All on Board? Changing the Culture of Couplet Care


Paper Presentation

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

Before the implementation of couplet care, this organization separated mothers from their newborns when providing 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 that questioned the rational (which was not supported by the literature) for continued separation of mothers and newborns. 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 identify 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 staff, and physicians. Verbal and written information also was provided to patients at childbirth classes and prenatal visits. Skin-to-skin contact began in the delivery room for all healthy term and late preterm newborns. After transfer to the maternity unit skin-to-skin contact was 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 new practice has been challenging. Some staff nurses are resistant to change their delivery of care. The mother's exhaustion often was sited as the reason for the newborn 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 nonseparation of new mothers and newborns focus on both patients and staff. Increased patient satisfaction scores, decreased neonatal intensive care unit admissions, reduced incidences of 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. Though 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.