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

Abstract

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.

Neonatal Abstinence Syndrome: Non-pharmacologic Interventions for the Maternal-Infant Dyad

“…27 A study of health care workers revealed that prioritization of physical needs, compassion fatigue, poor continuity of care and stigma compromised the care of NAS infants. 28 Moral distress has been reported by the health care team working with these babies and mothers. 29…”

Neonatal Abstinence Syndrome: Prevention, Management and Outcomes: From Birth to Adulthood

“… Overview of the themes and specific papers discussed in this Special Issue [ 1 , 2 , 3 , 4 , 5 , 6 , 7 ]. …”

“…Related to clinical management, there are three papers with focus on different care providers involved in this care process, i.e., nurses and midwives, parents and foster carers respectively [ 3 , 4 , 5 ]. Shannon et al collected nurses’ and midwives’ experiences of delivering care for infants with NAS, using semi-structured interviews.…”

“…The authors hereby concluded that these five nursing themes demonstrated the complex nature of care provision for NAS infants. Competing priorities and the stigmatizing nature of NAS threaten optimal care being delivered to these vulnerable infants and their parents [ 3 ]. Attachment for hospitalized NAS neonates with their mothers has its challenges, as mothers with a history of substance abuse are likely less sensitive to their infants’ cues.…”

What’s in a name? The ethical implications and opportunities in diagnosing an infant with neonatal abstinence syndrome (NAS)

“…Unfortunately, the societal neglect of children and adults with a history of NAS seems rooted in normative moral values and confusion regarding what exactly constitutes a diagnosis of NAS [17], as well as concerns about the legal, social and ethical ramifications of how a diagnosis of NAS will impact upon the mother [18]. This deflects attention from the consequences of the primary problem, prenatal drug exposure, as well as from the child, resulting in ‘reflected stigma’ where a condition associated with societal disapproval or disgrace compromises care for the patient [19].…”