708 - Optimizing Eat, Sleep, Console in the NICU: A Collaborative Nursing Education Intervention

Publication Number: 1685.708

Sonia Kapoor, Nemours Children's Hospital, Orlando, FL, United States; Caroline Chua, Nemours Children's Hospital, Belle Isle, FL, United States; Laurie Reyna, Nemours Children's Hospital, Orlando, FL, United States; Rochelle Sequeira Gomes, Nemours Children's Hospital, Orlando, FL, United States

Background: The Eat, Sleep, Console (ESC) model offers a patient-centered approach for managing Neonatal Abstinence Syndrome (NAS), reducing hospital stay, pharmacologic treatment, and costs compared to the Finnegan scoring system. Nursing knowledge, attitudes, and practices (KAP) are critical to successful ESC implementation. A prior pilot survey in our NICU revealed inconsistent understanding and application of ESC, indicating a need for targeted education.

Objective: To assess changes in NICU nursing KAP scores following a three-month multiphase educational intervention, and to identify behavioral shifts, barriers, and opportunities to optimize ESC integration.

Design/Methods: We conducted a pre-post quasi-experimental study in a Level IV NICU using anonymous surveys. The intervention included (1) a didactic session with Q&A, (2) an ESC poster displayed in the NICU, and (3) emailed reference guides (Figure 1). ESC "coaches" were established to provide peer-to-peer support but were not active during the study period.

Results: Thirty-three NICU nurses completed both pre- and post-intervention surveys. Mean total KAP scores increased from 14.8 ± 2.2 to 15.3 ± 2.5 but were not statistically significant (p = 0.397) (Table 1). A two-way ANOVA revealed no significant main effect of years of NICU experience on individual or total KAP scores (p > 0.05) (Table 1). 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 (Table 1). Nurses reported a trend toward greater perceived safety and efficacy of ESC post-intervention (Figure 2). However, didactic session attendance did not significantly influence KAP scores (p = 0.791) (Table 1). Qualitative feedback identified multiple barriers to effective ESC implementation, including workflow constraints, limited support staff for infant comfort, minimal interdisciplinary collaboration with lactation and social work, and lack of educational resources for float staff. Nurses emphasized the importance of peer and family support, integration of cuddlers, and accessible ESC reference materials to promote consistent adoption of the ESC model.

Conclusion(s): Collaborative education alone may be insufficient to improve nursing KAP related to the ESC model. Enhancing implementation may require additional support strategies, including the integration of ESC coaches, dedicated cuddlers, and stronger interdisciplinary collaboration with lactation consultants and social workers to promote consistent practice and optimize patient outcomes.

Figure 1. Study Flow Diagram and Timeline for NICU Nursing KAP Evaluation.


Table 1. Comparison of pre- and post-intervention knowledge, attitude, and practice (KAP) scores for all NICU nurses and subgroups based on experience and attendance.


Figure 2. Changes in NICU Nurses' Likert Ratings of ESC for NAS After Educational Interventions.
A shift toward stronger agreement with less disagreement was noted following educational intervention.