Neonatal twin cobedding: a mixed method study of policy, practice and staff perceptions in Australia

Aim: To explore neonatal unit policy and practice, and neonatal healthcare workers' experiences, beliefs and perceptions of twin cobedding in Australia. Design and Methods: A two-part convergent mixed methods design was used. Part 1 data were collected via an online survey of neonatal units. Part 2 data were collected by focus groups and interviews with healthcare workers. Findings were integrated to create final results. Results: 21 neonatal units, and 17 healthcare workers participated in this study. Significant variations in twin cobedding practices were reported within and across neonatal units. Practice variation was influenced by several interlinked factors, captured in four themes: (1) Policy-Driven Practitioners in a Policy Vacuum; (2) Evidence, Knowledge and Education; (3) Personal Beliefs and Practice Observations; and (4) “The Parent Owns that Baby”—Being Family-Centred. Conclusions: Due to widespread practice and policy variations, and a lack of evidence-based education for staff, healthcare workers appear to be making individual decisions regarding cobedding practice, potentially creating confusion for twin families navigating care. Implications for the Profession and/or Patient Care: Improvements to twin cobedding practice education are needed to enable clinicians to support twin families in their care. Separation of twins in neonatal units needs to be addressed, regardless of twin cobedding practice. Research identifying benefits and any potential risks of twin cobedding practice is required. Impact: Neonatal healthcare workers are policy-driven practitioners who value clear evidence and education to confidently support the families in their care. It is important that evidence-based guidelines for twin cobedding are developed to support them in family-centred clinical practice. Reporting Method: MMAT guidelines were used to prepare this manuscript. Patient or Public Contribution: No Patient or Public Contribution.