1. Martin, Angel MSN, RN, CNS

Article Content


To improve early bonding for the high-risk maternal-infant dyads and to achieve national goals for early initiation of breastfeeding, a competency program was developed for postpartum clinical nurses to enhance practice-based interventions. Using the situation-background-assessment-recommendation rubric, the CNS's role in defining assessment criteria, evaluating patient data, implementing action plans, and reevaluating care will be described.



Intensive monitoring of high-risk maternal and neonatal patients led to unnecessary separation of the mother and infant during the critical immediate postpartum period. Such separation affected patient satisfaction and initiation of breastfeeding rates. The CNSs played a critical role in cultivating knowledge and developing skills of well newborn and postpartum clinical nurses to provide safe and appropriate care to a broader range of patients.



Historically, postpartum mothers receiving postpartum magnesium sulfate typically remained on the labor floor for 24 hours, limiting early postdelivery maternal-infant bonding and increasing time to initiation of breastfeeding. Infants of mothers with chorioamnionitis required 24 to 48 hours of observation in the intensive care nursery to rule out sepsis. Increasing rates for cesarean sections within this population interfered with mothers' abilities to bond with their infants in the first 12 to18 hours after delivery unless they were ambulatory. Separation of mother and infant, as well as bed utilization for intensive monitoring, reduced care efficiency, patient progression, and early bonding.



A CNS-driven comprehensive program based on improving interdisciplinary collaboration and defining competencies was accomplished through educational algorithms, practice guidelines, and a written policy. Criteria for patient and infant assessment and monitoring practices were developed to redesign care delivery to high-risk mothers and infants.



Earlier bonding experiences for high-risk maternal-infant dyads led to practice improvements such as better interdepartmental patient flow metrics, interprofessional communication, and patient satisfaction.



A structured educational program and clinical decisions tools were successful in making positive changes in our practice environment and in implementing safe and effective care for a growing high-risk obstetrical population.


Implications for Practice:

Redesigning care to promote early mother-infant bonding with high-risk births has important implications for providing more fulfilling birthing experiences for mothers and for supporting efforts to encourage breastfeeding.


Section Description

The 2009 NACNS National Conference will be held in St Louis, Missouri, on March 5 to 7. More than 350 clinical nurse specialists (CNSs), graduate faculty, nurse administrators, nurse researchers, and graduate students are registered. This year's theme, "Clinical Nurse Specialists: Vision, Value, Voice," demonstrates the essential leadership skills of the CNS as well as the CNS role in implementing evidence-based practice.


Seventy abstracts were selected for either podium or poster presentations. Again, this year, there is a CNS student poster session. The abstracts addressed CNS practice in 3 practice domains (spheres of influence), emphasizing patient safety and quality care outcomes, leadership, evidence-based practice, and new ways to shape CNS practice. Topics include CNS work activities incorporated into 3 spheres of influence-patients, nursing practice, organization/system-including the development of clinical inquiry skills among staff nurses, use of simulation technology, strategies to maintain clinical excellence, CNS practice in end-of-life care decisions, and many new and thoughtful ideas to support CNS education, practice, and research. Collectively, the abstracts represent the breadth, depth, and richness of the CNSs' contribution to the well-being of individuals, families, communities, as well as to the advancement of the nursing profession.


The conference abstracts were published here to facilitate sharing this emerging new knowledge with those who were unable to attend the conference. As you read each abstract, appreciate the intellectual talent and clinical scholarship of your CNS colleagues who are advancing the practice of nursing and contributing to the health of society through improved outcomes for patients and healthcare organizations. We encourage you to contact individual presenters to network, collaborate, consult, or share your thoughts and ideas on the conference topics. Watch out for next year's call for abstracts and consider submitting for presentation at NACNS' next annual conference in Portland, Oregon, on March 4 to 6, 2010.