The article under consideration is written by Angela F. Clark and entitled “Effect of a neonatal abstinence syndrome training program on nurses’ confidence and ability to use the Finnegan scoring tool.” The study is aimed to examine the effectiveness of a nursing education program on neonatal abstinence syndrome (NAS) and its impact on the reliability and accuracy of the Finnegan Scoring Tool (FST) (Clark, 2019). The researcher also explored nurses’ confidence in using the instrument before and after the completion of the program. This study deals with one of the significant issues in nursing practice, as it is estimated that up to 60-90% of newborns exposed to opioid drugs during pregnancy have symptoms of withdrawal of different severity (Clark, 2019). Although the number of women using opioids during pregnancy is hard to estimate correctly, it is rather alarming, so nurse practitioners have to be prepared to diagnose NAS and provide the appropriate care.
The growing rate of newborns with NAS has become rather burning during recent years. The incidence of this health condition has grown by 300% since the 1990s (Clark, 2019). It is reported that a baby with NAS is diagnosed every 30 minutes in the USA (Clark, 2019). The most vulnerable population is teenage mothers aged between 15 and 17, but it is also known that at least 4.4% of pregnant females misuse substances.
The adverse impact of pregnant women’s substance use is well recorded and includes birth defects, prematurity, sepsis, low birth weight, respiratory depression, perinatal hypoxia, and placental hemorrhage. Neonates with NAS experience poor weight gain, as well as failure to thrive, and have cognitive and behavioral deficits in their childhood and adolescence that persist in their adulthood (Clark, 2019). According to the assessment implemented in 2009, the total hospitalization cost for neonates with NAS was over $720 million. Due to such negative outcomes for neonates’ health and development, several tests and examinations are conducted to diagnose the NAS. At that, due to the lack of resources, not all of the available instruments are utilized, which makes nurses key players in the process of identification of newborns with NAS symptoms.
Due to the gravity of the impact and negative outcomes for children, several instruments to diagnose NAS symptoms have been developed. The Finnegan scoring tool is an instrument identifying neonates with NAS, widely employed in the USA (Clark, 2019). The study in question aims to evaluate the effectiveness of an educational program on the NAS and the use of the FST and nurses’ confidence when utilizing the instrument. Clark (2019) addressed the following research question in the article:
- Does the developed educational program enhance scoring accuracy?
- Does the developed training enhance scoring confidence?
Although the section on the review of the recent literature is relatively brief, it provides insights into the matter and helps understand the current focus in academia. The researcher concentrates on FST assessment employed in the clinical settings and training programs developed for nurses in relation to the reliability of the assessment tool mentioned above (Clark, 2019). The author concludes that, based on the reviewed literature, training programs have a positive effect on the accuracy of FST use and the identification of NAS symptoms. As far as the framework utilized to support this study, the Plan-DO-Study-Act cycle guided the implementation of the project under analysis.
This quantitative case study is characterized by the use of a quasi-experimental research design to address the research questions. Pre-test and post-test questionnaires were the data collection tools employed in this study (Clark, 2019). The sample size reached 17 nurses who volunteered to take part in the research, so it is possible to note that a convenience sampling method was utilized. The author does not report on the statistical power of the sample but only states that all neonatal departments of the hospital were included. As for the demographics, 65% of the nurses had bachelor’s degrees, 58% were 40 years old or older, and almost a quarter of them (23%) had 19-24 years of neonatal nursing experience (Clark, 2019, p. 489).
Since the study involves human participants, all the necessary permissions were obtained before the start of the project. Clark (2019) received the institutional review board approval, and the participants received a written consent form with all important details regarding the article described. The participating nurses also received monetary compensation for their participation in the educational program and the study.
The data collection tools included questionnaires measuring demographics, nurses’ self-confidence, as well as their satisfaction and self-confidence in learning. The FST developed in 1975 was utilized to assess NAS symptoms in neonates. Demographics questionnaires included such aspects as age, education, working experience, sex, certifications, and hospital unit. In order to measure nurses’ self-confidence, the participants answered a single question (using a Likert scale) before, after, and during a follow-up session (Clark, 2019). The student satisfaction and self-confidence in learning measurement tool developed in 2018 by the National League for Nursing was utilized to assess nurses’ views on the training and its outcomes.
The author provides specific information on the reliability and validity of the data collection methods used in this study. As for the identification of NAS symptoms using the FST, Clark (2019) reports that interobserver reliability grew from 64.7% prior to the training to 94.1% after the educational program completion. During the follow-up, the observer reliability was below 90%, so the participants did not meet the established benchmark. The use of the FST is discussed in the article, and the tool has been widely used in research and practice, so it has been validated in multiple studies. For instance, the mean interrater reliability coefficient of the FST ranged between.75 and.96, which suggests that the tool is characterized by high reliability (Clark, 2019). As far as the student satisfaction and self-confidence in learning measurement tool, this questionnaire has “a Cronbach’s alpha of.94 for satisfaction and.87 for self-confidence” (Clark, 2019, p. 489). This high score also indicates that the chosen instrument has the necessary level of reliability. The validity or reliability of the question on the participant’s self-confidence is not reported.
Overall, it is possible to note that the author uses data collection methods characterized by a high level of validity and reliability. For some tools, Clark (2019) reports the results of other researchers’ validations, for some means, the author implements a short verification to ensure that appropriate instruments are utilized. At that, the use of the question regarding the participants’ self-confidence should be validated as well, so the article would be enhanced if some reporting on the reliability of this question was given.
Clark, A. F. (2019). Effect of a neonatal abstinence syndrome Training program on nurses’ confidence and ability to use the Finnegan scoring tool. Nursing for Women’s Health, 23(6), 485-493. Web.