Staff perceptions and experiences of implementing the Baby Friendly Initiative in neonatal intensive care units in Australia

The aim of this study was to explore the perceptions, understandings, and experiences of maternity service staff toward the World Health Organization/United Nations Children's Fund (WHO/UNICEF) Baby Friendly Hospital Initiative (BFHI) and its implementation in the Neonatal Intensive Care Unit (NICU). An exploratory study using naturalistic methods of inquiry was conducted, with participants recruited from a total of four Australian metropolitan maternity hospitals of which two included a NICU. Focus groups and individual interviews were undertaken in the participants' choice of location, usually hospital. The forty-seven participants included nursing and midwifery staff and one pediatrician. Data from focus groups and interviews were transcribed and thematic analysis used to identify themes related to implementation and perceptions of staff regarding BFHI. Major themes identified focused on the differences in NICUs relative to maternity units, separate worlds of mother and infant, the hard work involved in implementing the BFHI, and the positive attitude that BFHI can be achieved. There were misconceptions by participants on the nature of the BFHI as it applied to NICUs. Factors hindering and supporting BFHI implementation were also identified. It was concluded that motivated staff, educational support, and clear guidelines are essential to support implementation of the BFHI in NICUs.