1. Ringham, Cathy PhD, RN
  2. McNeil, Deborah PhD, RN
  3. Benzies, Karen M. PhD, RN


Background: Integrating parents into the care of their infants in the neonatal intensive care unit (NICU) is vital for both parents and infants. Yet, parents are often not fully involved in important decision-making and care, even when practices are family- and patient-centered. Alberta Family Integrated Care (FICare) is a model of care designed to support integration of parents into their infant's care.


Purpose: The aim of this study was to describe and examine how mothers' work was coordinated by institutional processes when participating in Alberta FICare.


Methods: We used institutional ethnography to analyze written entries in Alberta FICare parent journals to show points of tension mothers experienced in the NICU.


Results: We illustrated the institutional activities that intersect with parental work of being present in the NICU. We argue that the journal text and the primary discourses that mothers are tuned to organize the way they knew and thought about their infant. Managing everyday NICU rules, navigating constant and unexpected changes, and the work of feeding their infant created tension. Mothers focused on milk supply, weight gain, and transition from gavage to nipple feeds. We show how mothers' activities were coordinated by practices that prioritize progression toward discharge rather than supporting them through the roller coaster of emotions and practical challenges of being present in the NICU.


Implications for Practice: This illustration of institutional systems and processes may assist practitioners to understand the barriers mothers face when caring for their infants in the NICU.