Moral Distress in Neonatal Intensive Care Nurses Who Care for Infants with Neonatal Abstinence Syndrome

Monday, 31 October 2011: 2:25 PM

Mary S. Webb, RN, PhD1
Genieveve J. Cline, DNP, NNP-BC2
Denise Passmore, PhD1
Denise Maguire, PhD, RN1
(1)College of Nursing, University of South Florida, Tampa, FL
(2)Neonatal Intensive Care Unit, All Children's Hospital, St. Petersburg, FL

Learning Objective 1: 1.Describe the presenting symptoms and treatment of an infant with neonatal abstinence syndrome.

Learning Objective 2: 2.Explain at least one moral issue encountered by NIU nurses who care for infants with neonatal absence syndrome.

Moral distress has been defined as being the painful psychological disequilibrium that results from recognizing the appropriate action, yet not taking it because of some obstacle or constraint.  Neonatal intensive care unit (NICU) nurses are thought to be at particular risk for moral distress due to the nature of this highly specialized nursing. Technological advances in the care of the newborn infants have been rapid and diverse, and often lead to extremely complex management of very ill infants who formerly would never have survived. More recently, NICU nurses are responsible for the care of babies with Neonatal Abstinence Syndrome (NAS) which creates numerous ethical and moral issues.

Participants for this study are registered nurses who are assigned to work in a neonatal intensive care in a specialty licensed children’s hospital. A snowball, purposive sampling technique is being used to initiate contact with potential. Recruitment will continue until data saturation is obtained. The principle investigator is conducting audio taped one-on-one interviews with each participant. Thematic and domain analysis will then be done to develop a rich description of the NICU nurses lived experience.

Seventeen interviews have been completed. Each participant has identified caring for an infant born with Neonatal Abstinence Syndrome as a significant stressor. Participants have reported distress when observing manifestation of withdrawal symptoms from narcotics and have discussed the inconsolability of the babies. Participants sincerely want the mothers to be successful in their recovery/sobriety. However, nurses experience anger and frustration as they observe the effects of the drug withdrawal manifested in the infant. Most importantly nurses fear discharging the infant to a potentially unsafe environment and/or unstable care provider.

Completed thematic and domain analyses will be presented at the conference. Recommendations for appropriate interventions for the nurses and families will also be presented.