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Welborn AC, Nichols T, Gringle M, Lewallen L. Neonatal intensive care nurses' accounts of care for mothers/families with substance-exposed pregnancies: A critical discourse analysis. J Adv Nurs 2024; 80:566-579. [PMID: 37545100 DOI: 10.1111/jan.15807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 07/10/2023] [Accepted: 07/22/2023] [Indexed: 08/08/2023]
Abstract
AIMS To explore the effects of power dynamics and hospital organizational structure upon neonatal intensive care nurses' experiences caring for infants and families from a substance-exposed pregnancy (SEP). DESIGN This secondary data analysis further investigated the results of a primary study after the original analysis suggested differences in work environments may impact relationship-building opportunities between nurses and mothers/families. Critical discourse analysis served as both the theoretical lens and analytic technique. METHOD Nine (9) nurses from the southeast region of the United States (U.S.) were interviewed in 2019. Fifty-one (51) stories of caregiving experiences were analysed with a focus on narratives related to organizational structure and care delivery. RESULTS Study findings revealed nurses experienced challenges providing high-quality, family-centered care for patients in the neonatal intensive care unit (NICU) affected by substances during pregnancy. Nurses described the central challenge of workload, exacerbated by power imbalances and structural constraints within the hospital's organizational structure. Findings suggest workload issues may endorse stigma by inhibiting opportunities to build relationships. Nurses report manageable workloads can support healthcare teams and recipients of care. CONCLUSION The study suggests power imbalances between nurses, families and adjacent healthcare professionals can inhibit the delivery of high-quality care. Supporting healthcare teams and recipients of care while centering the role of organizational structure is critical. Questions emerged about workload demands impacting the potential production of stigma in clinical environments. IMPACT This study examines the intersection of nurses' care experiences and hospital organizational structure. It identifies how the unique needs of caring for infants and families from a SEP increase the complexity of power imbalances and organizational constraints to further increase workload demands. Findings have implications for global healthcare organization leaders who build and maintain the structural integrity of clinical environments and nurse leaders who advocate and guide clinical teams to provide high-quality care in stressful healthcare environments. REPORTING METHOD EQUATOR guidelines were followed, using the COREQ checklist. PATIENT OR PUBLIC CONTRIBUTION NICU nurses were interviewed about their care-provision experiences. Interviews were analysed in the primary study and the current analysis of secondary data.
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Affiliation(s)
- Amber C Welborn
- Department of Nursing, Appalachian State University, Boone, North Carolina, USA
| | - Tracy Nichols
- Department of Public Health Education, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - Meredith Gringle
- Department of Public Health Education, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - Lynne Lewallen
- School of Nursing, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
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Carroll JJ, Cummins ER, Formica SW, Green TC, Bagley SM, Beletsky L, Rosenbloom D, Xuan Z, Walley AY. The police paradox: A qualitative study of post-overdose outreach program implementation through public health-public safety partnerships in Massachusetts. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 120:104160. [PMID: 37597344 DOI: 10.1016/j.drugpo.2023.104160] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 07/27/2023] [Accepted: 08/05/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND Post-overdose outreach has emerged in the United States as an increasingly common response to non-fatal overdose. This qualitative study investigates the implementation of such programs through public health-public safety partnerships in Massachusetts. METHODS We conducted semi-structured interviews with post-overdose outreach team members, overdose survivors, and family members who received outreach. Interview transcripts were inductively analyzed to identify emergent themes and subsequently organized within the framework of Ecological Systems Theory. RESULTS Forty-nine interviews were conducted, including 15 police officers (80% male, 100% non-Hispanic White); 23 public health partners (48% male, 87% non-Hispanic White); 8 overdose survivors who received outreach services and 3 parents of survivors who received services (collectively 27% male, 64% non-Hispanic White). Implementation factors identified across all levels (macrosystem, exosystem, mesosystem, and microsystem) of Ecological Systems Theory included key program facilitators, such as access to police data and funding (macro), interagency collaboration (exo), shared recognition of community needs (exo), supportive relationships among team members (meso), and program champions (micro). Common barriers included inherent contradictions between policing and public health mandates (macro), poor local treatment and service capacity (exo), divergent staff views of program goals (exo), overdose survivors' prior negative experiences with law enforcement (meso), difficulty locating overdose survivors (meso), and police officers' lack of qualifications or training in providing psycho-social services (micro). CONCLUSIONS Most post-overdose outreach programs in this study were dependent on funding and data-sharing partnerships, which police agencies largely controlled. Yet, police participation, especially during outreach visits presented numerous challenges for engaging overdose survivors and establishing non-coercive linkages with evidence-based services, which may undermine the public health goals of these programs. These findings should inform state and federal efforts to expand the role of law enforcement in behavioral health initiatives.
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Affiliation(s)
- Jennifer J Carroll
- Department of Sociology & Anthropology, North Carolina State University, 10 Current Drive, Raleigh, NC 27605, United States; Department of Medicine, Brown University, 222 Richmond St., Providence, RI 02903, United States.
| | - Emily R Cummins
- Ariadne Labs, Harvard T.H. Chan School of Public Health, 405 Park Drive, Boston, MA 02215, United States
| | - Scott W Formica
- Social Science Research and Evaluation, Inc., 84 Mill St., Lincoln, MA 01773, United States
| | - Traci C Green
- The Heller School for Social Policy and Management at Brandeis University, Institute for Behavioral Health, 415 South Street MS 035, Waltham, MA 02453, United States
| | - Sarah M Bagley
- Boston Medical Center and Boston University School of Medicine, Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, 801 Massachusetts Ave, 2nd Floor, Boston, MA 02118, United States
| | - Leo Beletsky
- Northeastern University School of Law, Bouvé College of Health Sciences, and the Action Lab, 416 Huntington Ave, Boston, MA 02115, United States; Health in Justice Action Lab, Northeastern University, 416 Huntington Ave, Boston, MA 02115, United States
| | - David Rosenbloom
- Boston University School of Public Health, Department of Community Health Sciences, Crosstown Building - CT 454, 801 Massachusetts Ave, 4th Floor, Boston, MA 02118, United States
| | - Ziming Xuan
- Boston University School of Public Health, Department of Community Health Sciences, Crosstown Building - CT 454, 801 Massachusetts Ave, 4th Floor, Boston, MA 02118, United States
| | - Alexander Y Walley
- Boston Medical Center and Boston University School of Medicine, Grayken Center for Addiction, Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, 801 Massachusetts Ave, 2nd Floor, Boston, MA 02118, United States
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Developments in Nursing Practice to Address Substance Use in the Perinatal Period. J Obstet Gynecol Neonatal Nurs 2022; 51:361-376. [PMID: 35568096 DOI: 10.1016/j.jogn.2022.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2022] [Indexed: 12/30/2022] Open
Abstract
Since 1972, the year of the inaugural issue of Journal of Obstetric, Gynecologic, & Neonatal Nursing, substance use during pregnancy has remained a public health concern in the United States. This concern is currently exacerbated by factors such as the opioid and stimulant use crisis and widening health and social inequities for many women and families. The purposes of this historical commentary are to describe trends in the perception of women with substance use disorder and their infants and related sociolegal implications and to trace the evolution of related nursing practice and research during the past 50 years. We provide recommendations and priorities for practice and research, including further integration of support for the mother-infant dyad, cross-sectoral collaborations, and equity-oriented practices and policies.
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Schiff DM, Partridge S, Gummadi NH, Gray JR, Stulac S, Costello E, Wachman EM, Jones HE, Greenfield SF, Taveras EM, Bernstein JA. Caring for Families Impacted by Opioid Use: A Qualitative Analysis of Integrated Program Designs. Acad Pediatr 2022; 22:125-136. [PMID: 33901729 PMCID: PMC8542059 DOI: 10.1016/j.acap.2021.04.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 04/13/2021] [Accepted: 04/18/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE We sought to 1) identify models of integrated care that offer medical care and social services for children and families impacted by opioid use disorder (OUD) in the postpartum year; and 2) describe how each program was developed, designed, and sustained, and explore facilitators and barriers to implementation of a dyadic, two-generation approach to care. METHODS In-depth semi-structured interviews (n = 23) were conducted with programs for women and children affected by OUD across North America. Using a phenomenologic approach, key program components and themes were identified. Following thematic saturation, these results were triangulated with experts in program implementation and with a subset of key informants to ensure data integrity. RESULTS Five distinct types of programs were identified that varied in the degree of medical and behavioral care for families. Three themes emerged unique to the provision of dyadic care: 1) families require supportive, frequent visits with a range of providers, but constraints around billable services limit care integration across the perinatal continuum; 2) individual program champions are critical, but degree and reach of interdisciplinary care is limited by siloed systems for medical and behavioral care; and 3) addressing dual, sometimes competing, responsibilities for both parental and infant health following recurrence of parental substance use presents unique challenges. CONCLUSIONS The key components of dyadic care models for families impacted by OUD included prioritizing care coordination, removing barriers to integrating medical and behavioral services, and ensuring the safety of children in homes with ongoing parental substance use while maintaining parental trust.
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Affiliation(s)
- Davida M. Schiff
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, 125 Nashua St, Suite 860, Boston, MA, 02114
| | - Shayla Partridge
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, 125 Nashua St, Suite 860, Boston, MA, 02114
| | - Nina H. Gummadi
- Boston University School of Medicine, 72 E. Concord St, Boston, MA
| | - Jessica R. Gray
- Department of Medicine and Pediatrics, Massachusetts General Hospital, 55 Fruit St, Boston, MA
| | - Sara Stulac
- Boston University School of Medicine, 72 E. Concord St, Boston, MA,Department of Pediatrics, Boston Medical Center, 801 Albany Street, Boston, MA 02119, USA
| | - Eileen Costello
- Boston University School of Medicine, 72 E. Concord St, Boston, MA,Department of Pediatrics, Boston Medical Center, 801 Albany Street, Boston, MA 02119, USA
| | - Elisha M. Wachman
- Department of Pediatrics, Boston Medical Center, 801 Albany Street, Boston, MA 02119, USA
| | - Hendrée E. Jones
- UNC Florizons and Department of Obstetrics and Gynecology, University of North Carolina Chapel Hill, 410 North Greensboro St., Carrboro, NC
| | - Shelly F. Greenfield
- Boston University School of Medicine, 72 E. Concord St, Boston, MA,Division of Women’s Mental Health and Division of Alcohol, Drugs, and Addiction, McLean Hospital, 115 Mill St, Belmont, MA 02478,Harvard Medical School, 25 Shattuck Street, Boston, MA 02115
| | - Elsie M. Taveras
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, 125 Nashua St, Suite 860, Boston, MA, 02114,Boston University School of Medicine, 72 E. Concord St, Boston, MA
| | - Judith A. Bernstein
- Division of Community Health Sciences, Boston University School of Public Health, 715 Albany St, Boston, MA 02118
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Knowledge of and Perceived Competence in Trauma-Informed Care and Attitudes of NICU Nurses Toward Mothers of Newborns With Neonatal Abstinence Syndrome. J Obstet Gynecol Neonatal Nurs 2020; 49:373-387. [PMID: 32553592 DOI: 10.1016/j.jogn.2020.05.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To explore how knowledge of and perceived competence in trauma-informed care inform the attitudes of NICU nurses toward mothers of newborns with neonatal abstinence syndrome (NAS). DESIGN A cross-sectional survey study. SETTING A southern U.S. metropolitan children's hospital with 145 NICU beds. PARTICIPANTS Convenience sample of 150 NICU nurses. METHODS Participants completed an online survey questionnaire adapted from the Attitudes About Drug Abuse in Pregnancy questionnaire and the Trauma-Informed Pediatric Care survey. Participants also responded to one open-ended question about their experiences in working with mothers of newborns with NAS. We used descriptive and inferential statistics and content analysis to analyze the survey data. RESULTS Participants demonstrated low to moderate knowledge about and perceived competence in trauma-informed care and showed more judgmental attitudes toward mothers of newborns with NAS. Level of knowledge about mothers with substance use disorder and perceived competence in trauma-informed care were associated with participants' attitudes toward mothers of newborns with NAS. Emergent themes from qualitative data included the following: Mother-Newborn Dyads Shape Nurses' Judgmental Attitudes, Caring for Mothers of Newborns With NAS Is a Challenging Experience, and Need to Refine Care for Mothers Through Intra- and Interdisciplinary Collaboration. CONCLUSION NICU nurses need further education about mothers of newborns with NAS. Improved knowledge about these women and adaptation of the principles of trauma-informed care may influence NICU nurses' judgmental attitudes toward mothers of newborns with NAS.
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Salameh TN, Hall LA. Depression, Anxiety, and Substance Use Disorders and Treatment Receipt Among Pregnant Women in the United States: A Systematic Review of Trend and Population-Based Studies. Issues Ment Health Nurs 2020; 41:7-23. [PMID: 31855501 DOI: 10.1080/01612840.2019.1667460] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The objective of this systematic review was to synthesize findings of trend and population-based studies on depression, anxiety, and substance use disorders and treatment receipt among pregnant women in the United States. Twenty-eight articles (nine trend studies and 19 population-based studies) were included for review. Two trend studies showed that illicit drug use disorder increased in pregnant women over the past decade, particularly opioid and marijuana use disorders. Three studies reported an increase in treatment admissions for these disorders from 1992 to 2012; however, the overall treatment admission rate for pregnant women remained relatively stable at 4%. Three studies identified an increase in antidepressant use from 1995 to 2010 in pregnant women. Nine of 19 population-based studies revealed that White ethnicity, older reproductive age, college education, and health insurance coverage were associated with mental health and substance use treatment receipt among pregnant women. Further studies are warranted among a nationally representative sample of pregnant women.
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Affiliation(s)
| | - Lynne A Hall
- University of Louisville School of Nursing, Louisville, Kentucky, USA
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Cook CE, Fantasia HC. Interventions for the Treatment of Neonatal Abstinence Syndrome. Nurs Womens Health 2019; 23:357-365. [PMID: 31251931 DOI: 10.1016/j.nwh.2019.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 03/06/2019] [Accepted: 05/01/2019] [Indexed: 06/09/2023]
Abstract
The growing incidence of neonatal abstinence syndrome (NAS) among newborns is a public health crisis that is a sequela of the national opioid crisis. When fetuses are exposed to opioids in utero, whether through prescription pain medication, illicit substances, or supervised medication-assisted opioid treatment, neonates can experience withdrawal symptoms shortly after birth. Opioid withdrawal manifests with symptoms of central nervous system and autonomic nervous system dysfunction. Treatment of NAS begins with nonpharmacologic interventions, and if a neonate requires more intensive treatment, care will escalate to include pharmacologic treatments, including morphine, methadone, and buprenorphine. When pharmacologic therapy begins, nonpharmacologic intervention is not ceased; rather, the two are used in conjunction in an attempt to reduce the amount of medication required for successful treatment. Herein we review nonpharmacologic nursing interventions, discuss the most common pharmacologic treatments for NAS, and present practice implications for nurses who work with childbearing families.
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Whalen BL, Holmes AV, Blythe S. Models of care for neonatal abstinence syndrome: What works? Semin Fetal Neonatal Med 2019; 24:121-132. [PMID: 30926259 DOI: 10.1016/j.siny.2019.01.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Opioid use disorders and the prescription of long-acting medications for their treatment have increased dramatically over the last decade among pregnant women. Newborns who experience prolonged in utero opioid exposure may develop neonatal abstinence syndrome (NAS). Until recently, much of the focus on improving care for NAS has been on pharmacologically-based care models. Recent studies have illustrated the benefits of rooming-in and parental presence on NAS outcomes. Single center Quality Improvement (QI) initiatives demonstrate the benefits of non-pharmacologic care bundles and symptom prioritization in decreasing the proportion of infants pharmacologically treated and length of hospital stay. Little remains known about the impact of these varied cared models on maternal-infant attachment and mental health. In this review article, we will propose an optimal model of care to improve short- and long-term outcomes for newborns, their mothers and families, and perinatal care systems.
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Affiliation(s)
- Bonny L Whalen
- Geisel School of Medicine at Dartmouth, Children's Hospital at Dartmouth-Hitchcock, Dartmouth-Hitchcock Medical Center, DHMC Pediatrics, One Medical Center Dr., Lebanon, NH, 03756, USA.
| | - Alison V Holmes
- Geisel School of Medicine at Dartmouth, Children's Hospital at Dartmouth-Hitchcock, Dartmouth-Hitchcock Medical Center, The Dartmouth Institute, DHMC Pediatrics, One Medical Center Dr, Lebanon, NH, 03756, USA.
| | - Stacy Blythe
- School of Nursing and Midwifery, Western Sydney University, Translational Health Research Institute (THRI), Locked Bag 1797, Western Sydney University, Penrith, NSW, 2751, Australia.
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