Background:
Separation of mothers from their newborn during the first few hours of life has become standard practice related to equipment needs, variation in room size, and nursing convenience. These identified barriers create unnecessary interruptions in maternal-child bonding, duplication of efforts that disrupts family time and inefficiencies in workflow. The healthy newborn received two assessments within four hours of life.
Objectives:
The purpose of researching a single staged newborn model is to eliminate duplications and the number of interruptions in newborn care while promoting skin to skin care (SSC) to enhance the maternal-child bonding experience.
Method:
This study was a convenience sample of thirty vaginal deliveries over a three-month period. The study was limited to healthy newborns. The project was coordinated by the obstetrical supervisor and included both quantitative and qualitative data. The data was compiled and analyzed into metrics: parents’ receptiveness to SSC, uninterrupted time, breastfeeding, and staff feedback.
Results:
The 30 families were educated on the benefits of SSC. Twenty-six of the mothers were interested in SSC, however only 42.3% were able to provide SSC. Delays were attributed to unexpected neonatal and maternal complications (46.2%) and maternal requests such as exhaustion (11.5%). The average length of SSC time was 47.15 minutes. All of the mother baby nurses who offered feedback described the model as an efficient process that promotes couplet care. The twelve parents who volunteered feedback supported having the newborn assessment completed in their presence.
The responses from the mother baby staff indicated that the single staged assessment promoted couplet care and provided more opportunity for family bonding. Based on this feedback, the newborn coordination of care model was considered to improve teamwork and efficiency. One mother baby nurse explained, “Both mother baby and labor & delivery benefit. So, both units feel as though they are receiving help from the newborn assessment nurse.”
Nursing Implications:
The contemporary newborn coordination of care model requires a dedicated neonatal nurse expert in to complete the neonatal assessment. After analyzing the quantitative and qualitative data collection results, a proposal for a dedicated NANN, (Neonatal Assessment Newborn Nurse) was submitted to the CNO and was approved.
The job description for the NANN was drafted with the assistance of the Obstetrical Supervisor and a veteran Neonatal Intensive Care Unit (NICU) nurse. This core group of nurses developed the workflow process of the immediate care of the newborn according to maternal preferences with the goal of providing uninterrupted skin to skin care for the first hour of life. The role was defined and an educational skills checklist was developed.
Staff education was another critical component to sustain this contemporary newborn care model. All the Women’s & Children’s staff, neonatology and obstetrical providers, respiratory therapists, operating room staff members, and anesthesia personnel were informed of the new NANN role along with benefits of skin to skin care for both mother and baby. Women & Children staff members were supportive of the new role and were instrumental in providing feedback to help create the model- “From the Start, Never apart”.
As an additional patient safety benefit, this newborn care model supports bringing the newborn nurse as the expert to the mother’s bedside after delivery to complete a full newborn assessment. The experienced newborn nurse is available for the immediate needs of the newborn and to facilitate early and successful breastfeeding and can notify the neonatology providers of any suspected concerns. With this model, earlier intervention can decrease the need for a direct NICU admission.
Conclusion:
A single staged newborn admission will carve the imprint for success in sustaining the couplet care model from birth to discharge. This model was perceived as an efficient process that fosters teamwork and leads to improved patient satisfaction. This project can be adopted by similar hospitals to become more family-centered and customize the birthing experience as one of the most cherished moments in a lifetime.
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