Posted by: Write My Essay on: December 6, 2018

Essay Writing Sample: Nursing Scenario Discussion Boards


Nursing Scenario Discussion Boards: Neonatal Abstinence Syndrome

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The Neonatal Abstinence Syndrome (NAS) is a drug-addiction medical condition occurring after in utero subjection to opioids. The syndrome commonly present itself at the beginning as mild tonicity, irritability, poor feeding habit and mottled skin color accompanied with seizure. From the early 2000s to 2012, the NAS condition in America has doubled whereby numerous states have recorded increased rates. The rise is due to increased use of opioids by expectant women. It can also be attributed to the lack of uniform evidence-based research and pharmacological protocols that should review and improve any NAS case.  This paper, thus, clarifies the need for an integrated evidence-based practice care for treatment and management of NAS patients.


  1. Asking a clinical question

The length of hospitalization for patients with the NAS condition varies greatly depending on the amount of drug taken, socioeconomic factors and withdrawal symptoms. Recent research shows that pharmacological factors play an insignificant role in managing the NAS condition in infants such as BammBamm. Thus, it is considered professional to offer an extended therapy services to BammBamm when administering medication.  However, mothers receiving methadone dose of more than 20mg/24h are advised not to breastfeed since they are prone to fluoxetine which is responsible for the production of a significant amount of plasma concentration especially if the exposure began in utero (Chau et al., 2016). Also, methadone-exposed infants have been observed to exhibit increased development complications such as motor rigidity, decreased activity, and deregulated motor patterns. However, despite this fact, it should be noted that breastfeeding boosts the immune system of infants and has also been proven to increase parent-infant bonding. Since, through various studies, it is a small amount of methadone that is present in the breast milk, it is always advisable to breastfeed the child.

  1. Searching for the Best Evidence

Non-pharmacological supervision of the opioids subjected to infants should be done under careful assessment of the child and the mother (in this case Pebble and his son BammBamm). It also calls for nurses’ participation and modifications of the surroundings and social interactions affecting the infant’s neurodevelopment and physiological stability. Traditional-based care tends to offer uniform attention to all children affected by the NAS conditions since few NAS-focused nursing interventions are scientific-based (Schaffer et al, 2013). Most essential components of the traditional-based care are instructional and aim at facilitating parental engagement with the child. [“Write my essay for me?” Get help here.]

Every newborn baby has different styles of processing and reacting to environmental factors and nurses’ cues. Mostly, children display diverse NAS symptoms with varying magnitude and severity over time. According to Schaffer et al. (2013), suitable supportive environment of the in utero opioid-subjected-child, such as BammBamm, calls for a thorough assessment and accurate analysis of physiological and observable expressions of the NAS condition – ranging from the actual cause of the condition to individualized plan for treatment and adjustment to the environmental and nurse interactions. Sometimes it is hard to analyze the condition in suffering infants. For instance, when BammBamm was crying out loudly, it was advisable for Nurse Stone to adjust/decrease environmental stimuli since the baby had just breastfed. What is more, despite the fact that Pebble wanted to tolerate and help her child, she lacked the required expertise and emotional awareness to recognize the observable traits and support to make BammBamm stable. This challenge calls for Nurse Stone (and nurses in general) to provide a pacifier for non-nutritive sucking and swaddle BammBamm as she makes Pebble aware of the prevailing situation.

  1. Critically Appraising The Evidence

The National Council on Alcoholism and Drug Dependency conducted a research in the United States and estimated that about 9% of infants born per year get subjected to harmful substances in utero (Pryor et al, 2017). On the other hand, the American Academy of Pediatrics (AAP) published a report in which it estimated that almost 48% of infants are exposed to opioids such as methadone and heroin, and thus are susceptible to develop the NAS condition. Additionally, the AAP noted that optimal care of NAS populace in the United States is affected by the deficiency of evidence-based revised guidelines and procedures for pharmacological organizations and care that promotes improved results for NAS victims.

According to Pryor et al. (2017), there is a growing need for development and implementation of evidence-based medical practice guidelines, protocols and education schedule on NAS and the Finnegan Neonatal Abstinence Scoring Tool (FNAST), to facilitate the assessment and management of NAS infants and the scoring accuracy of the FNAST.  Evidence-based practices on NAS and FNAST equip caregivers such as Nurse Stone with the required tool to invariably and accurately evaluate the infants with NAS while using the FNAST.  Current research shows that offering education to the nurse result to skill gain and promotes patient care goals (Pryor et al., 2017). Consequently, education equips nurses with the required skills to manage complex NAS conditions. For instance, it could have been easier for Nurse Stone to manage BammBamm without making calls to Dr. Slate.

  1. Integrating the Evidence

The use of NAS clinical practice guidelines and protocols have shown to result into increased identification of infants with NAS, lessened NAS severity, and decreased length of hospitalization. These guidelines include: Firstly, a pharmacological algorithm such as combining inpatient and outpatient care in treatment programs to reduce the length of hospitalization and reduction on inpatient cost should be employed. Notably, outpatient needs to be for mothers who enroll in a program on methadone.  Secondly, mother rooming-in with the infant should be permitted to allow for breastfeeding bonding when the baby is hungry. However, after allowing mother rooming-in with the child, it is wise to incorporate into the discharging plan a social work assessment, discuss community resources for the mother, and create a plan for how the home environment will support the mother and the baby. According to Hoagwood et al. (2014) argue that until the specific discharge guidelines for the NAS condition  have not been developed and the incorporation of these components into the release plan, the mother and the child ought to receive the continued care  that they need.  For instance, when Pebble is scheduled to leave the hospital for home, the healthcare system needs to have a mechanism in place to make a follow up of her progress with the child. The grandmother should also be made to understand the situation so as to facilitate Pebble and BammBamm with quality integrated care as required. [Click Essay Writer to order your essay]

  1. Evaluating the Outcome of an EBP Change

The evaluation of evidence based practice (EBP) change is conducted by comparing the length of hospitalization for neonates with NAS that sought treatment under the protocol to a group of NAS newborns treated before the protocol implementation. Currently, evidence-based programs are in place for some health conditions such as kidney failure, diabetes, and to lesser extent NAS patients. Most importantly, the methods rarely manifest in the health facility management practices and service delivery. Habitually, consumer safety research is based on data analysis to establish patient safety problems and demonstrate that a modern rationale will create better quality and patient safety. However, little research has been done to establish full implementation of these protocols in the healthcare system.

EBP is the platform for critical analysis and use of modern best evidence in line with clinical expertise and consumer values to mentor health care decisions. Perfect examples include empirical exhibit from randomized controlled trials (RCT), scientific-based methods; such as qualitative evidence and the inclusion of information from research reports. Currently, EBP on the length of hospitalization for neonates treated under the NAS protocol implementation shows a decrease in the severity as contradicted to infants treated before the implementation of the protocol (Hoagwood et al., 2014). The improvement is due to an integrated care between caregivers, patients, and family thus ensuring availability of quality care as required. [Need an essay writing service? Find help here.]


Although much has been researched on opioid dependence in pregnant women, little research has been done to adequately provide quality care in fair and complex medical conditions such as NAS. Private and public hospital in partnership with the state health agencies have a unique contribution to make to the broad knowledge base and support of best practices in caring for women and infants affected by NAS. Also, it is worth noting that optimal treatment and management of the NAS patient is affected by the deficiency of evidence-based revised manuals and protocols for traditional and scientific based healthcare that promotes improved results for NAS patient. Thus, the situation can be enhanced with practice guidelines and education on NAS and FNAST-the required equipment to accurately evaluate children with NAS.


Part 7

  Date  Hours Knowledge

What knowledge from the course did you apply? How did you learn more about this content?  Use words like: Describe, Discuss, Explain, Identify, Recognize, Review


What actions/behaviors did you observe in stakeholders/staff? How did they explain their role in patient outcomes? What values did they demonstrate/express?


What do these actions/behaviors reflect about how this organization values EBP?

What did you learn about the staff’s role in EBP?

How you will apply EBP in clinical practice?

Complete Simulation Case Scenario     Evidence-based practice.

Personally, I researched on the internet and interacted more with people who are familiar with NAS symptoms.

At home I had the chance to interact with a friend whose aunt had a NAS child. Identification was not enough for my research so I opted to have an interview with the aunt and I came to recognize that she resorted to drug and substance abuse due to financial constrains such as unemployment and bills to be paid.

The behavior of the staff is well described as ambitious owing to the fact that most nurses were eager to learn new technology to help them deliver quality services to NAS patients.

During the presentations and learning of new technologies through videos and powerpoint slides, nurses and the healthcare staff demonstrated patience and humility. Whenever they could not understand the functioning of any medical equipment such as the FNAST, most of them did not shy away from being taught over and over again.

The staffing behavior explains the uptake of EBP in the healthcare system as optimistic to helping most NAS patients. Evidence-based practice according to the staff describes and addresses all aspects of the healthcare through an integrated approach.

The staff was determined to mobilize NAS patients and families to seek counseling and be in the look out for NAS symptoms

In a clinical set up and practice EBP is applied through guidance and counseling sessions. Advising both the patient and the family on the effects of NAS and the importance of living a NAS-free life



Chau, K. T., Nguyen, J., Miladinovic, B., Lilly, C. M., Ashmeade, T. L., & Balakrishnan, M.

2016). Outpatient Management of Neonatal Abstinence Syndrome: A Quality Improvement Project. The Joint Commission Journal on Quality and Patient Safety, 42(11), 506-515.

Hoagwood,, K. E., Olin, S. S., Horwitz, S., McKay, M., Cleek, A., Gleacher, A., … & Kuppinger,

  1. (2014). Scaling up evidence-based practices for children and families in New York State: toward evidence-based policies on implementation for state mental health systems. Journal of Clinical Child & Adolescent Psychology, 43(2), 145-157.

Pryor, J. R., Maalouf, F. I., Krans, E. E., Schumacher, R. E., Cooper, W. O., & Patrick, S. W.

(2017). The opioid epidemic and neonatal abstinence syndrome in the USA: a review of the continuum of care. Archives of Disease in Childhood-Fetal and Neonatal Edition, fetalneonatal-2015.

Schaffer, M. A., Sandau, K. E., & Diedrick, L. (2013). Evidence?based practice models for organizational change: overview and practical applications. Journal of advanced nursing,             69(5), 1197-1209.



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