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.
BMC Pediatr. 2021 Nov 4;21(1):489. doi: 10.1186/s12887-021-02955-y.
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.
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.
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.
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.
多达 95%的在子宫内接触过阿片类药物的新生儿在出生时会出现新生儿阿片类药物戒断综合征。非药物治疗方法（如母乳喂养；母婴同室；皮肤接触护理）是有循证依据的，应予以实施。这些方法，尤其是母乳喂养，依赖于新生儿母亲的参与来帮助新生儿。然而，对于实施产妇提供的非药物护理的结构和社会动态背景障碍和促进因素知之甚少。
使用定性描述性设计，来自美国中西部一家医院家庭分娩中心、新生儿重症监护病房和住院儿科病房的围产期护士接受了采访。这些单位参与了照顾受阿片类药物使用影响的母亲和新生儿。电话访谈遵循为本研究制定的半结构化访谈指南，进行录音，持续约 30-60 分钟。访谈逐字转录，并由五名研究人员使用恒定性比较方法进行独立分析。主题进行了讨论，直到达成共识，然后映射到为本研究改编的概念模型。
21 名护士参与了这项研究（家庭分娩中心，n=9；新生儿重症监护，n=6；儿科，n=6）。分析产生了四个主要主题：1）向员工和母亲提供的教育和资源不足；2）跨学科和学科内护理协调的重要性；3）新生儿阿片类药物戒断综合征护士人员配置模式的灵活性；4）病房结构和布局影响产妇的参与。每个主要主题都有支持性的次要主题。所有主题都映射到概念模型。
本研究更全面地了解了影响产妇参与新生儿阿片类药物戒断综合征非药物护理实施的障碍和促进因素。未来实施非药物方法的努力必须考虑影响实施的背景因素，包括单位、医院和更广泛社区内的结构和社会因素。
