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Author: Jeanne Franza
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Category :
Languages : en
Pages : 0
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"Neonatal Abstinence Syndrome (NAS) is a multisystem disorder that occurs in newborns after birth when the mother has been taking addictive drugs, usually opiates, during pregnancy. These infants experience withdrawal symptoms and require prolonged hospital stays. When and infant with NAS requires treatment with medication, the length of stay is greatly prolonged due to the need to slowly taper the medication before discharge. Patrick et al. (2012) found that the incidence of NAS increased from 1.2 per 1000 live births in 2000 to 3.39 per 1000 live births in 2009, and the mean hospital cost for an infant with NAS increased from $39,400 in 2000 to $53,4000 in 2009. NAS has become a costly epidemic. Nurses who care for these infants require specialized knowledge. The RNs and APRNs in a community hospital expressed uncertainty regarding assigning Finnegan scores, which indicate the level of withdrawal symptoms. Many of these nurses were very experienced but had not had recent education focused on NAS or addiction, or experience in addiction medicine or behavioral health. The nurses required tools to be able to establish a therapeutic relationship with mothers who have addiction issues. A recently updated clinical practice guideline was in place, but education had not been provided to the RNs and APRNs regarding the updated guideline for the care of these infants, achieving accuracy in Finnegan scoring, or the establishment of a therapeutic relationship with the mother. The purpose of this evidence-based practice change was to increase nurses' knowledge in the care of these infants and their mothers. The plan included an educational program consisting of three parts; a PPT presentation on NAS, an interactive DVD session to achieve reliability in Finnegan scoring, and journal club style discussions focused on establishing a therapeutic relationship with mothers who have addiction issues. A pre/post test survey was done to measure increase in knowledge. All participants showed an increase in knowledge, with a change in score of 36.21%, well over the 10% increase benchmark. This change represents 71.92% growth. This outcome is statistically significant. The RNs and APRNs also overwhelmingly agreed in the program evaluations that they had increased confidence in their ability to care for infants and communicate effectively with their mothers, as a result of the educational program. The outcome of this project supports the provision of education focused on NAS for RNs and APRNs who care for these infants and their mothers. " -- Abstract.
Author: Jeanne Franza
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ISBN:
Category :
Languages : en
Pages : 0
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"Neonatal Abstinence Syndrome (NAS) is a multisystem disorder that occurs in newborns after birth when the mother has been taking addictive drugs, usually opiates, during pregnancy. These infants experience withdrawal symptoms and require prolonged hospital stays. When and infant with NAS requires treatment with medication, the length of stay is greatly prolonged due to the need to slowly taper the medication before discharge. Patrick et al. (2012) found that the incidence of NAS increased from 1.2 per 1000 live births in 2000 to 3.39 per 1000 live births in 2009, and the mean hospital cost for an infant with NAS increased from $39,400 in 2000 to $53,4000 in 2009. NAS has become a costly epidemic. Nurses who care for these infants require specialized knowledge. The RNs and APRNs in a community hospital expressed uncertainty regarding assigning Finnegan scores, which indicate the level of withdrawal symptoms. Many of these nurses were very experienced but had not had recent education focused on NAS or addiction, or experience in addiction medicine or behavioral health. The nurses required tools to be able to establish a therapeutic relationship with mothers who have addiction issues. A recently updated clinical practice guideline was in place, but education had not been provided to the RNs and APRNs regarding the updated guideline for the care of these infants, achieving accuracy in Finnegan scoring, or the establishment of a therapeutic relationship with the mother. The purpose of this evidence-based practice change was to increase nurses' knowledge in the care of these infants and their mothers. The plan included an educational program consisting of three parts; a PPT presentation on NAS, an interactive DVD session to achieve reliability in Finnegan scoring, and journal club style discussions focused on establishing a therapeutic relationship with mothers who have addiction issues. A pre/post test survey was done to measure increase in knowledge. All participants showed an increase in knowledge, with a change in score of 36.21%, well over the 10% increase benchmark. This change represents 71.92% growth. This outcome is statistically significant. The RNs and APRNs also overwhelmingly agreed in the program evaluations that they had increased confidence in their ability to care for infants and communicate effectively with their mothers, as a result of the educational program. The outcome of this project supports the provision of education focused on NAS for RNs and APRNs who care for these infants and their mothers. " -- Abstract.
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Category :
Languages : en
Pages : 60
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Abstract Background: Neonatal abstinence syndrome (NAS) is increasing in the United States as a result of increased opioid-use disorder among women of childbearing age. NAS affects three out of four babies who are exposed to chronic use of opioids during the mother's pregnancy. Caring for infants with NAS is challenging. Researchers have identified a deficit of knowledge and skills, and have discovered judgmental attitude of nurses caring for babies with NAS. Globally, nurses caring for infants with NAS need education on current evidence-based practice to improve quality of care. The purpose of this project was to create an educational intervention based on assessed, localized, educational needs for NICU staff nurses caring for babies experiencing NAS. Methods: This project used the design thinking implementation framework and IHI Psychology of Change framework to assess the needs of NICU nurses caring for infants experiencing NAS and develop related education. A baseline survey of the nurses' knowledge, attitudes, and practices was done. Similarly, nurse stakeholder interviews were completed and themes were analyzed using thematic content analysis to further specify localized needs. Educational materials were prototyped in subsequent interviews with the nurses until the materials were found useful. Findings/Results: RNs correctly identified symptoms and treatment for NAS. RNs overall felt empathy for infants with NAS, but less empathetic towards the infant's mothers and blamed them for the infant's health problems. The RNs were confident in their knowledge to provide adequate care for the infants but self-identified a need for improvement in knowledge, care, and documentation. RNs appropriately use nonpharmacological treatment, but desire more education in the interventions. Other areas for needed improvement were medication treatment, in-home and outpatient care, and parameters for breastfeeding. RNs identified educational needs through interviews and provided feedback on the two prototypes created using empathy mapping. Conclusions: The proposed next step is to implement the designed educational intervention and study related outcomes. The IHI Psychology of Change Framework and the design thinking process, when combined, offer a strong method for participant engagement. The design thinking process may be important to timely and effective care in-so-much that it allows flexibility to change as the context changes.
Author: Autumn Cooper
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ISBN:
Category : Drug abuse in pregnancy
Languages : en
Pages : 0
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Studies have indicated that with maternal opiate use, including methadone and buprenorphine, newborns are at risk for experiencing neonatal abstinence syndrome (NAS). Approximately 21- 94% of newborns who are exposed to opiates in utero will experience the symptoms of NAS (Isemann, Meinzen-Derr, and Akinbi, 2011).To help decrease the severity of withdrawal symptoms related to NAS, studies have indicated that breastfeeding after delivery will not just help to decrease NAS symptoms, but can also help to decrease lengths of hospital stay, and help to decrease overall costs associated with the care required for the NAS neonate. To help increase the number of NAS neonates who breastfeed it is important for the nursing staff and health care team involved with the care of the mother during pregnancy and the neonate after delivery be educated on current evidence based practice (EBP) that supports and encourages the mother to breastfeed. There has been noticeable increase of patients who are pregnant and using opiates. In a small rural hospital it has been identified that the nursing staff are lacking knowledge on how to care for this increasing population and how to support them when the mother chooses to breastfeed her infant. The staff expressed concern over harm to the neonate with exposure to opiates through excreted breast milk. Studies show that small amounts are excretebreast milktmilk, this is not harmful to the neonate and helps to decrease the withdrawal symptoms associated with NAS. This paper discusses the risks and benefits related to breastfeeding the NAS neonate and how to educate the nursing staff, along with the rehealth carehealthcare team. With good EBP education the staff will be able to support, educate, and help to enhance the overall outcome of the NAS neonate by supporting and encouraging opiate addicted mothers who choose to breastfeed their newborns.
Author: Mary L. Puchalski
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ISBN:
Category :
Languages : en
Pages : 0
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"The rapidly increasing incidence of Neonatal Abstinence Syndrome (NAS) in the U.S. has been identified as a national healthcare crisis. An evidence-based practice change project, "Interprofessional Healthcare Provider Education on NAS" (IHPEN) was designed to implement a protocol to increase consistency in treatment for infants with NAS and provision of healthcare provider education to increase knowledge regarding NAS, as well as sensitivity to the signs and symptoms of withdrawal. The target population included all healthcare providers in the Neonatal Intensive Care Unit and Mother/Baby Unit of a large, urban, not-for-profit perinatal center. The project was developed in response to a need for an organized, structured, systematic, and collaborative approach to assessment and treatment. This need was based on the following observations: (a) increasing numbers of patients admitted to the NICU who were diagnosed with NAS, (b) long lengths of stay for infants with NAS, (c) an inconsistent approach to the pharmacologic treatment and weaning of medications because of a lack of a protocol for infants with NAS, (d) frustration expressed by all neonatal healthcare providers as how to "best" handle infants with NAS, and (e) a need for staff education on the topic of NAS. 141 healthcare providers participated in the educational intervention. 32% of the participants reached the benchmarked level of improvement of 10% from pretest to posttest, and 53% percent of the participants improved their pretest to posttest score. A paired-sample t-test was conducted to compare the differences in pretest and posttest score and found to be significant pretest (p = 0.000164). Thus, the outcomes of this evidence-based educational intervention supported the importance of providing comprehensive, interprofessional training on the assessment and treatment of infants with NAS in order to enhance healthcare provider knowledge." -- Abstract.
Author: Ashley Regimbal
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ISBN:
Category : Drug withdrawal symptoms
Languages : en
Pages : 0
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Author: Elnora Cokley
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ISBN:
Category : Drug abuse in pregnancy
Languages : en
Pages : 0
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There has been an increasing incidence of infants being born with neonatal abstinence syndrome (NAS) secondary to exposure of maternal drug use, particularly opioids. Most of these neonates require pharmacological treatment to manage their withdrawal symptoms therefore increasing their length of hospitalization anywhere from one week to several months. Nurses routinely perform assessments on the severity of the infant's withdrawal using clinical assessment tools to provide scores that help direct the management of these neonates. This highlights the importance of the consistency between the nurses in utilizing these assessment tools to help guide non-pharmacological interventions and pharmacological treatment in infants with NAS and decreasing the length of hospital stay. The objective of this paper is to improve the management of infants with NAS by implementing standardized evidence-based practice guidelines and education around NAS, the Finnegan Neonatal Abstinence Scoring Tool, and the inter-observer reliability program to increase accuracy in withdrawal assessments. The inter-observer reliability program will provide the education and skill set required to provide accurate and consistent assessment scores using the FNAST and for managing these neonates. A literature search and critical review was performed using eighteen articles that supported the establishment of practice guidelines, inter-observer reliability, and education to improve the management and care of infants with NAS. This approach will provide nurses the skill and knowledge needed to consistently and accurately assess neonates for signs and symptoms of withdrawal to guide the management of these infants and therefore possibly lead to a reduction in length of hospital stay.
Author: Valarie Artigas
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ISBN:
Category : Electronic dissertations
Languages : en
Pages :
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Maternal substance misuse/abuse during pregnancy may lead to adverse neonatal outcomes, including neonatal abstinence syndrome (NAS). NAS is a constellation of withdrawal symptoms exhibited in newborns in response to the discontinuance of in-utero exposure to licit and illicit substances. The incidence of NAS is directly related to the increasing rates of maternal substance use/abuse. The United States has experienced a five-fold increase of newborns born with NAS. The care of the newborn with NAS is one of the most challenging conditions for the neonatal nurse. Management of newborns with NAS requires knowledge that has not been traditionally partnered within care of the neonatal intensive care unit (NICU) but rather more often in the newborn nursery. And thus, understanding addiction, addictive behaviors and the psychological needs of substance misusing/abusing parents have not been common place in all NICU settings. Caring for the newborn with NAS and interacting with the addicted parent and parents may present ethical and moral dilemmas for the neonatal nurse. This pilot study explored the presence of moral distress among neonatal nurse caring for the newborn with NAS whose mothers used illicit substances during pregnancy. A descriptive study engaged neonatal nurses from a Level III NICU in completing the Moral Distress Scale Pediatric version. Frequency and intensity of moral distress among the sample assisted in determining the presence and levels of moral distress. Neonatal nurses caring for newborns with NAS whose mothers used illicit substances during pregnancy experienced varying degrees moral distress.The results of this research study revealed that indeed, neonatal nurses experience moral distress to varying degrees within the NICU setting. Caring for newborns with NAS within this sample participant group produced moral distress especially when these nurses interacted with substance misusing mothers and care givers. Although not all neonatal nurses caring for newborns with NAS and/or interacting with substance misusing care givers experienced moral distress the review of the data is imperative for identifying strategies to support nurses universally to prevent/address moral distress in the NICU.
Author: Tricia E. Wright
Publisher:
ISBN: 1108400981
Category : Health & Fitness
Languages : en
Pages : 155
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Gain guidance and support when treating the high-risk population of women confronting (or battling) opioid-use disorders during pregnancy.
Author: Noreen Kearney Beckett
Publisher:
ISBN:
Category : Drug abuse in pregnancy
Languages : en
Pages : 0
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The number of infants being admitted to neonatal intensive care units (NICU) for treatment for Neonatal Abstinence Syndrome (NAS) has increased over the last 10 years(Alcoholism and Drug Abuse Weekly, 2012). There is evidence to support maternal involvement in the infants care, improves outcomes during the NICU admissions. Current models used in NICU's miss opportunities to improve the care of NAS infants. The purpose of this intervention is to improve the care of NAS infants (Jones, 2012) in NICU's, by educating at risk mothers early in pregnancy and supporting their involvement during the NICU admission (Armstrong, 2012). Development and dissemination of educational material would initiate the process. Evaluation of this intervention would look at length of stay to make predictions, whether early education of mothers decreased length of stay (Pritham, 2012). Next NICU's would have to consider the ability to change current practice models and environments and look for ways to increase mothers' involvement during the infants' admission (Mundy, 2010) (Young, 2013). The circumstances creating the NAS admission are often complicated, with many variables to consider in determining the success of the intervention. Having a child is a life changing moment, and may provide an opportunity to improve not only the life of the infants but also the life of the infant's opiate dependent mother. Changing current model could provide and environment that will increase attachment between mother and infant, decreasing days of treatment, and improving longer-term outcome for child (Marie-Mitchell, 2013).
Author: Cynthia Woods
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ISBN:
Category : Drug abuse in pregnancy
Languages : en
Pages : 0
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Neonatal Abstinence Syndrome (NAS) is a condition affecting neonates who have been exposed to illicit or prescription drugs while in the womb. NAS, also known as newborn withdrawal syndrome, is a serious concern as the incidence of drug abuse in pregnancy is increasing, with a corresponding rise in infant withdrawal cases. The symptoms of NAS range from excessive crying and irritability to seizures and death; the average hospital stay is from one week to several months, depending upon the gravity of the symptoms. There is a lack of evidence-based practices and standardized protocols to guide the management of care for these babies. Nonpharmacological nursing interventions, in addition to pharmacological treatments, are vital in the care of these infants. Non-pharmacological nursing interventions have been shown to decrease the severity of neonatal abstinence syndrome and reduce the amount of days in the hospital. Non-pharmacological treatments include: providing a quiet, dimly lit environment; swaddling; the use of pacifiers; holding the infant vertically when rocking; rubbing the baby instead of patting; kangaroo mother care; breastfeeding; and encouraging the rooming in of mother and child whenever feasibly possible. Establishing standardized nursing intervention protocols and providing appropriate training for the nursing staff are effective ways to treat NAS infants resulting in the positive outcome of decreased days in the hospital.
