Rooting for the breast: breastfeeding promotion in the NICU.

PURPOSE

This study explored the structure and process of breastfeeding promotion in the NICU.

METHODS

An ethnographic approach was used with the techniques of participant observation, interviewing, and artifact assessment. This 14-month study took place in a level IV NICU in a Northeastern US children's hospital. General informants consisted of 114 purposively selected NICU nurses. From this group, 18 nurses served as key informants. There was an average of 13 interactions with each key informant and 3.5 for each general informant. Audiotaped interviews, feeding artifacts, and observational notes were gathered for descriptions of breastfeeding promotion. Data were coded and analyzed for recurring patterns. NUD*IST-aided data management and analysis.

FINDINGS

There were three main findings: (1) organizational and human resources were developed to create a web of support to promote breastfeeding in the NICU; (2) variations in breastfeeding knowledge and experience within the nursing staff, marketing practices of formula companies, and insufficient support from other health professionals served as sources of inconsistent breastfeeding messages; and (3) promotion of breastfeeding in this NICU is evolving over time from a current breast milk feeding focus to the goal for a future breastfeeding process orientation.

CLINICAL IMPLICATIONS

NICU nurses should advocate for organizational and human resources to promote breastfeeding in the unit. To decrease inconsistent messages, staff development should be expanded to all professionals, and formula marketing practices should be curtailed.