1. Callister, Lynn Clark PhD, RN, FAAN

Article Content

My coverage of global health and nursing has focused on care of immigrant and refugee women giving birth, and provision of respectful care of all childbearing women and their newborns. Here I discuss vulnerable mothers and their fragile babies hospitalized in newborn intensive care units (NICU). Overwhelming challenges may face immigrant and refugee mothers whose newborns are in the NICU and their nurses. Kyno and Hanssen (2021, p. 2) described it this way an unknown language, an unknown structure, and an organization of the health care system that is difficult to comprehend, as well as a new and unknown societal culture. Barriers include health care delivery constraints impeding nurses in giving culturally competent care such as lack of time, limited nurse staffing, lack of educational initiatives to enhance ability of nurses to provide quality care to vulnerable mothers, linguistic communication barriers, trust issues, maternal mental health issues including anxiety and depression, socioeconomic barriers, and cultural traditions (Kynoe et al., 2020; McGowan et al., 2019; Shorey et al., 2021).


Effective strategies are being developed to assist mothers and NICU nurses including those reported in a study on approaches to assist in provision of culturally appropriate care. Nurses concluded that being compassionate, competent, and knowledgeable built trust with mothers of babies in the NICU (Kyno & Hanssen, 2021). They demonstrated cultural humility as they sought to understand the lived experiences of immigrant and refugee women having a child in the NICU. In another study of the immigrant and refugee mothers and NICU nurses, mothers reported nurses who focused on creative ways of information sharing and provision of guidance and skills building made a significant difference in maternal confidence that they could provide appropriate care for their vulnerable child. One mother described it this way: Use hands, hand language for example. And then [if the nurse] notices that I do not understand...then she uses her gestures to point and signal so that I can understand. So, she tries more than one way to communicate to me so that I can understand (Kyno & Hanssen, 2021, p. 2229). Use of peer parents, matching those with a similar language and culture, is an effective strategy for immigrant and refugee mothers of babies in the NICU. Interpreters and on-line translating sites may be used, but generally are less effective and feasible. A Fragile Infant Parental Readiness Evaluation (FIPRE) has been developed to measure readiness for parents to care for their fragile child after discharge from the hospital. It evaluates parents' perceptions of NICU support, infant and maternal wellbeing, and comfort (McGowan et al., 2019).


Clinicians, administrators of health care facilities, and policy makers should be cognizant of the importance of targeting immigrant and refugee mothers and babies for enhanced assistance. It begins at the bedside, with NICU nurses who care, who are sensitive, and who have a desire to provide care that makes a difference in long-term outcomes for those who are vulnerable and in need of assistance. Immigrant and refugee mothers and babies are at a critical time of transition and need our compassion and commitment to promote optimal outcomes. As per a NICU nurse: When you show you are interested in them, you see that something happens. They are happy that you care (Shorey et al., 2021, p. 7). Caring for babies of immigrant and refugee mothers in the NICU can be challenging due to language barriers and lack of in-depth knowledge of various cultural practices that may be encountered, however the rewards are worth the effort.




Kyno N. M., Hanssen I. (2021). Establishing a trusting nurse-immigrant mother relationship in the neonatal unit. Nursing Ethics, online ahead of print.[Context Link]


Kynoe N. M., Fugelseth D., Hanssen I. (2020). When a common language is missing: Nurse-mother communication in the NICU. A qualitative study. Journal of Clinical Nursing, 29(13-14), 2221-2230.[Context Link]


McGowan E. C., Abdulla L. S., Hawes K. K., Tucker R., Vohr B. R. (2019). Maternal immigrant status and readiness to transition to home from the NICU. Pediatrics, 143(5), e20182657.[Context Link]


Shorey S., Debby E., Downe S. (2021). Cultural competence and experiences of maternity health care providers on care for migrant women: A qualitative meta-synthesis. Birth, online ahead of print.[Context Link]