Nursing care of the opioid addicted pregnant woman, postpartum mother, and her newborn demands a multi-disciplinary, non-stigmatic approach that meets the patient’s physical, psychological, and psycho-social needs. Based on a review of existing literature this presentation will identify the demand for an updated evidence-based nursing protocol that encompasses the care, treatment, and educational needs of this complex patient dyad as well as share pertinent nursing considerations.
Methods:
In order to develop an educational plan regarding the care, treatment, and education protocols of the opioid addicted pregnant woman, postpartum mother, and her newborn; research of current, evidence-based articles and professional healthcare websites were evaluated. A literature search was conducted during August and September 2016 using CINAHL, PubMed, Medline, and the Cochrane databases. Keywords and phrases used were: ‘opioid dependency’, ‘nursing care of addicted pregnant women’, ‘patient education needs of addicted pregnant women’, ‘effects of opioid addiction with pregnancy’, ‘postpartum care and substance abuse’, ‘addiction treatment during pregnancy’ and ‘neonatal abstinence’. Health-based website resources were also evaluated for relevance and quality using the Health on the Net Code of Conduct. No date restrictions were imposed during the initial search. However, upon review of the over one-hundred research articles and tens of health-based websites, the sources utilized were all written within the last five years.
Results:
Within the United States the rate of opioid addiction of pregnant women has become a public health issue of epidemic proportions (Meyer & Phillips, 2015). Specific to the pregnant population, there was a 5-fold increase of antenatal substance abuse and a 3-fold increase for neonatal abstinence syndrome (NAS) regarding occurrence and treatment between 2000 to 2009 (Meyer & Phillips, 2015). The Substance Abuse and Mental Health Services Administration (SAMHSA) report an increase in the use of illicit substances to 5.9% of pregnant women (Amatetti & Young, 2016). These staggering statistics reveal the need for change in healthcare practices specifically; the care, treatment, and education of the opioid abusing pregnant woman during the antepartum period as well as the mother-newborn within the postpartum period. The overarching principles of a new plan of care would be inclusive of ensuring this vulnerable population have access to treatment services, receives respectful care with patient autonomy, are provided with comprehensive medical and psychological care and education, and are safeguarded against discrimination and stigmatization (World Health Organization [WHO], 2014). These principles should be employed into patient care and education through the initiation of a standardized substance abuse screening assessment, physical and psychological assessment and support, medication-assistance treatment (MAT), pain control assessment and management, breastfeeding assistance, mother-newborn bonding, neonatal abstinence syndrome assessment and treatment, as well as maternal and newborn discharge needs.
Conclusion:
It is apparent based upon the intensive literature review this vulnerable patient dyad requires comprehensive, holistic, and ongoing care and education. The protocols in place currently do not appear to meet the patients’ physical and psychological needs. Therefore, nurses working collaboratively with varied healthcare providers (HCPs) need to enable a change in the plan of care promptly as it would affect healthy outcomes for the opioid addicted pregnant woman, postpartum mother, and her newborn. Implementation of an opioid care and education protocol reflective of the physical, psychological, and psycho-social needs would be most effective toward a holistic positive outcome. Providing these comprehensive services in a non-threatening, and non-stigmatic approach throughout the hospitalization would improve treatment success and lead to improved patient addiction recovery and a healthier future for the mother and newborn family (Amatetti & Young, 2016; WHO, 2014). Each article and organizational resource significantly confirmed the mandate for an enhanced care and education protocol, wherein the opioid abusing pregnant woman, postpartum mother, and newborn would receive collaborative holistic care and education leading to addiction treatment compliance and improved health outcomes.
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