All On Board? Changing the Culture of Couplet Care

Purpose for the program: For many years traditional couplet care has separated mothers and newborns shortly after birth. Studies have shown the detrimental effects on mothers and newborns when care is given in separate locations.  

Proposed change: Prior to the implementation of couplet care this organization separated mothers from their newborns, with newborns receiving care during transition and at night in the nursery. Using the Iowa Model of Evidence-Based Practice to Improve Quality Care, we developed evidence based practice changes that were guided by nurses questioning the rational for continued separation of mothers and newborns that are not supported by the literature. The planning phase included development of an interdepartmental team, literature review, survey of comparable facilities and piloting models of couplet care.  

Implementation, outcomes and evaluation: In 2011 the implementation process began with interdepartmental and interdisciplinary meetings lead by the clinical nurse specialist and staff development instructors to foresee barriers and assist with the change process. Discussion at unit based committees provided staff input and feedback for the change. Education was provided for registered nurses, ancillary staffs and physicians. Verbal and written information was also provided to patients at childbirth classes and prenatal visits.  Skin-to-skin begins in the delivery room for all healthy term and late preterm newborns. After transfer to the maternity unit skin-to-skin is uninterrupted throughout the transition period.

The journey to the standard of couplet and family centered care has had many challenges and rewards. Changing the nursing culture to embrace this practice change has been challenging. Some staff nurses are resistant to change their delivery of care. The mother’s exhaustion is often sited as reason for their baby’s being returned to the nursery at night. Some staff members use pacifiers to comfort newborns. Difficulty in maintaining sustained practice changes contribute to the challenges.Positive outcomes related to the non-separation of new moms and babies focus on both patients and staff. Increased patient satisfaction scores, decreased neonatal intensive care unit admissions, reduced incidences to hypoglycemia as well as positive feedback from families about their experience validate the success of our care model. Staff satisfaction and interdepartmental teamwork related to bedside report for new admissions have improved.Although there have been many successes and challenges along the way, our organization is committed to evolve a culture of best practice for couplet care.

Implications for nursing practice: The nursing culture shifted from traditional care to evidence based care.

Keywords: couplet care, skin-to-skin