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Mattson NM, Ohlendorf JM, Haglund K. Grounded Theory Approach to Understand Self-Management of Opioid Recovery Through Pregnancy and Early Parenting. J Obstet Gynecol Neonatal Nurs 2024; 53:34-45. [PMID: 37778395 DOI: 10.1016/j.jogn.2023.09.001] [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: 05/08/2023] [Revised: 09/02/2023] [Accepted: 09/07/2023] [Indexed: 10/03/2023] Open
Abstract
OBJECTIVE To develop a theory to explain the processes women use to self-manage recovery from opioid use disorder during pregnancy, the postpartum period, and early parenting. DESIGN Constructivist grounded theory approach. PARTICIPANTS Women (N = 16) who gave birth during the past 12 months and used medication for opioid use disorder for recovery through pregnancy and the postpartum period. METHODS We recruited participants through seven medication-assisted treatment clinics in a mid-size Midwestern city and the surrounding suburbs and through online parenting and recovery community groups with national-based memberships. We conducted semistructured, individual audio interviews from November 2020 to July 2021. Interviews continued until we reached theoretical and meaning saturation. We used constant comparative methods during initial and intermediate coding. RESULTS Participants described a central process, Growing as a Healthy Dyad, that included six processes they used to self-manage recovery: Maintaining Vigilance, Performing Self-Care, Putting in the Work of Recovery, Advocating, Navigating Social Support, and Acquiring Skills and Knowledge. These processes were affected by personal and social contextual factors. CONCLUSIONS The grounded theory, Self-Management of Opioid Recovery Through Pregnancy and Early Parenting, can be used to explain the unique processes of self-management by women in opioid recovery and highlights the need for a strengths-based approach to caring for the maternal-infant dyad.
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Schiff DM, Muftu S, MacMillan KDL, Work EC, Hoeppner BB, Greenfield SF, Schwartz L, Chaiyachati B, Wilens TE, Bernstein JA. Mutual Mistrust: The Multilayered Experiences at the Intersection of Healthcare and Early Parenting Among Mothers With Opioid Use Disorder. J Addict Med 2024; 18:55-61. [PMID: 37994464 PMCID: PMC10872799 DOI: 10.1097/adm.0000000000001242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
OBJECTIVE The aim of the study is to explore the early parenting experiences among a cohort of postpartum individuals with opioid use disorder (OUD) both during and after the delivery hospitalization to identify areas of intervention to strengthen bonding and attachment. METHODS Semistructured qualitative interviews with recently pregnant people with OUD assessed parenting needs, supports, and goals in the context of the demands of addiction treatment and early motherhood. Probes explored the relationship between early parenting experiences, addiction, and recovery, as well as enabling factors and barriers to mother-infant bonding. Interviews were completed between 2019 to 2020. A constant comparative methods approach was used for codebook development and analysis. RESULTS Twenty-six women completed interviews a mean of 10.1 months postpartum. Twenty-four women were receiving methadone or buprenorphine treatment at delivery for OUD. Four interrelated themes emerged. Women experienced the following: (1) increased surveillance from healthcare workers who doubted their parenting ability; (2) a desire for a "normal" early parenting experience that was not disrupted by increased medical monitoring and surveillance; (3) complex and intersecting identities of being both a mother and a person in recovery; and (4) the importance of support from and advocacy by clinicians and peers to developing maternal confidence and connection. CONCLUSIONS Interventions are needed to improve the early parenting experiences of opioid-exposed mother-infant dyads, to address the mutual mistrust between health care providers and parents, and to provide additional supports to families. Promotion of positive attachment and parental self-efficacy should be prioritized over increased surveillance and scrutiny to sustain maternal recovery trajectories into early childhood and foster family well-being.
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Affiliation(s)
- Davida M. Schiff
- Division of General Academic Pediatrics, MassGeneral Hospital for Children, 125 Nashua St Suite 860, Boston, Massachusetts, 02114
| | - Serra Muftu
- Division of General Academic Pediatrics, MassGeneral Hospital for Children, 125 Nashua St Suite 860, Boston, Massachusetts, 02114
| | | | - Erin C. Work
- Division of General Academic Pediatrics, MassGeneral Hospital for Children, 125 Nashua St Suite 860, Boston, Massachusetts, 02114
| | - Bettina B. Hoeppner
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit St, Boston, Massachusetts, 02114
| | - Shelly F. Greenfield
- 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
| | - Leah Schwartz
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115
| | - Barbara Chaiyachati
- Department of Pediatrics, Perelman School of Medicine, and Leonard Davis Institute, University of Pennsylvania
- Division of General Pediatrics, PolicyLab and Clinical Futures, Children’s Hospital of Philadelphia
| | - Timothy E. Wilens
- Division of Child and Adolescent Psychiatry, Massachusetts General Hospital, 55 Fruit St, Boston, Massachusetts, 02114
| | - Judith A. Bernstein
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA
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Shore S, Lewis N, Olsen M. Rise in Neonatal Abstinence Syndrome Rate Is Associated with Increase in Buprenorphine Prescription Numbers. South Med J 2023; 116:930-937. [PMID: 38051165 DOI: 10.14423/smj.0000000000001634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
OBJECTIVES Southern Appalachia is a region of the United States that is disproportionately affected by the opioid epidemic and by increasing rates of neonatal abstinence syndrome (NAS). NAS rates increased approximately 400% between 1999 and 2012. Buprenorphine prescriptions written to treat opioid use disorder also increased dramatically. The present study was undertaken to ascertain any relationship between the number of buprenorphine prescriptions compared with NAS rates in southern Appalachia. METHODS A total of 250 southern Appalachian counties across seven states, including all of West Virginia and portions of Virginia, Kentucky, Maryland, North Carolina, Ohio, and Tennessee were identified. A retrospective cohort analysis of these counties was conducted for the years 2005-2018. All of the data were obtained from publicly accessible sources or direct communication with government offices. Measures from each county in southern Appalachia included annual NAS rates, buprenorphine prescription rates, drug-induced death rates, and opioid prescribing rates. Associations among these variables were examined using a generalized linear regression. RESULTS Significant linear associations exist between the rising rate of NAS diagnoses and the rising rate of buprenorphine prescriptions (r = 0.977, R2 = 95.53%, P < 0.001) and between the rising rate of buprenorphine prescriptions and the increase in drug-induced deaths (r = 0.712, R2 = 50.82%, P = 0.031). CONCLUSIONS This is the first report that documents an association between rising NAS rates and increasing buprenorphine prescribing. Between the years 2010 and 2018, the NAS rate in southern Appalachia rose by 335%, and the number of buprenorphine prescriptions rose by 413%. Discussions regarding the current policies for buprenorphine management during pregnancy are warranted. We suggest a reevaluation of buprenorphine prescribing recommendations during pregnancy and further research on establishing the lowest effective buprenorphine dose for each pregnant patient.
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Affiliation(s)
| | - Nicole Lewis
- Department of Medical Education, James H. Quillen College of Medicine
| | - Martin Olsen
- Department of Obstetrics/Gynecology, James H. Quillen College of Medicine, East Tennessee State University, Johnson City
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Morton J, Vignato J, Anbari AB. Stigma Experienced by Perinatal Women with Opioid Dependency in the United States: A Qualitative Meta-Synthesis. West J Nurs Res 2023; 45:843-853. [PMID: 37382361 DOI: 10.1177/01939459231182495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
Stigma is a barrier to accessing care and treatment for perinatal women with pain and opioid dependency, resulting in increased maternal/neonatal morbidity and mortality, prolonged neonatal hospitalizations, and increased healthcare-related costs. This theory-generating qualitative meta-synthesis includes 18 qualitative research reports and describes the stigma-related experiences of perinatal women with opioid dependency. A model emerged consisting of cyclical yet pivotal care points, facilitators/deterrents of stigma, and stigma experiences including infant-associative stigma. Findings of this qualitative meta-synthesis include the following: (a) Perinatal stigma experiences may prevent women from accessing care; (b) Infant-associative stigma may influence the woman to deflect stigma from her infant onto herself; and (c) There is the risk of mothers withdrawing their infants from healthcare to protect from future anticipated stigma. Implications reveal ideal time points to enact healthcare interventions to reduce perinatal stigma experiences and its consequences on maternal/child health and wellness.
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Affiliation(s)
| | | | - Allison B Anbari
- University of Missouri Sinclair School of Nursing, Columbia, Missouri, USA
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Holcomb L, Koob C, Mayo R, Charron E, Dickes L, Sherrill W, Hudson J. "It's a proactive intervention instead of a reactive one": measuring facilitators and barriers regarding readiness to implement a treatment program for infants with neonatal opioid withdrawal syndrome. BMC Health Serv Res 2023; 23:754. [PMID: 37452415 PMCID: PMC10347713 DOI: 10.1186/s12913-023-09734-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 06/22/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Managing Abstinence in Newborns (MAiN) is an evidence-based, cost-saving approach to caring for infants at risk of developing neonatal opioid withdrawal syndrome (NOWS). MAiN provides medication management in combination with education and is being implemented in hospitals across South Carolina (SC). This expansion of MAiN throughout the state includes educational training for providers on managing NOWS symptomology and evaluation support for data collection and analysis. This evaluation assessed the readiness of hospitals to implement MAiN by identifying potential barriers and facilitators to early program adoption. METHODS We used the Consolidated Framework for Implementation Framework (CFIR) to guide the evaluation. As part of the ongoing evaluation of MAiN implementation, brief, structured interviews were conducted with healthcare providers (n = 82) at seven hospitals between 2019 and 2022 to learn more about perceived barriers and facilitators to implementation readiness. Two coders independently reviewed all transcripts and used deductive thematic analysis to code qualitative data using Atlas.ti Web using the established CFIR codebook. RESULTS We identified barriers and facilitators to implementing MAiN in all five CFIR domains. Providers identified MAiN as an evidence-based, patient-centered model with the flexibility to adapt to patients' complex needs. Specific champions, external support, alignment with providers' personal motivation, and an adaptable implementation climate were identified as facilitators for implementation readiness. Barriers included a lack of consistent communication among hospital providers, minimal community resources to support patients and families after discharge, and a lack of provider buy-in early in implementation. CONCLUSIONS Key barriers and facilitators of MAiN implementation readiness were identified at seven participating hospitals throughout SC. Communication, staff and hospital culture and climate, and internal and external resource were all reported as essential to implementation. These findings could inform the MAiN program expansion in hospitals across SC.
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Affiliation(s)
- Leah Holcomb
- Department of Public Health Sciences, 503 Edwards Hall, Clemson University, Clemson, SC, 29634, USA.
| | - Caitlin Koob
- Department of Public Health Sciences, 503 Edwards Hall, Clemson University, Clemson, SC, 29634, USA
| | - Rachel Mayo
- Department of Public Health Sciences, 503 Edwards Hall, Clemson University, Clemson, SC, 29634, USA
| | - Elizabeth Charron
- Department of Health Promotion Sciences, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Schusterman Center, 4444 E 41St St, Tulsa, OK, 74135, USA
| | - Lori Dickes
- Department of Political Science, 2023 Barre Hall, Clemson University, Clemson, SC, 29634, USA
| | - Windsor Sherrill
- Department of Health Promotion Sciences, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Schusterman Center, 4444 E 41St St, Tulsa, OK, 74135, USA
| | - Jennifer Hudson
- Newborn Services, Prisma Health Upstate, 701 Grove Road, Greenville, SC, 29605, USA
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Renbarger KM, Phelps B, Broadstreet A, Abebe S. Factors Associated with Maternal Engagement in Infant Care When Mothers Use Substances. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2023; 4:48-64. [PMID: 36874237 PMCID: PMC9983138 DOI: 10.1089/whr.2022.0082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/03/2023] [Indexed: 02/09/2023]
Abstract
Introduction Mothers who use substances can play a key role in the treatment and care of their infants. However, challenges exist to engaging these mothers in the care of their infant. The purpose of this study was to identify factors associated with maternal engagement in infant care when mothers are experiencing substance use disorders. Materials and Methods A systematic search was conducted using the databases of CINAHL, APA PsycINFO, and PubMed along with a manual search of Google Scholar between the years of 2012 and 2022. Studies were included if they were (1) original qualitative research; (2) published in English; (3) peer reviewed; (4) from the perspective of mothers who use substances or nurses; (5) included descriptions of interactions between mothers who use substances and their infants during postpartum care, and/or in the nursery or neonatal intensive care unit; and (6) conducted in the United States. The studies were assessed for quality and validity using 10 criteria from the Joanne Briggs Institute critical appraisal checklist for qualitative research. Results Findings from 22 qualitative studies were synthesized using a thematic synthesis approach and revealed 3 overarching themes that included 7 descriptive subthemes that identified factors to maternal engagement. The seven descriptive subthemes included: (1) Attitudes Toward Mothers Who Use Substances; (2) Knowledge on Addiction; (3) Complicated Backgrounds; (4) Emotional Experiences; (5) Managing Infant Symptoms; (6) Model of Postpartum Care; and (7) Hospital Routines. Discussion Participants described stigma from nurses, complex backgrounds of mothers who use substances, and postpartum models that influenced mothers' engagement in infants' care. The findings suggest several clinical implications for nurses. Nurses should manage their biases and approach mothers who use substances in a respectful manner, increase their knowledge of issues and care related to addiction in the perinatal period, and promote family-centered approaches to care. Conclusion The findings of 22 qualitative studies described factors associated with maternal engagement in mothers who use substances that were integrated using a thematic synthesis method. Mothers who use substances have complex backgrounds and experience stigma which can negatively impact their engagement with their infants.
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Affiliation(s)
| | - Barbara Phelps
- School of Nursing, Ball State University, Muncie, Indiana, USA
| | | | - Sheila Abebe
- School of Nursing, Ball State University, Muncie, Indiana, USA
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Burduli E, Winquist A, Smith CL, Brooks O, Chiou M, Balsiger D, Shogan M, McPherson SM, Barbosa-Leiker C, Jones HE. Supporting perinatal individuals with opioid use disorder and their newborns experiencing neonatal abstinence syndrome: impressions from patients and healthcare providers. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2022; 48:596-605. [PMID: 36166744 PMCID: PMC9645816 DOI: 10.1080/00952990.2022.2122483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Background: Facilitating maternal-newborn involvement and care is critical for improving outcomes for perinatal individuals receiving opioid agonist therapy (OAT) and newborns experiencing Neonatal Abstinence Syndrome (NAS). Comprehensive education strategies are needed to prepare pregnant individuals receiving OAT for navigating the perinatal period.Objectives: Identify facilitators to successful care of perinatal individuals receiving OAT and newborns experiencing NAS via interviews with perinatal individuals and healthcare providers. The goal of identifying this information is to inform a future educational tool development.Methods: Ten perinatal individuals receiving OAT and ten healthcare providers participated in interviews conducted via phone or video conference using semi-structured, open-ended questions. Data were analyzed separately for the two groups and later merged across samples using a qualitative descriptive content analysis approach to identify themes.Results: Under the overarching theme of empowerment to improve outcomes for perinatal women, four themes arose from perinatal and provider interviews: 1) Preparation for Child Protective Services (CPS) involvement, 2) Healthcare providers shape experience through stigma and support 3) Caring for newborns with NAS, and 4) Managing health and resources during postpartum.Conclusion: Perinatal participants emphasized the importance of self-advocacy while navigating healthcare and social systems. Providers highlighted the importance of communicating expectations to empower patients. Education is needed for pregnant individuals receiving OAT on what to expect during pregnancy and postpartum, as well as for providers to help them optimally support their perinatal patients receiving OAT.
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Affiliation(s)
- Ekaterina Burduli
- College of Nursing, Washington State University, Spokane, WA, USA,Analytics and PsychoPharmacology Laboratory, Washington State University, Spokane, WA, USA,Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA
| | - Anna Winquist
- College of Nursing, Washington State University, Spokane, WA, USA
| | - Crystal Lederhos Smith
- Analytics and PsychoPharmacology Laboratory, Washington State University, Spokane, WA, USA,Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA,Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Olivia Brooks
- College of Nursing, Washington State University, Spokane, WA, USA,Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA
| | - Michelle Chiou
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Danica Balsiger
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Maureen Shogan
- College of Nursing, Washington State University, Spokane, WA, USA
| | - Sterling M. McPherson
- Analytics and PsychoPharmacology Laboratory, Washington State University, Spokane, WA, USA,Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA,Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Celestina Barbosa-Leiker
- College of Nursing, Washington State University, Spokane, WA, USA,Program of Excellence in Addictions Research, Washington State University, Spokane, WA, USA
| | - Hendrée E Jones
- Department of Obstetrics and Gynecology, UNC Horizons, University of North Carolina, Chapel Hill, NC, USA
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8
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Mothers overcoming remorse to care for self and baby: An emerging concept. Int J Nurs Sci 2022; 9:529-532. [PMID: 36285086 PMCID: PMC9587397 DOI: 10.1016/j.ijnss.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/29/2022] [Accepted: 09/13/2022] [Indexed: 11/24/2022] Open
Abstract
Objectives Method Result Conclusion
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9
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Renbarger KM, Trainor KE, Place JM, Broadstreet A. Provider Characteristics Associated with Trust When Caring for Women Experiencing Substance Use Disorders in the Perinatal Period. J Midwifery Womens Health 2022; 67:75-94. [DOI: 10.1111/jmwh.13320] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 10/04/2021] [Accepted: 10/06/2021] [Indexed: 01/19/2023]
Affiliation(s)
| | | | - Jean Marie Place
- Department of Science and Nutrition Ball State University Muncie Indiana
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Shuman CJ, Wilson R, VanAntwerp K, Morgan M, Weber A. Elucidating the context for implementing nonpharmacologic care for neonatal opioid withdrawal syndrome: a qualitative study of perinatal nurses. BMC Pediatr 2021; 21:489. [PMID: 34736443 PMCID: PMC8567648 DOI: 10.1186/s12887-021-02955-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 10/15/2021] [Indexed: 11/24/2022] Open
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.
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Affiliation(s)
- Clayton J Shuman
- 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.
| | - Roxanne Wilson
- Department of Nursing, St. Cloud State University, St. Cloud, MN, USA
- St. Cloud Hospital, St. Cloud, MN, USA
| | - Katherine VanAntwerp
- School of Nursing, University of Michigan, 400 N. Ingalls, Ste. 4162, Ann Arbor, MI, USA
| | - Mikayla Morgan
- School of Nursing, University of Michigan, 400 N. Ingalls, Ste. 4162, Ann Arbor, MI, USA
| | - Ashley Weber
- College of Nursing, University of Cincinnati, Cincinnati, OH, USA
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Cheng F, McMillan C, Morrison A, Berkwitt A, Grossman M. Neonatal Abstinence Syndrome: Management Advances and Therapeutic Approaches. CURRENT ADDICTION REPORTS 2021. [DOI: 10.1007/s40429-021-00387-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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12
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Engaging Mothers to Implement Nonpharmacological Care for Infants With Neonatal Abstinence Syndrome: Perceptions of Perinatal and Pediatric Nurses. Adv Neonatal Care 2020; 20:464-472. [PMID: 33009157 DOI: 10.1097/anc.0000000000000812] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Little is known about nurse perceptions regarding engagement of mothers in implementation of nonpharmacological care for opioid-exposed infants. PURPOSE This study was designed to describe perinatal and pediatric nurse perceptions of (1) engaging mothers in the care of opioid-exposed infants and (2) facilitators and barriers to maternal engagement. METHODS This study used a qualitative descriptive design to interview perinatal and pediatric nurses in one Midwest United States hospital. Interviews were conducted via telephone using a semistructured interview guide and audio recorded. Audio files were transcribed verbatim and thematically analyzed using the constant comparative method. RESULTS Twenty-one nurses participated in the study, representing a family birth center, neonatal intensive care unit, and pediatric unit. Five major themes resulted from analysis: (1) vulnerability and bias; (2) mother-infant care: tasks versus model of care; (3) maternal factors affecting engagement and implementation; (4) nurse factors affecting engagement and implementation; and (5) recommendations and examples of nursing approaches to barriers. Minor themes supported each of the major themes. IMPLICATIONS FOR PRACTICE Nurses must engage mothers with substance use histories with empathy and nonjudgment, identify and promote maternal agency to care for their infants, and engage and activate mothers to deliver nonpharmacological care during the hospital stay and following discharge. IMPLICATIONS FOR RESEARCH Findings suggest interventions are needed to improve (1) nursing education regarding maternal substance use and recovery, (2) empathy for substance-using mothers and mothers in treatment, and (3) identification and support of maternal agency to provide nonpharmacological care to withdrawing infants.
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13
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Goyal NK, McAllister J. Hospital Care of Opioid-Exposed Newborns: Clinical and Psychosocial Challenges. J Hosp Med 2020; 15:613-618. [PMID: 32118559 DOI: 10.12788/jhm.3369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 12/06/2019] [Indexed: 11/20/2022]
Abstract
In the past two decades, the incidence of neonatal abstinence syndrome (NAS) has risen fivefold, mirroring the rise of opioid use disorder (OUD) among pregnant women. The resulting increases in length of stay and neonatal intensive care utilization are associated with higher hospital costs, particularly among Medicaid-financed deliveries. Pregnant women with OUD require comprehensive medical and psychosocial evaluation and management; this combined with medication-assisted treatment is critical to optimize maternal and newborn outcomes. Multidisciplinary collaboration and standardized approaches to screening for intrauterine opioid exposure, evaluation and treatment of NAS, and discharge planning are important for clinical outcomes and may improve maternal experience of care.
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Affiliation(s)
- Neera K Goyal
- Department of Pediatrics, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania
- Nemours/AI duPont Hospital for Children, Wilmington, Delaware
| | - Jennifer McAllister
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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14
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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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