The Social Organization of Neonatal Nurses' Feeding Work

Area of Science:

• Neonatal care
• Nursing studies
• Health systems research

Background:

• Neonatal intensive care units (NICUs) are increasingly complex, technologically driven environments.
• Nurses' work in NICUs involves intricate feeding practices crucial for infant development.
• The integration of technology and protocols shapes the delivery of neonatal care.

Purpose of the Study:

• To conduct an institutional ethnography (IE) examining nurses' infant feeding practices in NICUs.
• To understand how the technical organization of NICUs impacts nurses' feeding work.
• To identify barriers and facilitators in neonatal nurses' feeding practices.

Main Methods:

• Institutional ethnography (IE) approach.
• Data collection through field observations, interviews, and communication (phone, email).
• Analysis of nurses' work within the textual organization of NICU practices.

Main Results:

• Nurses' feeding practices are governed by protocols from documentation systems and clinical technologies.
• These systems create barriers to nurses' skilled infant feeding efforts.
• Safety-focused protocols and technologies can paradoxically impede nurses' real-time clinical reasoning and responsiveness to infant cues.

Conclusions:

• Quality and safety priorities can overshadow essential clinical reasoning in neonatal feeding.
• Clinical technologies, intended for safety, may disrupt nurses' ability to respond to infant needs.
• Findings offer insights for nurses, leaders, and policymakers on adherence to policies and procedures.