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

AIMS: To 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). DESIGN: This 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. METHOD: Nine (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. RESULTS: Study 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. CONCLUSION: The 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. IMPACT: This 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 METHOD: EQUATOR guidelines were followed, using the COREQ checklist. PATIENT OR PUBLIC CONTRIBUTION: NICU nurses were interviewed about their care-provision experiences. Interviews were analysed in the primary study and the current analysis of secondary data.

Exploration of the Care Giving Dynamic Between NICU Nurses and Mothers with a Substance-Exposed Pregnancy.

PURPOSE: To explore the caregiving dynamic between NICU nurses and mothers with a substance-exposed pregnancy (SEP) by examining how nurses view these mothers compared to mothers without an SEP. DESIGN: A qualitative design using interviews with NICU nurses who care for infants and families with an SEP. SAMPLE: The sample (n = 9) was all female, with an average of approximately 10 years of nursing experience in the NICU, with two-thirds having achieved a Bachelor of Science in Nursing (BSN) or higher. MAIN OUTCOME VARIABLE: Perceptions of nurses working with families affected by an SEP. RESULTS: Stigmatized views and trust issues shaped nurses' views of mothers with an SEP as different from other mothers. Empathy levels toward mothers differed related to nurses' views of substance use as either a moral decision or chronic disease. These viewpoints shaped the nurse's judgment of the mother's potential to provide a safe environment and independently care for the infant at home. Nurses described personal distress when caring for these families.

Now What? The Lived Experience of Women Forced to Retire and Implications to Health in Later Life.

Women in the United States are retiring at an unprecedented rate, with many retirements driven by recent economic downturns and social expectations, such as caregiving. Successful retirement transition is a key component of happiness during older adulthood, but many factors suggest that forced retirement may have a negative impact on health. The purpose of the current research study was to explore the lived experiences of women who were forced to retire. The current study population comprised 10 women, age ≥55, recruited from community settings to participate in individual semi-structured interviews. Participants shared common experiences, despite having different reasons for retiring. The overarching theme of Now What? Denied the Opportunity to Mentally Prepare was identified. Findings suggest opportunities for nurses to assess women for mental and physical health indicators and assist them as they transition into retirement, particularly if the retirement was unplanned. [Journal of Psychosocial Nursing and Mental Health Services, 57(10), 12-16.].

Online Graduate Student Retention: Integrative Review With a Theoretically Framed Case Exemplar.

BACKGROUND: Retention of online nursing students in graduate education is essential as the need for nurses exceeds the current supply. METHOD: The factors contributing to student attrition are reviewed, and a real-world case exemplar is presented to demonstrate the theoretical design and implementation of an orientation to support retention. RESULTS: Knowles' theory of adult learning and Cooper's PECS (purpose, expectations, connections, and support) model for an evidence-based orientation framework guided the design of the orientation. Knowles' theory was aligned with the PECS model to further describe how student and environmental factors can be addressed in an orientation framework and provide strategies for implementation. Additionally, these PECS definitions were applied to specific activities within a conceptual, theoretical, and empirical framework for development of orientations. CONCLUSION: This case exemplar demonstrated an orientation framework for a feasible application of theory and evidence-based strategies for graduate online nursing programs. [J Nurs Educ. 2022;61(6):314-321.].

Moral distress of nurses surrounding neonatal abstinence syndrome: Application of a theoretical framework.

TOPIC: Neonatal nurses who care for infants with symptoms of neonatal abstinence syndrome (NAS) may experience moral distress through conflicting professional ethics. The nurse may find it difficult to simultaneously exemplify beneficence and nonmaleficence. OBJECTIVE: The purpose of this paper is to explore the moral distress of nurses in the context of infants experiencing symptoms of NAS and apply a new conceptual model to this phenomenon. Understanding how nurses navigate moral dilemmas may provide insight into strategies to better support them to address moral conflict. METHODS: Moral distress was explored in the context of nurses who care for infants with symptoms of NAS. A literature review was completed, followed by the application of the model onto the derived themes. RESULTS: The theoretical application resulted in a framework that exemplifies the experience of caring for infants with symptoms of NAS and their families described by many nurses within the literature. If moral distress is not resolved, negative outcomes may be experienced by the nurse, with additional negative outcomes experienced by the family. CONCLUSION: This theoretical model provided insight into the experience of moral distress surrounding nursing care for infants with symptoms of NAS. Additional research is needed to investigate moral residue and moral resilience in this particular caregiving dynamic.