PhD, University of Cincinnati, 2024, Nursing: Nursing - Doctoral Program

Background: Many children are directly and indirectly affected by the opioid epidemic and the consequences of opioid use during pregnancy through prenatal opioid exposure. Prenatal opioid exposure is associated with adverse neonatal and long-term outcomes and may develop into neonatal opioid withdrawal syndrome. Although recent reviews largely suggest negative outcomes after prenatal opioid exposure, they are limited by the heterogeneity of identification methods used to ascertain exposure. The impact of varying identification methods on the prevalence and outcomes of exposure is not clearly understood. The use of big data and larger data linkages in nursing science may help illuminate the impact of varying identification methods used to ascertain prenatal opioid exposure. Aims: This three-manuscript dissertation aimed to (1) discuss the use and potential of big data for nurse scientists, (2) conduct a scoping review of the varying identification methods in current literature, and (3) perform a secondary data analysis of a large integrated data to explore the prevalence of prenatal opioid exposure across identification methods to inform research, practice, and support children and families impacted by prenatal opioid exposure. Methods: The first manuscript was a discursive paper that provided an introductory guide for leveraging big data in nursing research. The second manuscript was a scoping review that synthesized the various identification methods used to ascertain opioid exposure in the United States over the last decade. Insights from the scoping review generated three identification methods leveraged in the third dissertation manuscript: (1) Maternal data (e.g., toxicology and diagnoses), (2) Infant data (e.g., toxicology and diagnoses), and (3) Combined method using maternal and infant data. The third manuscript was a secondary data analysis of a large perinatal linkage database in the Midwest to explore the prevalence of prenatal opioid expo (open full item for complete abstract)

Committee: Joshua Lambert Ph.D. (Committee Chair); Sara Arter Ph.D. R.N. (Committee Member); Nichole Nidey Ph.D. (Committee Member); Samantha Boch Ph.D. R.N. (Committee Member) Subjects: Nursing

Master of Arts in Medical Ethics and Humanities, Northeast Ohio Medical University, 2021, College of Graduate Studies

Despite the Anti-Drug Abuse Act of 1986 that declared a “war on drugs”, criminalized substance abuse, and opened up treatment programs specific to pregnant women, the number of pregnant women using opioids increased five-fold from 2000 to 2009, skyrocketing the related costs for state Medicaid programs (Patrick et al., 2012). Unfortunately, this law has had a pervasive effect on the public's attitudes and clinicians' treatment toward opioid use disorder (OUD) in pregnancy. My analysis according to the principles of biomedical ethics has outlined several ethical dilemmas that have been created by criminalization of substance abuse, mandatory reporting laws, stigma toward OUD and its treatments, and little understanding of the social determinants of health. This ethical framework alone does not emphasize the relational aspect of pregnancy, support patient-centered care, or address the intersectionality of this patient population. I will argue how using a care and justice ethics approach to treatment of women with OUD who would like to carry a fetus to birth is the preferable ethical approach to guide physician and public health treatment of this issue. I will discuss how this framework revives the idea of using Ulysses contracts for this patient population and how Ohio has successfully implemented caring structures already. Finally, I will envision how Ohio can continue to expand its wraparound services and fight stigma against OUD in pregnancy, which stymies clinicians' potential to form caring relationships.

Committee: Rebecca Fischbein (Advisor); Julie Aultman (Committee Member) Subjects: Ethics; Medicine; Neurosciences; Psychobiology; Public Health; Public Policy; Womens Studies