Date of Award

4-2018

Document Type

Dissertation

Copyright Status, No Creative Commons License

All Rights Reserved

Degree Name

Doctor of Philosophy (Ph.D.) Nursing

Department

Nursing

Abstract

Problem: Opioid addiction in pregnancy is a public health crisis that is growing daily. This increased use of opioids during pregnancy has caused a steady rise in the number of infants born addicted to opioids. Current trends in maternal child heath (MCH) settings encourage mothers and babies to be cared for together. Nurses who work in MCH settings care for the opioid addicted mother and her infant(s) as a single patient dyad. Care required for the opioid-addicted mother-infant dyad (OAMID) presents challenges to maternal-child health (MCH) nurses related to the consequences of opioid addiction.

Purpose: The purpose of this grounded theory study was to explore and identify how care rendered to the OAMID is perceived by the MCH nurse. Educational opportunities for both the MCH nurse and the OAMID were also identified.

Background: Opioid dependence has become an increasing problem in the healthcare of pregnant women. The number of opioid dependent mothers has soared within the last several years in the United States (U.S.). The forms of opioid addiction are as varied as the women who use them. The results of maternal opioid use have a direct impact on the developing fetus. This can range from premature birth, growth restriction, still birth, and neonatal abstinence syndrome (NAS). This study focused on the nurses caring for the OAMID experiencing the effects of NAS.

Theoretical Framework: The theoretical framework underpinning the concept of care for the OAMID by the MCH nurse is based on Jean Watson’s theory of Human Caring/Caring Science. Her ten Carative Factors are a framework depicting the tenets of caring which give nursing its own voice within the healthcare milieu (Watson, 2008).

Research Question: The overarching research question investigated was how do MCH nurses experience caring for the OAMID.

Methodology: This study utilizes the grounded theory methodology of Strauss and Corbin. Data was obtained from subject interviews and field notes with ongoing analysis utilizing the constant comparative approach. Strauss and Corbin’s method for developing a grounded theory utilizes a simultaneous process of data collection and analysis. This continual examination of data lead to the discovery of common themes that are connected. The connectedness is revealed through a process of coding the data, and the resulting theory is said to be grounded within the data.

Findings: The basic psychosocial problem was the inability for the MCH nurses to view the opioid addicted mother and infant as one patient dyad. The MCH nurses experienced personal difficulty caring for the opioid addicted mother, due to feelings of frustration and bias, however they readily felt empathy and concern for her infant who was going through the opioid withdrawal process. The main categories composed of sub concepts that emerged from the data were a) fear for the infant’s future, b) challenging care, c) judgmental behavior d) lack of education e) conflicted care. These five categories and their related concepts led to the development of the theory of conflicted caring.

Significance to Nursing and Health Care: The study highlighted a need for educational opportunities for MCH nurses in regard to providing thoughtful, compassionate and non-biased care to the opioid addicted mother and her infant. The growing prevalence of opioid addiction among pregnant women has made it necessary for healthcare providers to develop strategies that will support the MCH nurse in delivering comprehensive and culturally sensitive care to this vulnerable population.

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