Healthcare professionals' perceptions of barriers to baby-friendly neonatal care

Neonatal Intensive Care Units

Phenomenon of Interest

The phenomenon of interest involved in the study relates around current and past healthcare environments, specifically within the neonatal care unit. It is a field that is very specific, but also very vulnerable to being negatively affected by any issues or snags within the delivery of neonatal care to infants and new mothers. Given the sensitivity of the field, this particular article aims to help increase the strength of healthcare strategies involved in caring for new babies. Benoit and Semenic (2014) are very clear in identifying their phenomenon of interest. Essentially, they explain that there are certain factors that influence success of neonatal care strategies in both positive and negative ways. Healthcare professionals often spread their biases regarding infants and breast feeding practices, which then influence the breastfeeding behaviors of the mother. This is especially true for cases seen in intensive care. The research focuses on using perceptions of those who work in the field to judge what is considered barriers and facilitators in actual clinical practice. Thus, the main evidence is the recorded perceptions of the study participants involved. Due to the abstract nature of the phenomenon being studied, being that it would be hard to measure quantitatively; a qualitative design is an appropriate measurement. The descriptive nature of the design would not effectively represent the perceptions of healthcare professionals within the actual field, which is why qualitative features fit this research design much better than quantitative ones.

Method

In order to measure the perceptions of those working in the field, Benoit and Semenic (2014) used a qualitative descriptive design to investigate. This design aimed to explore perceptions of those working in the field in regards to the BFHI and how it was being practiced within their respective NICU wards in Canada. The design utilized the PARHIS framework to structure interview questions. First, a semi-structured interview was conducted in person. The participant's demographic information was gathered and then the researcher began a series of structured questions. These interviews were between 45 and 90 minutes and were then transcribed. To ensure the reliability of these transcriptions, interviews were played and read several times in order to get the most accurate representations of the participants' responses.

Sampling

Out of the fifteen participants invited, a total of ten participants were included in the study based on the requirements that they were managers, educators, or clinical leaders in neonatal units and were willing to be recording for an interview. The participants had to speak and understand English fluently and were willing to participate in the study. These individuals were currently working within an NCIU context and had up-to-date credentials that were verifiable. There were two nurse educators, one neonatal nurse practitioner, one medical director, and four nursing managers that ended up participating in the study until its completion.

Data Collection

The method of data collection was through semi-structured interviews. Each participant was recorded during interviews that were previously sketched out in order to probe into the perceptions of the participants' knowledge of breastfeeding in the NCIU. Interview questions were open ended, with additional key phrases and suggestions to probe even further if the researcher felt there was a need to. All interviews were audio recorded and then transcribed, as previously mentions. These transcriptions then served as the primary data for the qualitative analysis in the underlying design of the research model.

Data Analysis

Benoit and Semenic (2014) then used a type of content analysis in order to classify and categorize particular themes that were frequently brought up within the participant interviews. There were three major themes extrapolated: "nature of the evidence, contextual barriers, and facilitation" (Benoit & Semenic, 2014). Interview content was then coded based on its relationship with these three categories. This strategy was appropriate for covering the abstract nature of the interview. However, there was little insurance for reliability, which could have ultimately impacted the study's credibility.

Findings

There were a number of interesting findings. First, in regards to the nature of the evidence, most participants believed that breast milk was the healthiest for infants in NCIU settings. Based on what they had experienced, it was clear that the kangaroo mother care method was the best way to establish neo-BFHI standards within a NCIU setting. A number of barriers were also frequently mentioned. These included infant health stability, the separation between infant and parent, involvement of parents in the care of the infants, and staff knowledge and workloads. These factors were the most notable in regards to what barriers were hindering the implementation of baby-friendly practices. Yet, it was clear that increased breastfeeding education, strong influence from breastfeeding champions, and interprofessional collaboration were major facilitators of baby friendly practices that got mothers to participate more in breast feeding within a NCIU setting.

Conclusions and Recommendations

Overall, the study was successful in modeling clear factors that were seen to both hinder and facilitate baby-friendly breastfeeding practices in NICU. However, the study design was small, too small to appropriately represent a larger sample population. Thus, a recommendation would be to increase the size of the study and to include a number of different healthcare facilities to represent a greater percent of the population.