Objectives: To explore why so few mothers breastfeed when their babies are admitted to neonatal intensive care unit (NICU), and to gain an understanding of the impact of this for the mothers and staff involved. DESIGN: This study adopted an ethnographic approach. The data collection involved 135 hours of participant observation over a 6-month period and 32 semi-structured interviews of 17 mothers, 10 nurses, and 5 physicians. Findings: Data from the participants’ interviews and the participant observation were analysed focusing on the two different perspectives; one relating to the mothers and the other to the staff members and their working conditions. The mothers’ experiences were revealed as a developing process as their feeling changed from fearful and terrifying toward becoming and feeling like a ‘real’ mother. Their experience of mothering and breastfeeding differed from their expectations in that breastfeeding became a complex process for some and impossible for others. Five distinct themes emerged; the first highlighted the crisis, which involved the mother's feelings of emotional instability, their strategies for coping such as not visiting the baby, and recognition of the NICU as a stressful environment. The second theme described issues relating to control and power. This involved the perception of having a lack of control and needing to seek permission, the use of language as a mechanism for control, and mothers being placed in a subordinate role. The third theme related to the separation, which included difficulties of acceptance, feeling like stranger and not being important, and the need for physical closeness. Acceptance and adaptation comprised the fourth theme in which gradual acceptance occurred and a spiritual aspect emerged. The final theme, becoming a mother, included issues such as the special moments, breastfeeding as a turning point, and practical and informational needs. Almost all the mothers in this study spoke about going through all these stages during their infants’ stay in the NICU. Analysis of these findings suggests that mothers who deliver prematurely, may have their rite of passage into motherhood interrupted, resulting in them being placed in a position of suspended liminality. v The data also suggest that while staff members agree with the benefits of breastfeeding for preterm infants, the actual implementation of a breastfeeding policy within the neonatal units is more problematic. Three key themes emerged from the analysis relating to the staff perspectives. The first described the contradiction that exists between the staff beliefs and behaviours in relation to breastfeeding and supporting mothers. Elements that comprised this theme were “breast milk is best”, perceiving breastfeeding promotion as a nicety not a necessity; lacking support for mothers, and abdication of responsibility. The second theme related to their working conditions: this included a lack of institutional support for the health care team, and barriers to support breastfeeding. The final theme of controlling relationships captured the essence of the practitioner: mother association. Together, these elements revealed a situation whereby staff appeared more preoccupied in addressing the task aspect of care for the babies than supporting mothers in feeding and subsequently mothering their preterm child. Conclusions: An understanding of the experiences of mothers of preterm infants who wish to breastfeed, and the connection that breastfeeding has to the process of becoming a mother, allows for the finding of more positive strategies to support mothers and breastfeeding within the NICU. This study reveals a new understanding of how breastfeeding is connected to the process of becoming a mother, within the context of two Jordanian NICUs. It also highlights the difficult working conditions for nurses within these units. It is anticipated that recognition of these findings may assist with service developments and lead to improvements in the NICU environment in Jordan, thus enhancing health care delivery in accordance with the individual needs of infants and their mothers.

Project (D. Min.)--Trinity Evangelical Divinity School, 1990. / Includes bibliographical references (leaves 136-139).

Thesis. / Typescript (photocopy). Bibliography: p. 290-333.

Thesis (M.A.)--Trinity International University, 2000. / Abstract. Includes bibliographical references (leaves 123-128).

Thesis (M.T.S.)--Catholic Theological Union at Chicago, 1993. / Vita. Includes bibliographical references.

Thesis (D. Min.)--Concordia Seminary, St. Louis, MO, 2006. / Abstract. Includes text of five sermons plus "Case study interview transcripts" with 9 nursing home residents. Includes bibliographical references (leaves 146-151).

Thesis (D. Min.)--Concordia Seminary, St. Louis, MO, 2006. / Abstract. Includes text of five sermons plus "Case study interview transcripts" with 9 nursing home residents. Includes bibliographical references (leaves 146-151).

Thesis (M.A.)--Trinity International University, 2000. / Abstract. Includes bibliographical references (leaves 123-128).

Thesis (M.A.)--Trinity International University, 2000. / Abstract. Includes bibliographical references (leaves 123-128).

Este estudo de caráter qualitativo e quantitativo, tipo exploratório-descritivo, trata da caracterização do trabalho de enfermagem em laboratórios de análises clínicas. O objetivo geral visa identificar os aspectos da atuação da enfermagem nos laboratórios de análises clínicas, que permitam caracterizar o processo de trabalho da enfermagem. Os objetivos específicos buscaram identificar os trabalhadores da saúde que atuam na coleta de exames; reconhecer as atividades desempenhadas pelos diferentes agentes da enfermagem e conhecer sua inserção na estrutura organizacional. O referencial teórico adotado pautou-se nos estudos do processo de trabalho e de recursos humanos em saúde e em enfermagem. Para a coleta de dados utilizou-se um questionário e a amostra foi composta por 45 instituições. A análise dos resultados revelou que, quanto à caracterização dos laboratórios, 15,6% não realizam treinamento em serviço e 60% fazem-no de modo isolado, não continuado; o enfermeiro é o profissional que assume majoritariamente a responsabilidade por essa ação. Quanto aos recursos humanos, 77,8% são auxiliares de enfermagem, 13% enfermeiros e 9,1% técnicos de enfermagem. Evidencia-se a divisão social e técnica do trabalho, no qual os auxiliares executam o cuidado direto, o enfermeiro gerencia o processo e os técnicos desempenham ambas ações, sem diferenças relevantes entre as atividades dos auxiliares e técnicos de enfermagem. Além disso, há outros profissionais que compartilham das mesmas atividades realizadas pela enfermagem e esta se encontra, em grande parte, subordinada a outras áreas de atuação, com escassa autonomia na estrutura organizacional. / This qualitative and quantitative study, an exploratory-descriptive study, examines the characteristics regarding the work performed by nursing professionals in clinical laboratories. The general goal aims to identify roles played by nursing professionals in clinical laboratories that allow us to characterize the nursing work process. The specific goals seek to identify health workers that are responsible for collecting samples, to distinguish the activities played by different nursing professionals and to learn how they are inserted in the organizational structure. The theoretical reference adopted is based on studies regarding work procedures and human resources in health and nursing. A questionnaire was used to collect data and the sample comprised 45 institutions. Regarding the clinical laboratories, result analysis revealed that 15.6% of them do not offer in-service training and 60% do not do it on a continuous manner; nurses basically take on the responsibility for training other nursing professionals. Regarding human resources, 77.8% are nursing assistants, 13% are nurses, and 9.1% are practical nurses. There is evidence of a social and technical division of the workload: nursing assistants provide direct care, nurses manage the processes, and practical nurses perform both activities. No relevant differences were observed between the activities played by nursing assistants from those played by practical nurses. Furthermore, there are other professionals that share the same activities played by those nursing professionals. In most cases, nursing professionals are subordinated to other areas and have little autonomy in the organizational structure.