Honors Theses and Capstones

Date Completed

Spring 2026

Abstract

Introduction: Nursing education prepares students to care for patient populations by enhancing knowledge of clinical pathophysiology and applying foundational nursing skills to tailor to the unique care requirements of each patient. When analyzing the nursing course curriculums as guides for what is included in nursing education, it is essential to consider relevant patient populations to ensure adequate representation in lectures. Inclusivity of relevant patient populations within curriculums equips students to encounter a variety of patients in a clinical setting. Perinatal substance use has prevalence in the local community of this university, with 6% of all births in New Hampshire in 2024 involving a mother who engaged in substance use during pregnancy (Britt, 2025). Students enrolled in the maternity nursing course at the university are likely to encounter these patients during clinical hours, prompting a need for adequate nursing education in the classroom that studies this topic.

Substance use during pregnancy poses great maternal and fetal harm, increasing the risk for miscarriages, still births, premature births, intrauterine growth restriction, and fetal birth defects (Ross et al., 2015). There are associated long term deficits of the child, including a slowed neurological and physical growth, behavioral issues, and learning disabilities (Ross et al., 2015). In addition, babies born to mothers who engaged in substance use during pregnancy often require extensive stays in a neonatal intensive care unit for treatment of neonatal abstinence syndrome, a condition in which a newborn exhibits withdrawal symptoms from substance exposure (Lee, 2016). During pregnancy, women who engage in substance use are less likely to seek prenatal care, which enhances birthing complications by prohibiting access to necessary treatments and screenings (Britt, 2025). Barriers for this patient population in receiving care include inconsistently implemented screenings, avoidant behaviors due to a fear of judgment from healthcare workers, socioeconomic disadvantages, and insufficiencies in transportation to appointments. Because this patient population faces negative judgment from healthcare workers, it is essential to improve training for nursing staff in fostering a nonjudgmental healthcare environment to encourage the mother to continue to receive prenatal care.

Methods: This project aimed to include perinatal substance use in the curriculum of the maternity course by dedicating a lecture to this topic. The intervention was a presentation style lecture including information about the clinical presentation of substance use in infants, risk factors for substance use during pregnancy, common disorders such as neonatal abstinence syndrome and fetal alcohol spectrum disorders, as well as screening tools and local New Hampshire resources. A documentary titled Forest For The Trees was also shown, focusing on reducing bias amongst healthcare staff in caring for this patient population and enhancing skills of nonjudgmental therapeutic communication (Whetsell, 2026). The intervention included the 90 minute class period, and all students currently enrolled in the nursing maternity course at the university were invited to participate.

Results: A quantitative study design was used to anonymously survey participants with the goal of assessing their knowledge before and after the lecture. The survey result comparison determined the effectiveness of the lecture in improving the ability of students to clinically care for women with an active substance use or a history of substance use during pregnancy. The survey included content-based multiple choice questions to assess their knowledge and opinion-based questions, which asked participants to rank their readiness to care for these patients using a likert scale (Appendix A). The results indicate that previous to the lecture, the average accuracy score of the survey questions was 58% (Appendix B), while after the lecture the same questions were surveyed and results showed an average accuracy score of 81% (Appendix C). In total, 70% of participants demonstrated an increase in survey accuracy after the lecture in comparison to their original performances. In addition, prior to the lecture when asked if they felt they had adequate nursing knowledge surrounding substance use during pregnancy, most participants replied that they disagreed or felt neutral (Figure 3). After the lecture when asked the same question, most replied that they agreed they had adequate knowledge to clinically care for these patients (Figure 4). The results are indicative of the lecture’s effectiveness in improving student’s knowledge and reported confidence levels in caring for this patient population.

Discussion: Perinatal substance use remains to be a prevalent issue in the local community of the University of New Hampshire, demonstrating a demand for nursing students enrolled at this university to engage in educational material discussing this topic. Student nurses should learn to manage the clinical care required for these patients, to expand their nursing knowledge to be inclusive of this patient population. Because a significant barrier to receiving prenatal care for pregnant patients experiencing substance use disorders is avoidance due to a fear of judgment from healthcare workers, it is essential for nurses to implement therapeutic communication to foster an unbiased environment to encourage a continuation of healthcare. Overall, the study demonstrated effectiveness in the lecture in preparing nursing students to encounter perinatal substance use in a clinical setting, since students demonstrated an improvement in knowledge. The inclusion of perinatal substance use should be standardized in the curriculum of the maternity nursing course at the university to enhance the knowledge of nursing students, with the goal of improving adequate and unbiased nursing care for pregnant patients experiencing a substance use disorder.

Document Type

Undergraduate Thesis

First Advisor

Amy McGreevy

Second Advisor

Alyssa O’Brien

College or School

CHHS, School of Nursing

Department or Program

Nursing

Degree Name

Bachelor of Science

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