Lisa M. Cleveland

Symbolic Interactionism and Nurse-Mother Communication in the Neonatal Intensive Care Unit

The admission of an infant to the neonatal intensive care unit (NICU) has the potential to cause significant stress for the mothers of these infants. Researchers have found that nurse–mother communication has the potential to either aid or hinder the mother’s adaptation to the NICU environment. These communication patterns are relatively complex in nature and therefore warrant further investigation. Symbolic interactionism (SI) is a theoretical framework that offers the potential to direct such an investigation. The purpose of this article is to examine nurse–mother communication patterns in the NICU through the theoretical lens of SI.

Normative cultural values and the experiences of Mexican-American mothers in the neonatal intensive care unit.

PURPOSE:To explore the experiences of Mexican-American mothers who have had infants in the neonatal intensive care unit (NICU). PARTICIPANTS:A convenience sample of 15 English-speaking, Mexican-American women was interviewed. DESIGN:The study used an exploratory qualitative approach. METHODS:Data collection was conducted through audiotaped, transcribed, semistructured, individual interviews and field notes. The 5 normative cultural values for Latino families—(1) simpatia, (2) personalismo, (3) respeto, (4) familismo, and (5) fatalismo—were used as a sensitizing framework to guide data interpretation. RESULTS:The womens discussions of their NICU experiences clearly reflect the 5 normative Latino cultural values. Positive and negative exemplars of these values are provided as evidence. CONCLUSIONS:These findings can be used to inform nursing care provided for Mexican-American mothers and their infants by assisting nurses to customize care to meet the cultural needs of this population.

A Mexican American mother's experience in the neonatal intensive care unit.

BackgroundMost parents would agree that the admission of an infant to the neonatal intensive care unit (NICU) is stressful. Existing research is focused on white mothers, with little known about the experiences of Spanish-speaking, Mexican American mothers who have an infant in the NICU. PurposeThe purpose of this qualitative case study was to describe the experiences of a Spanish-speaking, Mexican American mother whose infant had been in the NICU. MethodsQualitative description was used to conduct this study. One Spanish-speaking, Mexican American mother who had an infant in the NICU was recruited through purposive sampling. An in-depth interview was conducted, audio-recorded, and transcribed verbatim. Conventional content analysis was used to analyze the data. FindingsAnalysis of the data revealed that the experience of a Spanish-speaking, Mexican American mother who had an infant in the NICU was one of uncertainty, involvement, trust, and anticipating discrimination.

Systematic Review of Skin-to-Skin Care for Full-Term, Healthy Newborns

Objective: To determine the effect of skin‐to‐skin mother–infant holding, touch, and/or massage on full‐term, healthy newborns and their primary caregivers. Data Sources: A seven‐member scientific advisory panel searched the databases PubMed, CINAHL, and Scopus using the search terms massage, skin‐to‐skin contact, kangaroo care, touch, therapeutic touch, and full‐term newborns for research with human participants published in English with no date parameters. Study Selection: The initial search yielded 416 articles. After reviewing titles and retaining only articles that met the review criteria, 280 articles remained. The panel co‐chairs reviewed and discussed the abstracts of these articles and retained 90 for review. Data Extraction: Each article was assigned to one panel member and one co‐chair for review. Members of the panel met via teleconference to present articles and to determine whether they had scientific merit and addressed the research question. Articles that did not meet these standards were eliminated. Forty articles included relevant evidence: 33 articles on skin‐to‐skin holding and 7 on infant massage. Data Synthesis: We created a table that included the purpose, design, and findings of each study. This information was synthesized into a feasibility report by the co‐chairs. Conclusion: Evidence supports recommendations for skin‐to‐skin care for all full‐term, healthy newborns. Although there is inadequate evidence to recommend massage as standard care for all newborns, massage has been shown to help consolidate sleep patterns and reduce jaundice.

The Mothering Experiences of Women With Substance Use Disorders

The aim of this qualitative study was to describe the mothering experiences of women with substance use disorders. We conducted semistructured, individual interviews with 15 mothers. Using thematic analysis, 5 themes were identified: (1) facing the reality of a pregnancy complicated by substance use, trauma, and loss, (2) finding a higher meaning, (3) dealing with the consequences, (4) managing the details of daily life, and (5) looking toward a future with my children. Moreover, the women described entering motherhood with uncertainty, fear, shame, and stress. We hope that these findings will lead to more compassionate nursing care for this population.

Taking care of my baby: mexican-american mothers in the neonatal intensive care unit.

Objectives: The admission of an infant to the neonatal intensive care unit (NICU) can produce significant stress for mothers and may contribute to a difficult transition following discharge. Past research has primarily focused on Caucasian women. Mexican-Americans are the fastest growing ethnic population in the U.S. with the highest fertility rate; therefore, the purpose of this grounded theory study was to gain a better understanding of the NICU experience for Mexican-American mothers. Methods: Fifteen women were recruited and data were collected through semi-structured interviews. Results: A theoretical model, taking care of my baby, was developed. The mothers’ experiences began with the unexpected event of having an infant admitted to the NICU and played out in a context that fluctuated between being supportive (making meaningful connections) or inhibitive (struggling to mother). The women developed strategies to help them take care of their babies during the NICU stay: balancing responsibilities, leaving part of me with my baby, and watching over. The process concluded in one of two ways: bringing my baby home or losing my baby. Conclusion: These findings offer insight for neonatal nurses who provide care for Mexican-American NICU mothers and may help inform their practice. Further research is needed with this growing population to ensure supportive nursing care and influence positive outcomes.

Breastfeeding Recommendations for Women Who Receive Medication-Assisted Treatment for Opioid Use Disorders: AWHONN Practice Brief Number 4

An official practice brief from the Association of Women’s Health, Obstetric and Neonatal Nurses AWHONN 1800 M Street, NW, Suite 740 South, Washington, DC 20036, (800) 673-8499 AWHONN periodically updates practice briefs. For the latest version go to http://www.awhonn. org. The information herein is designed to aid nurses in providing evidence-based care to women and newborns. These recommendations should not be construed as dictating an exclusive course of treatment or procedure. Variations in practice may be warranted based on the needs of the individual patient, resources, and limitations unique to the institution or type of practice.

Baby Boy Jones Interactive Case-Based Learning Activity: A Web-Delivered Teaching Strategy.

Faced with limited resources, nurse educators are challenged with transforming nursing education while preparing enough qualified nurses to meet future demand; therefore, innovative approaches to teaching are needed. In this article, we describe the development of an innovative teaching activity. Baby Boy Jones is a Web-delivered, case-based learning activity focused on neonatal infection. It was created using e-learning authoring software and delivered through a learning management system.

The Right to Mother’s Milk: A Call for Social Justice That Encourages Breastfeeding for Women Receiving Medication-Assisted Treatment for Opioid Use Disorder:

Inequitable access to mother’s milk represents a social injustice with the potential to negatively impact the health and well-being of future generations (Jones, Power, Queenan, & Schulkin, 2015). Mother’s milk is globally accepted as the optimal source of infant nutrition, yet breastfeeding initiation and duration rates among minority populations (e.g., women with opioid use disorders [OUDs]) continue to lag those of the general population (Demirci, Bogen, & Klionsky, 2015). For example, 56% of women receiving medication-assisted treatment (MAT) for an OUD initiate breastfeeding (Schiff et al., 2018) compared to the national initiation rate of 82% (Centers for Disease Control and Prevention [CDC], 2017). Further, only 50% of mothers receiving MAT for an OUD who initiate breastfeeding continue beyond the first week of life (Demirci et al., 2015; Wachman, Byun, & Phillip, 2010). These numbers reflect some of the lowest breastfeeding rates in the United States (Demirci et al., 2015). Considering the current U.S. opioid crisis and its increasing influence on women of reproductive age (CDC, 2015), women with an OUD and their infants represent an emerging disparate population that may have inequitable access to breastfeeding and the benefits of mother’s milk. More than 50 years of evidence now exists to support the safety and benefits of MAT, particularly the use of methadone, during pregnancy and lactation (Sachs, 2013); however, a delay in the implementation of this evidence into clinical practice continues (McGlothen, Cleveland, & Gill, 2017). Therefore, this policy paper serves as a call for social justice with the intent of empowering lactation support providers to advocate for the use of scientific evidence that informs breastfeeding practices for women receiving MAT for an OUD. OUD is a serious global health concern (National Institute on Drug Abuse [NIDA], 2014) with an estimated 15 million people experiencing opioid dependence worldwide (Information Sheet on Opioid Overdose, 2014). As a result of the current U.S. opioid crisis, the rate of opioid use among American women has doubled since 2004 (NIDA, 2014) and has also had an influence on pregnant women and their infants. It is estimated that 21,000 pregnant, American women misuse opioids annually (Smith & Lipari, 2017). Prenatal opioid use can contribute to numerous pregnancy complications (e.g., placental abruption, preterm birth, and low birth weight) (Minozzi, Amato, Bellisario, Ferri, & Davoli, 2013). Medically supervised opioid detoxification during pregnancy is not recommended since it can contribute to high rates of maternal relapse into opioid use and risk for overdose due to the reduction in opioid tolerance that results from detoxification (American College of Obstetricians & Gynecologists [ACOG], 2017). Thus, stabilization of pregnant, opioid-dependent women, with the long-acting opioids methadone or buprenorphine, is considered the standard of care (ACOG, 2017). Further, pregnant opioid-dependent women who are stabilized on MAT tend to receive more consistent prenatal care, have better nutrition, and experience more positive pregnancy outcomes (Cleveland, Paradise, Borsuk, Courtois, & Ramirez, 2015; Jones et al., 2013). Although MAT during pregnancy is considered the standard of care for this population of women, neonatal abstinence syndrome (NAS) may still result from in utero exposure to medications used for MAT. NAS is a predictable 789401 JHLXXX10.1177/0890334418789401Journal of Human LactationMcGlothen and Cleveland research-article2018

“I’m Doing the Best That I Can for Her”: Infant-Feeding Decisions of Mothers Receiving Medication-Assisted Treatment for an Opioid Use Disorder:

Background: Several professional health organizations have made statements endorsing the safety of breastfeeding for women taking medication-assisted treatment for an opioid use disorder. Yet, breastfeeding initiation rates for this population are approximately 50% lower than the general United States’ population. Furthermore, little is known about what influences the infant-feeding decisions of these women. Research aim: This study aimed to describe what influences the infant-feeding decisions of women taking medication-assisted treatment for an opioid use disorder. Methods: Qualitative description was used. We conducted semistructured, individual interviews with mothers (N = 8) who were receiving medication-assisted treatment during the postpartum period. We analyzed our data using thematic analysis. Results: We identified two themes: (a) what I heard about breastfeeding, and (b) doing what I feel is best for my baby. What I heard about breastfeeding reflects the information and misinformation that women received about breastfeeding. Doing what I feel is best for my baby describes the inner conflict that the women experienced. Most of the women in this study desired to breastfeed; however, all women reported that the social stigma surrounding methadone use strongly influenced their infant-feeding decision. Conclusion: This study sheds new light on what influences the infant-feeding decisions of women taking medication-assisted treatment and represents an initial step toward the development of targeted interventions to improve breastfeeding rates for this unique population.