The importance of the nurse in caring for the Kangaroo method: Integrative literature review

— Aim: identify the importance of the nurse in the care of the kangaroo method. METHOD: It is an integrative literature review study, developed according to the production of the following steps: delimitation of the guiding question, establishment of inclusion and exclusion criteria, search and selection by primary studies in the databases, data evaluation and analysis, results presentation and interpretation. Results: the importance of the nurse's assistance in carrying out the kangaroo method, in consideration of he has an important role in this process, by the reason of he is responsible for promoting the care, encouraging the family to be present and acting during the stages of the kangaroo method. CONCLUSION: Therefore, the nurse's role in the kangaroo method is essential to conduct the teachings about the stages of the method at the moment the mother-child is going through this process, thus ensuring the effectiveness of this strategy.

Due to the high prevalence of infant mortality, the kangaroo method was initially conceived in Colombia in 1979 at the Instituto Materno Infantil de Bogotá by Dr. Reys Sanabria and Dr. Hector Martinez, as a proposal to improve the care provided to preterm newborns in that country (Brazil, 2015).
In this context, the policy of Humanized Attention to the Newborn of Low Weight -Kangaroo Method, which was regulated as Ordinance GM No. 693, on July 5, 2000, later revised as Ordinance No. 1,683, July 12, 2007(Brazil, 2017, emerged. This policy brought the qualification of global care to the newborn, benefiting the integral development of the child, the family bond and, as a consequence, the reduction of neonatal mortality rates (Sales et al., 2018).
The Kangaroo Method (MC) is a strategy divided into three stages, aiming at the humanization and participation of parents in neonatal care; the first stage begins in the prenatal period of high-risk pregnancy, followed by admission of the newborn (NB) in the neonatal ICU; in the second stage the baby remains continuously with its mother and the kangaroo position is performed most of the time and; the third stage is characterized by monitoring the child and the family in the outpatient clinic and at home until reaching the weight of 2,500g (Heck et al, 2016;Brazil, 2015).
In the research presented by Balduino (2018), regarding the nursing that will be in charge of this assistance, being the mediator between caring and teaching the family members, so that they come to participate in these strategies, such as early skin-to-skin contact between the RNPT and their family, individualized care, partnership with the family and encouraging breastfeeding (Brazil, 2015).
The nurse has a primary role in caregiving assistance, making it possible to welcome and develop balance in the environment, where the kangoro method will be carried out to introduce the strengthening of affective bonds between mother and child, guaranteeing integral and qualified care (Brazil, 2017;Sales et al., 2018).
The role of the nurse in the MC is essential to conduct the teachings about the stages of the method at the moment the mother-child is going through this process, thus ensuring the effectiveness of this strategy. In this context, the study of Tarcísio (2010), reinforces about the frequent training of the nurse in relation to the MC, the author still makes an observation that, by not passing on the training to the professionals, probably will contribute to the low rates of effectiveness of the second and third stages of the method.
The interest in the study is justified by the importance of the role of the nurse in relation to the practice of the MC, under its limits in the realization of the care of the method for the NT, emphasizing that the mothers have a fundamental role during the process of the stages of the method. In this sense, this study aims to identify the importance of the nurse in relation to the care of the kangaroo method.

II. METHOD
This is an integrative review study of the literature with a methodological approach to reviews, allowing the inclusion of experimental and non-experimental studies for a complete understanding of the phenomenon analyzed (Souza; Silva & Carvalho 2010). It was developed according to the production of the following steps: delimitation of the guiding question, establishment of inclusion and exclusion criteria, search and selection by primary studies in the databases, evaluation and analysis of data, presentation and interpretation of results (Crossetti, 2012& Soares et al., 2014. In the face of this, we tried to answer the guiding question: What is the importance of the nurse in the care of the newborn baby in the performance of the kangaroo method? The search for primary studies in the databases was developed in the period of September 2019, articles published in scientific health journals in the Scientific Electronic Library Online (Scielo), Virtual Health Library (VHL) and Latin American and Caribbean Literature in Health Science (Lilacs) databases, using the descriptors: nursing care, kangaroo method and premature newborn, follows in table 1 of the crossover performed to find as many articles as possible. The selection of primary studies in the databases was followed by reading and analyzing the studies found in accordance with the inclusion criteria, and was thus divided into three stages. In the first stage 1,032 articles were identified, of these 504 were duplicated and eliminated. In the second stage, 528 articles with titles and abstracts available according to the filters used in the research, of which 289 can be chosen.
Only then, after this careful evaluation the full texts were read with 239 articles, 225 not used and discarded because they do not fit the inclusion criteria and because it is not in accordance with the guiding question of this work, so after all this process obtained a final sample of 14 articles. Figure 1 shows all this selection. .

Fig.1: Flowchart of identification, selection and inclusion of Studies
Source: Authors, 2020.

III. RESULTS
Finally, with the final articles found in the literature after the data searches, in what concerns the nurse to be in charge of the care of the kangaroo method to the premature newborn, 3 categories were used for the analysis process: The importance of the benefits of the kangaroo method for the recovery of the premature newborn; The assistance of the nurse in the care of the kangaroo method; The Reception carried out by the nurse in the accomplishment of the kangaroo method. The three categories are in tables 2, 3 and 4.

International Journal of Advanced Engineering Research and Science (IJAERS)
[  The most benefits attributed to the kangaroo method include: reduction of hypothermia, sepsis, hospital stay and mortality risk, positive impact on cognitive and motor development of premature infants, maintenance of stability during transport of premature infants, as well as vital signs at physiological levels, even when performed in NB under mechanical ventilation and hemodynamically stable.

MENEZES, 2017 12
Tiradentes University, International Nursing Congress Benefits from the mother kangaroo method for low birth weight.
The kangaroo method brings numerous benefits, perceived and reported by the mothers themselves, such as the construction of the bond, the approach with the baby favors growth and development, allows quiet sleep, in addition to the security that the Method provides for mothers in the care of the baby and the pleasure in consolidating the maternal role.
The experience of the kangaroo method experienced by mothers in a public maternity ward in Maceió / Alagoas The low weight newborn will be caressed, touched and wrapped in the lap, will feel more welcomed and safe in the mother's lap, because through this method will contribute to the smooth transition to extrauterine life, having the mother as an indispensable role in the care and treatment of the baby in this process of the stages of the MC, especially when it is in the kangaroo infirmary. The importance of the kangaroo method, because it encompasses the family and it will be stimulated to early contact with the baby, forming bond and all this is extremely relevant in the recovery of the newborn.
In summary, the several benefits of the Kangaroo Method for both mother and baby are shown in table 3, regarding the autonomy perceived by mothers about the Kangaroo Method, there was a strengthening of the mother-child bond and the family, improving the clinical picture and its development, thus contributing to the hospital discharge and the nurse is always establishing an effective communication in all stages of the Kangaroo Method.  CRUZ, 2017 16 Unime

Kangaroo
Method: The importance of the family in skin-to-skin contact of the preterm newborn.
Promote a humanized and safe approach through skin-to-skin contact (kangaroo position).

SILVA; CRISPIM; FIGUEIREDO, 2017 17
UniSALESIANO Neonatal Intensive Care Unit: mothers' perception of lived experiences and the importance of nursing care and orientation.
Stimulate participation in all the activities developed during the stages of the kangaroo method.

Rev enferm UERJ
The maternal care promotion to the premature newborn: the perspective of problematizing education in health.
To promote newborn care through the kangaroo method, the nursing team should establish effective communication with mothers in order to instrumentalize and empower them to participate in the care of their child in an autonomous way, with the mother being gradually introduced into the care process.
In relation to the results observed in table 4, as for the assistance of the nurse in the care of the premature newborn, this professional needs to promote the participation of the family for the accomplishment of the process of the kangaroo method in all the stages. The conversation with mothers about the Kangaroo Method process is evident in the first stage they follow with special care: in the care of their family, guiding on the participation of the mother and father in the care of the Newborn, as well as stimulating the support of breastfeeding, discussing the experiences of mothers and the difficulties they face due to the health conditions of their Newborn

BEATRIZ Lelis et., 2018 20
Rev enferm UFPE Motherly welcome in the context of prematurity Nursing has the responsibility of welcoming relatives, focusing on the figure of fathers and special care for mothers.

Relationship of Kangaroo
Position Duration and Mother-Child Pre-Term Interaction at Alta Hospital The welcome during the kangaroo method, the interaction and communication of the team with the mothers are of fundamental importance so that the emotional experiences of this period are better elaborated and the suffering of the mothers minimized.

NUNES, Natália P, 2015 22
Rev Bras Promoção Saúde Maternal perception of the experience in the neonatal intensive care unit.
The reception of the multidisciplinary team to the mother who suffers at this moment, should be considered as relevant by the professionals, because the problems experienced can interfere in the realization of the Kangaroo Method, often, due to lack of information, the mothers are dominated by feelings of distrust, despair, fear and incomprehension in relation to the clinical picture of the baby.

IV. DISCUSSION
In this research, specifically, the importance of the nurse in the care of the kangaroo method was identified, besides observing the benefits of this practice, since the mothers have a fundamental role in the realization of the method.
In a study by Viana, Cunha & Leão (2018), they stated that the benefits of CM in relation to the newborn were analyzed, where positive impacts on its cognitive and motor development could be identified, with an improvement in its weight gain and reducing its length of stay, thus avoiding hospital infections. In this research it was possible to observe the benefits perceived by mothers about the Kangaroo Method, already in the studies of Menezes (2017), it positively points out about this perception of mothers that there was a strengthening of the mother-child bond, favoring the growth of this Newborn and provided their involvement in the care of their baby.
According to the author Araujo et al., (2016), if the newborn underweight is caressed, touched and wrapped in the lap, he will feel more welcomed and safe, because this tool is a technology that provides a smooth transition to extrauterine life, having the mother as an indispensable role in the care and treatment of the baby in the transition of the stages of the Kangaroo Method, especially when he is in the infirmary.
To reinforce this discussion, it is worth noting the statement of Balduino (2018), in this study it was observed that the method also contributes to include the family by encouraging early contact with the baby, increasing the bond and affection and improving the recovery of the newborn.
The results of the above approaches intensify that the importance of the nurse beside the mothers to direct the care to the newborn is notorious, because this professional needs to seek strategies that promote the well-being and protection of the baby, possess the technical capacity, based on scientific evidence to guide the care (Sales et al., 2018). Therefore, the kangaroo method is intended to include family participation in this process and to guide the mothers on the importance of exclusive breastfeeding (Klossoswski et al., 2016).
In this way promoting a humanized assistance stimulating the skin-to-skin contact by the kangaroo position (Cruz, 2017). Since the method brings challenges for nurses regarding the best way to teach mothers the care for their babies, these professionals should always demonstrate the importance of all stages of the process and seek to intermediate all these cares (Silva, Crispim & Figueiredo, 2017 importance of their participation in the recovery of their child in this care process. The studies of Pereira et al., (2018), show that it is important to welcome the nurse to mothers and their premature newborn, because they are responsible for passing on relevant information related to the stages of the kangaroo method and the importance of each one for the effectiveness of this strategy, stimulating them about breastfeeding, discussing and sharing about the experiences experienced to overcome this stage (Lelis et al., 2018).
This welcome and interaction needs to be effective, because if the nurse does not pass on information about the process of the stages of the Kangaroo Method, they will be dominated by feelings of distrust and despair, since they will be sensitized when they see the clinical status of their children (Nunes et al., 2017; N. P. Nunes, 2015). But if they are correctly guided these feelings will not dominate them and they will understand that they are part of this bond of care.
Since there are countless attributions developed by nurses in front of all this assistance of the Kangaroo Method, in which they contribute to the success of this tool, guaranteeing the teaching-learning for the mothers by means of the appropriate guidelines about this strategy and its benefits.

V. CONCLUSION
The present study denotes the importance of the nurse's assistance in the care of the kangaroo method, because it has an important role in this process, since it is responsible for promoting the care, encouraging the family to be present and acting during the stages of the kangaroo method.
In addition to encouraging the practice of breastfeeding, improving the clinical condition, and strengthening the affective bond between mother and newborn, the researchers analyzed prove this importance of the nurse as a mediator to favor the care and benefits of the Kangaroo Method for mother-child contributing to hospital discharge. Therefore, all the findings in this research are relevant for the performance of the Kangaroo Method mainly in relation to the reception, the way this professional will approach the mother, from the entrance until her discharge from hospital, passing on the important information for the realization of the Kangaroo Method strategy, thus they acquire the confidence in realizing the kangaroo position.