NURSES CARING FOR BIRTH TOURISM FAMILIES IN NEONATAL INTENSIVE CARE UNITS: A PHENOMENOLOGICAL INQUIRY DISSERTATION Presented in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy in Nursing Barry University Tamara LaCroix 2021 Copyright by Tamara LaCroix, 2021 All Rights Reserved Abstract Background: Birth tourism families plan their birthing experience that includes purchasing a maternity care package, traveling internationally to a preferred destination, and the delivery of a healthy newborn in an expected short hospital stay. However, some families admit a premature or ill infant into a South Florida neonatal intensive care unit. When admitted into this setting, neonatal nurses are unique in providing quality nursing care to birth tourism infants and their parents as a family unit. There remains a gap in nursing research in understanding neonatal nurses' lived experience caring for birth tourism families in the neonatal intensive care unit.
Purpose: The purpose of this hermeneutic phenomenological study using van Manen's (1990) methodology was to understand the lived experience of neonatal nurses caring for birth tourism families who admit a newborn into South Florida's neonatal intensive care units. Philosophical Underpinnings: Max van Manen's (1990) hermeneutic phenomenology guided the question: "What is the lived experience of neonatal nurses caring for birth tourism families who admit their infant into South Florida's neonatal intensive care units?" Methods: The target population was neonatal nurses working in South Florida's neonatal intensive care unit. Purposive and snowball sampling were used. Collected data from semi-structured interviews and participants' artworks were entered in NVivo 12-Pro software.
Max van Manen's (1990) six procedural activities and Miles, Huberman, and Saldaña's (2014) data flowing activities, line-by-line theming, and interpreting were adopted to organize, code, and categorize the gathered texts. iv Results: From 22 neonatal nurses interviewed, four themes emerged. Interpreted data yielded the funneling of cultural care in a continuous phase of recognizing cultural interactions, acknowledging cultural consciousness, canalizing compassionate care, and bridging family-centeredness. Conclusions: This study revealed the participants' experiences caring for birth tourism families who unexpectedly admit newborns into the neonatal intensive care unit.
When caring for a sick or ill newborn, neonatal nurses do not always recognize birth tourism families in the unit, hindering supporting their needs and delivering culturally competent care. Neonatal nurses experience the funneling of cultural care in a continuous phase of recognizing cultural interactions, acknowledging cultural consciousness, canalizing compassionate care, and bridging family-centeredness to provide quality family-centered and culturally competent care to meet the needs of birth tourism families. v ACKNOWLEDGMENTS I thank God for the vision, strength, perseverance, knowledge, and provisions to walk through this journey and accomplish this endeavor. I am so grateful to have been blessed with three strong, incredible women, stellar and knowledgeable in the craft, to comprise my dissertation committee.
Collectively, thank you for all of your insights, your commitment to time, and your dedication to excellence. Colin- committee chairperson, most enormous thank you for believing in my highest potential even before I believed in myself, as well as your guidance, instructions, and encouragement that lead me through the end; Dr. Ferrona Beason- committee member, thank you for your teaching and patience during the groundbreaking of this study; and Dr. Claudette Chin- committee member, thank you for being an exemplar of loving the profession of Nursing, all of your hard work, dedication, and especially mentorship to the most simple “sending warmest hug” messages which kept me going when times were so hard.
I could not have done it without my committee. My brother and two elder sisters: thank you for all the love, being proud of me, always expecting excellence, and encouraging me to deliver my fineness. My best friends, Shani, Laurel, Anabell, Mr. Cumberlander, and my partner in crime, Jonathan L.
Dotson: thank you for not giving up on our friendship, for the emotional support, always encouraging me, listening to me, laughing, crying, and not to forget, feeding me. My research participants: I am forever grateful for the stories and unique experiences you have shared, your nursing knowledge, and for the accolades you’ve given me. This Nursing research would not have been possible without your contributions. vi DEDICATION This dissertation is dedicated to my God, who is forever faithful even when I am not.
To my children, my angel, Tatiana R. Naar (1989-2010) (left me too soon), my princess, Katrina B. Naar, my only son and hero, Army Sergeant Naar, Wladimir Dimitri (HHC 2-35 IN 3IBCT), and my little prince Malachi Moxey (grandson). You are my reasons for living and embarking on this journey.
I love you to the moon and back. Blessings to all who God placed on my path to love, pray, support, and encourage me during this journey. "The LORD is my shepherd, I lack nothing. He makes me lie down in green pastures, he leads me beside quiet waters, he refreshes my soul.
He guides me along the right paths for his name's sake. Even though I walk through the darkest valley, I will fear no evil, for you are with me; your rod and your staff, they comfort me. You prepare a table before me in the presence of my enemies. You anoint my head with oil; my cup overflows.
Surely your goodness and love will follow me all the days of my life, and I will dwell in the house of the LORD forever." Psalm 23 vii TABLE OF CONTENTS TITLE PAGE…………………………………………….…………………………………………………………………ii COPYRIGHT PAGE…. vii TABLE OF CONTENTS. viii LIST OF TABLES. xii LIST OF FIGURES.
xiii CHAPTER ONE: PROBLEM AND DOMAIN OF THE INQUIRY. 1 Background of the Study. 2 Scope and Global Presence of Birth Tourism. 4 Social Aspects of Birth Tourism in the United States.
11 Birth Tourism Integrated in Business. 14 Birth Tourism Integrated in Healthcare. 17 Birth Tourism and Risk Factors for Admissions. 18 Neonatal Nurses in the Neonatal Intensive Care Unit.
20 Statement of the Problem. 23 Purpose of the Study. 34 Approaches to Qualitative Research. 36 Scientific Assumptions in Qualitative Inquiry.
40 viii Relationship of Hermeneutic Phenomenology to the Study. 50 Significance of the Study. 52 Significance of the Study to Nursing. 55 Implications for Nursing Education.
56 Implications for Nursing Practice. 57 Implications for Nursing Research. 58 Implications for Health and Public Policy. 59 Scope and Limitations of the Study.
64 CHAPTER TWO: REVIEW OF THE LITERATURE. 67 Birth Tourism and Birthright Citizenship. 76 Studies Addressing Benefits of Birth Tourism. 83 Birth Tourism and Healthcare.
87 Studies Addressing Admissions into Neonatal Intensive Care Units. 108 CHAPTER THREE: METHODS. 110 Sample and Setting. 118 Access and Recruitment of the Sample.
123 Data Collection Procedures. 126 ix Interview Questions. 135 Miles, Huberman, and Saldaña’s Method of Data Analysis. 145 CHAPTER FOUR: FINDINGS OF THE INQUIRY.
148 Characteristics of Participants. 169 Theme: Recognizing Cultural Interaction. 177 Theme: Acknowledging Cultural Consciousness. 182 Theme: Canalizing Compassionate Care.
195 Theme: Bridging Family-Centeredness. 204 Connection to a Theory. 214 CHAPTER FIVE: DISCUSSION AND CONCLUSION OF THE INQUIRY. 216 Exploration of the Meaning of the Study.
216 Interpretive Analysis of the Findings. 220 Theme: Recognizing Cultural Interaction. 220 Theme: Acknowledging Cultural Consciousness. 227 Theme: Canalizing Compassionate Care.
239 Theme: Bridging Family-Centeredness. 250 Connection of Themes to The Process of Cultural Competemility in the Delivery of Healthcare Services Model. 263 x Assumptions of the Model. 265 Constructs of the Model: The Process of Cultural Competemility in the Delivery of Healthcare Services.
266 Significance of the Study. 274 Significance of the Study to Nursing. 275 Implications for Nursing Education. 277 Implications for Nursing Practice.
278 Implications for Nursing Research. 279 Implications for Health and Public Policy. 280 Strengths and Limitations of the Study. 281 Recommendations for Future Study.
287 APPENDIX A: BARRY UNIVERSITY OFFICIAL INSTITUTIONAL REVIEW BOARD APPROVAL LETTER. 312 APPENDIX B: BARRY UNIVERSITY INFORMED CONSENT FORM. 313 APPENDIX C: BARRY UNIVERSITY LETTER OF REQUEST FOR ACCESS. 317 APPENDIX D: BARRY UNIVERSITY FLYER FOR RECRUITMENT OF SAMPLE.
318 APPENDIX E: BARRY UNIVERSITY INTERVIEW QUESTIONS. 319 APPENDIX F: BARRY UNIVERSITY DEMOGRAPHIC QUESTIONNAIRE. 320 APPENDIX G: BARRY UNIVERSITY THIRD-PARTY CONFIDENTIALITY FORM. 321 APPENDIX R: BARRY UNIVERSITY DISSERTATION CORRECTION SHEET 3222 APPENDIX H: BARRY UNIVERSITY VITA.
322 xi LIST OF TABLES Table 1 Demographic Representation of Participants. 150 Table 2 Demographic Representation of Participants by Age Group, Ethnicity, Level of Education and the Number of Years Experienced as a Neonatal Nurse. 152 Table 3 Demographics of Participants by Number of Years as a Neonatal Nurse, Number of Years in Current NICU, Additional Training on Care for the Family, Working in Family-Centered Care Facility, and Policy for Family-Centered Care. 154 xii LIST OF FIGURES Figure 1.
Birthright citizenship around the world year 2018 (LaCroix, 2020, adapted from The CIA World Factbook, 2018). Data analysis flow activities: (Lacroix, 2019 adapted from Miles, Huberman, & Saldaña, 2014). Conceptual representation of the findings of the lived experience of nurses caring for birth tourism families in South Florida’s neonatal intensive care unit (LaCroix, 2020). A kaleidoscope of hope.
The sad emoji (Conceptual representation adopted by Nurse Nancy, 2020). The Process of Cultural Competemility in the Delivery of Healthcare Services Model Copyrighted in 2018 by Campinha-Bacote. Conceptual representation of constructs from Campinha-Bacote’s Model of The Process of Cultural Competemility in the Delivery of Healthcare Services connecting to themes from Funneling Cultural Care for Birth Tourism Families in Family- Centered Neonatal Units (LaCroix, 2021, adapted from Campinha-Bacote, 2018). 26969 xiii 1 CHAPTER ONE PROBLEM AND DOMAIN OF THE INQUIRY Every family who chooses to have children deserves to give birth in the hospital and country of their choice for a beautiful beginning.
South Florida, being a popular gateway for tourism, receives pregnant women who travel from abroad with their expectations of delivering a healthy American baby before immediately returning to their home country (Grant, 2015; Mikhael et al. This group of women practices birth tourism—the act of a pregnant woman traveling internationally to a preferred destination to give birth on foreign soil (Folse, 2015; Grant, 2015). Birth tourism families travel with a birthing plan that often includes the purchase of a maternity care package, the travel to a destination that is offering the best maternity and newborn healthcare, the expectation of delivering a healthy newborn, and a short hospital stay (Folse, 2017; Ji & Bates, 2018). However, at times, some birth tourism families end up admitting their ill or premature newborn into the neonatal intensive care unit (NICU) (Folse, 2015; Grant, 2015; Mikhael et al.
When admitted to the NICU, neonatal nurses provide specialized care to the neonates and are in the best position to integrate their nursing philosophy into the care rendered to all families admitted. Although neonatal nurses rely on theoretical and conceptual models serving as a platform for disseminating nursing care, there remains a gap in the nursing literature regarding the quality of care delivered to birth tourism families (Marcotte, 2017; Mikhael et al. Nursing research is scant on the evidence, from neonatal nurses' perspectives, about the care that birth tourism families receive or on the quality of care rendered to them. Therefore, this hermeneutic 2 phenomenological nursing inquiry utilized the methodology of Max van Manen (1990) to explore the lived experience of neonatal nurses caring for birth tourism families in the context of providing quality nursing care in South Florida's NICUs.
Background of the Study Birth tourism quickly gained media attention in myriads of reports presenting this practice in (a) internet advertisements from travel agencies and maternity hotels in the sale of birth tourism packages, offering the best maternal healthcare in the United States (U.
