Evaluation of a Neonatal Abstinence Syndrome Training Program on Correct Use of the Finnegan Scoring Tool and Nurse Confidence

Abstract

Approximately 4.4% of women in the United States will abuse at least one substance during pregnancy. Drug-exposed newborns are diagnosed with neonatal abstinence syndrome (NAS) as a result of withdrawal symptoms. The incidence of NAS has risen more than 300% during the past 30 years. More than 60%–90% of newborns who are exposed to opiates during pregnancy will exhibit withdrawal symptoms. The Finnegan Scoring Tool (FST) can be used to assess newborn withdrawal symptoms. Identifying symptoms early prevents delay in care for these newborns. Training on correct use of the FST has been shown to increase confidence and validity when using the tool. A goal of at least 90% interobserver reliability suggests correct symptom identification. The purpose of this project was to evaluate the impact of an NAS educational training program on the accuracy and reliability of NAS scoring when using the FST, as well as the impact of training on nurse confidence. Pilot project using a quasi-experimental design. A convenience sample of 17 nurses from the mother–baby unit, NICU, and pediatrics watched a video of an infant and used the FST to score withdrawal symptoms before and after an educational training session, as well as at a 2–4-week follow up, and completed a self-confidence rating when using the tool. After training, participants improved by 29.4% in meeting the goal of at least 90% interobserver reliability for NAS scoring (pretraining = 64.7%; posttraining = 94.1%). No participants maintained 90% at follow up. There was a strong positive correlation between years of neonatal experience with confidence at pretraining, r = .524, p < .038; posttraining, r = .521, p < .032; and follow up, r = .558, p < .020. There was a statistically significant increase in confidence from pretraining (M = 2.0588, SD = 0.55572) to posttraining (M = 2.4706, SD = 0.51450), t(16) = –3.347, p < .004 (two-tailed). Eta squared (.41) indicated large effect size. Participants reported positive buy-in and the need for additional training. The total score did not translate to correct symptom identification. Analyzing the proportion of correct symptom identification for each symptom is an appropriate indicator if participants used the tool correctly. Competence does not equal confidence. Neonatal caregivers need advanced NAS training to improve symptom identification during orientation and annually to help improve NAS competence.