Substance use during pregnancy can adversely affect both health and social outcomes for the infant and the mother. Many practices related to the care of infants with prenatal substance exposure are not consistent from one facility to another and have been developed on an anecdotal basis rather than based on empirical research. A replication study of a 2002 national practice survey is being planned that will describe some of the practices related to daily care, discharge planning, and community support for this group of infants and their caregivers. In this thesis, I present the findings of a pilot study that was conducted as a prelude to this larger national study. A summary of a literature review of recent survey research is presented along with a description of the process of revising a previously developed instrument to survey the practices used when caring for infants with prenatal drug and alcohol exposure and their mothers in the hospital setting. Content validity of this revised instrument was established with the support of a content expert group and the revised instrument was pilot tested with a small sample of nurses who practice in hospitals that will not be eligible for the national study. The findings from this pilot study will guide the research team in developing and conducting the national survey. / Graduate / 0539 / 0380 / 0573

Neonatal abstinence syndrome (NAS) refers to the withdrawal symptoms experienced when an infant has been exposed to certain substances (e.g., opioids) in-utero, resulting in health challenges for infants. Previous studies have reported substantial variations in the clinical management of NAS, suggesting that some infants may not be receiving optimal care. High-quality clinical practice guidelines are crucial to support optimal patient outcomes and standardize care. In response, I conducted a systematic review and quality appraisal of available NAS guidelines and recommendations using the AGREE-II and AGREE-REX tools. I also developed and piloted a tool to measure family-centred care in guidelines. Most guidelines received low-quality appraisal scores on the AGREE-II and the AGREE-REX appraisals (16/20 and 10/20, respectively) and have conflicting pharmacological recommendations. Findings will improve clinicians’ awareness of the variation in the quality of guidelines and assist them to make care decisions that are from the best available evidence and family-centred.