Neonatal intensive care nurses' accounts of care for mothers/families with substance-exposed pregnancies: A critical discourse analysis.

AIMS: To explore the effects of power dynamics and hospital organizational structure upon neonatal intensive care nurses' experiences caring for infants and families from a substance-exposed pregnancy (SEP). DESIGN: This secondary data analysis further investigated the results of a primary study after the original analysis suggested differences in work environments may impact relationship-building opportunities between nurses and mothers/families. Critical discourse analysis served as both the theoretical lens and analytic technique. METHOD: Nine (9) nurses from the southeast region of the United States (U.S.) were interviewed in 2019. Fifty-one (51) stories of caregiving experiences were analysed with a focus on narratives related to organizational structure and care delivery. RESULTS: Study findings revealed nurses experienced challenges providing high-quality, family-centered care for patients in the neonatal intensive care unit (NICU) affected by substances during pregnancy. Nurses described the central challenge of workload, exacerbated by power imbalances and structural constraints within the hospital's organizational structure. Findings suggest workload issues may endorse stigma by inhibiting opportunities to build relationships. Nurses report manageable workloads can support healthcare teams and recipients of care. CONCLUSION: The study suggests power imbalances between nurses, families and adjacent healthcare professionals can inhibit the delivery of high-quality care. Supporting healthcare teams and recipients of care while centering the role of organizational structure is critical. Questions emerged about workload demands impacting the potential production of stigma in clinical environments. IMPACT: This study examines the intersection of nurses' care experiences and hospital organizational structure. It identifies how the unique needs of caring for infants and families from a SEP increase the complexity of power imbalances and organizational constraints to further increase workload demands. Findings have implications for global healthcare organization leaders who build and maintain the structural integrity of clinical environments and nurse leaders who advocate and guide clinical teams to provide high-quality care in stressful healthcare environments. REPORTING METHOD: EQUATOR guidelines were followed, using the COREQ checklist. PATIENT OR PUBLIC CONTRIBUTION: NICU nurses were interviewed about their care-provision experiences. Interviews were analysed in the primary study and the current analysis of secondary data.

Poems Upon Reading "Say Goodbye to the Toddler Stars of the Pandemic Office Zoom" in Bloomberg Law.

I wrote the poems that comprise this work after reading a news article about the changing expectations of remote work and childcare. The article is ostensibly about negotiating the terms and expectations of remote work, yet it also read to me like a manual of maternal erasure. The message quickly evolves into making first care-work and then mothers disappear. The poems span from free verse, to limerick, to villanelle, concluding with a poem that, as its title announces, is not a poem at all. All are meant to speak(back) to discourses around mothering, care, and labor in the United States.

The Role of Bias in Knowledge Translation: Lessons Learned from a Dissemination of Best Practices in Maternal Opioid Use.

INTRODUCTION: Increases in opioid use during pregnancy fueled concerns among reproductive health advocates, policy makers, and providers in North Carolina, United States. A stakeholder group designed a set of knowledge translation (KT) interventions to increase the use of evidence-based practices across relevant health care and social service arenas. Efforts to decrease stigma was included as a best practice. Understanding the process and the contexts in which KT intervention activities occur can help increase their effectiveness. Toward that end, this study examined how stigma was addressed and how audiences responded to evidence-based messages. METHODS: Data were collected over a seven-year period and included observations of KT activities (conferences, workshops, and community meetings), focus groups and interviews conducted with providers, and a review of publicly available documents, including KT intervention materials. Clarke's situational mapping was initially applied, and stigma emerged as a critical contextual element. Data were then analyzed to identify how stigma was addressed and how evidence-based messages were received. RESULTS: Despite direct stigma-reduction messages, biases against maternal drug use and ambivalence toward evidence-based recommendations of harm reduction principles were found in audience responses. Findings also revealed tensions around the interpretation of knowledge and the appropriate implementation of best practices between "experts" and among practitioners. DISCUSSION: Stigma and professional biases may serve as significant barriers to KT activities. Results suggest that even under the best of circumstances, evidence-based practices for highly stigmatized and controversial issues are difficult to disseminate and may require unique approaches.

Using research poetics "responsibly": applications for health promotion research.

Research poetics, a form of arts-based research methods, has been under-utilized in the field of health promotion. Poetic methods have most commonly been used as a form of re/presentation of the lived experience in qualitative research. For the community-engaged researcher, re/presenting findings through poetry offers unique opportunities for engaging the reader and reaching diverse communities. However, this approach also has implications as an analytic method and allows the analyst to have a more meaningful and personal engagement with participants' stories. Perhaps most importantly, this approach acknowledges and brings to the forefront the co-construction of qualitative findings and de-centers the authority of the researcher by preserving and promoting the participant's voice. Using examples from the authors' own research, this article describes opportunities for incorporating research poetics into health promotion research and argues for its applicability for community-engaged health promotion researchers.