An Institutional Ethnography of Nurses’ Support of Breastfeeding on the Night Shift

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Objective: To describe nurses’ support of breastfeeding on the night shift and to identify the interpersonal interactions and institutional structures that affect this support.

Design: Institutional ethnography.

Setting: The mother/baby unit of a tertiary care hospital with 4200 births per year.

Participants: Registered nurses (N = 16) who provided care on the night shift to mother/infant dyads in the immediate postpartum period.

Methods: Data were collected using focus groups, individual and group interviews, and mother/baby unit observations. The focus groups were held before the night shift and had five participants. The nine individual and group interviews were conducted between 0100 and 0230 on the mother/baby unit. Three unit observations were conducted. Interviews were recorded, professionally transcribed, and analyzed using a content analysis method.

Results: Data analysis yielded three themes that described these nurses’ support of breastfeeding on the night shift: competing priorities, incongruent expectations, and influential institutional structures. The need of visitors to see their new family members competed with the needs of mothers to rest and breastfeed their newborns. Helping breastfeeding dyads who experienced difficulties competed with providing care to other patients. Parents’ expectations regarding newborn behavior were incongruent with the reality of newborn feeding and sleeping patterns. Institutional structures that affected the provision of breastfeeding support by nurses included hospital breastfeeding practices, staffing, and policies.

Conclusion: Nurses’ support of breastfeeding on the night shift encompasses a complex interplay of interpersonal interactions with new families and visitors regarding priorities and expectations and negotiating institutional structures such as feeding policies and staffing.