Emotional dimensions of nurses' daily work in newborn units in Kenya: a qualitative study.

BACKGROUND: The importance of developing and supporting emotional well-being among all frontline health system staff, including those in leadership positions, is increasingly recognized as essential to health system resilience and patient outcomes. Nurses working in many public sector newborn units in sub-Saharan Africa work in highly stressful environments; often asked to perform what has been described as 'an impossible task' of meeting international standards of nursing in significantly under-resourced environments. This paper focuses on the emotional dimensions of nurses' daily work in newborn units in Kenya. These dimensions of newborn nurses' work are rarely documented and are under-supported in policy and practice. METHODS: We conducted an empirical qualitative study design in two public hospital newborn units in Kenya. Methods included observations of nurses in their workplaces, individual in-depth interviews with 21 health workers (mostly nurses), and reviews of self-administered questionnaires submitted to us by these staff. Data were analyzed using a thematic analysis approach. RESULTS: Neonatal nurses reported emotions ranging from pride and satisfaction to devastation, heartache, and indifference, with handling infant deaths and communicating bad news to families particularly distressing. Influenced by individual, interpersonal, and structural factors, emotions play a central role in nurses' interactions with their peers, supervisors, ward-in charges, and parents. Interactions with supervisors and in-charges have a an especially powerful impact on staff emotional well-being and team cohesion, and informal support from peers is a key coping strategy. CONCLUSION: We draw on our data, the wider literature, and nurses' recommendations to reflect on the interplay between emotional well-being and ethical nursing practice, and to make suggestions for ongoing health system strengthening efforts.