Process and Outcome Disparities in NICUs: A Grounded-Theory Study

<p><strong>Purpose:</strong> This dissertation explored the process of care within neonatal intensive care units (NICUs) that may be impacting neonatal health outcomes, as perceived by NICU registered nurses (RNs).</p> <p><strong>Background:</strong> NICUs are one of healthcare’s most demanding environments. Persistent neonatal outcome disparities exist in birthweight, mortality, and care quality. Recent studies highlight internal factors—staffing, workflows, policies—and external factors—social determinants of health, prenatal health—influencing neonatal outcome disparities.</p> <p><strong>Methods:</strong> A constructivist grounded theory design was used to explore the complex processes and relationships within NICU settings. This inductive approach used constant comparative analysis through initial, focused, and theoretical coding. Iterative coding, theoretical sampling, and member checking refined emerging concepts.</p> <p><strong>Findings:</strong> Eleven active NICU RNs were interviewed individually until saturation was achieved. Initial and focused coding was performed. Theoretical coding yielded three codes: shaping perinatal influences on neonatal outcomes, performing relational-technical caring for neonates, and guiding neonates along the struggling–to–thriving continuum. The core category, <em>navigating NICU caring dynamics</em>, emerged to explain how participants believed the process of care within NICUs may be affecting neonatal health outcomes. Navigating NICU caring dynamics represented the grounded theory of this study.</p> <p><strong>Significance of Study:</strong> Navigating NICU caring dynamics integrates relational, technical, and ethical care to address inequities in neonatal practice. It informs nursing education, theory, practice, and policy by promoting adaptive, compassionate, and evidence-based care while guiding future research on equity-centered clinical processes.</p>

Name thesis:degree_name

PhD Nursing

Level thesis:degree_level

Dissertation: USD Users Only

Discipline thesis:degree_discipline

Nursing

Year dc:date.available

2026

Author dc:creator

• Smith, Jason W

• racism
• structural racism
• health equity
• neonatal outcomes
• NICU
• Civil Rights and Discrimination
• Ethnic Studies
• European History
• Health Law and Policy
• Law and Race
• Legal Theory
• Maternal, Child Health and Neonatal Nursing
• Public Health and Community Nursing

Repository record dc:identifier

https://digital.sandiego.edu/dissertations/1089

OAI identifier oai:identifier

oai:digital.sandiego.edu:dissertations-2101