Maintaining equilibrium : altering maternal perceptions of mothering in the NICU [Neonatal Intensive Care Unit]

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The aim of this study was to examine the developing relationship between infants and their mothers when facing serious illness in the Neonatal Intensive Care Unit. (NICU) The complexity of the NICU environment is confronting for many families and may interfere with the quality of the developing parent-infant relationship. This research is a grounded theory analysis of mothers’ perceptions of their relationships with their infants. Symbolic interactionism provided the theoretical perspective for studying how mothers interpreted their world and how this interpretation influences their behaviour in the NICU. Mothers of 12 infants diagnosed with a congenital anomaly requiring surgery were interviewed just before discharge using an unstructured interview technique. Data were concurrently collected, coded and analysed. Comparative analysis of data with previously collected data provided theoretical leads, which were then followed by interviewing participants who were thought to be able to shed light on emerging concepts. The choice of which mothers to interview next was therefore based on theoretical purpose and relevance. The identified core category of “maintaining equilibrium” described the way in which mothers dealt with their predominant problem, identified as “preserving a relationship while enduring a crisis”. Mothers endured this problem within the context of, the “diagnosis to discharge continuum”. What emerged from this study was the level of anxiety mothers undergo during their journey from diagnosis of their infant’s anomaly to discharge of the infant from hospital. This journey equates to a series of crises which they are challenged to overcome. Three mediating factors were found to impact on mothers’ perceptions of their situation during each crisis event - “interaction with others”, “interaction with health system ” and “mother and infant interaction”. The way in which mothers managed each crisis event was able to be explained through the “maintaining equilibrium” process. Mothers were able to regain some control of the situation which in turn enabled them to maintain contact with their infant and sustain their developing relationship. Armed with this knowledge the neonatal nurse can potentially alter mothers’ perception of the situation, thereby lessening the distress associated with the experience and facilitating the mother-infant relationship. Recommendations for practice have been described which surround the introduction of alternative models of practice which support the efforts of mothers to develop relationships with their sick newborns. In order to implement family-centred interventions, neonatal nurses require support through educational preparation and professional development.
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