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Table 2 Themes and exemplar quotes

From: Elucidating the context for implementing nonpharmacologic care for neonatal opioid withdrawal syndrome: a qualitative study of perinatal nurses

Major Theme Minor theme Exemplar quotes
Lack of education and resources provided to staff and mothers Limited education during orientation When I was first hired in the NICU, we were shown an assessment video to show how they assess early withdrawal babies; but that’s all.
[When] I train new staff, I am trying to help make sure that they don’t form biases ahead of time...and trying to teach the newer, younger staff.
Need for continued training I just think we [perinatal nurses] need the whole opioid addiction education. We just don’t get any of it really.
I think just by continuing to educate nurses as well to help give them skills to pass along to their patients would help as well, because I feel like some of the knowledge is limited and some of it’s just experience-based.
Limited education on community resources available for mothers [Nurses should] be more aware of the resources in the area and probably just like more education for us to teach the parents.
Nurses should be more educated in the aspect of social work though because let’s say we’re on the weekend and we can’t necessarily get ahold of a social worker.
Improved discharge education can better support maternal recovery More information in the community [would be helpful at discharge for these mothers]...but as far as mom goes, as far as helping her to stop using substances, I think that—I wish we had a little bit more resources for that.
I don’t feel like enough is really done to help them [mother’s] at discharge to tell ya the truth.
Need for improved prenatal education I guess the scenario that could use a little more improvement is a little more prenatal preparation and education.
We need to do some more education with these moms when they’re still pregnant.
Importance of interdisciplinary and intradisciplinary care coordination Standardized care promotes consistency across care settings [We promote consistency by] reading the care plan, following the care plan, [in order to] stay consistent with what our - our end goal is.
Poor communication can result in poor care consistency Consistency between units is based solely on the quality of the report that you’re being given...they’re not familiar with each other’s policies, and things like that, so, um, they don’t always know what they need—they don’t always know what the other nurse needs to know.
I can think of not too long ago, um, the baby was receiving routine scores of 13 to 15 [in Family Birthing], which are really high. And the baby got over there [to NICU] and once we scored, it was actually 6 to 8. All we knew were the scores, not why they scored higher.
Interdisciplinary communication is important I feel like a lot of times there is, um, kind of like this process of the mothers being a little bit like manipulative of them [nurses] kind of trying to play “oh, but the doctor didn’t say this,” or, and I think sometimes the barrier of us not being completely unified and having like a one, one time to go in and discuss it with everybody involved at that point...I feel like the barrier is just not having essentially like a care conference with the patient with the providers and the nursing staff and with a social worker, doctors, whatever.
I think that a lot of times the problem with the congruency isn’t congruency of nurses to nurses. It’s more like well the doctor said this, but that’s so-and-so doctor, and now this one’s on call, and the social worker, but she’s not here on the weekend...a lot of times where the problem lies is within different disciplines.
Flexibility in nurse staffing models for NOWS Primary nursing may improve consistency and maternal trust If the same nurse has been here on Friday, she’s gonna be here all weekend then keep giving that child back to that nurse, cuz she gets to know that mom and that baby really well.
[I recommend] one nurse for the day and one nurse for the night to keep consistency throughout that [patient’s stay].
Consider maternal characteristics when staffing In the NAS [neonatal abstinence syndrome] situation, you’re - you’re doing more education on those kind of primary situations.
[A barrier is] what acuity we put mom at. You know, babies who are NAS scoring are up, you know, at an acuity level automatically, but that doesn’t mean that, um, we factor in mom’s view and mom’s educational needs.
Mothers interact with many different clinicians in different settings Having so many different nurses for each [patient]...it would be inconsistency I guess with nurses. Um, where I feel like if we did have the same nurses who were working, you know, 3 days in a row, three twelves in a row, if we could staff them with these - with these couplets, I feel like that would be pretty consistent.
You might labor a patient and then send them to a postpartum nurse...or you might have had someone else labor them and get them sent to you. Some people only work one or the other area in our unit, and if the baby’s not well, it might go to NICU and stay there.
Staffing ratios and assignments affect NOWS care These babies often would benefit from lower staffing ratios.
Just assignments, in general, can be a problem. Sometimes you don’t have a choice, like I said, how—what an NAS baby is put—what kind of assignment they’re put into.
Unit architecture and layout affects maternal involvement Allowing rooming-in improves maternal presence One of the reasons why, um, we get the NAS babies transferred over to the pediatric unit is the moms are able to stay with them over there [pediatric unit].
I think the fact that we [pediatric unit] have, um, private rooms is huge because if the mothers are allowed to, um, they can be there, and we can work with them there for 24 h a day.
Separation occurs when baby leaves birth unit and is admitted to a new service There’s no separation [in the Family Birth Center]. The separation would come if baby goes to NICU [and mom stays in Family Birth Center].
if baby needs that special care [virtual special care nursery], they’re able to be with their moms instead of going to NICU…which I think before that, usually it was kind of taking baby out of their rooms at that time and monitoring babies with the mom not even being involved.
Room layout can affect rooming-in A parent can stay at the bedside, um, but there is not their own bathroom and - and such [in the NICU]. Whereas now, we - we, um, house them [NOWS neonates] more on our pediatric unit...it’s a little bigger rooms, and they have bathrooms in their rooms.
We don’t give any food on the unit [pediatric], and I know a lot of parents complain about that, um, that we don’t provide them any food or snacks.