An exploration of discourses of NICU nurses caring for infants with symptoms of a substance-exposed pregnancy

UNCG Author/Contributor (non-UNCG co-authors, if there are any, appear on document)
Amber Welborn (Creator)
The University of North Carolina at Greensboro (UNCG )
Web Site:
Lynne Lewallen

Abstract: The opioid crisis continues to worsen nationally and has affected women who are pregnant and parenting across the nation. Mothers living in the southeast United States and rural areas have been disproportionally affected and experience multiple barriers to care. Infants born to mothers after a substance-exposed pregnancy (SEP) may experience symptoms of withdrawal after birth and need supportive care in the neonatal intensive care unit (NICU). Nurses who care for these infants and their families have previously reported negative attitudes surrounding care related to difficulty comforting the infant and frustration with families. Stigma against mothers who use substances in pregnancy further complicates the dynamic. A qualitative study using interviews with NICU nurses who care for infants and families with a SEP offered the opportunity to investigate the nursing discourse in the NICU surrounding SEPs. Using Critical Incident Technique, participants were asked to share their most memorable experience caring for infants and families with a SEP, generating data ripe for critical discourse analysis. Data were analyzed for the presence of sociopolitical narratives, social narratives within the healthcare system, and the participant’s word choices and style of storytelling to determine specific relevance. Results show that tensions exist at the bedside between nurses, others, and providers, surrounded by a healthcare culture that highly values patient satisfaction, where nurses experience high pressure to meet the needs of the infant and family with limited resources. Nurses verbalize concerns of safety and trust related to the mother’s perceived ability to care for the infant after discharge and need time with the family to build rapport. However, within the constraints of a business-model of healthcare, nurses lack the time and energy needed to build trust with families and implement family-centered care principles. Additionally, elements of stigma may influence the nurse-family dynamic in a variety of ways and may be continued through the oral traditions of nursing. As a part of the Quadruple Aim from the Institute for Healthcare Improvement to meet the need for high-value care, strategies to improve the experience of care by providers, patients, and families are necessary. This caregiving dynamic can be improved through a better understanding of the root causes of substance use and SEPs and organizational commitment to a supportive environment for both the mother and the nurse. Future research with a systems approach is positioned to investigate issues surrounding caregiving practices for families with a SEP and point to potential meaningful interventions.

Additional Information

Language: English
Date: 2020
Discourse, Healthcare systems, NICU, Opioid, Substance-exposed pregnancy
Drug abuse in pregnancy
Opioid abuse $z Southern states
Neonatal intensive care

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