"We Were Just so Sad and Devastated": NICU Nurses' Stories of Caring for Families With Substance-Exposed Pregnancies.

This secondary analysis re-examined stories of caregiving told by NICU nurses in the southeast US through a trauma theory lens expanding on research surrounding substance-exposed pregnancies. Narrative analysis identified distress-related experiences of nurses related to child custody decisions and outcomes, suggesting traumatic stress within this caregiving dynamic. Four distinct story types and three themes were identified across 23 stories, highlighting similarities and differences and illustrating how distress and trauma were experienced and may be manifested in care practices. Study findings suggest cumulative and residual effects from traumatic experiences can impact NICU nurses' well-being and care provision, in part by promoting anticipatory trauma. The role of relationship-building with families, as part of family-centered care, was also implicated in the intensity of distressful experiences and may increase nurses' vulnerability to trauma as well as create pathways to stigmatizing interactions. Incorporating principles of relational ethics into nurse practice guidelines, while recognizing how care work can influence and be influenced by the potential pathways from trauma to stigma, may provide valuable support for nurses. The application of such a framework could potentially reduce distressing and/or traumatic experiences for nurses caring for families with a substance-exposed pregnancy.