Learning Objective #1: know how Thai mothers develop maternal attachment to the preterm infant during hospitalization in the NICU.

Learning Objective #2: use the research findings in clinical practice, nursing education, and further research.

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Hospitalization of preterm infants in the neonatal intensive care unit (NICU) is a crisis for mothers in developing an attachment process. The purpose of this grounded theory study was to explore how mothers in Thailand develop maternal attachment to infants born preterm and requiring NICU hospitalization. Fifteen Thai mothers whose preterm infants had birth weights less than 1,500g, without congenital anomalies, and experiencing mechanical ventilation were interviewed and audiotaped. Four mother-preterm infant dyad interactions were observed and videotaped. The audiotape and videotape were transcribed for analysis. Textual data were analyzed through the constant comparative method. Findings indicate the basic social process of maternal attachment was “Struggling to Get Connected” through the crisis circumstance of preterm birth, composed of 4 phases of establishing the connections, disrupting of the connections, resuming to get connected, and becoming connected. The movement of actions/interactions of maternal attachment to the preterm infant in each phase depended on having concern for the baby, adjusting emotionally to the crisis, supporting connections, life experience, and health care system facilitating. Discussion includes the cultural context. Understanding this process is of value in clinical practice and nursing education. Future direction of qualitative and quantitative investigation is recommended.