937479

research-article2020
CNRXXX10.1177/1054773820937479Clinical Nursing ResearchGünay and Coşkun Şimşek

Research Article
Clinical Nursing Research

Emotions and Experience of Fathers 2021, Vol. 30(6) 840­–846

© The Author(s) 2020
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https://doi.org/10.1177/1054773820937479
DOI: 10.1177/1054773820937479

Eastern Anatolia Region of journals.sagepub.com/home/cnr

Turkey: A Qualitative Study

Ulviye Günay, RN, PhD1

and Didem Coşkun Şimşek, RN, PhD2

Abstract
The aim of this study was to investigate the emotions and experiences of fathers in Eastern Anatolia Region of Turkey who
applied kangaroo care in the neonatal intensive care unit. This study applied the qualitative descriptive design. The study
included 12 fathers at the NICU of a university hospital. The fathers practiced kangaroo care with their babies two times a
day for 15 days. Content analysis was then conducted to determine the main themes and sub-themes of the interviews. Three
main themes and six sub-themes emerged from the analysis: (1) Emotions of being a father (feeling that the baby belongs
to own and feeling the warmth and scent of the baby); (2) Confidence in fathering roles (self-confidence and caring for the
baby); and (3) Happiness in the new parent role (seeing the baby calm down, hugging the baby and touching the baby’s skin).

Keywords
Kangaroo care, new-born, emotions, experience, fathers

Introduction
Kangaroo care is the act of placing a new-born wearing only
a nappy on mother’s/father’s chest chest in a vertically or up-
right position so that skin-on-skin contact is achieved (Chan
et al., 2016). The new-born’s head is turned to one side in a
slightly extended position. This slightly extended head posi-
tion keeps the airway open and allows eye-to-eye contact
between the parent and the baby. The hips should be flexed
and extended in a “frog” position, while the arms should also
be flexed (World Health Organization, 2003).
This method of holding premature babies is being used in
countries with insufficient numbers of healthcare profession-
als and those without new-born warming equipment (Bastani
et al., 2017). Since 1993, the World Health Organization has
recommended kangaroo care as an ideal method to preserve
the body temperature of new-borns, and it has become part of
standard care in several countries around the world (World
Health Organization, 2003).
Kangaroo care requires certain criteria in three areas: the
suitability of the neonatal intensive care unit, the parent and
the infant (Ludington-Hoe et al., 2008). In the neonatal inten-
sive care unit, nurses, midwives and other healthcare profes-
sionals should have knowledge, experience and willingness
to apply kangaroo care (Günay & Coşkun, 2019). The envi-
ronment and atmosphere for applying kangaroo care should
have a temperature of 22 to 24°C, have fresh air and light and
be silent and calm.
Fathers should have sufficient knowledge about kangaroo
care and accept implementing it. It is also important that they
are emotionally ready for this process. Kangaroo care should
not be implemented if the fathers are crying, do not want to
see or embrace their baby or feel anxiety on the level of pan-
icking. Healthcare professionals should assess the infant’s
readiness for kangaroo care (e.g., heart rate, respiratory rate,
oxygen saturation level, temperature and activity). It should
not be implemented if the infant shows parameters of tachy-
cardia, bradycardia, apnea, desaturations, abnormal activity
and hyperthermia (Ludington-Hoe et al., 2008).
In the literature has reported that kangaroo care stabilizes
infants’ body temperature so that respiration and heart rates
reduce their need for oxygen and increase sleep duration
1
Department of Pediatric Nursing, Faculty of Nursing, Inonu University,
Malatya, Turkey
2
Department of Pediatric Nursing, Faculty of Health Sciences, Fırat
University, Elazığ, Turkey
Corresponding Author:
Uviye Günay, RN, PhD, Assistant Professor, Faculty of Nursing,
Department of Pediatric Nursing, Inonu University, Campus 44280,
Malatya, Turkey.
Email: ulviye.gunay@inonu.edu.tr
Günay and Coşkun Şimşek 841
(Ali et al., 2009; Athanasopoulou & Fox, 2014; Bastani
et al., 2017; Bera et al., 2014; Cunningham et al., 2017).
Kangaroo care facilitates healthy interactions between
parents and babies (Blomqvist et al., 2011; Güleşen & Yıldız,
2013). Studies have shown that parents who apply kangaroo
care are happy, their stress levels are decreased, their senses
of trust is developed and a strong bond develops between
them and their babies (Fegran et al., 2008; Hsieh & Huang,
2000; Ludington-Hoe et al., 2008; Parker & Anderson,
2002). In addition, it is also reported to help parents to learn
baby care after they are discharged (Feldman Eidelman,
Sirota & Weller Comparison of skin-to-skin, 2002;
Ludington-Hoe et al., 2008).Studies on fathers determined
that kangaroo care increases their self-confidence and skills
at looking after new-borns (Helth & Jarden, 2013).
Despite these benefits reported in the literature, kangaroo
care is not routinely applied in neonatal intensive care units
(NICU) in Turkey due to nurses’ busy schedules and lack of
knowledge of these benefits, the unsuitability of the physical
conditions in NICUs and parents’ fear of harming new-borns
(Çalik et al., 2015).
Culture has significant impacts on family life and baby
care. Turkey, particularly Anatolia, is one of the oldest set-
tled areas in the world, and due to its geographical location,
it has been influenced by different cultures from the East,
West, Middle East, Mediterranean and Islam (Republic of
Turkey Ministry of Culture and Tourism, 2019). Family has
a very important position in Turkish culture, and the family
structure is traditional, with marriage seen as the foundation
of society. Islam significantly affects women’s role and sta-
tus in society, as well as the lifestyle, worldview and family
structure of Turkish society. Women’s primary responsibility
is believed to be care for the home, family and children. In
Turkish society, motherhood is considered to be women’s
most sacred role. Men are seen as responsible for supporting
the household and usually do not take care of the children
(Kara & Çetinkaya, 2019; Kaypak & Kahraman, 2016;
Uğurlu & Koca, 2010).
Currently several Turkish cultural practices that nega-
tively affect babies’ health have largely been abandoned, but
some are still applied in the South-eastern Anatolia Region,
where this study was conducted. These practices include
covering the new-born’s face with a yellow headscarf (to
prevent hepatitis), swaddling the baby tightly (to straighten
the baby’s legs), and bathing the baby in saltwater (to keep
the baby’s sweat from smelling). Another practice is parents
not picking up the baby in front of family elders (Özyazıcıoğlu
& Polat, 2014).
Fathers caring for babies is frowned upon in rural areas
of Turkey as it is considered to be mothers’ duty. This
belief may lead to social prejudice against fathers who
practice kangaroo care, so most fathers do not participate
in kangaroo care (Kara & Çetinkaya, 2019). Studies con-
ducted on fathers’ application of kangaroo care have been
mostly carried out in western countries (Athanasopoulou
& Fox, 2014; Blomqvist et al., 2011; Helth & Jarden,
2013) Few studies have been carried out in eastern coun-
tries (Feldman et al., 2003; Parmar et al., 2009). This can
be resulting from the fact that the role of looking after chil-
dren is mostly attributed to mothers and also because of
sociocultural factors. In a study conducted in Iran, it was
reported that only mothers are allowed to take care of
babies in NICU. In the same study, mothers stated that they
wanted to be supported by their spouses in child care
(Aliabadi et al., 2014).
It is unknown how the emotions of fathers who practice
kangaroo care in Turkey, which has a traditional social
structure. The purpose of this study was to investigate the
emotions and experiences among fathers in the Eastern
Anatolia Region of Turkey who apply kangaroo care in
NICUs. The results of this study can contribute to the spread
of fathers’ applying kangaroo care in the countries with tra-
ditional structure.
Methods
Study Design
This study adopted a the qualitative descriptive design
approach to determine the emotions and experiences of
fathers who practiced kangaroo care with their babies. The
goal of a qualitative descriptive design approach is to focus
on impartially and comprehensively uncovering, explaining
and defining the subjective life experiences of individuals
and groups.
Data were analyzed using qualitative content analysis.
Content analysis is a research technique used to derive repro-
duceable and valid results regarding the content of data
(Graneheim & Lundman, 2004).
Institutional review board approval was obtained before
this study was conducted. The hospital where the study was
conducted also provided written permission. The fathers
gave verbal and written consent after being informed that
they would be interviewed about their emotions and experi-
ences two weeks after applying kangaroo care.
Population and Sampling
This study was conducted in the third-degree NICU of a
training and research hospital in the Eastern Anatolia Region
of Turkey over January to May 2019. Kangaroo care was
done as current practice in this NICU.
The inclusion criteria for infants were birth weight
≥1000 g, gestational age 27 to 36 weeks and postnatal age
≤28 days. The fathers of infants who had these characteris-
tics were included in the study. The exclusion criteria for
infants were congenital anomalies, <27 weeks gestational
age, >36 weeks gestational age, tachycardia, bradycardia,
hyperthermia, apnea and 85% and lower oxygen saturation.
Fathers who could not visit their infants regularly and fathers
842 Clinical Nursing Research 30(6)

who had serious health problems were excluded. This study Table 1.  Demographics Characteristics of the Fathers (n = 12).
involved 12 fathers. Data saturation was reached with 12
Demographic Characteristics N %
fathers.
Father’s age
  25–31 age 6 50
Kangaroo Care   32–38 age 6 50
Preparation.  Training on the benefits and application of kan- Father’s level of education
garoo was provided to the fathers who agreed to participate  Primary 8 67
in the study. The training took place in a meeting room at the  University 4 33
hospital, utilized a PowerPoint presentation and visual mate- Father’s job
rials and lasted an average of 45 min. The fathers’ questions  Worker 4 33
were answered after the training. A handbook explaining the  Engineer 2 17
 Jobless 2 17
kangaroo care process was distributed to the fathers.
 Teacher 4 33
New-born’s gender
Implementation.  The fathers who met the inclusion criteria
 Male 8 67
were enrolled in kangaroo care intervention groups of two or
 Female 4 33
three. The kangaroo care intervention was carried out near the New-born’s diagnosis
incubator where the new-born slept. Fifteen minutes before  Prematurity 4 33.3
kangaroo care, the new-born’s life signs and oxygen saturation  RDS 3 25.0
were assessed. When it was determined that the new-born was  SGA 3 25.0
suitable for kangaroo care, a comfortable chair for the parent  IUGR 2 16.7
was placed near the incubator. The participating father per- Father’s living place
formed hand hygiene in the NICU’s hand washing station.  Village 5 41.7
While the father uncovered the chest area near the baby’s incu-  City 7 58.3
bator, the researcher wrapped the baby in a blanket and removed Father’s total number of children
the baby from the incubator. The baby was then placed on the  1 6 50
father’s epigastric region. Kangaroo care was implemented 15  2 2 25
to 30 min two times a day for 15 days. Kangaroo care was  3 2 25
implemented to these babies twice a day by the father.
RDS = Respiratory distress syndrome; SGA = Small gestasyonel age;
IUGR = Intrauterine growth retardation.
Data Collection
The data collection was conducted 2 weeks after. Data were expressed verbally by the fathers. Both researchers indepen-
collected through face-to-face, in-depth interviews in which dently transcribed the audio recordings gathered as a result
open-ended questions were asked and detailed answers of the one-to-one interviews. They read and reread tran-
obtained to examine all aspects of the subject investigated scripts and coded the same, similar and different statements.
(Patton, 2005). In the interviews, the fathers were asked two Then the two researchers met to compare their coding and
questions: Can you tell me about your experiences of kanga- found no differences. As a result the coded data were orga-
roo care? What kinds of emotions did you experience while nized, and their main themes and sub-themes were identified
applying kangaroo care with your baby? (Corbin & Strauss, 1990; Graneheim & Lundman, 2004).
Audio recordings were made of the in-person interviews.
The participants provided consent before recording was Results
started. Each father was interviewed once, and each inter-
view lasted approximately 45 to 50 min. During the inter- The participants came from various backgrounds including
views, a setting was created to allow the fathers to feel education, age, job and place of residence. Five father lived
comfortable expressing their emotions. All the in-person in the village. The mean age was 29.7 years for the fathers.
interviews were carried out in a quiet room at the NICU. Their education levels varied from primary school to uni-
versity graduates. The babies were the first-borns of six
fathers. Table 1 summarizes the participants’ demographic
Data Analysis characteristics.
The interview texts were analyzed using inductive qualita- The analysis identified three main themes and six sub-
tive content analysis as described by Graneheim and themes: (1) emotions of being a father (feeling the warmth
Lundman (2004). The unit of analysis was the emotions of and scent of the baby and feeling that the baby belongs to
the fathers practicing kangaroo care with their babies in the one); (2) confidence in fathering roles (self-confidence and
NICU. In the analysis was reported only emotions that were caring for the baby); and (3) happiness in the new father role
Günay and Coşkun Şimşek 843
(seeing the baby calm down, hugging the baby and touching
the baby’s skin).
(1) Emotions
Emotions that the baby belongs to them.  They felt that they
were their baby’s fathers, not strangers. The emotions of a
father who practiced kangaroo care were striking:
Would a man carry a baby on his chest? We have always
approached it like this, . . . but everything has changed now. I
embraced a new-born baby like this for the first time in my life.
I felt that it is my child, that I am a father. This is my child now.
I am not in the position of an uncle. I am very happy. [It was
observed that the father became emotional and cried after the
statement.] (Father 1, 29 years old)
My baby has been in the hospital for 89 days. Before kangaroo
care, I went to the hospital for a visit like a stranger. It did not
matter for me whether my baby lived or not. Thanks to kangaroo
care, there has been a connection between me and my baby. Now
I am afraid of losing my baby (Father 13, 31 years old)
Feeling the Warmth and Scent of the Baby
The fathers who practiced kangaroo care stated that they
felt the warmth, scent and presence of their baby
When my baby is on my chest, it feels my warmth and does
not want to leave me. This practice made me feel fatherhood.
There can’t be a better feeling than this (Father 5, 29 years
old)
I felt the fear of losing my baby before practicing kangaroo care.
But now, I felt that my baby is not going anywhere, and I am its
father. I think good days are close. (Father 9, 27 years old)
(2) Confidence in Fathering Roles
Self-confidence.  Embracing the babies and achieving first
contact with them increased the fathers’ belief that they
would be able to perform their fatherhood roles.
My self-confidence increased. I can even make my wife
jealous by giving my baby kangaroo care at home (Father 8,
26 years old)
I felt responsible; there is now a baby in my life I am responsible
for. I became aware that we are a family. My self-confidence
increased (Father 4, 27 years old)
I think that I can help my wife with the care of the baby at home.
For example, my wife can rest while I am applying kangaroo
care to my baby (Father 1, 25 years old)
Caring for the baby. The fathers stated that they became
responsible for their babies after practicing kangaroo care.
Not only my wife but I also can look after my child from now on.
I can care for my child when we get home. I am not afraid of
embracing my child anymore. (Father 2, 28 years old)
I embraced my child. It now knows its father. I feel that it
relaxes when I hug it. Its respiration becomes regular. (Father 7,
33 years old)
(3) Happiness in the New Father Role
Seeing the baby calm down.  The fathers stated that they became
happy after practicing kangaroo care, and they observed that
their babies were also happy. The fathers experienced highly
emotional moments when they practiced kangaroo care with
their babies, and most cried for happiness.
My first contact with my baby happened. I felt it. They laid my
baby on my bosom. I cannot describe that moment. I hugged my
child for the first time. I felt my child’s scent and breath on my
chest. (Father 12, 25 years old)
I held my baby. Its skin touched my skin. .  .  . It became calmer. I
became calmer. My baby also feels the same things. We are very
happy. (Father 4, 30 years old)
Hugging the baby and touching the baby’s skin. The parents
experienced that they practiced kangaroo care with their
babies and they touched the baby’s skin
I was afraid of touching my baby before applying kangaroo
care. I was anxious that I would harm it if I held it, but I was
wrong. I was surprised to see that my baby got calmer. Thanks
to this type of care, I learned that a baby can relax on its father’s
chest and sleep. It is a beautiful feeling. I cannot describe it.
(Father 7, 30 years old)
Discussion
The aim of this study was to investigate the emotions and
experiences of fathers in Eastern Anatolia Region of Turkey
who applied kangaroo care in the neonatal intensive care
unit. After practicing kangaroo care, the fathers in this study
stated that they felt that they were fathers and had developed
an emotional bond with their babies. Through kangaroo care,
the fathers ceased to be strangers watching their babies from
afar. By taking their babies on their chests and achieving
skin-on-skin contact, they felt that they became real fathers.
This approach set the foundations for safe connections
between the fathers and the babies (Lopes et al., 2019).
According to the literature, kangaroo care leads fathers to
feel that they are fathers and helps them gain emotions of
adequacy (Blomqvist et al., 2011; Helth & Jarden, 2013).
Studies have found that compared to routine care meth-
ods, fathers prefer skin-to-skin contact with their babies as it
brings the baby very close to the father and increases their
contact and vocal interactions (Blomqvist et al., 2011;
844 Clinical Nursing Research 30(6)
Leonard & Mayers, 2008). A qualitative study found that
parents who practice kangaroo care establish close, special
bonds with babies (Leonard & Mayers, 2008). A baby usu-
ally bonds with the mother first and other persons later. Basic
bonding between babies and fathers happens much the same
as with mothers (Bowlby, 1977). A study found that fathers
who practice kangaroo care with their babies feel a stronger
sense of fatherhood (Blomqvist et al., 2011).
Roles considered to be suitable for men in Turkey usually
are related to financial support of the family, so fathers have
only small roles in childcare. The participating fathers’ state-
ments that they could now take care of their babies and help
their wives, therefore, show that the practice of kangaroo
care is highly unique and effective. The study findings dem-
onstrate that kangaroo care is a highly effective practice pro-
moting the role of parenthood and parent–baby bonding.
Parents’ involvement in their babies’ lives through prac-
ticing kangaroo care increases their self-confidence and
sense of adequacy as parents (Athanasopoulou & Fox, 2014;
Helth & Jarden, 2013). In this study, the fathers stated that
their self-confidence increased due to kangaroo care. Our
study adds to those of other international studies and further
illustrates the contribution of kangaroo care to parents’,
especially fathers’ discovery of the positive aspects of infant
care. The kangaroo care helps fathers view culturally defined
gender roles in a new perspective and enhances an under-
standing of their own role in relation to their infant (Helth &
Jarden, 2013). Parmar et al. (2009) investigated the experi-
ences of practicing kangaroo care for 7 days by 60 mothers
and 40 fathers in India and reported that their confidence in
their parenting skills increased, they established close rela-
tionships with their babies (Parmar et al., 2009).
Parents of babies receiving treatment in NICUs experi-
ence intense stress and anxiety due to the strange setting
and people, the babies’ treatment process and separation
from the babies (Abdeyazdan et al., 2014). In this study, the
fathers who practiced kangaroo care stated that they
embraced their baby and felt their baby’s breath, scent and
presence. The fathers stated that their babies also sensed
their presence and became relaxed, calm and happy. A study
found that fathers who establish skin-on-skin contact with
their babies early in life describe it as a very positive experi-
ence (Kim & Cho, 2017).
Kangaroo care is practiced mostly by mothers in the
whole world. Fathers practice this care rarely. The reasons
for this are reported as lack of opportunity for fathers, gen-
der role related issues, lack of awareness and the fear of
hurting the baby (Seidman et al., 2015). In the literature, the
majority of papers identified focuses on mothers and
excludes fathers. Most of the few studies conducted on
fathers have been carried out in developed countries.
Emotions of fathers who apply kangaroo care in eastern
countries are not known sufficiently. In this study, it was
found that fathers who apply kangaroo care developed a
very positive emotional interaction with their babies. The
fathers developed confidence in themselves and their father-
hood role. Biases of fathers who applied kangaroo care to
their babies changed. These results can contribute to chang-
ing the thought “fathers do not apply kangaroo care to their
babies,” especially in male-dominated traditional societies.
Significance of the Study
Fathers experience positive emotions in doing kangaroo care
with their babies. The fathers who practiced kangaroo care
experienced that they felt the warmth, scent and presence of
their baby. In addition, the fathers believed that they would
be able to perform their parental roles.
Study Limitations
A low number of fathers participated in this study as Turkish
culture frowns upon the practice of kangaroo care by fathers,
and some fathers had returned to work.
Conclusion
In this study was determined that the parents felt that they
were fathers by means of the practice of kangaroo care and
gained confidence in their parenting skills. In addition, it was
found that the fathers were happy and formed emotional
bonds with their babies.
Healthcare professionals should encourage and assist
fathers to practice kangaroo care. Moreover, it is recom-
mended that suitable physical environments for the practice
of kangaroo be established and that hospital administrators
improve their institutional policies accordingly.
Acknowledgments
The authors sincerely thank the fathers and new-born nurses.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect
to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, author-
ship, and/or publication of this article.
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Ulviye Günay is an assistant professor in RN, PhD, pediatric nurs-
ing department. Malatya Inonu University Faculty of Nursing and
Child Health Nursing Department, Turkey.
Didem Coşkun Şimşek, RN, PhD, Elazığ, is an assistant professor
at the Department of Pediatric Nursing at Fırat University Faculty
of Health Sciences.