School of Nursing, University of Minnesota, Minneapolis, MN, USA.
Children's Minnesota, Minneapolis, MN, USA.
Cardiol Young. 2023 Oct;33(10):2000-2011. doi: 10.1017/S1047951122003808. Epub 2022 Dec 9.
Lactating parents of infants hospitalised for critical congenital heart disease (CHD) face significant barriers to direct breastfeeding. While experiences of directly breastfeeding other hospitalised neonates have been described, studies including infants with critical CHD are scarce. There is no evidence-based standard of direct breastfeeding care for these infants, and substantial practice variation exists.
To explain how direct breastfeeding is established with an infant hospitalised for critical CHD, from lactating parents' perspectives.
MATERIALS & METHODS: This study is a qualitative grounded dimensional analysis of interviews with 30 lactating parents of infants with critical CHD who directly breastfed within 3 years. Infants received care from 26 United States cardiac centres; 57% had single ventricle physiology. Analysis included open, axial, and selective coding; memoing; member checking; and explanatory matrices.
Findings were represented by a conceptual model, "Wayfinding through the 'ocean of the great unknown'." The core process of Wayfinding involved a nonlinear trajectory requiring immense persistence in navigating obstacles, occurring in a context of life-and-death consequences for the infant. Wayfinding was characterised by three subprocesses: navigating the relationship with the healthcare team; protecting the direct breastfeeding relationship; and doing the long, hard work. Primary influencing conditions included relentless concern about weight gain, the infant's clinical course, and the parent's previous direct breastfeeding experience.
For parents, engaging in the Wayfinding process to establish direct breastfeeding was feasible and meaningful - though challenging. The conceptual model of Wayfinding explains how direct breastfeeding can be established and provides a framework for research and practice.
患有危重心血管疾病（CHD）的住院婴儿的哺乳父母面临着直接母乳喂养的重大障碍。虽然已经描述了直接母乳喂养其他住院新生儿的经验，但包括患有危重心血管疾病的婴儿在内的研究却很少。目前尚无针对这些婴儿的直接母乳喂养护理的循证标准，而且实践存在很大差异。
从哺乳父母的角度解释如何为患有危重心血管疾病的住院婴儿建立直接母乳喂养。
这是一项对 30 名直接母乳喂养患有危重心血管疾病婴儿的哺乳父母的访谈进行的定性扎根维度分析，这些婴儿在 3 年内接受了治疗。婴儿接受了来自 26 个美国心脏中心的护理；57%的婴儿有单心室生理结构。分析包括开放、轴向和选择性编码；备忘录；成员检查；和解释矩阵。
研究结果以“在‘茫茫未知之海’中寻找方向”的概念模型呈现。“Wayfinding”的核心过程涉及到一条非线性轨迹，需要在为婴儿的生命和死亡后果导航时具有巨大的毅力，这一过程发生在一个生死攸关的环境中。“Wayfinding”的特点是三个子过程：与医疗团队建立关系；保护直接母乳喂养关系；以及完成长期而艰难的工作。主要影响条件包括对体重增加、婴儿的临床过程和父母以前的直接母乳喂养经验的持续关注。
对于父母来说，参与“Wayfinding”过程以建立直接母乳喂养是可行的，也是有意义的——尽管具有挑战性。“Wayfinding”的概念模型解释了如何建立直接母乳喂养，并为研究和实践提供了框架。
