Elucidating the context for implementing nonpharmacologic care for neonatal opioid withdrawal syndrome: a qualitative study of perinatal nurses

BMC Pediatrics

Ashley Weber¹  Roxanne Wilson²  Mikayla Morgan³  Katherine VanAntwerp³  Clayton J. Shuman⁴ 

[1] College of Nursing, University of Cincinnati, Cincinnati, OH, USA;Department of Nursing, St. Cloud State University, St. Cloud, MN, USA;St. Cloud Hospital, St. Cloud, MN, USA;School of Nursing, University of Michigan, 400 N. Ingalls, Ste. 4162, Ann Arbor, MI, USA;School of Nursing, University of Michigan, 400 N. Ingalls, Ste. 4162, Ann Arbor, MI, USA;Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA;Center for the Study of Drugs, Alcohol, Smoking, and Health, University of Michigan, Ann Arbor, MI, USA;

关键词: Neonatal abstinence syndrome;    Perinatal substance use;    Maternal engagement;    Nonpharmacologic care;    Neonatal opioid withdrawal syndrome;    Implementation;   

DOI  :  10.1186/s12887-021-02955-y

来源: Springer

【 摘 要 】

BackgroundUp to 95% of neonates exposed to opioids in utero experience neonatal opioid withdrawal syndrome at birth. Nonpharmacologic approaches (e.g., breastfeeding; rooming-in; skin-to-skin care) are evidence-based and should be implemented. These approaches, especially breastfeeding, rely on engagement of the neonates’ mothers to help deliver them. However, little is known about the structural and social dynamic context barriers and facilitators to implementing maternal-delivered nonpharmacologic care.MethodsUsing a qualitative descriptive design, perinatal nurses from a Midwest United States hospital family birthing center, neonatal intensive care unit, and inpatient pediatric unit were interviewed. These units were involved in caring for mothers and neonates affected by opioid use. Telephone interviews followed a semi-structured interview guide developed for this study, were audio-recorded, and lasted about 30–60 min. Interviews were transcribed verbatim and independently analyzed by five investigators using the constant comparative method. Themes were discussed until reaching consensus and subsequently mapped to a conceptual model adapted for this study.ResultsTwenty-one nurses participated in this study (family birth center, n = 9; neonatal intensive care, n = 6; pediatrics, n = 6). Analysis resulted in four major themes: 1) Lack of education and resources provided to staff and mothers; 2) Importance of interdisciplinary and intradisciplinary care coordination; 3) Flexibility in nurse staffing models for neonatal opioid withdrawal syndrome; and 4) Unit architecture and layout affects maternal involvement. Minor themes supported each of the four major themes. All themes mapped to the conceptual model.ConclusionsThis study provides a more comprehensive understanding of the barriers and facilitators affecting implementation of maternal involvement in nonpharmacologic care of newborns with neonatal opioid withdrawal syndrome. Future efforts implementing nonpharmacologic approaches must consider the context factors affecting implementation, including structural and social factors within the units, hospital, and broader community.

【 授权许可】

CC BY