title: Barriers and facilitators to implementing the Baby-Friendly hospital initiative in neonatal intensive care units.
abstract: OBJECTIVE
  To explore manager, educator, and clinical leader perceptions of barriers and facilitators to implementing Baby-Friendly practice in the neonatal intensive care unit (NICU).
  
  
  METHODS
  Qualitative, descriptive design.
  
  
  METHODS
  Two university-affiliated level-III NICUs in Canada.
  
  
  METHODS
  A purposive sample of 10 medical and nursing managers, nurse educators, lactation consultants, and neonatal nurse practitioners.
  
  
  METHODS
  In-depth, semistructured interviews transcribed and analyzed using qualitative content analysis.
  
  
  RESULTS
  Participants valued breastfeeding and family-centered care yet identified numerous contextual barriers to Baby-Friendly care including infant health status, parent/infant separation, staff workloads and work patterns, gaps in staff knowledge and skills, and lack of continuity of breastfeeding support. Facilitators included breastfeeding education, breastfeeding champions, and interprofessional collaboration.
  
  
  CONCLUSIONS
  Despite identifying numerous barriers, participants recognized the potential value of expanding the Baby-Friendly Hospital Initiative (BFHI) to the NICU setting. Recommendations include promoting BFHI as a facilitator of family-centered care, interdisciplinary staff education, increasing access to lactation consultants, and establishing a group of NICU champions dedicated to BFHI implementation.
authors.forename: Britney
authors.initials: B
authors.lastname: Benoit
authors.forename: Sonia
authors.initials: S
authors.lastname: Semenic
mesh_terms: D001942:Breast Feeding / Q000379:methods*; D002170:Canada; D004777:Environment; D004779:Environment Design; D022143:Family Nursing / Q000458:organization & administration*; D005260:Female; D006272:Health Facility Environment / Q000458:organization & administration*; D006785:Hospitals, University; D006801:Humans; D007224:Infant Care / Q000458:organization & administration*; D007229:Infant Welfare; D007231:Infant, Newborn; D015931:Intensive Care, Neonatal / Q000458:organization & administration*; D007400:Interprofessional Relations; D007407:Interviews as Topic; D008297:Male; D009034:Mother-Child Relations; D024802:Nurse's Role; D016134:Organizational Policy; D010348:Patient Care Team / Q000458:organization & administration*; D036301:Qualitative Research
keywords: BFHI; Baby-Friendly Hospital Initiative; NICU; barriers; breastfeeding; facilitators; implementation; neonatal intensive care unit