practice in lectures. 3.2. Benefits of KMC While there are few participants who understood the concept of KMC, various benefits were provided which shows that KMC can be beneficial to the intended people during its implementation. For instance, a participant from hospital 2 explained that it resulted into emotional support for both the mother and the child. Another benefit that was associated with KMC is that it results into improved bonding between the mother and the child. This response was provided by a participant from hospital 1 and also reported from participants in hospital 3 and 4. As a result, there is more agreement that when mothers practice KMC, emotional bonding is likely to be one of the benefits. In addition, the benefit of breastfeeding was explained as an example of the effect of KMC. This is a condition where a mother provides the child with additional more milk compared with the care of the child when placed in the incubator or when the child is under the care of the nurses (Charpak 2011). The respondents also reported that when KMC is practiced, the mother is provided with the opportunity to take care of her child, hence understanding the child while the child also understands the mother. Some respondents explained that they could not explain more about the benefits of KMC apart from breastfeeding because they had not tried to implement it. 3.3. Facilities The study shows that in order to practice KMC effectively, there are a number of facilities that need to be provided. For instance, there should be areas in hospitals where mothers are allowed to provide their children with KMC so that their privacy is assured. It was also reported that the current hospital spaces are limited and there is the need to improve capacity by constructing additional rooms where mothers who have newborn babies can be attended to. Another facility that can enhance the practice of KMC in hospitals is installation of technologies such as computers and the internet where practitioners can learn about KMC in the internet or You Tube (Chen, Oetomo and Feijs 2012). This is because, a number of respondents such as a respondent from Hospital 2, explained that they learned about the practice from You Tube. Another facility that is relevant in the implementation of KMC can be additional learning materials for nurses such as lectures and reading materials where they can learn about KMC in terms of how it is practiced and its benefits. Training facilities should involve providing periodical training to the nurses of the hospitals by an expert in KMC. 3.4. Challenges An example of a challenge affecting the practice of KMC in some hospitals is that they relied on the use of incubators for the care of newborn babies and did not want to change to KMC. This can be explained by the possibility that policies in the hospitals have been that newly born babies should be placed in incubators in such hospitals. Another challenge that was evident during the study is that culture of the people may not allow them to breastfeed their children in open areas. This is illustrated by the response from a participant from Hospital 2 who explained that their culture does not allow women to expose themselves while they did not understand the benefit of KMC and its positive impact on the mother and the child. This is because one of the characteristics of KMC is providing the child with breast milk while there were no placed set aside where mothers could provide this milk to their children in private. Another challenge is privacy itself. This is because of the fact that KMC involves exposure of the mother’s breast while feeding the child while there were no places allocated for the practice (Donna 2010). This is illustrated by a response from Hospital 2 who explained that there is lack of privacy in their hospital while they live in a country where they should be covered. There was also the problem of capacity since the unit was full and crowded. It was also found that there was a problem of lack of qualified staff that could provide support and training to mothers who have newborn babies who need to be provided with KMC service. This was coupled with the complacency of the management to recruit more staff. For instance, a respondent from Hospital 3 explained, ‘We need management support by recruit more staff to have adequate patient-nurse ratios and staffing to have the time to provide it’. This is an illustration that recruitment of additional staff is an area that needs to be addressed before the implementation of KMC can be successful. 4. Table of pattern Finding Research Qsn No. Research Question Finding 1 What is your view about Kangaroo mother Care (KMC)? Uncertainty: Some respondents did not know have an idea about Kangaroo Mother Care (KMC) Relationship: Most participants believed that the idea of KMC is the relationship between mothers and children 2 Have you seen much KMC taking place? Source of information: Some respondents obtained information about KMC from lectures and You Tube People involved: Some participants observed KMC from mothers who carried their babies. 3 What do you see as the benefits of KMC? Breastfeeding: Most participants believed that the main benefit that results from KMC is that babies are breastfed by their moms. Emotional support: it was also highly agreed that children get emotional support as a result of being provided with KMC. 4 What would you say was the most important benefit of KMC? Bonding: The results showed that most respondents were of the view that KMC contributed significantly towards improved bonding between mothers and their children. This is a situation where the mother is in close contact with the child most of the time, thus enjoying each other’s company and comfort. 5 Could you explain please? Trust: The study showed that when a child was provided with KMC, it was possible to develop trust compared to other methods of taking care of children after birth. Psychological: there was also a psychological impact associated with KMC because the baby developed a positive attitude as a result of being provided with the care compared with the use of an incubator. 6 What potential problems do you see? Problems: the study showed that the problem experienced in the process of trying to implement the KMC practice in hospitals is that there is lack of privacy; hence most women have not been able to provide their children with the KMC care. Incubator: it was found that incubators are currently used in hospitals where KMC is not provided to act as an alternative care for children who have just been born. However, it was found that when KMC is implemented, there are more advantages that can result when compared with incubators. 7 Explain please? Culture: Another barrier that prevented the implementation of KMC in some hospitals is that culture prohibited women from breastfeeding their children in public places and the women were also not aware of the benefits of KMC. Education: A suggestion that was explained to be useful in ensuring the popularity of KMC is attained and women are able to apply it adequately in the care of their children is education. This is where women who have new-born babies are taught the benefits of KMC and how they can apply it during the care of their young children. Equipment: This is a suggestion that was made so that KMC can be implemented in hospitals. It is where hospitals are equipped with the latest facilities which enable them implement KMC during the care for their young children. These facilities include areas where mothers can provide their children with KMC without interference by other activities in the hospitals. 8 What would support nurses involved in KMC in a clinical environment? Education: it was found that support nurses could facilitate education of women on how to apply KMC while taking care of their children. They could also contribute towards educating women about health care policies that need to be observed during implementation of KMC. Extra support: extra support could be provided by support nurses in the area of educating families about KMC as well as assisting women who are still not conversant with the practice during the care for their children in the hospitals where they are born. 9 Could you explain more please? Recruitment: It was explained that when more training staff is recruited, it will be possible to provide training to women who need to know the concept of KC so that they can implement it in the care of their children. Management support: Some nurses who were interviewed explained that it was necessary to get support from the management through recruitment of more staff. This response was obtained from a participant from hospital 3. 10 Is it desirable to introduce KMC in other hospitals? Approval: Most respondents were of the view that KMC should be implemented in other hospitals. Improve: They also suggested that current KMC practices should be improved first before introduction of the practice in other hospitals. Doubt: there are also participants who had not observed the implementation of KMC in other hospitals; hence they did not know the effectiveness of the practice in the care for children by their parents. 5. Summary of the study The study shows that Kangaroo Mother Care (KMC) is still not effectively implemented in most hospitals due to lack of initiatives by most hospitals to implement it. It also shows that people are still not aware of the benefits associated with KMC to a greater extent and its implementation is subject to their understanding of these benefits. However, most participants in this study who were employees of the hospitals where the study was conducted were receptive of the idea and willing to train so that they could apply it in the care of newborn babies. Thus, it is the responsibility of hospitals to decide whether they would like to implement KMC and also whether they are willing to allocate resources aimed at implementing the practice. 6. References Charpak, N. 2011. Kangaroo Babies: A Different Way of Mothering. London: Souvenir Press. Chen, W., Oetomo, S. B., & Feijs, L. M. G. 2012. Neonatal monitoring technologies: Design for integrated solutions. Hershey, PA: Medical Information Science Reference. Donna, S. 2010. Optimal birth: what, why & how: A reflective, narrative approach based on research evidence. England: Fresh Heart. Fitzpatrick, J. J., & Kazer, M. W. 2012. Encyclopedia of nursing research. New York: Springer Pub. Guest, G., MacQueen, K. M., & Namey, E. E. 2012. Applied thematic analysis. Los Angeles: Sage Publications. Lauwers, J., & Swisher, A. 2011. Counseling the nursing mother: A lactation consultant's guide. Sudbury, MA: Jones & Bartlett Learning. Ludington-Hoe, S. 2013. Kangaroo care: The best you can do to help your preterm infant. New York: Bantam Books. Mills, A. J. 2010. Encyclopedia of case study research: 2. Thousand Oaks, Calif. [u.a.: Sage Publications. Moccia, P., Anthony, D., & UNICEF. 2008. The state of the world's children 2009: Maternal and newborn health. New York: Unicef. Mohrbacher, N., Kendall-Tackett, K., & Newman, J. 2010. Breastfeeding Made Simple: Seven Natural Laws for Nursing Mothers. Oakland: New Harbinger Publications. Pope, C., Mays, N., & Popay, J. 2007. Synthesizing qualitative and quantitative health evidence: A guide to methods. Maidenhead, England: Open University Press, McGraw Hill Education. Read More