Nurses' Perceptions of Caring for Opiate Abusing Pregnant and Post-Partum Women

Purpose: This study explored obstetric nurses’ perceptions of caring for women during their hospital birthing and postpartum experiences who had prior histories of opioid abuse during pregnancy. Specific aims included to 1) describe common themes associated with nurses’ perceptions of caring for this population, and 2) identify specific areas for intervention development. Background: The use of prescription and illicit opiate medications among women of childbearing age has increased dramatically over the last 30 years in the United States. Although the exact prevalence of female drug use in the United States is unclear, roughly 30% of those considered to be substance-addicted are females in their childbearing years. It is apparent that opiate use during pregnancy is no longer a rare occurrence. There is a critical gap in the literature specific to nurses’ perceptions of caring for pregnant women who arrive to the hospital with prior opioid abuse histories. Filling the gap is particularly important if nurses’ beliefs, biases, and specific educational needs for providing effective care for opiate using women can be identified and described, then specific areas for intervention development can be discovered. Methods: Grounded theory methods of inquiry, as described by Corbin and Strauss, were used to guide data collection and to identify common themes. Initially, eight, inpatient, obstetric nurses working in large birthing centers in Washington State were interviewed using semi-structured interviews. Follow-up interviews with four of the nurses were conducted to validate emergent themes.  Results: Four themes were derived from the data: needing more knowledge, feeling challenged, expressing concern for the infant, and knowing the truth. Implications: The four themes identified can impact nursing practice and patient outcomes by providing specific areas for intervention development focusing on this population of vulnerable women. Obstetric nurses described several ideas for intervention development (e.g., continuing education offerings relevant to caring for opiate abusing mothers, collaborating with providers to design education, re-evaluating pain management philosophies and practices at all levels, and working with social workers to explore available and needed community resources).. Future research includes the evaluation of newly developed personalized interventions; the examination of the empirical linkages among key mother and child health outcomes; the delivery of specific nursing therapeutics; and the exploration of providers’ and patients’ perceptions and knowledge of opiate use during pregnancy, birth, and beyond.