Date of Completion


Embargo Period



Neonatal Nurses, Neonatal Abstinence Syndrome, Illicit Substances, Pregnancy, Moral Distress

Major Advisor

Sandra Bellini, DNP

Associate Advisor

Jacqueline McGrath, PhD

Associate Advisor

Michael Witman, MD

Field of Study



Doctor of Nursing Practice

Open Access

Open Access


Maternal substance misuse/abuse during pregnancy may lead to adverse neonatal outcomes, including neonatal abstinence syndrome (NAS). NAS is a constellation of withdrawal symptoms exhibited in newborns in response to the discontinuance of in-utero exposure to licit and illicit substances. The incidence of NAS is directly related to the increasing rates of maternal substance use/abuse. The United States has experienced a five-fold increase of newborns born with NAS. The care of the newborn with NAS is one of the most challenging conditions for the neonatal nurse. Management of newborns with NAS requires knowledge that has not been traditionally partnered within care of the neonatal intensive care unit (NICU) but rather more often in the newborn nursery. And thus, understanding addiction, addictive behaviors and the psychological needs of substance misusing/abusing parents have not been common place in all NICU settings. Caring for the newborn with NAS and interacting with the addicted parent and parents may present ethical and moral dilemmas for the neonatal nurse. This pilot study explored the presence of moral distress among neonatal nurse caring for the newborn with NAS whose mothers used illicit substances during pregnancy. A descriptive study engaged neonatal nurses from a Level III NICU in completing the Moral Distress Scale Pediatric version. Frequency and intensity of moral distress among the sample assisted in determining the presence and levels of moral distress. Neonatal nurses caring for newborns with NAS whose mothers used illicit substances during pregnancy experienced varying degrees moral distress.The results of this research study revealed that indeed, neonatal nurses experience moral distress to varying degrees within the NICU setting. Caring for newborns with NAS within this sample participant group produced moral distress especially when these nurses interacted with substance misusing mothers and care givers. Although not all neonatal nurses caring for newborns with NAS and/or interacting with substance misusing care givers experienced moral distress the review of the data is imperative for identifying strategies to support nurses universally to prevent/address moral distress in the NICU.