The burden of care: a focus group study of healthcare practitioners in Scotland talking about parental drug misuse

Abstract

Parenting and family support are key prevention and intervention strategies for improving outcomes for children and families affected by parental drug misuse. However, little is known about the delivery of parenting support for drug-dependent parents, particularly within universal healthcare services. This study aimed to explore the way healthcare practitioners engage with this challenging agenda. Four multidisciplinary focus groups involving a purposive sample of 18 experienced healthcare professionals were conducted in Scotland. Participants included general practitioners, midwives, public health nurses and addiction staff who work together to provide care for vulnerable families. A focus group topic guide was developed to explore the views and experiences of these healthcare professionals in relation to providing parenting support for drug-using parents, predominantly those receiving opioid substitution therapy. Data were analysed using a constant comparison method and thematic approach. The overarching narrative which united the focus group discussions was about the 'burden of care' that these families pose for frontline healthcare professionals. Recurring themes centred on three key issues: the problematic nature of drug-using parents themselves; clinical challenges in living up to the ideals of professional practice; and the wider context in which current practice is governed. Professionals expressed ambivalence over their parenting support role; anxiety over responsibility for intervening with this 'hard-to-engage' population; and concern over 'dwindling' resources and lack of organisational support. Nevertheless, strategies and opportunities for providing parenting support were acknowledged and there was consensus about the need for further skills training. Despite a proliferation of policy and good practice guidance on the delivery of parenting support for drug-dependent parents, the findings of this study suggest that significant challenges remain. Notably, our findings raise questions about whose role it is to provide parenting support to drug-using mothers and fathers, especially those who are not involved in the child protection system.

Moral distress of nurses surrounding neonatal abstinence syndrome: Application of a theoretical framework

“…Concerns about less than desirable quality of care resulting from poor availability of staff and support is a predominant theme in the literature describing causes of moral distress . The literature thematically supports the idea that the moral saliency of quality of care is aligned with the values of beneficence and nonmaleficence as they directly relate to the well‐being of the individual patient …”

“…The goal of nonmaleficence may be challenged through the experience of verbal abuse and physical threats from some families of infants with NAS. Nurses fear for the safety of the infant upon discharge in the absence of a healthcare provider to protect the infant from harm . If the nurse perceives that harm to the infant, in any circumstance, is a consequence of their inability to protect them, moral distress may be triggered.…”

“…The NAS epidemic affects a broad range of healthcare providers, including neonatologists, and neonatal nurse practitioners, obstetricians, maternal‐child nurses, social workers, physical therapists, and pharmacists. However, it is the neonatal intensive care (NICU) nurse who is charged with providing skilled critical care to high‐risk infants including the overwhelming comfort needs of infants exhibiting signs of opiate withdrawal . The presentation of physical symptoms of withdrawal is highly individualized with each infant, as it is not uncommon for mothers to use multiple substances including caffeine, tobacco, opioids, and nonopioids, which produce nontraditional and/or synergistic effects in the neonate .…”

“…However, it is the neonatal intensive care (NICU) nurse who is charged with providing skilled critical care to high-risk infants including the overwhelming comfort needs of infants exhibiting signs of opiate withdrawal. [5][6][7][8][9] The presentation of physical symptoms of withdrawal is highly individualized with each infant, as it is not uncommon for mothers to use multiple substances including caffeine, tobacco, opioids, and nonopioids, which produce nontraditional and/ or synergistic effects in the neonate. 6 The care needs for infants exhibiting signs of NAS include creating a low stimulation environment, various feeding interventions, and a multitude of ongoing and sometimes simultaneous comfort techniques such as holding, tight swaddling, rocking and swaying.…”

“…Nurses consistently report families of NAS infants to be the most difficult to work with due to the inconsistency of visitation, defensive attitudes, and lack of disclosure. 5,[7][8][9]12,13 Often unbeknownst to nurses, mothers may be experiencing a multitude of stressors, anxieties, and fears leading to some of these described behaviors. 7,14,15 Competing priorities of the nurse to meet the needs of all the patients and families under their care creates an environment ripe for moral distress.…”