According to the Institute for Patient- and Family-Centered Care (2015) "patient-and family-centered care is an approach to the planning, delivery, and evaluation of healthcare that is grounded in mutually beneficial partnerships among healthcare providers, patients, and families." It has been endorsed by the American Academy of Pediatrics, American Nurses Association, Association of Maternal and Child Health Programs, Maternal and Child Health Bureau of the United States Department of Health and Human Services, and Society of Pediatric Nurses and has been the standard of pediatric healthcare in most institutions since the early 1990s. In spite of widespread support, family-centered care continues to be inconsistently defined and applied in newborn nurseries today. Barriers in effective implementation remain even though there is evidence that family-centered care in the nursery is baby- and family-friendly, has clear economic benefits, improves long-term development of the child, and enhances maternal infant attachment. These barriers include ambiguity on what family-centered care actually is and what actions constitute its full implementation, in some cases inadequate reimbursement policies for such practices, and lack of well-controlled research studies that document related outcomes (Kuo et al., 2012).

A better understanding of a nursing practice framework for family-centered care in the nursery is necessary. One model has as its major tenets relationship-based care, nurse as servant leader, and thinking in action (Small & Small, 2011). Servant leaders are characterized as visionary, humble, accountable leaders who help guide patients and families in directing their own care. The definition of "thinking in action" is from Benner's theory (Benner, Hooper-Kyriakidis, & Stannard, 1999) that focuses on "thinking linked with actions in ongoing situations." Along with the concept of relationship-based care, this model stresses the need for nurses to develop strong relationships with their patients and families (Small & Small).

Building on this concept and principles of maternal-infant attachment, Karl, Beal, O'Hare, and Rissmiller (2006) reconceptualized the role of the postpartum nurse as relational where the nurse acts as an "attacher." Viewed from a more traditional lens, the nurse in a baby-friendly nursery functions primarily as a "teacher" meeting a mother's learning needs and as a "doer" providing task-by-task care as needed to mothers and babies separately. Viewing the mother-baby couple as a single entity works better in promoting family-centered care. "Acting as an 'attacher', the nurse first uses the care, feeding and behavior of the infant to initiate a nurse-mother relationship, and in turn, uses the relationship created with the mother to facilitate a connection between the mother and her newborn" (Karl et al., p. 258). This nurse-mother relationship, wherein the nurse anticipates mothers' needs can be effective in modelling how the mother in turn can anticipate and respond to her baby's needs. Mothers who feel the nurse's caring approach may internalize this feeling and use it as a standard for interacting with their baby (Karl et al.). This mutuality is the precursor of attachment.

The relational approach is the hallmark of family-centered care and could be helpful in clarifying family-centered care in the nursery. It is an inexpensive way to implement baby-friendly practices. Research on outcomes of maternal-infant attachment as a result of family-centered nursing care is needed. In the interim, a reexamination of the nurse's role during this critical period and full implementation of patient- and family-centered care in the nursery is warranted.

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