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Concept Analysis Paper

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Concept Analysis Paper

A concept analysis in nursing research is often developed to determine the defining

characteristics of a certain concept that is poorly understood or needs clarification (Foley &

Davis, 2017). In the neonatal intensive care unit kangaroo care is a way mothers can bond with

their baby. The chosen phenomenon of interest, kangaroo care for the extremely preterm infant

of less than twenty-eight weeks gestational age, is a phenomenon that directly relates to the

concept of maternal newborn bonding. Barker et al. (2017) provide evidence supporting the

maternal infant bonding experience in the article “Maternal-Newborn Bonding Concept

Analysis”. The purpose of this paper is to critically examine this article, discuss the concept as it

relates to the chosen POI and to discuss the articles use of Avant and Walker’s (2005) concept

analysis guidelines.

Selecting a Concept

Mother’s bond to their infant through many ways such as speaking, eye contact, and

through skin to skin holding or kangaroo care (Cho et al., 2016). Maternal infant bonding is a

concept that most neonatal nurses and providers understand and advocate for in the NICU.

Although the concept of maternal bonding through kangaroo care is promoted and accepted in

the NICU kangaroo care with the extremely preterm infant is resisted by nurses and providers for

fear of causing harm to the infant (Seidman et al., 2015). The concept analysis by Barker et al.

(2017) describe the concept of maternal newborn bonding as “it relates to the advanced practice

nurse (APN), the patient, and health care” (Barker et al., 2017). The authors provide a better

understanding of the importance of maternal infant bonding by demonstrating that among other

interventions, placing an infant skin to skin promotes this bond by creating a positive

environment for both the mother and the infant (Barker et al., 2017). The authors relate the
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concept to the APN by discussing how important it is for the APN to be aware of the maternal

infant bond and how the APN can influence the infants care plan to support the bond between

mother and infant.

This concept analysis was selected because of the relationship between the concept of

maternal infant bonding and kangaroo care in the NICU. Placing an infant skin to skin as with

kangaroo care the mother can bond with her infant resulting in improved physiological state of

the infant and emotional state of the mother (Boundy et al., 2016). The authors of this concept

analysis point out that touch is an important antecedent in maternal newborn bonding and that

kangaroo care achieves this by placing the infant skin to skin with the mother (Barker et al.,

2017). This is directly related to kangaroo care in the NICU and understanding the importance of

maternal newborn bonding the APN can facilitate and promote kangaroo care for the extremely

preterm infant supporting the chosen POI.

Appraisal of the Concept Analysis

Barker et al. (2017) define the concept of maternal newborn bonding through a concept

analysis using guidelines described by Walker and Avant (2005). The authors thoroughly

described and defined the concept maternal newborn bonding and related it to implications for

the advanced practice nurse, the patient, and health care. All eight steps of Walker and Avant’s

(2019) guideline steps were used in this concept analysis article. There are eight procedures in

developing a concept analysis defined by Walker and Avant (2005). Barker et al (2017) include

all eight procedures in their concept analysis of maternal newborn bonding. The first step is to

choose a concept. Choosing a concept should be done with care and should be something that

does not have the literature to support it or has need of better understanding and clarity (Foley &

Davis, 2017). In the chosen analysis Barker et al (2017) the selection of the concept is clearly
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stated as maternal newborn-bonding. The purpose of this analysis was to define bonding and

explain the importance of the maternal-newborn bond (Barker et al., 2017).

Walker and Avant’s (2005) third procedure is to identify all uses of the concept. Barker et

al (2017) were not able to find the terms maternal-newborn bonding exactly through a literature

search however the term bonding was used to develop the most accurate definition. The authors

primarily focused on the definition of bonding in the literature search and how it related to the

maternal-newborn connection (Barker et al., 2017). The next step in the concept analysis

procedure is defining the attributes, “the heart of the concept analysis”(Walker & Avant, 2005).

Barker et al (2017) identify “affection, association, attachment, and relationship” as the defining

attributes for maternal-newborn bonding. In a similar concept analysis, the authors identified

“cuddling, feelings of happiness, closeness, love, and confidence of the mother in caring for her

child” as the defining attributes for maternal-infant bonding (Hill & Flanagan, 2019). Although

the verbiage is somewhat different theses attributes support the findings by the chosen concept

analysis by Barker et al (2017).

Walker and Avant’s (2005) fifth procedure is to include a model case that is defined as

“an example of the use of the concept that demonstrates all the defining attributes of the

concept”. Walker and Avant’s (2005) next step is to identify additional cases such as borderline,

related, contrary, invented and illegitimate cases. These cases are not always included but are

suggested to help the researcher define the attributes for the concept (Walker & Avant, 2005). In

this concept analysis Barker et al (2017) used a model case which has all the defining attributes

of maternal-newborn bonding, a borderline case that contains most of the defining attributes but

not all of them, and a contrary case that does not contain any of the attributes defining maternal-

newborn bonding. The next step in the process is identifying the antecedents and consequences
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relevant to the concept. Walker and Avant (2005) explain that although antecedents and

consequences are helpful in refining the attributes, the antecedents nor the consequences can be

an attribute. The authors explain further that antecedents are described as something that occurs

prior to the concept and the consequences occur as a result of the concept (Walker & Avant,

2005). In the concept analysis by Barker et al (2017) the antecedents are identified as “birth, two

people, touch, breastfeeding, eye contact, and vocal tone.

Barker et al (2017) describe “security and protection, love, trusting relationship and

prolonged breastfeeding” as the consequences of the concept maternal-newborn bonding. The

last step in the concept analysis procedure is ascertaining empirical referents that identify or

measure the defining characteristics (Walker & Avant, 2005). Empirical referents are “categories

of actual phenomena that by their existence or presence demonstrate the occurrence of the

concept itself” (Walker & Avant, 2005). These empirical referents are important to concept

analysis because they make each concept measurable (Schiller, 2018). In the concept analysis by

Barker et al (2017) the authors identify “affectionate acts including hugging, kissing, skin-to-skin

contact, and breastfeeding” as empirical referents for the concept of maternal-newborn bonding.

The authors used a bonding scale to measure and ascertain the mother’s feelings toward the

infant that consisted of eight questions and recommend that the mother should take it after the

birth of her baby within the first three days (Barker et al., 2017).

Summary of Key Points

Barker et al (2017) sought to define the concept of bonding and the importance of the

maternal-newborn bond regarding the health and development of mother and newborn and the

implications of the maternal-newborn bond as it relates to the advanced practice nurse. The

attributes the authors identified are “affection, association, attachment, and relationship” (Barker
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et al., 2017). The critical attribute the authors identified is attachment. Attachment in the

immediate postpartum period after birth can have lifelong implications for both mother and

infant(Barker et al., 2017) The maternal-newborn bond has a significant influence on the

maternal phycological state and on the infants’ physiological state.

What occurs during the early postpartum period can carry lifelong implications for both mother

and newborn. Therefore, it is important to implement interventions to enhance the bonding

process and overcome barriers that may hinder it from occurring.

Because the concept of transition to motherhood in clinical settings is not well

understood in nursing, this concept analysis will allow nurses and health care providers to gather

information and allow for highest quality of care

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References

Barker, J., Daniels, A., O'Neal, K., & Van Sell, S. L. (2017). Maternal-Newborn Bonding

Concept Analysis. International Journal of Nursing & Clinical Practices, 4(229).

https://doi.org/10.15344/2394-4978/2017/229

Boundy, E. O., Dastjerdi, R., Spiegelman, D., Fawzi, W. W., Missmer, S. A., Lieberman, E.,

Kajeepeta, S., Wall, S., & Chan, G. J. (2016). Kangaroo Mother Care and Neonatal

Outcomes: A Meta-analysis. Pediatrics, 137(1). https://doi.org/10.1542/peds.2015-2238

Cho, E. S., Kim, S. J., Kwon, M. S., Cho, H., Kim, E. H., Jun, E. M., & Lee, S. (2016). The

effects of kangaroo care in the neonatal intensive care unit on the physiological functions

of preterm infants, maternal-infant attachment, and maternal stress.. Journal of Pediatric

Nursing, 31(4), 430–438. https://doi.org/10.1016/j.pedn.2016.02.007

Foley, A. S., & Davis, A. H. (2017). A Guide to Concept Analysis. Clinical Nurse Specialist,

31(2), 70–73. https://doi.org/10.1097/NUR.0000000000000277

Hill, R., & Flanagan, J. (2019). The maternal–infant bond: Clarifying the concept. International

Journal of Nursing Knowledge, 31(1), 14–18. https://doi.org/10.1111/2047-3095.12235

Schiller, C. J. (2018). Teaching concept analysis to graduate nursing students. Nursing Forum,

53(2). https://doi.org/10.1111/nuf.12233

Seidman, G., Unnikrishnan, A., Kenny, E., Myslinski, S., Cairns-Smith, S., Mulligan, B., &

Engmann, C. (2015). Barriers and enablers of Kangaroo Mother Care practice: A

systematic review. PLOS ONE, 10(5). https://doi.org/10.1371/journal.pone.0125643

Walker, L. O., & Avant, K. C. (2005). Strategies for Theory Construction in Nursing (4 ed.).

Pearson Education.
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