Atwood Emily C, Sollender Grace, Hsu Erica, Arsnow Christine, Flanagan Victoria, Celenza Joanna, Whalen Bonny, Holmes Alison V
Department of Pediatrics, Children's National Medical Center, Washington, District of Columbia;
Department of Pediatrics, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
Hosp Pediatr. 2016 Oct;6(10):626-632. doi: 10.1542/hpeds.2016-0024. Epub 2016 Sep 19.
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.
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.
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.
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.
尽管2000年至2012年间美国新生儿戒断综合征（NAS）的发病率增长了四倍，但对于住院期间家庭方面的情况却知之甚少。我们对家庭进行了访谈，以了解他们在新生儿因NAS住院期间的经历，并改善以家庭为中心的护理。
来自3个医院科室的多学科团队基于文献综述、临床经验和内部迭代过程编写了开放式访谈问题。经过培训的调查人员在医院出院时对20个患有NAS的新生儿家庭进行了半结构化访谈。访谈进行了录音并逐字转录。两名调查人员独立分析每份转录本，通过归纳定性方法确定主题，并就每个编码达成共识。研究团队通过一个需要4名团队成员达成共识的迭代过程，将这些主题归纳为更广泛的领域。
确定了家庭经历的五个领域：父母对NAS病程和治疗相关教育的需求；父母重视自己在护理团队中的角色；与医护人员互动的质量（支持性与评判性）以及关于临床病程的沟通；科室之间的转诊以及医护人员之间的不一致；以及诸如成瘾康复和经济限制等外部因素。
在新生儿因NAS住院期间，家庭面临许多挑战。通过改善围产期教育、增加在护理团队中的参与度、提供持续的护理和沟通以及尽量减少护理过程中的转变来满足父母的需求，可以改善NAS住院体验。这项定性研究的结果可能有助于改善对患有NAS婴儿的以家庭为中心的护理。
