Experiences of mothers in the context of a staffing intervention in select newborn units in Kenyan public hospitals

Background

Maternal involvement, effective communication and adequate support are widely recognised as promoting respectful care and better maternal experience of small and sick neonate care. Nurses play a critical role in neonatal care, but staffing shortages and workplace stress significantly impact their ability to provide quality care. Few studies have examined the implications of staffing interventions for maternal care experiences in newborn units.

Methods

In this ethnographic study, we explored mothers' experiences following a staffing intervention (addition of 3 nurses and 3 ward assistants) across four newborn units in Kenyan County referral hospitals. Data were collected through nonparticipant observations and interviews with mothers. Across the four hospitals, we interviewed 46 mothers and conducted over 1000 observation hours over three phases of data collection. We examined mothers' experiences of care and any changes with the staffing intervention in relation to communication, involvement in care, nurse-mother relationships and support.

Findings

Mothers in newborn units face intense emotional, physical and practical challenges with limited guidance and support to cope with the demands of neonatal caregiving. We did not observe significant changes in communication, nurse-mother relationships, or the support offered to mothers due to the additional nurses. However, the addition of ward assistants was valued by mothers, who appreciated their role in orientation, maintaining ward cleanliness, and cleaning feeding cups. Following the staffing intervention, mothers continued to report challenges with adequacy of information, disrespectful communication, and limited support with tasks. Peer-to-peer support between mothers was evident across all sites and study phases. Contextual factors and norms of care greatly influenced nursing practices.

Conclusions

Enhancing mothers' experiences in neonatal units will require integrated approaches that acknowledge their critical role in newborn care. Mothers need structured psychosocial and practical support, strengthened communication with healthcare providers, and broader structural interventions that significantly increase staff numbers and shift care norms.