Everyday Nursing Practice Values in the NICU and Their Reflection on Breastfeeding Promotion

In this ethnographic study I examined neonatal intensive care unit (NICU) nurses' everyday practice values and explored how breastfeeding promotion fit within this context. The study was conducted over a 14-month period and included participant observation and interviewing of 114 purposively selected nurses in a level-IV NICU in the United States. Uncertainty emerged as a central concern underlying everyday practice values. Three themes described these values: (a) maximizing babies' potentials in the midst of uncertainty; (b) relying on the sisterhood of NICU nurses to deal with uncertainty; and (c) confronting uncertainty through tight control of actions, reliance on technology, and maximal efficiency in use of time. A fourth theme demonstrated how these values were reflected in NICU breastfeeding practices. Although high-control, high-tech, and time-urgent practice values were helpful in confronting uncertainty, these values also posed challenges to ongoing nursing efforts to promote breastfeeding. These values must be addressed for effective breastfeeding promotion.