Department of Pediatrics, University of Washington, Seattle, Washington
Providence St Joseph's Health System, Seattle, Washington.
Hosp Pediatr. 2021 Sep;11(9):968-981. doi: 10.1542/hpeds.2020-003830.
Prioritizing nonpharmacologic care for neonatal abstinence syndrome (NAS) requires a team-based care (TBC) approach to facilitate staff and family engagement. We aimed to identify the important structures and processes of care for TBC of infants with NAS and quality of care outcomes that are meaningful to care team members (including parents).
Using a Donabedian framework, we conducted semistructured interviews from May to October 2019 with care team members at 3 community hospitals, including parents, nurses, social workers, physicians, lactation nurses, child protective services, volunteers, and hospital administrators. We used thematic analysis to identify important structures, processes of care, and outcomes.
We interviewed 45 interprofessional care team members: 35 providers and 10 parents. Structures critical to providing TBC included (1) building a comprehensive network of interprofessional team members and (2) creating an NAS specialized unit. Necessary processes of care included (1) prioritizing early involvement of interprofessional team members, (2) emphasizing nonjudgmental incorporation of previous experience with addiction, (3) establishing clear roles and expectations, and (4) maintaining transparency with social services. Lastly, we identified 9 outcomes resulting from these identified structures and processes that are meaningful to care team members to assess the quality of care for infants with NAS.
In this study, we identify important structures, processes of care, and meaningful outcomes to enhance and evaluate TBC for infants with NAS. Hospitals that adopt and implement these structures and processes have the potential to improve the quality of care for infants, caregivers, and providers who care for these infants.
优先考虑新生儿戒断综合征（NAS）的非药物治疗需要团队为基础的护理（TBC）方法，以促进员工和家庭的参与。我们旨在确定 TBC 对 NAS 婴儿护理的重要结构和过程以及对护理团队成员（包括父母）有意义的护理质量结果。
使用 Donabedian 框架，我们于 2019 年 5 月至 10 月在 3 家社区医院对护理团队成员（包括父母、护士、社会工作者、医生、哺乳护士、儿童保护服务、志愿者和医院管理人员）进行了半结构化访谈。我们使用主题分析来识别重要的结构、护理过程和结果。
我们采访了 45 名跨专业护理团队成员：35 名提供者和 10 名父母。提供 TBC 的关键结构包括（1）建立一个由跨专业团队成员组成的综合网络，以及（2）创建一个 NAS 专科病房。必要的护理过程包括（1）优先考虑尽早让跨专业团队成员参与，（2）强调无偏见地纳入以前的成瘾经验，（3）明确角色和期望，以及（4）与社会服务部门保持透明。最后，我们确定了 9 个结果，这些结果源自这些确定的结构和过程，对护理团队成员评估 NAS 婴儿的护理质量具有意义。
在这项研究中，我们确定了提高和评估 NAS 婴儿 TBC 的重要结构、护理过程和有意义的结果。采用和实施这些结构和过程的医院有可能提高婴儿、照顾者和照顾这些婴儿的提供者的护理质量。
