Mothers in the NICU: Outsider to Partner
The emerging care delivery model for Neonatal Intensive Care Units (NICU) is family-focused, developmentally supportive care. The purpose of this study was to explore and describe mothers' experience of becoming a mother while their infants were receiving care in the NICU.

A qualitative research design was used. Interviews with 15 mothers whose infants were in a Level III NICU were analyzed using Spradley's domain analysis approach. Mothers developed from outsider to engaged parent along four continua: 1) focus: from NICU to baby; 2) ownership: from their baby to my baby; 3) caregiving: from passive to active; and 4) voice: from silence to advocacy. Mothers entered the continua at different points and moved at different rates toward "engaged parenting." The final stage, partnering, required active participation of nurses. Mothers' development evolved in predictable patterns. The results of this study can be considered in implementation and evaluation plans for NICUs moving to family- focused developmental care.

Mothers of infants who require special care begin their experience of parenthood in the unfamiliar and intimidating environment of the Neonatal Intensive Care Unit (NICU). The emerging care delivery model for NICUs is family-focused, developmentally supportive care, a model with an excellent research base (Als & Gilkerson, 1995; Als et al., 1986; Als et al., 1994; Becker, Brazy, & Grunwald, 1997; Lawhon, 1997; Ludington-Hoe & Swinth, 1996; McGrath & Conliffe-Torres, 1996). Al's synactive theory of infant development provides the framework for detailed observations of behaviors and enables professionals to individualize caregiving to facilitate neurobehaviorial development (Als & Gilkerson, 1995). Within the technological environment of the NICU, handling, positioning, and pacing of caregiving are guided by observations of five infant systems (autonomic, physiologic, motor, state organizational, attentive- interactive, and self-regulatory) (Aucott, Donohue, Atkins, & Allen, 2002). A developmentally supportive environment includes helping parents become competent in understanding their infant's capabilities and behaviors based on the infant's neurobehavioral functioning. This supports parents' participation in caregiving and promotes positive parent-infant interaction and infant development (Lawhon, 2002). The change to this model requires caregivers to think and act in ways that are often contrary to long-held practices (Heermann & Wilson, 2000; Premji & Chapman, 1997).

The emphasis within family-focused developmental care is the infant's developmental trajectory including interventions to promote parenting within the framework. Do mothers have a developmental sequence as well that should be acknowledged and considered as nurses make the transition to this model of care? The voice of mothers provides an additional perspective in the process of modifying and refining care practices. The purpose of this qualitative study was to explore and describe mothers' experience of becoming a mother while their infants were receiving care in the NICU.