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Abstract

Background: The Neonatal Intensive Care Unit (NICU) is a stressful environment for mothers, infants, parents, families, and healthcare providers. Mothers regard nurse-mother relationships as the most significant relationship encountered in the NICU. Nurse-mother relationships can facilitate and/or hinder optimal mother-infant relationships. Disrupted maternal-infant relationships and maternal role alteration are leading sources of maternal stress and linked to worse health outcomes for mothers, infants, and families. Limited in the extant literature are neonatal nurses’ perspectives of their caregiving relationships with mothers, infants, and parents, within the context in the single-family room (SFR) NICU. Purpose: To explore neonatal nurses’ caregiving experiences with mothers and infants in a single-family room (SFR) NICU. Methods: This qualitative inquiry was guided by an Interpretive Description (ID) methodology and informed by a relational theoretical orientation. 10 NICU nurses were recruited. A total of 12 interviews were conducted using a semi-structured interview guide. Data were manually categorized and coded and thematically analyzed. Results: Three main themes were identified across the interviews: 1) The Shifting Nature of Nurses’ Work in the SFR NICU; 2) Navigating the Relational Space in the SFR NICU; and 3) Maintaining the Status Quo. The move to the SFR NICU significantly changed how nurses worked and disrupted their sense of teamwork. The SFR NICU advanced an integrated family-centred care (iFCC) model, creating both a space and “place” for parents that invites parents’ presence and involvement in the care and decision making for their baby. The nurses described how they navigated nurse-parent relationships within a model of iFCC, and how they supported mother-infant relationships in the SFR environment. Many routine and unchallenged nursing practices, beliefs and rituals carried over from the open bay (OB) NICU and contributed to maintaining the status quo. Significantly, maternal-infant separation beyond the immediate post-partum period went unnoticed and constructed by nurses as maternal absence in the NICU. Maternal absence was either justified, and often encouraged by the nurses, or judged and problematized. While the nurses acknowledged their role supporting mother-infant relationships, they minimally referenced their role in relation to mothering and motherhood in the NICU. Recommendations for nursing practice are offered.