Top

BMC Pediatrics

Published in:

01-12-2021 | Opioids | Research

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

Authors: Clayton J. Shuman, Roxanne Wilson, Katherine VanAntwerp, Mikayla Morgan, Ashley Weber

Published in: BMC Pediatrics | Issue 1/2021

Abstract

Background

Up 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.

Methods

Using 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.

Results

Twenty-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.

Conclusions

This 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.

Available only for authorised users

Centers for Disease Control and Prevention. Understanding the Epidemic. 2020. https://www.cdc.gov/drugoverdose/epidemic/index.html. Accessed 30 July 2020.

Tolia VN, Patrick SW, Bennett MM, Murthy K, Sousa J, Smith B, et al. Increasing incidence of the neonatal abstinence syndrome in U.S. neonatal ICUs. N Engl J Med. 2015;372(22):2118–26. https://doi.org/10.1056/NEJMsa1500439.CrossRefPubMed

McQueen K, Murphy-Oikonen J. Neonatal abstinence syndrome. N Engl J Med. 2016;375:2468–79. https://doi.org/10.1056/NEJMra1600879.CrossRefPubMed

Ryan G, Dooley J, Finn LG, Kelly L. Nonpharmacological management of neonatal abstinence syndrome: a review of the literature. J Matern Fetal Neonatal Med. 2019;32(10):1735–40. https://doi.org/10.1080/14767058.2017.1414180.CrossRefPubMed

Finnegan LP, Hagan T, Kaltenbach KA. Scientific foundation of clinical practice: opiate use in pregnant women. Bull N Y Acad Med. 1991;67(3):223–39.PubMedPubMedCentral

Raffaeli G, Cavallaro G, Allegaert K, Wildschut EED, Fumagalli M, Agosti M, et al. Neonatal abstinence syndrome: update on diagnostic and therapeutic strategies. Pharmacotherapy. 2017;37(7):814–23. https://doi.org/10.1002/phar.1954.CrossRefPubMed

Grisham LM, Stephen MM, Coykendall MR, Kane MF, Maurer JA, Bader MY. Eat, sleep, console approach: a family-centered model for the treatment of neonatal abstinence syndrome. Adv Neonatal Care. 2019;19(2):138–44. https://doi.org/10.1097/ANC.0000000000000581.CrossRefPubMed

Holmes AV, Atwood EC, Whalen B, et al. Rooming-in to treat neonatal abstinence syndrome: improved family-centered care at lower cost. Pediatrics. 2016;137(6):e20152929. https://doi.org/10.1542/peds.2015-2929.CrossRefPubMed

Abrahams RR, Kelly SA, Payne S, Thiessen PN, Mackintosh J, Janssen PA. Rooming-in compared with standard care for newborns of mothers using methadone or heroin. Can Fam Physician. 2007;53(10):1722–30.PubMedPubMedCentral

10.

Hünseler C, Brückle M, Roth B, Kribs A. Neonatal opiate withdrawal and rooming-in: a retrospective analysis of a single center experience. Klin Padiatr. 2013;225(5):247–51. https://doi.org/10.1055/s-0033-1347190.CrossRefPubMed

11.

Saiki T, Lee S, Hannam S, Greenough A. Neonatal abstinence syndrome--postnatal ward versus neonatal unit management. Eur J Pediatr. 2010;169(1):95–8. https://doi.org/10.1007/s00431-009-0994-0.CrossRefPubMed

12.

Holmes AP, Schmidlin HN, Kurzum EN. Breastfeeding considerations for mothers of infants with neonatal abstinence syndrome. Pharmacotherapy. 2017;37(7):861–9. https://doi.org/10.1002/phar.1944.CrossRefPubMed

13.

Casper T, Arbour M. Evidence-based nurse-driven interventions for the care of newborns with neonatal abstinence syndrome. Adv Neonatal Care. 2014;14(6):376–80. https://doi.org/10.1097/ANC.0000000000000118.CrossRefPubMed

14.

Kondili E, Duryea DG. The role of mother-infant bond in neonatal abstinence syndrome (NAS) management. Arch Psychiatr Nurs. 2019;33(3):267–74. https://doi.org/10.1016/j.apnu.2019.02.003.CrossRefPubMed

15.

Shuman CJ, Weber A, VanAntwerp K, Wilson R. Engaging mothers to implement nonpharmacological care for infants with neonatal abstinence syndrome: perceptions of perinatal and pediatric nurses. Adv Neonatal Care. 2020;20(6):464–72. https://doi.org/10.1097/ANC.0000000000000812.CrossRefPubMedPubMedCentral

16.

Rockefeller K, Macken LC, Craig A. Trying to do what is best: a qualitative study of maternal–infant bonding and neonatal abstinence syndrome. Adv Neonatal Care. 2019;19(5):E3–E15. https://doi.org/10.1097/ANC.0000000000000616.CrossRefPubMedPubMedCentral

17.

Maguire D, Webb M, Passmore D, Cline G. NICU nursesʼ lived experience: caring for infants with neonatal abstinence syndrome. Adv Neonatal Care. 2012;12(5):281–5. https://doi.org/10.1097/ANC.0b013e3182677bc1.CrossRefPubMed

18.

Atwood EC, Sollender G, Hsu E, Arsnow C, Flanagan V, Celenza J, et al. A qualitative study of family experience with hospitalization for neonatal abstinence syndrome. Hosp Pediatr. 2016;6(10):626–32. https://doi.org/10.1542/hpeds.2016-0024.CrossRefPubMed

19.

Shuman CJ, Liu X, Aebersold ML, Tschannen D, Banaszak-Holl J, Titler MG. Associations among unit leadership and unit climates for implementation in acute care: a cross-sectional study. Implement Sci. 2018;13(1):62. https://doi.org/10.1186/s13012-018-0753-6.CrossRefPubMedPubMedCentral

20.

Novick G. Is there a bias against telephone interviews in qualitative research? Res Nurs Health. 2008;31(4):391–8. https://doi.org/10.1002/nur.20259.CrossRefPubMedPubMedCentral

21.

Sturges JE, Hanrahan KJ. Comparing telephone and face-to-face qualitative interviewing: a research note. Qual Res. 2004;4(1):107–18.CrossRef

22.

Trier-Bieniek A. Framing the telephone interview as a participant-centred tool for qualitative research: a methodological discussion. Qual Res. 2012;12(6):630–44.CrossRef

23.

Cachia M, Millward L. The telephone medium and semi-structured interviews: a complementary fit. Qual Res Org Manage. 2011;6(3):265–77.CrossRef

24.

Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci. 2009;4(1):50. https://doi.org/10.1186/1748-5908-4-50.CrossRefPubMedPubMedCentral

25.

Glaser BG, Strauss AL. Discovery of grounded theory: strategies for qualitative research. New York: Routledge; 2017.

26.

Jaye C. Doing qualitative research in general practice: methodological utility in engagement. Fam Pract. 2002;19(5):557–62.CrossRefPubMed

27.

Spehr MK, Coddington J, Ahmed AH, Jones E. Parental opioid abuse: barriers to care, policy, and implications for primary care pediatric providers. J Pediatr Health Care. 2017;31(6):695–702.CrossRefPubMed

28.

Warren JI, McLaughlin M, Bardsley J, Eich J, Esche CA, Kropkowski L, et al. The strengths and challenges of implementing EBP in healthcare systems. Worldviews Evid-Based Nurs. 2016;13(1):15–24. https://doi.org/10.1111/wvn.12149.CrossRefPubMed

29.

Yoo JY, Kim JH, Kim JS, Kim HL, Ki JS. Clinical nurses' beliefs, knowledge, organizational readiness and level of implementation of evidence-based practice: The first step to creating an evidence-based practice culture. PLoS One. 2019;14(12):e0226742. https://doi.org/10.1371/journal.pone.0226742.CrossRefPubMedPubMedCentral

30.

Doede M, Trinkoff AM, Gurses AP. Neonatal intensive care unit layout and nurses' work. HERD. 2018;11(1):101–18. https://doi.org/10.1177/1937586717713734.CrossRefPubMed

31.

Bosch S, Bledsoe T, Jenzarli A. Staff perceptions before and after adding single-family rooms in the NICU. HERD. 2012;5(4):64–75. https://doi.org/10.1177/193758671200500406.CrossRefPubMed

32.

O'Callaghan N, Dee A, Philip RK. Evidence-based design for neonatal units: A systematic review. Matern Health Neonatol Perinatol. 2019;5:6. https://doi.org/10.1186/s40748-019-0101-0.CrossRefPubMedPubMedCentral

33.

Ramm K, Mannix T, Parry Y, Gaffney MP. A comparison of sound levels in open plan versus pods in a neonatal intensive care unit. HERD. 2017;10(3):30–9. https://doi.org/10.1177/1937586716668636.CrossRefPubMed

34.

Feeley N, Robins S, Genest C, Stremler R, Zelkowitz P, Charbonneau L. A comparative study of mothers of infants hospitalized in an open ward neonatal intensive care unit and a combined pod and single-family room design. BMC Pediatr. 2020;20(1):38. https://doi.org/10.1186/s12887-020-1929-1.CrossRefPubMedPubMedCentral

Title: Elucidating the context for implementing nonpharmacologic care for neonatal opioid withdrawal syndrome: a qualitative study of perinatal nurses
Authors: Clayton J. Shuman
Roxanne Wilson
Katherine VanAntwerp
Mikayla Morgan
Ashley Weber
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Opioids
Opioids
Care
Published in: BMC Pediatrics / Issue 1/2021
Electronic ISSN: 1471-2431
DOI: https://doi.org/10.1186/s12887-021-02955-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2021

Anemia among children living with HIV/AIDS on HAART in Mekelle Hospital, Tigray regional state of northern ethiopia – a cross-sectional study

Growth and tolerance of healthy, term infants fed lower protein extensively hydrolyzed or amino acid-based formula: double-blind, randomized, controlled trial

Determinants of the type of health care sought for symptoms of Acute respiratory infection in children: analysis of Ghana demographic and health surveys

Cortisol concentration affects fat and muscle mass among Polish children aged 6–13 years

Testing positive pressure delivered from commercial and WHO-style pediatric bubble CPAP devices

Neonatal rebound hyperkalemia associated with ritodrine alone: a case report