Interactional Compression and Maternal Participation in Neonatal Intensive Care Units: A Qualitative Study of Nurse–Mother Communication Barriers and Co-Produced Solutions

TL;DR

This study explores how communication between nurses and mothers in NICUs is limited by workload and stress, and proposes strategies like protected Q&A time and visual aids to improve maternal participation.

Contribution

The study introduces co-produced strategies such as post-round Q&A windows and visual 'mini-packs' to address communication barriers in NICUs.

Findings

Mothers often have only two or fewer speaking turns per encounter in NICUs due to workload rhythms.

Three interaction patterns—threat–compression, convergence-to-coping, and resource-scaffolded participation—were identified as shaping maternal engagement.

Co-produced solutions like protected Q&A time and standardized visual aids can reduce information fragmentation and improve comprehension.

Abstract

What are the main findings?
Workload rhythms in NICUs structurally compress communication, often restricting mothers to two or fewer speaking turns per encounter.Three interaction patterns—threat–compression, convergence-to-coping, and resource-scaffolded participation—demonstrate how stress appraisal and accommodation shape maternal engagement.

Workload rhythms in NICUs structurally compress communication, often restricting mothers to two or fewer speaking turns per encounter.

Three interaction patterns—threat–compression, convergence-to-coping, and resource-scaffolded participation—demonstrate how stress appraisal and accommodation shape maternal engagement.

What are the implications of the main findings?
Co-produced strategies—protected post-round Q&A windows with teach-back and standardized visual “mini-packs”—strengthen comprehension verification and reduce information fragmentation.Leadership should operationalize communication as a safety infrastructure by ensuring predictable two-way exchange and timely professional interpreter access, rather than relying on individual nurse effort.

Co-produced strategies—protected post-round Q&A windows with teach-back and standardized visual “mini-packs”—strengthen comprehension verification and reduce information fragmentation.

Leadership should operationalize communication as a safety infrastructure by ensuring predictable two-way exchange and timely professional interpreter access, rather than relying on individual nurse effort.

Background/Objectives: Nurse–mother communication is central to maternal participation in Neonatal Intensive Care Units (NICUs), yet high acuity and workflow rhythms can compress dialogue and weaken shared understanding. This study used Communication Accommodation Theory and the Transactional Model of Stress and Coping to explain multilevel drivers of communication barriers and to co-produce feasible improvement strategies. Methods: A dyadic qualitative design was conducted across four Level III NICUs. Data were triangulated from 37 semi-structured interviews (18 mothers and 19 nurses, recruited through purposive maximum-variation sampling), approximately 40 h of non-participant observation, and 12-unit documents. A team-based codebook thematic analysis was applied, integrating observational logs with interview and document data to refine patterns and mechanisms. Results: A context-produced pattern of interactional compression was identified. Mothers contributed 2 or fewer speaking turns in 21/30 logged bedside encounters and were present in 13/16 observed round episodes, speaking in 5/13 of those episodes. Interpretability and language access gaps were common: unexplained technical terms occurred in 24/46 logged interactions; teach-back prompts occurred in 7/18 education encounters; professional interpreters were present in 3/9 language-discordant events. Three participation configurations described coping-linked engagement: threat–compression (n = 8), convergence-to-coping (n = 6), and resource-scaffolded participation (n = 4). In co-production, stakeholders co-produced (i.e., collaboratively identified and prioritized) three mechanism-targeted changes: protected post-round question-and-answer time incorporating teach-back, standardized visual “mini-packs,” and 24/7 interpreter access. Conclusions: Nurse–mother communication in NICUs can be structurally compressed by workload rhythms and uneven interpretability supports. Co-produced organizational scaffolds may expand opportunities for accommodation, comprehension verification, and equitable maternal participation.

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