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covert attachment, ethnography, neonatal intensive care unit, overt attachment



  1. Bialoskurski, Maria MA, Adv Dip Ed, BA (Hon), RGN
  2. Cox, Carol L. PhD, MSc, MA, PG Dip Ed, BSc, RN
  3. Hayes, Julie A. PhD, BSc, RGN


Attachment is defined as the formation of a relationship between a mother and her newborn infant. The concept of attachment has been inadequately defined and often confused with feelings associated with love, instinct, engrossment, and being connected to others. Prematurity and associated maternal-infant separation at birth can affect the attachment process. In this article, a research project, using Leninger's ethnonursing approach is described. Leninger's method was chosen to study the phenomenon of attachment in a neonatal intensive care unit (NICU). Ethnonursing has been found to be a suitable approach for the study of complex situations. Ethnonursing is based on an observation, participation in care, and reflection model. Qualitative data for this study were collected by observation, participation in care, and interviews of mothers (N = 25) in a tertiary NICU. Data were analyzed by comparison of narratives from field notes and transcripts. Findings from the analysis indicate the process of attachment was not automatic. Attachment should be considered as an individualized process. Two dichotomies associated with attachment were identified through the research. These were overt and covert attachment processes and may be dependent on the health status of the infant and the mother, environmental circumstances, and on the quality of care the infant receives.