Document Type

DNP Project

Department

School of Nursing

Date of Degree

Spring 2026

Degree

Doctor of Nursing Practice (DNP)

Primary Advisor

Angela Stanley, DNP, MA, FNP-BC, PHCNS-BC, NEA-BC, FAANP, FAAN

Keywords

Neonatal Abstinence Syndrome; Neonatal Health; Opioid Exposure

Abstract

Background

Neonatal Abstinence Syndrome (NAS) affects up to 94% of opioid-exposed neonates. A needs assessment at a rural Minnesota hospital, where the local NAS rate exceeds the state average, revealed that neonates at risk are not consistently screened. This lack of screening can delay treatment, leading to prolonged withdrawal, and increase hospital stays and costs.

Aims

This quality improvement project aimed to (1) improve nurse confidence and (2) identify barriers and facilitators to consistent implementation of NAS screening using the Eat, Sleep, Console (ESC) assessment tool following a nurse education intervention.

Methods

Twelve full-time and part-time nurses on the Labor, Delivery, Recovery, and Postpartum unit received education on the ESC assessment tool. Surveys measuring self-confidence in using the tool were administered pre- and post-education. Interviews were then conducted with nursing staff, guided by the 14-item pCAT survey from the Consolidated Framework for Implementation Research, to identify perceived barriers or facilitators to consistent NAS screening.

Results

Mean pre- to post-education confidence scores rose by 3.6 points (p=0.005, Wilcoxon test). This improvement may correlate with increased screening compliance.  CFIR constructs identified as facilitators included “Patient Needs and Resources,” “Compatibility,” and “Relative Advantage,” meaning nurses recognized the clinical need and found the tool aligned with existing workflows. “Reflecting and Evaluating” was identified as a barrier, as nurses lacked structured opportunities to review screening practices. This barrier may affect screening consistency.

Recommendations

This project identified specific barriers and facilitators affecting consistent screening of newborns at risk for NAS in a rural setting. Findings can inform targeted implementation strategies, such as structured screening review sessions and onboarding education. This will improve the identification and outcomes for affected neonates at this facility and may also influence state-level NAS screening guidelines for similar rural hospitals.

Open Access

1

Download

Available for download on Sunday, May 24, 2026

Share

COinS