Date of Award

2019

Embargo Period

8-1-2024

Document Type

Dissertation - MUSC Only

Degree Name

Doctor of Philosophy (PhD)

College

College of Nursing

First Advisor

Cristina Lopez

Second Advisor

Sarah Miller

Third Advisor

Barbara Englehardt

Abstract

Purpose: The purpose of this dissertation was to evaluate current neonatal acupuncture studies and develop a consistent delivery protocol that may be feasibility implemented within the standard of care for neonatal abstinence syndrome (NAS). Initially, a scoping review was conducted to evaluate the safety and efficacy of acupuncture for infants and further answer the research question: What is known from existing research about acupuncture in the neonatal population? Following this broad review, an integrative review was performed to thoroughly evaluate the quality of current neonatal acupunctures studies and identify essential characteristics necessary for NAS acupuncture treatment. Finally, a developed auricular acupressure protocol as informed by the Near Term Infant (NTI) conceptual framework was implemented in a pilot feasibility study at an academic medical center. Aims: Specific aims for this dissertation study were as follows: • Aim 1: Assess feasibility of training, certifying, and credentialing of advanced practice providers to administer acupressure on neonates at risk for developing NAS. • Aim 2: Assess feasibility of delivering an auricular acupressure protocol for the treatment of NAS. • Aim 3: Assess acceptability and implementation of the acupressure protocol as an adjunct treatment within NAS standard of care. Design: A feasibility pilot study implemented an auricular acupressure protocol as informed by the NTI conceptual framework for the treatment of NAS at a medical institution. Feasibility benchmarks were examined for each of the three aims as outlined below: • Aim 1: provider training, certification, and credentialing • Aim 2: demographics, recruitment metrics, enrollment metrics, and auricular acupressure administration. • Aim 3: parental satisfaction (CSQ8) and healthcare provider acceptability (AIM, IAM, and FIM) Findings: Three advanced practice providers (75%) attained credentialing at Monroe Carrell Jr. Children’s Hospital Vanderbilt (MCJCHV) and were granted privileges to administer auricular acupressure on neonates. A total of 12 neonates at risk for developing NAS due to in utero substance exposure were enrolled in this dissertation study and underwent auricular acupressure. Acupressure was successfully implemented in combination with first line, non-pharmacological interventions and well tolerated by neonates. Mothers were satisfied with acupressure as an additional treatment with mean CSQ8 scores ranging from 3.8-4.0 (out of a possible 4.0). The majority of healthcare providers were also supportive (66%, mean scores 3.6-4.0 out of a possible 5.0), however response rates were only 35.8%. Conclusion: As demonstrated in this feasibility pilot study, auricular acupressure may be integrated into the standard of care for NAS without interruption of current clinical practices. Future studies should incorporate recommendations highlighted in this dissertation research to further evaluate maternal and healthcare provider acceptability as well as efficacy of auricular acupressure in treating neonatal withdrawal.

Rights

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