Abstract

Background and Objective

• Few studies have described the experiences of healthcare providers involved in custody apprehensions of substance-exposed newborns. None of these prior studies have taken place in Canada.
• The aim of this study is to explore newborn custody apprehensions from the perspective of the New Brunswick nursing staff who provide direct care to substance-exposed newborns or their birthing parents who use substances.

Methods

• Eligible participants: Licensed practical nurses and registered nurses who are employed within the Saint John Regional Hospital, the Moncton Hospital, or the Dr. Everett Chalmers Hospital.
• Potential participants were recruited via advertising within hospital wards, as well as through invitation to attend a presentation pertaining to the study.
• Participants (n=9) were invited to participate in semi-structured interviews. The interview questions were replicated from the study conducted by Everitt et al. (2015), with alterations and additions made to be more applicable to a New Brunswick nursing population.
• The interview transcription data was subject to a thematic analysis (Braun & Clarke, 2006). Key themes from the interview transcriptions were identified through independent coding performed by the members of the research team. The initial coding was discussed in a group setting, then these codes were further classified into overarching themes, followed by an analysis of each of overarching theme, as supported by participant quotations as evidence.

Results

6 Key Themes:

• Emotional toll of caring for families undergoing newborn custody apprehension.
• Nurses’ desires for support for themselves and their patients.
• Nurses' desires for training to care for affected families: Clarity needed on standard of care and roles.
• Communication as a foundational component of care and interprofessional collaboration.
• Conflict: Intrapersonal and Role Conflicts
• Provision of trauma informed care

6 Key Recommendations:

1. Implement trauma-informed care training, specific to substance use disorders, in undergraduate and continuing- education activities.

2. Develop comprehensive and transparent procedures for all providers and allied professionals who are involved in newborn custody apprehensions.

3. Implement debriefing sessions for all providers and allied professionals following situations where newborn custody apprehension is being considered/has occurred.

4. Educate patients on harm-reduction during the post-birth 'sensitive period' where parents who use substances may be especially motivated to seek treatment.

5. Account for social factors, such as possibility of apprehension, when assessing the level of nursing care required for newborns and parents.

6. Advocate for family-centred supports for birthing parents who use substances.

Conclusion

• Similarities were apparent between the present study and the study conducted by Everitt et al. (2015), such that both New Brunswick nurses and Australian midwives described feeling unsupported and unprepared in their roles during newborn custody apprehensions.
• Nurses experience challenges, both emotionally and professionally, with custody apprehensions of substance-exposed newborns.
• Nurses perceive barriers to providing trauma-informed care to birthing parents who use substances when their newborn is apprehended. Barriers are evident through a lack of education and training pertaining to the provision of trauma-informed care to people who use substances.