Modifying a Family Centered Neonatal Abstinence Syndrome Care Program for Mothers and Infants
Background: Opioid use and misuse remain a significant Public Health issue whose effects have extended to pregnant women and infants.1 Opioid use during pregnancy has paralleled the growing national trend over the past decade. The increasing prevalence of opioid use disorder (OUD) reported at delivery has led to increasing rates of newborn infants experiencing a Neonatal Abstinence Syndrome (NAS) diagnosis, due to in-utero opioid exposure.2 The U.S. NAS newborn hospitalization rate increased from 2.9 to 7.3 per 1,000 from 2009 to 2017. Arizona’s increased from 1.7 to 7.9 per 1,000 from 2009 to 2017.3 OUD in pregnancy and NAS are complex maternal and child health (MCH) issues affecting the life course and health outcomes of mothers and infants. Research shows new, family centered care models using non-pharmacological treatment as first line clinical management for infant opioid withdrawal in neonatal intensive care units (NICUs).4 These approaches empower mothers to manage their infant's needs, increase mother/infant bonding, and improve the likelihood of discharge home together. Short term outcomes demonstrate a reduced length of hospital stay and reduced need for traditional pharmacological intervention.5 These outcomes demonstrate some effectiveness, yet research gaps for best practices for NAS management persist. In June 2017, Banner Hospital, Tucson, implemented a family centered NAS care model where mothers room in and learn non-pharmacological strategies to help their infants through withdrawal. The program also has a Neurodevelopmental Follow Up Clinic (NDFC) to monitor infants up to age three. The purpose of the dissertation project was to partner with Banner NICU and assist them in modifying their Family-Centered NAS Care Program to improve the management of infants with NAS and mothers with OUD. Methods: A mixed-methods approach was used to identify staff priorities to fill knowledge gaps related to working with mothers with OUD and caring for infants with NAS. Qualitative methods included semi-structured, in-depth interviews with NICU staff (n=12) and (n=2) mothers who participated in the NICU program. Quantitative methods included an online staff survey (n=21). Data analysis informed development of field-based deliverables for the community partner. Results: Data analysis revealed the top three priorities for staff education; 1.) Long-term effects of NAS on infants, 2.) Trauma Informed Care (TIC) approaches and 3.) Medication Assisted Treatment (MAT) for mothers with OUD. The top three parent education priorities were 1.) Understanding NAS and infant withdrawal, 2.) Calming and soothing techniques, and 3.) Safe sleep practices for mom and baby. Field-based deliverables included 1.) an interactive online nursing education course via the Western Region Public Health Training Center platform eligible for continuing education credit, 2.) parent education videos, 3.) paper supplement to videos, 4.) executive summary results that identified potential program gaps and assets related to NDFC. Discussion: Banner Tucson’s program model provides supportive care for mothers to be the first line of care for their infants with NAS using non-pharmacological approaches. The staff education priorities align with best practices for improving nursing education for NAS management and may increase staff knowledge related to caring for infants with NAS and working with mothers with OUD in hospital settings. The parent education topics contribute to emerging evidence of families’ desire to be more involved in their infant’s care and to receive better communication and have the potential to reinforce bedside teaching and increase confidence in managing infant needs in the hospital and post-discharge home.
Networked Digital Library of Theses and Dissertations