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Healthcare Professionals' Attitudes and Practices in Supporting and Promoting the Breastfeeding of Preterm Infants in NICUs

Shattnawi, Khulood Kayed PhD, RN

Section Editor(s): Dowling, Donna PhD, RN; ; Thibeau, Shelley PhD, RNC-NIC;

doi: 10.1097/ANC.0000000000000421
Original Research

Background: Breastfeeding preterm infants is shown to have important health benefits for both infants and mothers. A positive relationship between mothers and healthcare teams and supportive practices tend to facilitate maternal competence and promote early initiation of breastfeeding within neonatal intensive care units (NICUs).

Purpose: The aim of this study was to understand attitudes and behaviors of healthcare professionals toward breastfeeding practices and supporting mothers of preterm infants.

Methods: This study adopted an ethnographic research design that involved 135 hours of participant observation over a 6-month period and semistructured interviews of 10 nurses and 5 physicians.

Results: Data analysis suggests that while staff members agree with the benefits of breastfeeding for preterm infants, the actual implementation of a breastfeeding policy within NICUs is problematic. Three key themes emerged. The first described the contradiction that exists between the staff beliefs and behaviors in relation to breastfeeding and supporting mothers. The second theme was related to staff working conditions, which described the lack of institutional support and barriers to supporting breastfeeding. The final theme of controlling relationships captured the essence of the practitioner to mother association. Together, these elements revealed a situation whereby the staff appeared more preoccupied with addressing the task of caring for the babies than with supporting mothers in feeding and subsequently caring for their preterm children.

Implications for Practice: The institutional barriers to breastfeeding promotion within NICUs should be addressed by healthcare providers. Actions that provide a supportive environment within NICUs for both mothers and nurses are essential to improve the overall quality of care.

Implications for Research: Future research may include an examination of hospital policies and practices of promoting breastfeeding for preterm infants.

Maternal & Child Health Department, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan.

Correspondence: Khulood Kayed Shattnawi, PhD, RN, Maternal & Child Health Department, Faculty of Nursing, Jordan University of Science and Technology, PO Box 3030, Irbid 22110, Jordan (

The name of the institution where the work occurred: Anglia Ruskin University, United Kingdom.

This is part of a PhD study that was supported by a scholarship from Jordan University of Science and Technology. The author is grateful to her PhD supervisor, Dr Trudy Stevens, for her constructive discussions and guidance, which helped the author and informed her thinking all the way.

The author declares no conflicts of interest.

© 2017 by The National Association of Neonatal Nurses