Acessibilidade / Reportar erro

Mother role conflicts in studies with mothers of hospitalized newborns: an integrative review

Abstracts

The hospitalization of a newborn separates mother and child at a time when their contact is essential for developing the mother's role. Therefore, mothers tend to feel incapable of meeting their child's needs, and face difficulties in dealing with their personal feelings and the demands of their family. The objective of this study was to identify the defining characteristics of the nursing diagnosis Conflict in performing the role of mother in studies addressing the experience of being a mother in the neonatal unit. This is an integrative literature review, which utilized 15 qualitative studies published between 2004 and 2009, in journals indexed in the Latin American and Caribbean Health Sciences Literature and on the Medical Literature and Retrieval System Online. This diagnosis is a nursing phenomenon to be studied by neonatal nurses so they are able to recognize and propose interventions to meet the mothers' needs, considering that nine out of ten defining characteristics were identified in the mothers' statements.

Mother-child relations; Infant; Hospitalization; Child; Maternal behavior; Nursing diagnosis


A hospitalização de um recém-nascido provoca a separação entre mãe e filho quando o contato é fundamental para o desenvolvimento do papel materno. Assim, as mães tendem a se sentir incapazes de atender as necessidades dos filhos, enfrentando dificuldades para lidar com seus sentimentos e com as demandas dos familiares. O objetivo deste estudo foi identificar as Características Definidoras do Diagnóstico de Enfermagem Conflito no desempenho do papel de mãe em estudos sobre a experiência de ser mãe na unidade neonatal. Trata-se de uma revisão integrativa da literatura, que utilizou 15 estudos qualitativos, publicados de 2004 a 2009 em periódicos indexados na Literatura Latino-Americana e do Caribe em Ciências da Saúde e Medical LiteratureandRetrieval System OnLine. Este diagnóstico é um fenômeno de enfermagem a ser estudado por enfermeiros neonatais para que possam reconhecer e propor intervenções às necessidades maternas, visto que nove das dez Características Definidoras foram identificadas nos depoimentos das mães.

Relações mãe-filho; Recém-nascido; Hospitalização; Criança hospitalizada; Comportamento materno; Diagnóstico de enfermagem


La hospitalización del neonato provoca separación entre madre e hijo cuando el contacto es fundamental para el desarrollo del papel materno. Consecuentemente, las madres tienden a sentirse incapaces de atender las necesidades del hijo, tienen dificultad para afrontar el sentimiento y las demandas familiares. Se objetivó identificar Características Definidoras del Diagnóstico de Enfermería Conflicto en el desempeño del papel maternal en estudios acerca de la experiencia de ser madre en la unidad neonatal. Revisión integral de la literatura, habiéndose utilizado quince estudios cualitativos, publicados entre 2004-2009 en períodos indexados en la Literatura Latinoamericana y del Caribe en Ciencias de Salud y Medical Literature and Retrieval System Online. Este diagnóstico constituye un fenómeno de Enfermería a ser estudiado por enfermeros neonatales para que puedan reconocer y proponer intervenciones para las necesidades maternas, en virtud de que nueve de las diez Características Definidoras fueron identificadas en los testimonios de las madres

Relaciones madre-hijo; Recién nacido; Hospitalización; Niño hospitalizado; Conducta materna; Diagnóstico de enfermería


ARTIGO DE REVISÃO

Mother role conflicts in studies with mothers of hospitalized newborns: an integrative review

Conflicto en el desempeño del papel maternal en estudios con madres de recién nacidos hospitalizados: revisión integral

Elenice Valentim CarmonaI; Kelly Pereira CocaII; Ianê Nogueira do ValeIII; Ana Cristina Freitas de Vilhena AbrãoIV

IRN. Doctoral student in Nursing, Federal University of São Paulo. Professor, Nursing Department, College of Medical Sciences, University of Campinas. Campinas, SP, Brazil. elenice@fcm.unicamp.br

IIRN. Doctoral student in Nursing, Federal University of São Paulo. Coordinator of the Obstetrical Nursing Specialization Course, Centro Universitário São Camilo. São Paulo, SP, Brazil. kcocaepm@hotmail.com

IIIRN. Ph.D. Professor, Nursing Department, College of Medical Sciences, University of Campinas. Campinas, SP, Brazil. ianenvale@gmail.com

IVPh.D. Professor, Nursing Department, Federal University of São Paulo. São Paulo, SP, Brazil. ana.abrao@unifesp.br

Correspondence addressed

ABSTRACT

The hospitalization of a newborn separates mother and child at a time when their contact is essential for developing the mother's role. Therefore, mothers tend to feel incapable of meeting their child's needs, and face difficulties in dealing with their personal feelings and the demands of their family. The objective of this study was to identify the defining characteristics of the nursing diagnosis Conflict in performing the role of mother in studies addressing the experience of being a mother in the neonatal unit. This is an integrative literature review, which utilized 15 qualitative studies published between 2004 and 2009, in journals indexed in the Latin American and Caribbean Health Sciences Literature and on the Medical Literature and Retrieval System Online. This diagnosis is a nursing phenomenon to be studied by neonatal nurses so they are able to recognize and propose interventions to meet the mothers' needs, considering that nine out of ten defining characteristics were identified in the mothers' statements.

Descriptors: Mother-child relations; Infant, newborn; Hospitalization; Child, hospitalized; Maternal behavior; Nursing diagnosis

RESUMEN

La hospitalización del neonato provoca separación entre madre e hijo cuando el contacto es fundamental para el desarrollo del papel materno. Consecuentemente, las madres tienden a sentirse incapaces de atender las necesidades del hijo, tienen dificultad para afrontar el sentimiento y las demandas familiares. Se objetivó identificar Características Definidoras del Diagnóstico de Enfermería Conflicto en el desempeño del papel maternal en estudios acerca de la experiencia de ser madre en la unidad neonatal. Revisión integral de la literatura, habiéndose utilizado quince estudios cualitativos, publicados entre 2004-2009 en períodos indexados en la Literatura Latinoamericana y del Caribe en Ciencias de Salud y Medical Literature and Retrieval System Online. Este diagnóstico constituye un fenómeno de Enfermería a ser estudiado por enfermeros neonatales para que puedan reconocer y proponer intervenciones para las necesidades maternas, en virtud de que nueve de las diez Características Definidoras fueron identificadas en los testimonios de las madres.

Descriptores: Relaciones madre-hijo; Recién nacido; Hospitalización; Niño hospitalizado; Conducta materna; Diagnóstico de enfermería

INTRODUCTION

Prematurity (when a child is born with a gestational age of less than 37 weeks) and low weight at birth (less than 2500g) are the most common causes for hospitalizing newborns in developing countries such as Brazil. Neonatal death and higher risks of complications are associated with this situation. These causes are triggered due to unfavorable social and economic conditions, infections and deficient prenatal medical care(1).

Progress in the provision of health care has mitigated mortality of premature and ill newborns, increasing the number of children living with severe and chronic diseases. NBs (newborns) are patients with high clinical fragility, mainly low weight premature infants; in addition, they spend long periods of time in the hospital(2-4). In neonatal care, just as infant patients are fighting for their lives, mothers experience hospitalization of their infant as a frequently unexpected and difficult situation. Mothers tend to feel incapable of meeting their child's needs, and experience difficulties in dealing with their personal feelings and the demands of their family(2).

Referring to the literature, we verified that many authors who have studied the experience of women whose newborns were hospitalized describe maternal statements that present Defining Characteristics (DCs) of the Nursing Diagnosis (ND) Conflicts in performing the role of mother, without specifically naming them. Such observation has triggered the interest in developing a specific investigation regarding the presence of these DCs in qualitative studies that approach the theme.

The diagnosis mentioned above is defined, according to NANDA-I(5) (North American Nursing Diagnosis Association publication, currently denominated as NANDA International), version 2009-2011, as: mothers experience confusion and conflict in performing their role as a response to crisis. This ND presents the following DCs (observable and communicable signs and symptoms that represent the presence of diagnosis): Anxiety; Disturbances demonstrated in care routines; Mothers face concerns regarding the acknowledged loss of control over decisions regarding their children; Fear; Mothers express concern(s) regarding the family (e.g., functioning, communication, health), Mothers express concerns regarding changes in their role as a mother; Mothers express feelings of inadequacy in order to meet their children's needs (e.g., physical and emotional); Reluctance in taking part in usual care activities, even when encouraged; Mothers verbalize personal feelings of guilt and Mothers verbalize feelings of frustration.

ND is a clinical judgment regarding individual, family or community responses to real or potential vital health processes/ problems. It provides a basis for nursing interventions selection that achieves satisfying results for patients the nurse is responsible for. It involves a cognitive process through which inferences regarding patient data are stated, focusing on their answers(5). The use of ND regarding the mother in a neonatal unit is still incipient, since neonatal nurses are much more focused on doctors' diagnosis and on the care of the NB.

Constructing the mother role is a complex cognitive-affective process, originating in the mother's own experience as a daughter and gradually processed throughout pregnancy. It continues to be constructed and modified in constant interactions with the infant for which the woman is responsible. Infants play an important role in this interaction since they regulate maternal behaviors from their responses(6-7). In addition, bonding is a deep and complex experience that requires early physical contact(6,8). On the opposite end, mothers of NBs who have been hospitalized have sporadic contact with their infant, postponing the development of this relationship. In addition, due to the severity of the infant's clinical condition, bonding can be deeply compromised as a maternal defense mechanism(8-10).

Throughout the process of taking on responsibility for the hospitalized infant's care, mothers commonly report feelings of low self-esteem, insecurity, feelings of failure and an inability to overcome difficulties arising from caring for the infant. They allude to doubts regarding their own competence to care for their infant, as well as acknowledging and solving problems (11). In addition, they face challenges that interfere in the family functioning such as: the meaning of the infant's hospitalization; separation of family members; other children requiring care; health problems; the need for great psychological support for the family and the increase in financial worries(8-10).

Hence, it is irrefutable that taking care of the NB must include caring for the mother. Therefore, maternal ND must also be identified in neonatal units, since nurses providing care do so with the objective of offering better conditions to allow mothers to care for their infants by themselves. When they are fully supported and assisted, they can contribute to the infants' recovery and fully provide future care.

In order to plan nursing care it is important to strongly acknowledge this phenomenon. Pointing out the importance of NDs holds great value in this care context because, if the human response cannot be identified and intervened for, mothers may experience Damaged Motherhood (12): a diagnosis describing a situation in which there is the incapability of the primary care taker to create, maintain or reestablish an environment that promotes good growth and development for the child(5). In addition, although it is not possible to confirm the presence of a Conflict in performing the role of mother in the analyzed studies, the importance of this work is based on demonstrating how subjective data originated from qualitative studies can promote the study of nursing phenomena, assisting in the development of a standard communication to better describe them and making them increasingly more useful for clinical practice. There is a great need for studies in this area.

This present study had as the objective to analyze, through an integrative literature review, the defining nursing characteristics for Conflict in performing the role of mother from mothers' statements, through a qualitative study about experiencing motherhood in a neonatal hospital unit.

METHOD

An integrative literature review(13) approaching the mothers' experience as mother to a hospitalized newborn infant. Integrative review is a relevant research analysis method supporting decision-making and the improvement of clinical practice. According to this method, the first stage was to identify the theme and develop a hypothesis to be tested: in this case, verify if studies approaching the experience of motherhood in a neonatal hospital unit presented defining characteristics of the Conflict in performing the role of mother nursing diagnosis in their results.

The next stage involved establishing inclusion and exclusion criteria for the studies and for the literature search. Hence, the following reference sources were utilized for the studies selection: Latino-American and Caribbean Literature in Health Sciences (LILACS) and Medical Literature and Retrieval System Online (MEDLINE).

Descriptors utilized for the search were: mother-infant relationships; maternal behavior; newborn; hospitalization; hospitalized child; and qualitative research, including their respective versions in English. These descriptors were defined from a survey in the Virtual Library of Health Sciences and Health descriptors. Non-exact descriptors were also employed: companion mother; motherhood; hospitalized newborn; mother; and maternal role.

The following criteria for inclusion were considered for these studies:

  • Studies published from 2004 to February of 2009, in indexed journal in the LILACS and MEDLINE database, written in English and Portuguese;c

  • Qualitative methodological approach, using interviews for collecting data

  • Focus on the mothers' experience in the neonatal hospital unit, where the mother was the research subject and therefore submitted to an interview

  • The presence of at least one nurse as the co-author of the study

Exclusion criteria were as follows: studies in which interviews occurred after the infant was discharged from the neonatal unit; review studies; studies approaching maternal experience in their home after hospitalization; studies presenting no available abstract; studies not fully presented; and studies in which the sample used the Kangaroo Method (skin-to-skin contact), because it is considered to be a very different experience than a situation in which contact is not possible. Another exclusion criteria established throughout data collection was the fact that the study method was not clearly described.

In the literature integrative review it is important to define the information that must be extracted from the selected studies. Therefore, a data collection instrument was developed and was completed for each study, comprising the following data: bibliographic reference; index data base; objective and method. In addition, the instrument presented the specific diagnosis DCs that were marked with an x when they appeared in the results of the study. The instrument also provided a field specifically for observations.

A bibliographic survey was performed in order to determine the study references, using descriptors and mentioned words. Abstracts from the data base were read in an effort to identify studies compatible with the objective. Therefore, the selected studies were read and an instrument was filled out for each one of them. The completed instruments were revised regarding legibility and information occurrences. Data were extracted from study results and discussions.

Each study was read by at least two authors who separately performed the filling out of the instrument; in other words, two separate instruments were filled out for each study. In case of discordance between the authors regarding the presence or absence of a specific DC, the study was then read by a third author in order to reach an agreement.

RESULTS

With the use of the mentioned descriptors and keywords, 124 research references were found, 85 in MEDLINE and 39 in LILACS. From reading the abstracts, 37 studies were selected for a full reading, 17 from Medline and 20 from LILACS.

After the reading of the 37 studies, 15 were determined to be eligible for inclusion in this present study. Several studies were not included due to the fact that, after a full analysis, they did not meet the required inclusion criteria, since method details were better described in the study rather than in the abstract.

Studies had the objective, in general, to investigate the experience of mothers of hospitalized infants in neonatal units, focusing on their feelings and experiencing motherhood in this context. Data were collected through recorded semi-structured interviews. Sample sizes ranged from 6 to 26 women. Regarding data analysis, eight studies performed analysis according to Bardin's Content Analysis, three utilized Phenomenology, two utilized Theory-Based Data, one utilized the Pichon-Riviére Bonding Theory, and one utilized Ethnography. Ten studies were developed by Brazilian nurses and five by foreign nurses.

The ND Conflict in performing the role of mother presents 10 DCs, according to NANDA-I(5) classifications. It is important to point out that only one of them (Distress demonstrated in care routines) was not present in the interviews statements, while the remaining nine presented a frequent relevance in maternal statements (Table 1).

DISCUSSION

Comparison between the ND and data from the studies demonstrates content relevance in describing the situation of women who experience the hospitalization of a newborn infant, since the objective is to describe the conflict experienced by them in performing their role with their infant in the midst of a crisis. DCs, without a doubt, provide important signals that women need support in order to feel more confident and better perform their mother role. This study does not have the objective of discussing the interventions for this phenomenon, but instead aims to demonstrate the presence of these signals in maternal statements.

The following DCs are discussed in a decreasing order of frequency in the study samples, as shown in the table above.

Fear

The most present DC in women's statements, fear was demonstrated as related to the infants' future, specifically to whether the infant would survive. It was the predominant feeling for the mothers and was related, above all, to fear regarding the possibility of the infants' death. They also referred to other factors that triggered fear, including the devices and equipment utilized on infants, the neonatal unit environment and the infants' appearance and fragility(11,14-26).

Mothers express concern(s) regarding changes in the maternal role.

Mothers reported feelings of lack of accomplishment in being a mother since they were not responsible for the care for their infants, since they could not care for them in their own manner and because they could not have the relationship they imagined with their infants. They describe a distancing in the relationship with their infants due to hospitalization, as an extremely different experience than that idealized by them. In addition, they express discomfort generated by their perception that they are not important and necessary for their own children(11,15-16,18,21-27).

Interviews demonstrate difficulties in performing the mother role due to not knowing how to care for their own child. Some statements show a feeling of uselessness as a mother(22), while other statements describe the experience as not being a mother(18). They also stated that the husband was not even useful to produce milk, stressing the perception that their maternal role was not being exercised(18).

Maternal speeches describe how their feelings are related to the fact that they did not see the birth of their children and did not experience all sensations of childbirth and of caring for their children. Women question how they can be mothers when they feel useless and at a distance from their infants. Others mention that the beginning of acquiring the mother role process was quite postponed(15). One of the mothers mentions that, due to distancing and the changes in the mother role she expected to perform, she began to avoid taking care of and having any contact with her child, because she feared bonding(24).

Mother expresses guilty feelings.

Guilty feelings were stated by mothers as being related to something they did or did not do (for instance, prenatal care) that might have damaged their children, triggering a health problem and the need for hospitalization immediately after birth(14,16,18,20,22-25).

Such guilt was also linked by a few mothers to receiving punishment for some wrong they perpetrated towards another person, a sin described as severe enough to deserve punishment. Punishment is the hospitalization of a newborn child, consequently making the mother, child and family suffer(20,22).

Guilt was also related to a desire to leave the hospital and go home to be with the family, whether to fill their own emotional needs related to being with the family, or to fulfill the need to provide care for them. Guilt was also related to the perception that they appropriately met neither the needs of the hospitalized child nor the family needs throughout the process(25). This feeling of guilt was also related to the fact they did not feel an immediate bond with their child, as they expected(18).

Mothers express feelings of inadequacy in meeting the infants' needs.

Mothers express their lack of confidence in their own ability to care for their infants with special needs; some refer to an emotional difficulty, while others refer to financial problems, lack of ability and lack of expertise to perform direct care for their children(11,16,18,21-22,25-26).

Mothers express concern(s) regarding the family.

As described in the examples in brackets following the DC in NANDA-I(5) Classification, maternal interviews demonstrate concerns regarding the family functioning during their absence due to the child's hospitalization. They worry about daily dynamics, financial issues, communication among family members and the health of a specific family member. The main concern regards the care of other children(15,21-23,25-26).

Mothers report difficulties in explaining the child's clinical condition to other family members(22). Some reported that the family, in addition to asking for information, was expecting satisfactory results, generating additional worries and anxiety(22).

Maternal statements demonstrate how much they feel they owe their family, above all their other children; at the same time they feel they do not spend enough time with the hospitalized child. Roles and responsibility conflicts make it difficult to spend the needed time with their hospitalized child(21,26). Mothers also describe the impact of their NB hospitalization on the family, and the conflict they feel because they want to be with their NB and with other family members at the same time, especially other children. Some described a truthful and intense feeling of loneliness(25). All these worries are also related to the feelings of guilt mentioned repeatedly by them.

Mothers express feelings of frustration.

Feelings of frustration described by mothers are related to the fact that the whole process of birth and hospitalization is vastly different from the expected and desired outcome they imagined (14,19,22-23,25). Being apart from their children, immediately after birth, was described as very frustrating(25). Birth, under these conditions, was described as an unaccomplished dream, since they expected a normal childbirth(19).

Anxiety

Women describe a disturbing feeling triggered by various issues and name it anxiety. It is related to the desire to go home, and seeing the first positive results of treatment and the possibility of the child being discharged from the hospital shortly. The feeling was also described by women as related to the perception that maternal milk production was decreasing(14-15,21,24-25).

Anxiety came up numerous times in these mothers' interviews in describing the situation and feelings experienced by them in the process of mothering a hospitalized child. NANDA-I(5) presents a ND named Anxiety, defined as a vague and disturbing feeling of discomfort or fear, followed by an autonomic response. The source is frequently non-specific or unknown to the individual. It may be caused by anticipating danger, an alert signal calling attention to an imminent danger, allowing the individual to take measures to deal with an imposing threat.

Discourses did not refer to autonomic responses that fully characterize anxiety; however, the mothers experience, without a doubt, discomforts and fears caused by anticipating a danger they need to react to. This DC, specifically, needs to be fully and carefully investigated in order to define clinical practice.

Reluctance in taking part in usual care activities even when encouraged and supported.

Mothers report they will be able to care for their child only after hospital discharge, demonstrating a lack of perception regarding the necessary preparation for it. They compare their ability with nursing professionals' ability; therefore they feel unable to care for them as professionals do. They seem to believe there is a specific way to care for their child and they do not feel able to do it(15,18,24).

Their statements suggest they are committed to the care; however, they feel incapable of performing it due to the health situation the NB is in and their own lack of preparation in taking part in the care. One of the studies (15) demonstrated a maternal comment that expressed these findings well: The problem is me, right? I feel very insecure, but they support me very much!

Mothers express concerns regarding the perceived loss of control over the decisions regarding the infants.

Mothers reported they feel as if the nursing team owns their infants and is therefore always in control. They dislike the fact that they need to ask for permission even to touch their own children(11,18,25-26).

This discourse did not appear in studies with Brazilian mothers. This interesting fact can be explained by cultural differences, since mothers in other countries show greater awareness regarding their rights as a mother to a hospitalized infant, therefore they are more disturbed by rules and limitations imposed by the nursing team.

Disturbance demonstrated by care routines.

This DC was not present in maternal interviews from the included studies. Likely this is related to the fact that such an event is observed and evaluated by the nurse and not described by the mother regarding themselves.

Other data in maternal discourses related to Conflict in performing the role of mother.

Although not the objective of this study, it is important to mention that some factors related to the Conflict in performing the role of mother ND were present in maternal interviews. This fact corroborates the need for developing studies regarding this nursing phenomenon in neonatal hospital units. These related factors, displayed through the interviews with mothers, are not always described exactly as proposed by NANDA-I(5).

Regarding the related fact home care of a special needs child, maternal statements demonstrate a concern related to other young children at home, and also a concern regarding the care for the NB after hospital discharge, regarding their special needs: for instance, the use of a catheter and oxygen therapy(22).

Interruption in the family life due to the home care regime (e.g., treatments, caretakers, lack of rest) is present in mother's speeches as a constant concern, above all due to changes in planning and family functioning as a whole(21-22).

Intimidation regarding invasive and restrictive treatments appears in many studies as an extremely important aspect of the maternal experience(14-15,18,26).

Factors related to child separation due to chronic disease are present in the contexts of studies as a separation of mothers and infants due to the hospitalization of the child(11,15-16,26).

Policies in specialized care centers, such as restrictive rules, are also present in maternal discourses as a factor that made the experienced situation even more difficult for these women(15,18,26).

Different from the expected, the "changes in marital status" factor did not appear in maternal statements in these studies.

CONCLUSION

From the literature review, the neonatal hospital unit is considered as a very propitious location for studying the ND in this study, since a NB hospitalization can mean crisis and modifications in the role mothers expect to perform with children and the family. Literature demonstrates that mothers of premature infants are more likely to have problems due to early childbirth and separation, situations that interfere in the construction and development of the mother role.

In maternal statements collected from qualitative studies regarding hospitalized NB mothers' experience, data agrees with the DCs and the Conflict in performing the role of mother ND-related factors, as demonstrated in the 15 selected studies.

Different roles exercised by these women, as mothers, wives, housewives and professionals generate many conflicts, enhancing emotional distress. Their interviews describe conflicts regarding duties, needs and emotions. The difficulties seem to be greater for those who have other children, dependent family members and/or outside jobs.

We do not intend to confirm other nursing diagnoses demonstrated by the mothers in this study since individualized investigations would be needed, including a survey of many other factors that should occur at the time these studies were developed. On the other hand, maternal speeches compared to DCs from this diagnosis demonstrate the need for a careful eye on this phenomenon in the care of mothers in neonatal units. In addition, the importance of training nurses to be able to evaluate subjective issues, name nursing phenomena and propose interventions must be stressed.

Maternal speeches by these women evidence their need for support in the process of developing the role of mother when their newborns are hospitalized, and also in the conflict they experience regarding family and other children. Despite all discussions regarding humanization in neonatal care, systematized strategies for formal support for these women and their families are lacking. Most of the time, initiatives come from a few professionals sensitive to the subject.

REFERÊNCIAS

  • 1. Araújo BF, Tanaka AC, Madi JM, Zatti H. Estudo da mortalidade de recém-nascidos internados na UTI neonatal do Hospital Geral de Caxias do Sul, Rio Grande do Sul. Rev Bras Saúde Mater Infant. 2005;5(4):463-9.
  • 2. Wereszczak J, Miles MS, Holditch-Davis D. Maternal recall of the neonatal intensive care unit. Neonatal Netw.1997;16(4):33-40.
  • 3. Miles MS, Holditch-Davis D, Burchinal P, Nelson D. Distress and growth outcomes in mothers of medically fragile infants. Nurs Res.1999;48(3):129-40.
  • 4. Fenwick J, Barclay L, Schmied V. Struggling to mother: a consequence of inhibitive nursing interactions in the neonatal nursery. J Perinat Neonatal Nurs. 2001;15(2):49-64.
  • 5. North American Nursing Diagnosis Association International (NANDA-I). Diagnósticos de enfermagem da NANDA: definições e classificação 2009 -2011. Porto Alegre: Artmed; 2010.
  • 6. Brazelton TB. O desenvolvimento do apego: uma família em formação. Porto Alegre: Artes Médicas; 1988.
  • 7. Kimura AF. A construção da personagem mãe: considerações teóricas sobre identidade e papel materno. Rev Esc Enferm USP. 1997;31(2):339-43.
  • 8. Bialoskurski M, Cox CL, Hayes JA. The nature of attachment in a neonatal intensive care unit. J Perinat Neonatal Nurs. 1999;13(1):66-77.
  • 9. Belli MAJ. Assistência à mãe de recém-nascido internado na UTI neonatal: experiências, sentimentos e expectativas manifestadas pelas mães. Rev Esc Enferm USP. 1995;29(2):193-210.
  • 10. Cunha MLC. Recém-nascidos hospitalizados: a vivência de pais e mães. Rev Gaúcha Enferm. 2000;21(n.esp):70-83.
  • 11. Flacking R, Ewald U, Nyqvist KH, Starrin B. Trustful bonds: a key to becoming a mother and to reciprocal breastfeeding. Stories of mother of very preterm infants at a neonatal unit. Soc Sci Med. 2006;62(1):70-80.
  • 12. Carpenito LJ. Diagnósticos de enfermagem: aplicação à prática clínica. 8Ş ed. Porto Alegre: Artmed; 2002.
  • 13. Mendes KDS, Silviera RCC, Galvão CM. Revisão integrativa: método de pesquisa para a incorporação de evidências na saúde e na enfermagem. Texto Contexto Enferm. 2008; 17(4):758-64.
  • 14. Camargo CL, La Torre MPS, Oliveira AFVR, Quirino MD. Sentimentos maternos na visita ao recém-nascido internado em unidade de terapia intensiva. Ciênc Cuidado Saúde. 2004; 3(3):267-75.
  • 15. Centa ML, Moreira EC, Godoy MN, Pinto HR. A experiência vivida pelas famílias de crianças hospitalizadas em uma unidade de terapia intensiva neonatal. Texto Contexto Enferm. 2004;3(3):444-51.
  • 16. Fraga ITG, Pedro ENR. Sentimentos das mães de recém-nascidos prematuros: implicações para a enfermagem. Rev Gaúcha Enferm. 2004;25(1):89-97.
  • 17. Rocha RG, Silva ROL, Handem PC, Figueiredo NMA. Imaginário das mães de filhos internados em UTI-Neonatal no pós-parto: contribuições para a enfermagem. Esc Anna Nery Rev Enferm. 2004;8(2):211-6.
  • 18. Heermann JA, Wilson ME, Wilhelm PA. Mothers in the NICU: outsider to partner. Pediatr Nurs. 2005;31(3):176-200.
  • 19. Sales CA, Muriel RV, Mikuni PK, Ferreira EA, Andrade VCC, Godoy AV, Lopes NAG, Zanoni CN. Vivenciando a facticidade em dar existência a filho prematuro: compreensão dos sentimentos expressos pelas mães. Acta Sci Health Sci. 2005;27(1):19-23.
  • 20. Sales CA, Alves NB, Vrecchi MR, Fernandes J. Concepções das mães sobre os filhos prematuros em UTI. Rev Bras Enferm. 2006;59(1):20-4.
  • 21. Vasconcelos MGL, Leite AM, Schochi CGS. Significados atribuídos à vivência materna como acompanhante de recém-nascido pré-termo e de baixo peso. Rev Bras Saúde Mater Infant. 2006;6(1):47-57.
  • 22. Battikha EC, Faria MCC, Kopelman BI. As representações maternas acerca do bebê que nasce com doenças orgânicas graves. Psicol Teor Pesq. 2007;23(1):17-24.
  • 23. Monteiro MAA, Pinheiro AKB, Souza AMA. Vivência de puérperas com filhos recém-nascidos hospitalizados. Esc Anna Nery Rev Enferm. 2007;11(2):276-82.
  • 24. Shin H, White-Traut R. The conceptual structure of transition to motherhood in the neonatal intensive care unit. J Adv Nurs. 2007;58(1):90-8.
  • 25. Lindberg B, Ohrling K. Experiences of having a prematurely born infant from the perspective of mothers in Northern Sweden. Int J Circumpolar Health. 2008;67(5):461-71.
  • 26. Lee SN, Long A, Boore J. Taiwanese women's experiences of becoming a mother to a very-low-birth-weight preterm infant: a grounded theory study. Int J Nurs Stud. 2009;46(3):326-36.
  • 27. Moreno RLR, Jorge MSB. O cuidar do outro na unidade de terapia intensiva neonatal: concepção fenomenológica. Ciênc Cuidado Saúde. 2005;4(3):242-9.
  • Correspondência:
    Elenice Valentim Carmona
    Av. Dr. Luís de Tella, 788 – Cidade Universitária
    CEP 13083-000 - Campinas, SP, Brasil
  • Publication Dates

    • Publication in this collection
      07 May 2012
    • Date of issue
      Apr 2012

    History

    • Received
      12 Jan 2011
    • Accepted
      09 Sept 2011
    Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
    E-mail: reeusp@usp.br