Symbolic interactionism and nurse-mother communication in the neonatal intensive care unit.

The admission of an infant to the neonatal intensive care unit (NICU) has the potential to cause significant stress for the mothers of these infants. Researchers have found that nurse-mother communication has the potential to either aid or hinder the mother's adaptation to the NICU environment. These communication patterns are relatively complex in nature and therefore warrant further investigation. Symbolic interactionism (SI) is a theoretical framework that offers the potential to direct such an investigation. The purpose of this article is to examine nurse-mother communication patterns in the NICU through the theoretical lens of SI. Keywords: symbolic interactionism; nurse-patient communication; neonatal intensive care unit ; neonate; nurse-mother relationship; mothering Approximately 10%-15% of American infants are admitted to a neonatal intensive care unit each year (March of Dimes, 2008). Typically admissions are unexpected (Evans & Madsen, 2005) and include reasons such as prematurity, sepsis, and congenital anomalies (March of Dimes, 2008). Infants are usually admitted directly to the NICU resulting in separation and limited opportunities for the infant and mother to bond (Evans & Madsen, 2005). Such an interruption in the mother-infant relationship in combination with the intimidating nature of the NICU environment, may interfere with maternal role development ( Fenwick, Barclay, & Schmied, 2001a, 200b; Heerman, Wilson, & Wilhelm, 2005; Hurst, 2001a, 2001b; Lupton & Fenwick, 2001). Unfortunately, this may result in long-lasting consequences for the infant- mother relationship (Rautava, Lehtonen, Helenius, & Sillanpaa, 2003). Effective nurse-mother communication is critical in supporting the development of the maternal role and more positive outcomes for families (Fenwick et al., 2001a, 2001b; Heerman et al., 2005; Lupton & Fenwick, 2001). In instances where this supportive relationship is absent, some mothers report feelings of alienation and exclusion from the infant's care. Therefore, a closer investigation into the communication patterns of nurses and mothers is needed. Thoughtful consideration must be given to truly capture the nuances and dynamics of this complex relationship. Some scholars believe that the study of communication is central to interactionist theory and research ( Denzin, 1992). One such scholar, Duncan, went as far as to state "We must return the study of man in society to a study of communication, for how we communicate determines how we relate as human beings" (1962, p. 438).With this in mind, symbolic interactionism is a theoretical perspective of value for directing research that explores nurse-mother communication patterns in the NICU. In this article, I will explore the use of SI with a qualitative methodology for the study of this vulnerable population. VULNERABLE POPULATIONS AND SYMBOLIC INTERACTIONISM VULNERABLE POPULATIONS A vulnerable population can be described as a group of individuals at risk for poor "physical, psychological, or social health, such as high risk mothers, high-risk infants, chronically ill people, and disabled persons" (Aday, 1994, p. 490). The NICU mother-infant dyad meets this description. Mothers of NICU infants are at increased risk for developing symptoms of acute stress disorder (ASD), a precursor to posttraumatic stress disorder (PTSD; Holditch-Davis, Bartlett, Blickman, & Miles, 2003; Shaw et al., 2006). Unfortunately, following a NICU admission, adjustment of the mother and infant may continue to be negatively affected (Browne & Talmi, 2005; Rautava et al., 2003). In this article, mothers are the specific focus because researchers have found that mothers are less assertive than fathers in verbalizing their needs and concerns in the NICU environment (Fenwick et al., 2001a). In these studies, mothers seemed to rely on the infant's father to verbalize any concerns about the infant's care because the father was more likely to do so. …