Abstract
Background: The harmful effect of the substance abusing environment on child health is well documented (Cicchetti & Toth 1995; Tomison 1998), however a positive parent-child relationship may ameliorate the effect of such environmental factors. Neonatal nurses caring for substance exposed infants and their familles are well placed to influence the parentchild interaction, and the parents' adaptation to the role through the development of a therapeutic and empathic relationship with the family. However, there appears to be significant organisational and contextual barriers to the establishment of such relationships and delivery of quality care in this environment. This paper discussed findings from research exploring these issues. Aim: To explore neonatal nurses experience of, and barriers to, caring for substance exposed infants and their families. Methods: Qualitative methods included four (4) focus group interviews with groups of neonatal nurses in South- East Queensland, Australia. Focus groups consisted of 6-8 participants. Purposive sampling was used to recruit participants with experience in caring for infants in this clinical context. Thematic analysis of data was undertaken. Results: Five themes were identified: the relationship with the baby; responses to the family; tensions within the care environment; nurses' needs; and making a difference. Discussion: Participants discussed the issues and challenges experienced when caring for this group. Barriers to effective care included lack of knowledge and understanding, staff shortages, the organisational environment, and the burden of the emotional work involved. Despite the difficulties, participants reflected on times that they had made a difference and suggested a number of strategies to improve nursing practice in this area. This research contributes to knowledge and practice by describing the experience of, and barriers to, caring for this population, and provides a basis for development of alternative models of care.