Decreased Severity of Symptoms with Breast Milk Feeding

Capstone – NAS Infants’ Decreased Severity of Symptoms with BreastMilk Feeding/Usage Introduction Breastfeeding implementation practice and treatment for the Neonatal Abstinence Syndrome (NAS) Infant  Culture and Readiness Assessment Organizational Culture & Readiness for System-wide Integration of Evidence-Based Practice Survey o Determine how ready a health organization is to implement change in practice o Categorized by levels o “Getting Ready” stage o Potential Barriers o Lack of computer skills o Lack of time-sufficient staff education Problem Description o Neonatal Abstinence Syndrome • Postnatal withdrawal from opioids • Dysfunction of Central Nervous System (CNS) • Dysfunction of Autonomic Nervous System (ANS) • Dysfunction of Gastrointestinal System (GI) • Syndrome lasts for weeks to months • Possible developmental delay later in childhood PICOT Question  In newborns that develop Neonatal Abstinence Syndrome (NAS) after being exposed to drugs in utero, how effective is mother’s breast milk when given to these infants compared to infants that receive only formula in decreasing the severity and longevity of withdrawal symptoms during the infant’s withdrawal process? Proposed Solution Breastfeeding NAS Infants OUTCOMES  Lessens severity of  Engages and Empowers  Decreases  Promotes bonding between symptoms pharmacological intervention  Decreases length of hospital stay mom in infant’s care mother and infant  Decreases the effects of the detoxification process in the NAS Infant Breast feeding NAS Infants…cont.  Method of Achievement  Hospital resources  Clinicians and ancillary staff  Timeline scheduled feedings  Education to mother  Limitations  Mother’s consistency with schedule  Trust issues between mother & staff  Mother-baby separation Change Model  Transtheoretical Model (TTM) of Change  Precontemplation  Contemplation  Preparation and Determination  Action  Maintenance  Relapse Implementation Plan  Breastfeeding Initiation and Environment  Intimate  Comforting  Nurturing  Supportive  Supplemental feeding plan  Timeline  Feed every 1-3 hours  Modified Finnegan’s Neonatal Abstinence Screening tool  Medication administration  One-to-one breast feeding training for mother from RN, or lactation consultant RN Evaluation of Process  Qualitative, participant observation method  Non-verbal expressions  Feelings  Interaction with each other (mother and infant) References  Melynk, B. M. & Fineout-Overholt, E. (2015). Evidence-Based Practice in Nursing & Healthcare: A Guide to Best Practice. 3rd Ed. Philadelphia, PA: Wolters Kluwer/ Lippincott Williams & Wilkins  Saunders H., Stevens K.R. & Vehviläinen-Julkunen K. (2016) Nurses’ readiness for evidence-based practice at Finnish university hospitals: a national survey. Journal of Advanced Nursing 72(8), 1863–1874. doi: 10.1111/jan.12963  Jansson, L., Velez, M., (2011). Infants of Drug-dependent Mothers. Pediatrics in Review, Vol 32 (1).  Logan, B. A., Brown, M. S., & Hayes, M. J. (2013). Neonatal Abstinence Syndrome: Treatment and Pediatric Outcomes. Clinical Obstetrics and Gynecology, 56(1), 186– 192. http://doi.org/10.1097/GRF.0b013e31827feea4  Stevens, K., (May 31, 2013) “The Impact of Evidence-Based Practice in Nursing and the Next Big Ideas.” OJIN: The Online Journal of Issues in Nursing Vol. 18, No. 2, Manuscript 4. Measured and Evaluated Outcomes  Modified Finnegan’s Abstinence Tool  Scores define how much pharmacological intervention needed  Self-report of mother  Nurse Observations and Assessments

References cont…  Mehta-Bhatt, V., Ng, C., & Schumacher, R. (2014, February). Effectiveness of a Clinical Pathway With Methadone Treatment Protocol for Treatment of Neonatal Abstinence Syndrome Following In Utero Drug Exposure to Substances of Abuse*. Pediatric Critical Care Medicine, 15(2), 16269.http://dx.doi.org/10.1097/PCC.0b013e3182a12611  Meier, P. P., Engstrom, J. L., Patel, A. L., Jegier, B. J., & Bruns, N. E. (2010). Improving the Use of Human Milk During and After the NICU Stay. Clinics in Perinatology, 37(1), 217–245. http://doi.org/10.1016/j.clp.2010.01.013  National Institue on Drug Abuse. (2015). https://www.drugabuse.gov/  Neonatal Abstinence Syndrome. (2016). Retrieved from http://www.stanfordchildrens.org/en/topic/default?id=neonatalabstinence-syndrome-90-P02387  Neonatal abstinence syndrome. (2015). Decreased Severity of Symptoms with Breast Milk Feeding

Retrieved fromhttps://medlineplus.gov/ency/article/007313.htm  Pritham, U. (2013, Sep-Oct). Breastfeeding promotion for management of neonatal abstinence syndrome. J Obstet Gynecol Neonatal Nurs., 42(5), 517-26. http://dx.doi.org/10.1111/1552-6909.12242. References cont…  Bamberg, S. (2013, June). Changing environmentally harmful behaviors: A stage model of selfregulated behavioral change. Journal of Environmental Psychology, 34, 151-59. Retrieved from http://www.sciencedirect.com/science/article/pii/S0272494413000042  Prochaska, J., DiClemente, C., & Norcross, J. (1992, September 4). In search of how people change. Applications to addictive behaviors. MEDLINE, 47(9), 1102-14. Decreased Severity of Symptoms with Breast Milk Feeding

Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/1329589  Data Collection Methods. Retrieved from: http://www.worldbank.org/poverty/impact/methods/datacoll.htm  Kawulich, B., (2005). Participant Observation as a Data Collection Method. Forum Qualitative Sozialforschung / Forum: Qualitative Social Research, [S.l.], v. 6, n. 2, may 2005. ISSN 1438-5627. Retrieved from: http://www.qualitativeresearch.net/indexphp/fqs/article/view/466/996.  Tools for Implementing an Evidence-Based Approach in Public Health Practice. (2012). Retrieved from http://www.medscape.com/viewarticle/766812_7  Data Collection Methods for ProgramEvaluation: Observation . (2008). Retrieved from https://www.cdc.gov/healthyyouth/evaluation/pdf/brief16.pdf  NEONATAL ABSTINENCE SCORING SYSTEM. (2007, January). Western Australian Centre for Evidence Based Nursing & Midwifery. Retrieved from http://www.lkpz.nl/docs/lkpz_pdf_1310485469.pdf  Short Vanessa L., Gannon Meghan, and Abatemarco Diane J., (2016). The Association Between Breastfeeding and Length of Hospital Stay Among Infants Diagnosed with Neonatal Abstinence Syndrome: A Population-Based Study of In-Hospital Births. Breastfeeding Medicine. September 2016, 11(7): 343-349. doi: 10.1089/bfm.2016.0084. … Decreased Severity of Symptoms with Breast Milk Feeding