Neonatal intensive care nurses' accounts of care for mothers/families with substance‐exposed pregnancies: A critical discourse analysis

Abstract

AbstractAimsTo explore the effects of power dynamics and hospital organizational structure upon neonatal intensive care nurses' experiences caring for infants and families from a substance‐exposed pregnancy (SEP).DesignThis secondary data analysis further investigated the results of a primary study after the original analysis suggested differences in work environments may impact relationship‐building opportunities between nurses and mothers/families. Critical discourse analysis served as both the theoretical lens and analytic technique.MethodNine (9) nurses from the southeast region of the United States (U.S.) were interviewed in 2019. Fifty‐one (51) stories of caregiving experiences were analysed with a focus on narratives related to organizational structure and care delivery.ResultsStudy findings revealed nurses experienced challenges providing high‐quality, family‐centered care for patients in the neonatal intensive care unit (NICU) affected by substances during pregnancy. Nurses described the central challenge of workload, exacerbated by power imbalances and structural constraints within the hospital's organizational structure. Findings suggest workload issues may endorse stigma by inhibiting opportunities to build relationships. Nurses report manageable workloads can support healthcare teams and recipients of care.ConclusionThe study suggests power imbalances between nurses, families and adjacent healthcare professionals can inhibit the delivery of high‐quality care. Supporting healthcare teams and recipients of care while centering the role of organizational structure is critical. Questions emerged about workload demands impacting the potential production of stigma in clinical environments.ImpactThis study examines the intersection of nurses' care experiences and hospital organizational structure. It identifies how the unique needs of caring for infants and families from a SEP increase the complexity of power imbalances and organizational constraints to further increase workload demands. Findings have implications for global healthcare organization leaders who build and maintain the structural integrity of clinical environments and nurse leaders who advocate and guide clinical teams to provide high‐quality care in stressful healthcare environments.Reporting MethodEQUATOR guidelines were followed, using the COREQ checklist.Patient or Public ContributionNICU nurses were interviewed about their care‐provision experiences. Interviews were analysed in the primary study and the current analysis of secondary data.