Optimizing Eat, Sleep, Console in the NICU: a collaborative nursing education intervention

The Eat, Sleep, Console (ESC) model of care offers a patient-centered approach for managing neonatal opiate withdrawal syndrome (NOWS), reducing hospital stay, need for pharmacologic treatment, and costs compared to the traditional Finnegan scoring system. Favorable nursing knowledge, attitudes, and practices (KAP) are critical to successful ESC implementation. A prior pilot survey in our neonatal intensive care unit (NICU) revealed inconsistent understanding and application of ESC, indicating a need for targeted education. This study assesses changes in NICU nursing KAP scores following a three-month multiphase educational intervention, and identifies behavioral shifts, barriers, and opportunities to optimize ESC integration.

We conducted a pre-post quasi-experimental study in a Level IV NICU using anonymous 11 point surveys completed by NICU nurses assessing knowledge, attitudes, and perceptions towards ESC before and after the collaborative educational intervention. The intervention included (1) a didactic session with open discussion, (2) an ESC poster displayed in the NICU, and (3) a one-page ESC reference guide. Statistical analyses utilized analysis of variance (ANOVA).

Thirty-three NICU nurses completed the pre- and post-intervention surveys; samples were independent and unmatched with an unknown degree of overlap. The increase in mean total KAP scores from 14.8 ± 2.2 to 15.3 ± 2.5 was not statistically significant (p = 0.40). Nurses with less than five years of experience showed the greatest improvement in knowledge and total KAP scores, increasing from 6.3 ± 1.5 to 8.3 ± 1.0 and from 14.3 ± 3.4 to 16.5 ± 1.9, respectively. Perceived safety and effectiveness of ESC improved slightly post-intervention. Didactic attendance did not significantly influence KAP (p > 0.80). Reported barriers to ESC implementation included staff and workflow constraints, limited family presence and parental involvement, lack of interdisciplinary support and system-level resources, and subjectivity and limitations of ESC assessments. Nurses emphasized the importance of greater social and family support, followed by increased nursing education, provider education, and improved lactation support.

Collaborative education was not associated with statistically significant changes in NICU nursing KAP scores related to the ESC approach for NAS and may be insufficient as a stand-alone measure. Additional system-level support strategies may be needed to support ESC implementation fidelity and facilitate favorable nursing perceptions and practices towards ESC. Additionally, minimizing barriers affecting families and staff through tailored interventions may promote feasibility of ESC practices, also leading to improved nursing KAP.