The Complexities Associated with Caring for Hospitalised Infants with Neonatal Abstinence Syndrome: The Perspectives of Nurses and Midwives

The global incidence of Neonatal Abstinence Syndrome (NAS) has increased significantly in the last decade. Symptoms of NAS manifest from the central and autonomic nervous systems as well as the gastrointestinal system and vary in severity and duration. The clinical management of infants experiencing NAS is dependent on symptoms and may include both pharmacological and non-pharmacological measures. In cases where symptoms are severe, infants may be admitted to special care nurseries or neonatal intensive care units. Existing research on nurses’ involvement in caring for infants with NAS focuses on pharmacological and non-pharmacological interventions to treat physical symptoms associated with NAS. This research sought to add to the body of knowledge around NAS and conveys nurses’ and midwives’ experiences of delivering care for infants with NAS. Semi-structured interviews were held with nine nurses/midwives. Interviews were audio-recorded, transcribed verbatim and thematically analysed. Five themes emerged from the data. These themes are: Complex care needs; Prioritising physiological care; Experiencing compassion fatigue; Lacking continuity of care; and Stigma. The findings demonstrated the complex nature of care provision for infants with NAS. Competing priorities and the stigmatising nature of NAS threaten optimal care being delivered to these vulnerable infants and their parents.

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Compassion Fatigue, Burnout, and Neonatal Abstinence Syndrome

Neonatal Network The Journal of Neonatal Nursing ◽

10.1891/0730-0832.36.1.7 ◽

2017 ◽

Vol 36 (1) ◽

pp. 7-11 ◽

Cited By ~ 9

Author(s):

Erin Sweigart

Keyword(s):

Compassion Fatigue ◽

Emotional Exhaustion ◽

Self Care ◽

Neonatal Abstinence Syndrome ◽

Abstinence Syndrome ◽

Care Needs

AbstractNICU nurses have seen a dramatic increase in cases of neonatal abstinence syndrome (NAS). The care needs of infants with NAS are highly demanding and can lead to feelings of frustration and emotional exhaustion among NICU nurses. Although studies have examined the experiences of nurses caring for NAS patients, none have specifically addressed the risk for compassion fatigue and burnout. Nurses need practical strategies to reduce their risk for compassion fatigue and burnout when caring for these patients. Improved education and implementation of self-care measures can help nurses more effectively manage stress and positively impact care of these infants and their families.

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Hospital patients’ perspectives on what is essential to enable optimal palliative care: A qualitative study

Palliative Medicine ◽

10.1177/0269216320947570 ◽

2020 ◽

Vol 34 (10) ◽

pp. 1402-1415 ◽

Cited By ~ 2

Author(s):

Claudia Virdun ◽

Tim Luckett ◽

Karl Lorenz ◽

Patricia M Davidson ◽

Jane Phillips

Keyword(s):

Palliative Care ◽

Qualitative Study ◽

Family Involvement ◽

Inpatient Care ◽

Sense Of Self ◽

The Body ◽

Structured Interviews ◽

Care Needs ◽

Number Of Patients ◽

Palliative Care Needs

Background: The majority of expected deaths in high income countries occur in hospital where optimal palliative care cannot be assured. In addition, a large number of patients with palliative care needs receive inpatient care in their last year of life. International research has identified domains of inpatient care that patients and carers perceive to be important, but concrete examples of how these might be operationalised are scarce, and few studies conducted in the southern hemisphere. Aim: To seek the perspectives of Australian patients living with palliative care needs about their recent hospitalisation experiences to determine the relevance of domains noted internationally to be important for optimal inpatient palliative care and how these can be operationalised. Design: An exploratory qualitative study using semi-structured interviews. Setting/participants: Participants were recruited through five hospitals in New South Wales, Australia. Results: Twenty-one participants took part. Results confirmed and added depth of understanding to domains previously identified as important for optimal hospital palliative care, including: Effective communication and shared decision making; Expert care; Adequate environment for care; Family involvement in care provision; Financial affairs; Maintenance of sense of self/identity; Minimising burden; Respectful and compassionate care; Trust and confidence in clinicians and Maintenance of patient safety. Two additional domains were noted to be important: Nutritional needs; and Access to medical and nursing specialists. Conclusions: Taking a person-centred focus has provided a deeper understanding of how to strengthen inpatient palliative care practices. Future work is needed to translate the body of evidence on patient priorities into policy reforms and practice points.

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Symptom monitoring and the uncertain threat of disease recurrence: A deductive thematic analysis with adolescent and young adult (AYA) cancer survivors.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.31_suppl.147 ◽

2019 ◽

Vol 37 (31_suppl) ◽

pp. 147-147

Author(s):

Lauren C Heathcote ◽

Nele Loecher ◽

Sheri L. Spunt ◽

Pamela Simon ◽

Gary Dahl ◽

...

Keyword(s):

Cancer Survivors ◽

Thematic Analysis ◽

Cancer Survival ◽

Physical Symptoms ◽

The Body ◽

Adolescent And Young Adult ◽

Structured Interviews ◽

Cancer Symptoms ◽

Symptom Monitoring ◽

Bodily Sensations

147 Background: Symptom monitoring plays an important role in both the physical and psychological challenges of surviving cancer. Anecdotally, cancer survival is characterized by uncertainty, symptom-related fear, and the interpretation of normal bodily sensations as symptomatic of cancer recurrence. This fear may lead to over-vigilance of benign bodily sensations, increasing anxiety and decreasing quality of life. Yet, there are few studies investigating how cancer survivors interpret and make sense of post-cancer symptoms. These studies are needed to guide considerations for clinical practice and the development of supportive interventions. Methods: We conducted in-depth semi-structured interviews with 18 AYA cancer survivors about how they interpret, manage, and respond to physical symptoms during survivorship. Participants were 15-25 years old. The sample was diverse in terms of disease history, ethnicity (8 Hispanic), and gender (9 females, 1 nonbinary). We conducted thematic analysis using a deductive coding scheme that was developed using our Cancer Threat Interpretation (CTI) theoretical model of cognitive, affective, and behavioral processes in post-cancer symptom perception. Results: AYA cancer survivors reported experiencing anxiety in the face of common physical sensations. These sensations were often interpreted as potential signs of recurrence or as late effects of treatment. Survivors most commonly reported worries about pain and fatigue, but also other sensations such as breathlessness. We coded participant transcripts into the following themes: biased attending towards symptoms, biased interpretations of symptoms as threatening, fear and worry about symptoms, and behavioral response to symptoms. In addition, we generated a new theme that was not previously captured in the CTI model: trust in the body. Conclusions: Knowing how to appraise and respond to symptoms such as pain is a challenge for AYA cancer survivors. This rich qualitative data provides support for the CTI model and suggests future directions. The results of this study can inform how clinicians talk to their patients about symptom monitoring after treatment ends.

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Neonatal Abstinence Syndrome: Essentials for the Practitioner

The Journal of Pediatric Pharmacology and Therapeutics ◽

10.5863/1551-6776-19.3.147 ◽

2014 ◽

Vol 19 (3) ◽

pp. 147-155 ◽

Cited By ~ 1

Author(s):

Anita Siu ◽

Christine A. Robinson

Keyword(s):

Adjunctive Therapy ◽

Primary Treatment ◽

Neonatal Abstinence Syndrome ◽

Placebo Control ◽

Abstinence Syndrome ◽

Management Options ◽

Optimal Care ◽

Relative Safety ◽

Scoring Tool ◽

Opioid Replacement Therapy

The incidence of neonatal abstinence syndrome (NAS) has increased dramatically during the past 15 years, likely due to an increase in antepartum maternal opiate use. Optimal care of these patients is still controversial because of the available published literature lacking sufficient sample size, placebo control, and comparative pharmacologic trials. Primary treatment for NAS consists of opioid replacement therapy with either morphine or methadone. Paregoric and tincture of opium have been abandoned because of relative safety concerns. Buprenorphine is emerging as a treatment option with promising initial experience. Adjunctive agents should be considered for infants failing treatment with opioid monotherapy. Traditionally, phenobarbital has been used as adjunctive therapy; however, results of clonidine as adjunctive therapy for NAS appear to be beneficial. Future directions for research in NAS should include validating a simplified scoring tool, conducting comparative studies, exploring home management options, and optimizing management through pharmacogenomics.

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Beliefs and taboos related to the care after delivery: their meaning for a women group

Acta Paulista de Enfermagem ◽

10.1590/s0103-21002008000200007 ◽

2008 ◽

Vol 21 (2) ◽

pp. 275-281 ◽

Cited By ~ 5

Author(s):

Juliana Stefanello ◽

Ana Márcia Spanó Nakano ◽

Flávia Azevedo Gomes

Keyword(s):

Qualitative Research ◽

Content Analysis ◽

Postnatal Period ◽

The Body ◽

Family Context ◽

Structured Interviews ◽

Care Needs ◽

Thematic Content Analysis ◽

The Family ◽

Mother And Child

OBJECTIVE: To identify the meaning of care in the puerperal phase, within the family context. METHODS: It is a qualitative research, developed with 12 puerperal women and their relatives, who helped them with care after delivery. Data collection was performed by means of semi-structured interviews. The data were analyzed based on the technique of thematic content analysis. RESULTS: In the postnatal period, care needs to be doubled, as it affects mother and child, besides the body vulnerability, which is open to diseases. In articulation with these ideas, the recommendations and restrictions as components of postpartum care are justified. CONCLUSION: Care in the puerperal phase is a feminine practice filled with beliefs and taboos that grants women with power of agents in this process, since she bears the knowledge of many generations at the same time that they act as subjects and reinvent the previously established systems, constructing themselves as mothers.

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‘This Adds Another Perspective’: Qualitative Descriptive Study Evaluating Simulation-Based Training for Health Care Assistants, to Enhance the Quality of Care in Nursing Homes

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18083995 ◽

2021 ◽

Vol 18 (8) ◽

pp. 3995

Author(s):

Catherine Aicken ◽

Lisa Hodgson ◽

Kay de Vries ◽

Iain Wilkinson ◽

Zena Aldridge ◽

...

Keyword(s):

Health Care ◽

Nursing Homes ◽

Descriptive Study ◽

Group Training ◽

Ageing Population ◽

Structured Interviews ◽

Care Needs ◽

Optimal Care ◽

Clinical Leadership ◽

Qualitative Descriptive

Much of the UK’s ageing population lives in care homes, often with complex care needs including dementia. Optimal care requires strong clinical leadership, but opportunities for staff development in these settings are limited. Training using simulation can enable experiential learning in situ. In two nursing homes, Health Care Assistants (HCAs) received training in clinical communication skills (Situation-Background-Assessment-Recommendation Education through Technology and Simulation, SETS: group training with an actor simulating scenarios); and dementia (A Walk Through Dementia, AWTD: digital simulation, delivered one-to-one). In this qualitative descriptive study, we evaluated the potential of this training to enhance HCAs’ clinical leadership skills, through thematic analysis of 24 semi-structured interviews with HCAs (before/after training) and their managers and mentors. Themes were checked by both interviewers. HCAs benefitted from watching colleagues respond to SETS scenarios and reported greater confidence in communicating with registered healthcare professionals. Some found role-play participation challenging. AWTD sensitised HCAs to the experiences of residents with dementia, and those with limited dementia experience gained a fuller understanding of the disease’s effects. Staffing constraints affected participation in group training. Training using simulation is valuable in this setting, particularly when delivered flexibly. Further work is needed to explore its potential on a larger scale.

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A Qualitative Study of Family Experience With Hospitalization for Neonatal Abstinence Syndrome

10.1542/9781610022798-a_qualitative ◽

2018 ◽

pp. 113-119

Author(s):

Emily C. Atwood ◽

Grace Sollender ◽

Erica Hsu ◽

Christine Arsnow ◽

Victoria Flanagan ◽

...

Keyword(s):

Qualitative Study ◽

Iterative Process ◽

Care Team ◽

Neonatal Abstinence Syndrome ◽

Family Centered Care ◽

Abstinence Syndrome ◽

Structured Interviews ◽

Family Experience ◽

Centered Care ◽

Family Centered

BACKGROUND AND OBJECTIVES Although the incidence of neonatal abstinence syndrome (NAS) in the United States quintupled between 2000 and 2012, little is known about the family perspective of the hospital stay. We interviewed families to understand their experiences during the newborn hospitalization for NAS and to improve family-centered care. METHODS A multidisciplinary team from 3 hospital units composed open-ended interview questions based on a literature review, clinical experience, and an internal iterative process. Trained investigators conducted semi-structured interviews with 20 families of newborns with NAS at hospital discharge. Interviews were recorded and transcribed verbatim. Two investigators independently analyzed each transcript, identified themes via an inductive qualitative approach, and reached a consensus on each code. The research team sorted the themes into broader domains through an iterative process that required consensus of 4 team members. RESULTS Five domains of family experience were identified: parents’ desire for education about the course and treatment of NAS; parents valuing their role in the care team; quality of interactions with staff (supportive versus judgmental) and communication regarding clinical course; transfers between units and inconsistencies among providers; and external factors such as addiction recovery and economic limitations. CONCLUSIONS Families face many challenges during newborn hospitalization for NAS. Addressing parental needs through improved perinatal education, increased involvement in the care team, consistent care and communication, and minimized transitions in care could improve the NAS hospital experience. The results of this qualitative study may allow for improvements in family-centered care of infants with NAS.

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Palliative Care Needs of People Living in a Newly Established Informal Settlement

Africa Journal of Nursing and Midwifery ◽

10.25159/2520-5293/2872 ◽

2018 ◽

Vol 20 (2) ◽

Author(s):

Martjie De Villiers ◽

Johanna Elizabeth Maree ◽

Corrien Van Belkum

Keyword(s):

Palliative Care ◽

Informal Settlement ◽

Palliative Care Service ◽

Physical Symptoms ◽

The Body ◽

Care Needs ◽

Care Clinic ◽

Medical Diagnoses ◽

Common Diagnosis ◽

Palliative Care Needs

Evidence-based guidance for the delivery of palliative care in Africa is rare. Identifying the palliative care needs of this community could contribute evidence to guide the services provided, and could add to the body of knowledge of palliative care in Africa. Using a retrospective chart review research method, the researchers aimed to describe the palliative care needs of people using a nurse-led palliative care service situated in a newly established, underserved, informal settlement in Tshwane, Gauteng, South Africa. A quantitative inductive content analysis method was used to analyse the data. The sample realised at 48 (n = 48). The ages of patients ranged from 21 to 78 with the median age 47. Nearly half (45.9%) of the patients were functionally illiterate. The records reflected 85 different medical diagnoses and some patients suffered more than one illness. The most common diagnosis was HIV/AIDS (54.2%). Furthermore, records revealed 379 health problems, ranging from 1 to 17 per patient, with an average of 8.1. Most problems were physical symptoms (50.3%; n = 195), while 38.8 per cent (n = 147) were psychosocial problems and 9.8 per cent (n = 37) were spiritual problems. The need for pain relief (89.6%; n = 43) was the greatest, followed by the need for emotional support. Patients suffering from various medical diagnoses used the services of the palliative care clinic. Patients’ care needs revolved around relief from total pain. Therefore, nurses should become aware of the suffering of palliative patients living in resource-poor communities, and through meticulous assessment, identify their main care needs.

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