Cultivating Better Outcomes For Mothers and Newborns Through Integrated Best Practice Models
Title: Cultivating Better Outcomes For Mothers and Newborns Through Integrated Best Practice Models
- Identify the challenges and opportunities in integrating multiple best practice models in an active practice.
- Describe methods to improve staff expertise and readiness to improve patient outcomes through an effective nurse-led maternal child care delivery team.
- Formulate a framework to successfully implement multiple best practice models in maternal child care in a community hospital.
Design: The proposed change involved identification and cultivation of nurse-led teams to successfully deploy and manage the integration of these practice models into the existing culture and practice setting. Implementation involved a well-staged sequential four year roll-out of five integrated best practice models.
Setting: Catholic Health Services at St. Catherine of Siena Medical Center community hospital.
Sample: The outcomes of interest were measures of quality and perception of transition care during delivery, frequency counts of continuous skin to skin contact, frequency of rooming-in, quality and perception of non-separation from delivery to discharge, and frequency of breast feeding exclusivity.
Methods: Both formative and summative evaluation of the program’s structure and processes and patient and staff outcomes were required to insure continual attention to the effect of the implementation and subsequent revision of methods. Quantitative and qualitative outcomes of multiple sources were examined for triangulation of evidence to drive program success.
Results: We modified our model of practice from traditional postpartum/nursery care to a couplet care model promoting non-separation from delivery to discharge. With these programmatic changes in our culture of care came staff resistance which warranted education, support and reward. These changes included continuous skin-to-skin contact, LATCH score initiation and compliance, rooming-in, a night-time plan and increasing breastfeeding exclusivity rates. Staff was provided with ongoing education including didactic training, staff driven cross training, modeling of care, shared governance, competencies and new evaluation tools to foster accountability. Policies were updated to support these changes. The maternity education line was increased from part-time to full-time and the Lactation Consultant staff line became an education position.
Conclusion/Implications for nursing practice: We discovered a major change in programmatic culture of care takes a great deal of education, time and patience. Budgeting monies is also a consideration. It is better to make small changes which includes staff for buy-in and reward each victory. We identified the need to slow our change process by taking “baby steps” and implementing phases. Collecting data and surveys are excellent tools to promote staff accountability and assure that patient’s needs are being met. A dedicated transition nurse to initiate biological harmony and adjustment to parenthood promotes best care and practice. Finally, a team approach which includes staff, management is essential to support success.
Keywords: programmatic changes, transition care, skin-to-skin, breastfeeding exclusivity, non-separation, rooming-in.