When a common language is missing: Nurse-mother communication in the NICU. A qualitative study.

Nina Margrethe Kynoe,Ingrid Hanssen,Drude Fugelseth

doi:10.1111/jocn.15212

Abstract

To explore how communication in neonatal intensive care units (NICUs) between immigrant mothers and nurses take place without having a common language, and how these mothers experience their NICU stay. Admission of infants to NICU affects both parents and infants. Immigrant mothers constitute a vulnerable hospital population in need of culturally, linguistically and individually tailored information. The study had a qualitative design reported according to the COREQ criteria. Eight mothers who spoke neither Scandinavian nor English went through individual semi-structured interviews. Six mother-nurse interactions were observed, and eight nurses' experiences were explored through focus-group interviews. All interviews were audio recorded and transcribed verbatim. The analysis was thematic and hermeneutic in character. Interpreters were present during the consultations with the physicians, but rarely during the daily nurse-mother interactions. Nurses focused on daily routines, infant care guidance and mother-infant attachment. The mothers learned through demonstrations and hands-on guidance. Language barriers made it difficult to assess the mothers' understanding, but the mothers expressed that they felt adequately included in the care of their infant and well informed and guided. Even so, both mothers and nurses expressed desire to use interpreters more regularly. The pictorial communication boards available lacked important vocabulary needed in neonatal nursing contexts and their use furthermore interrupted the mother-nurse conversation. Body language, simple words, guesswork, trial and error characterised the nurse-mother interaction. The nurses adopted various communication strategies to help the mothers understand and give them a voice. Competent interpreters were used duringmeetings with physicians, but not during daily bedside guidance and information giving by nurses. Knowledge of immigrant mothers' and nurses' communication strategies and how both parties think, feel and act to overcome communication problem is necessary to improve clinical practice and reduce communication barriers.

Highlights

Focus on the parents as well as the infants is of central importance for the healthcare providers in the neonatal intensive care units (NICUs)
Compared with majority ethnic mothers, immigrant mothers have shown a higher incidence of depressive symptoms when their infants are admitted to the NICU (Ballantyne, Benzies, & Trute, 2013) and increased psychological distress compared with parents of healthy infants (Grunberg, Geller, Bonacquisti, & Patterson, 2019; Woodward et al, 2014)
Much of the mother–nurse communication seemed to rely on both parties' best guess even though our observations indicated that the nurses more or less consciously used the communication strategy best suited in a given situation

Summary

Introduction

Focus on the parents as well as the infants is of central importance for the healthcare providers in the neonatal intensive care units (NICUs). Prematurity, sickness and admission to the NICU create serious stress on the parenting role and the family system as a whole. It may affect parental behaviours, responsibilities, everyday routines and cognition. Compared with majority ethnic mothers, immigrant mothers have shown a higher incidence of depressive symptoms when their infants are admitted to the NICU (Ballantyne, Benzies, & Trute, 2013) and increased psychological distress compared with parents of healthy infants (Grunberg, Geller, Bonacquisti, & Patterson, 2019; Woodward et al, 2014). If parents are anxious, depressed, grieving, isolated, suffer from sleep deprivation and/or feelings of inadequacy, this may affect the bonding process and the parent–infant attachment (Al Maghaireh, Abdullah, Chan, Piaw, & Al Kawafha, 2016; Grunberg et al, 2019)

Methods

Discussion

Conclusion