Evaluation of Nurses' Competency in the Assessment of Neonatal Abstinence Syndrome

Abstract

Neonatal abstinence syndrome (NAS) is a growing concern with the increased rate of prescription and illicit drug use during pregnancy. Assessment of NAS requires nurses to have knowledge and a complex skill set to provide quality care. The purpose of this quality improvement project was to evaluate the impact of an NAS educational intervention and the use of a systematically approached NAS scoring tool upon the nurses' ability to accurately assess infants with NAS. Nurses at a private community hospital participated in a comprehensive educational intervention guided by a cognitive learning theory to improve their knowledge and skills in the assessment of infants at risk for NAS. The education program focused on the presentation of NAS symptoms and principles of the modified Finnegan NAS scoring tool. The nurses were taught how to use the tool to assess for NAS and the importance of consistent use among staff members.

A pretest-posttest method demonstrated a gain in knowledge. There was a statistically significant increase from the pretest (M = 7.71, SD = 1.68) to the posttest scores (M = 9.06, SD = .98), t (33) = 5.68, P < .001. The mean increase from pretest to posttest score was 1.35 with a 95% confidence interval ranging from .868 to 1.838. The eta squared statistic (.49) indicated a large effect size. Four weeks later, a subsample of 12 participants scored videos and scenarios with predetermined NAS scores and were evaluated using an intraclass correlation coefficient which confirmed interrater reliability with a mean of .94 for the first video/scenario and .98 for the second. Comprehensive NAS education and the routine use of the modified Finnegan NAS scoring tool provided registered nurses with knowledge and skills needed to accurately assess infants at risk for NAS.