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Campbell-Yeo M, MacNeil M, McCord H. Pain in Neonates: Perceptions and Current Practices. Crit Care Nurs Clin North Am 2024; 36:193-210. [PMID: 38705688 DOI: 10.1016/j.cnc.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
All newborns experience pain during routine care, which can have long-lasting negative effects. Despite the availability of effective methods to prevent and reduce pain, most infants will receive ineffective or no treatment. Optimal pain management includes the reduction of the number of procedures performed, routine pain assessment and the use of effective pain-reducing interventions, most notably breastfeeding, skin-to-skin contact and sweet-tasting solutions. Parents are an essential component of the comprehensive assessment and management of infant pain; however, a gap exists regarding the uptake of parent-led interventions and the engagement of families. Practice recommendations for infant pain care are discussed.
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Affiliation(s)
- Marsha Campbell-Yeo
- Faculty of Health, School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada; MOM-LINC Lab, IWK Health, Halifax, Nova Scotia, Canada.
| | - Morgan MacNeil
- Faculty of Health, School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada; MOM-LINC Lab, IWK Health, Halifax, Nova Scotia, Canada. https://twitter.com/morganxmacneil
| | - Helen McCord
- Faculty of Health, School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada; MOM-LINC Lab, IWK Health, Halifax, Nova Scotia, Canada
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Neshat H, Hassankhani H, Jabraeili M, Negarandeh R. Organisational challenges of pain management in neonatal intensive care unit: a qualitative study. BMJ Open 2023; 13:e072695. [PMID: 37669843 PMCID: PMC10481740 DOI: 10.1136/bmjopen-2023-072695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 08/04/2023] [Indexed: 09/07/2023] Open
Abstract
OBJECTIVES Despite credible evidence, optimal neonates' pain management in the neonatal intensive care unit (NICU) is a challenging issue. In this regard, the organisational context is an essential factor. The existing challenges vary depending on the context, and investigating them can help to improve the quality of care. The study aimed to explore organisational challenges to neonates' pain management in the NICU. METHODS This qualitative study included 31 nurses and physicians in the NICU of Children's Hospital, Tabriz, Iran. Data collection was done through individual and focus group interviews. For data analysis, we used conventional content analysis. RESULTS The identified challenges included organisational culture (poor interprofessional collaboration and low parental participation), organisational structure (lack of unified approach in relieving pain and limited supervision for pain management) and organisational resources (lack of time due to high workload and inadequate educational programmes). CONCLUSIONS Many organisational factors consistently affect neonatal pain management. Adopting some approaches to enhance the cooperation of treatment team members, holding educational programmes, proper organisational supervision and implementing a unified neonatal-based pain management programme could improve neonatal pain management.
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Affiliation(s)
- Hanieh Neshat
- Nursing and Midwifery Faculty, Tabriz University of Medical Sciences, Tabriz, Iran (the Islamic Republic of)
| | - Hadi Hassankhani
- Nursing and Midwifery Faculty, Tabriz University of Medical Sciences, Tabriz, Iran (the Islamic Republic of)
| | - Mahnaz Jabraeili
- Nursing and Midwifery Faculty, Tabriz University of Medical Sciences, Tabriz, Iran (the Islamic Republic of)
| | - Reza Negarandeh
- Nursing and Midwifery Faculty, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
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Talus E, Seppänen H, Mikkonen K, Palomaa AK, Pölkki T. The competence of neonatal intensive care nurses: A systematic review. NURSE EDUCATION TODAY 2023; 128:105892. [PMID: 37393653 DOI: 10.1016/j.nedt.2023.105892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/04/2023] [Accepted: 06/22/2023] [Indexed: 07/04/2023]
Abstract
OBJECTIVE The objective was to conduct a systematic review describing the competencies required from nurses working in neonatal intensive care settings. DESIGN Systematic review. DATA SOURCES A total of eight databases, including PubMed, Scopus, CINAHL, MEDLINE, Mednar, Web of Science, ProQuest and Medic, were screened for relevant literature during February and September 2022. REVIEW METHODS The systematic review process followed Joanna Briggs Institute guidelines. The inclusion criteria were: 1) (P = population) registered nurses; 2) (C = concept) the competence; 3) (C = context) nursing in neonatal intensive care units; and 4) cross-sectional study as study method. A critical appraisal tool for cross-sectional studies from Joanna Briggs Institute was used by two independent reviewers. After data extraction, thematic analysis was performed. RESULTS The database searches yielded a total of 8887 studies and after two independent evaluations, a total of 50 eligible studies were identified comprising of 7536 registered nurses working in neonatal intensive care units across 19 countries. The studies described four main competence themes: 1) neonatal care interventions; 2) caring for a dying infant; 3) family-centered care; and 4) neonatal intensive care interventions. CONCLUSION Previous research has focused on evaluating specific competencies that are necessary in the neonatal intensive care setting. There is a need for research concerning the overall competence of nurses working in neonatal intensive care units. There was a lot of variety within the quality of the eligible studies and within the used instruments. PROTOCOL REGISTRATION This systematic review was registered in Prospero (PROSPERO 2022 CRD42022308028).
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Affiliation(s)
- Eeva Talus
- Research Unit of Health Sciences and Technology, University of Oulu, Finland Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; The Finnish Centre for Evidence-Based Health Care: A Joanna Briggs Institute, The Finnish Centre of Excellence, Helsinki, Finland.
| | - Hanna Seppänen
- Research Unit of Health Sciences and Technology, University of Oulu, Finland Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; The Finnish Centre for Evidence-Based Health Care: A Joanna Briggs Institute, The Finnish Centre of Excellence, Helsinki, Finland
| | - Kristina Mikkonen
- Research Unit of Health Sciences and Technology, University of Oulu, Finland Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; The Finnish Centre for Evidence-Based Health Care: A Joanna Briggs Institute, The Finnish Centre of Excellence, Helsinki, Finland
| | - Anna-Kaija Palomaa
- Research Unit of Health Sciences and Technology, University of Oulu, Finland Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; The Finnish Centre for Evidence-Based Health Care: A Joanna Briggs Institute, The Finnish Centre of Excellence, Helsinki, Finland
| | - Tarja Pölkki
- Research Unit of Health Sciences and Technology, University of Oulu, Finland Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; The Finnish Centre for Evidence-Based Health Care: A Joanna Briggs Institute, The Finnish Centre of Excellence, Helsinki, Finland
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Ozawa M, Yamashita K, Kawano R. Effectiveness of a Virtual Program on Nurses' Pain-Related Knowledge and Pain-Measurement Skills. Pain Manag Nurs 2022; 23:720-727. [PMID: 35915011 DOI: 10.1016/j.pmn.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 05/13/2022] [Accepted: 07/03/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Aim: To test whether a comprehensive virtual program for using pain scales to manage neonatal pain improved nurses' knowledge and skill acquisition. METHODS This non-blind randomized controlled trial included 64 participants who were randomly divided into intervention and control groups; changes in scores between pre- and posttests were compared. Certified neonatal intensive care nurses were recruited from across Japan. The learning intervention group received online training in pain measurement using structured scales, such as the Face Scale for Pain Assessment of Preterm Infants and the Japanese version of the Premature Infant Pain Profile. The control group received no training. Independent t tests and χ2 tests were used to compare the baseline scores. The outcome measure was score change on a 40-point test (20 for knowledge and 20 for skill) before and after the e-learning program. RESULTS No differences in baseline data were found between the groups. Generalized linear regression models yielded a significant difference in the least squared means (95% confidence interval [CI]) for the amount of change in the total, knowledge, and skill scores between groups: 6.22 (4.18, 8.26; p < .001) for total score, 4.66 (3.37, 5.95; p < .001) for knowledge score, and 1.53 (0.06, 3.00; p = .041) for skill score. CONCLUSIONS The results showed that the e-learning program improved nurses' neonatal pain knowledge and pain-measurement skills compared with no training.
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Affiliation(s)
- Mio Ozawa
- From the Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan.
| | - Kotomi Yamashita
- Graduate School of Health Sciences, Okayama University, Okayama, Japan
| | - Reo Kawano
- Clinical Research Center in Hiroshima, Hiroshima University Hospital, Hiroshima, Japan
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Ulmer M, Martakis K, Scholten N, Kuntz L. Existence and perceived application of pain management protocols in German neonatal intensive care units. PAEDIATRIC & NEONATAL PAIN 2022; 4:149-157. [PMID: 36618511 PMCID: PMC9798041 DOI: 10.1002/pne2.12089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 09/09/2022] [Accepted: 09/22/2022] [Indexed: 11/06/2022]
Abstract
We explored the existence and application of standard operating procedures (SOPs) for pain management (PM) in German neonatal intensive care units (NICUs), and identified the factors associated with their application in practice. This study was part of the Safety4NICU project, a cross-sectional survey conducted from 2015 to 2016. All 224 German NICUs were invited to participate, providing written consent from the head neonatologist and head nurse. We distributed questionnaires to the head neonatologist, the head nurse, and the NICU staff (physicians and nurses). We asked the head neonatologist whether written SOPs for PM existed, and we asked the staff whether these SOPs were applied in their daily routine. We received evaluable responses from 468 physicians and 1251 nurses from 76 NICUs. Of these 76 NICUs, the head neonatologists from 54 NICUs (71.1%) reported that written SOPs for PM exist. However, only 48.5% of the physicians and 53.7% of the nurses declared that these existing SOPs were also applied. We found various predictors for the existing SOPs as being applied, depending on the profession. For physicians, clinical training was important (OR: 2.482, p ≤ 0.05), while for nurses their working experience was a decisive predictor (OR: 1.265, p ≤ 0.05). For both, a high level of perceived cooperative norms between physicians and nurses increased the probability that SOPs for PM were applied, whereas a high bed turnover rate decreased that probability. According to the responses from head neonatologists, written SOPs for PM were common in German NICUs. However, if management strategies on pain existed, this did not mean that these were directly applied in the daily routine. Clinical training of the staff, the promotion of adequate interprofessional cooperation, as well as allowing time to deal with these SOPs might be all essential measures to strengthen the application.
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Affiliation(s)
- Melissa Ulmer
- Department of Business Administration and Health Care Management, Faculty of Management, Economics and Social SciencesUniversity of CologneCologneGermany
| | - Kyriakos Martakis
- Department of Pediatrics, University Hospital, Faculty of MedicineUniversity of CologneCologneGermany,Department of Pediatric Neurology, University Children's Hospital (UKGM), Faculty of MedicineJustus Liebig University of GiessenCologneGermany
| | - Nadine Scholten
- Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Faculty of Human Sciences and Faculty of MedicineUniversity of CologneCologneGermany
| | - Ludwig Kuntz
- Department of Business Administration and Health Care Management, Faculty of Management, Economics and Social SciencesUniversity of CologneCologneGermany
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Cheng X, Zhu H, Mei L, Luo F, Chen X, Zhao Y, Chen S, Pan Y. Artificial Intelligence Based Pain Assessment Technology in Clinical Application of Real-World Neonatal Blood Sampling. Diagnostics (Basel) 2022; 12:diagnostics12081831. [PMID: 36010186 PMCID: PMC9406884 DOI: 10.3390/diagnostics12081831] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/12/2022] [Accepted: 07/26/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Accurate neonatal pain assessment (NPA) is the key to neonatal pain management, yet it is a challenging task for medical staff. This study aimed to analyze the clinical practicability of the artificial intelligence based NPA (AI-NPA) tool for real-world blood sampling. Method: We performed a prospective study to analyze the consistency of the NPA results given by a self-developed automated NPA system and nurses’ on-site NPAs (OS-NPAs) for 232 newborns during blood sampling in neonatal wards, where the neonatal infant pain scale (NIPS) was used for evaluation. Spearman correlation analysis and the degree of agreement of the pain score and pain grade derived by the NIPS were applied for statistical analysis. Results: Taking the OS-NPA results as the gold standard, the accuracies of the NIPS pain score and pain grade given by the automated NPA system were 88.79% and 95.25%, with kappa values of 0.92 and 0.90 (p < 0.001), respectively. Conclusion: The results of the automated NPA system for real-world neonatal blood sampling are highly consistent with the results of the OS-NPA. Considering the great advantages of automated NPA systems in repeatability, efficiency, and cost, it is worth popularizing the AI technique in NPA for precise and efficient neonatal pain management.
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Affiliation(s)
- Xiaoying Cheng
- Quality Improvement Office, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China;
| | - Huaiyu Zhu
- College of Information Science and Electronic Engineering, Zhejiang University, Hangzhou 310027, China; (H.Z.); (Y.Z.)
| | - Linli Mei
- Administration Department of Nosocomial Infection, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China;
| | - Feixiang Luo
- Neonatal Intensive Care Unit, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China;
| | - Xiaofei Chen
- Gastroenterology Department, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China;
| | - Yisheng Zhao
- College of Information Science and Electronic Engineering, Zhejiang University, Hangzhou 310027, China; (H.Z.); (Y.Z.)
| | - Shuohui Chen
- Administration Department of Nosocomial Infection, The Children’s Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China;
- Correspondence: (S.C.); (Y.P.)
| | - Yun Pan
- College of Information Science and Electronic Engineering, Zhejiang University, Hangzhou 310027, China; (H.Z.); (Y.Z.)
- Correspondence: (S.C.); (Y.P.)
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Neonatal Nurse and Midwife Competence Regarding Pain Management in Neonates: A Systematic Review. Adv Neonatal Care 2022; 22:E34-E42. [PMID: 34224481 DOI: 10.1097/anc.0000000000000911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Neonates in need of intensive care are often subjected to numerous painful procedures. Despite the growing scientific research, hospitalized neonates continue to experience unrelieved pain. Enhancing the competence of neonatal intensive care nurses is an integral component of effective pain management. PURPOSE The purpose of this article is to identify and synthesize the existing evidence on nurses' and midwives' competence regarding neonatal pain management internationally. METHODS/SEARCH STRATEGY The review was guided by Whittemore and Knafl's 5-stage framework, with 8 databases searched in June 2020 including PubMed, CINAHL Complete (via EBSCOhost), MEDLINE (via EBSCOhost), PsycINFO (via Ovid), EMBASE, Scopus, Cochrane Library, and Google Scholar. Reference lists of selected articles were also hand-searched. Studies were reviewed independently for methodology and inclusion and exclusion criteria. The initial search yielded 3037 articles; 19 met the inclusion criteria and were included for analysis: qualitative (n = 5) and quantitative (n = 14). FINDINGS/RESULTS Nurses' and midwives' competence regarding neonatal pain management in the neonatal intensive care unit is discussed in relation to knowledge, attitudes, behaviors, and perceptions of competence by most studies. The barriers to effective neonatal pain management were found to relate to nurses' and midwives' factors, underutilized pain assessment tools, and organizational factors. Potential facilitators to effective neonatal pain management included clear evidence-based guidelines/protocols, adequate training, and the use of appropriate and accurate pain assessment tools. Parent involvement and a team approach to neonatal pain management were also identified. IMPLICATIONS FOR PRACTICE AND RESEARCH These findings suggest that further research is necessary to address the barriers and promote facilitators to improve neonatal pain management.
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Effectiveness of e-Learning on Neonatal Nurses' Pain Knowledge and Pain Measurement Skills: A Pilot Study. Adv Neonatal Care 2022; 22:132-139. [PMID: 34054010 DOI: 10.1097/anc.0000000000000894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Reported benefits of virtual programs include user satisfaction and feasibility to train nurses to utilize pain scales. However, the effectiveness of the virtual neonatal pain management program on nurses' knowledge and scoring skill acquisition has not been examined. PURPOSE This study developed a comprehensive virtual program on neonatal pain management and examined its effectiveness on nurses' knowledge and skill acquisition of selected pain scales. METHODS Evidence-based content was designed as a virtual program and pre-and posttests to examine skill and knowledge acquisition were developed and validated. Analysis of covariance was used to assess the differences from pre- to posttest based on the intensity of participants' involvement while examining the overall effectiveness of the program. RESULTS A total of 115 nurses representing 7 hospitals completed the virtual neonatal pain management program, and 52 nurses completed the posttest. The Student paired t test showed an increase in posttest scores from pretest scores among participants. Participants' final degrees and years of experience were not related to posttest scores. The analysis of covariance showed that the high study group had a significantly higher amount of change in total scores and pain measurement skill scores than the low study group on the posttest. IMPLICATIONS FOR PRACTICE The virtually delivered neonatal pain management program can be useful for nurses' attainment of knowledge and skills for managing neonatal pain, including an appropriate use of selected scoring tools. IMPLICATIONS FOR RESEARCH It is necessary to examine how organizational unit attendance rate for e-learning and posttest results are related to patient outcomes. VIDEO ABSTRACT AVAILABLE AT https://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx?autoPlay=false&videoId=46.
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Abstract
OBJECTIVES During hospitalization in neonatal intensive care units, neonates are exposed to many painful procedures within a stressful environment. To date, many evidence-based guidelines are available. However, the quality of these guidelines and their clinical application remain unclear. This systematic review aimed to determinie the quality of existing guidelines on the management of procedural pain in neonates and to summarize the recommendations provided by these guidelines. MATERIALS AND METHODS A structured search was conducted in Embase, PubMed, CINAHL, JBI database, and gray literature resources in November 2018 to identify relevant guidelines published from 2007 onward. Published guidelines and guidelines from complementary searches were included in the treating assessment or management of procedural pain in neonates. The methodological quality was analyzed using the Appraisal of Guidelines for Research and Evaluation (AGREE) II Instrument. RESULTS A total of 1154 records were identified. After screening for eligibility, 17 guidelines were included in this review. Among these, 11 were identified to be high-quality guidelines. Besides the usual recommendations for pharmacological and nonpharmacological treatments, the inclusion of parents, improving interprofessional collaboration, and considering the setting were identified as important elements. DISCUSSION The results of this review show that there is a need to improve the methodological quality of guidelines for procedural pain in newborns. The set of recommendations for procedural pain prevention needs to involve not only pharmacological and nonpharmacological pain treatment but also parents and interprofessional collaboration. It is also essential to take into account facilitators, barriers, and the context to improve pain management.
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Knowledge and Practices in Neonatal Pain Management of Nurses Employed in Hospitals with Different Levels of Referral-Multicenter Study. Healthcare (Basel) 2021; 9:healthcare9010048. [PMID: 33466529 PMCID: PMC7824971 DOI: 10.3390/healthcare9010048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/30/2020] [Accepted: 01/04/2021] [Indexed: 12/17/2022] Open
Abstract
Background: One of the key elements of patient care is the relief and prevention of pain sensations. The importance of pain prevention and treatment has been emphasized by many international organizations. Despite the recommendations and guidelines based on evidence, contemporary research shows that the problem of pain among patients in neonatal intensive care units (NICUs) in various centers is still an important and neglected problem. Aim: The aim of this study was to assess the level of knowledge of the medical personnel and their perception of the issue of pain in neonatal patients. Methods: A quantitative descriptive study carried out in 2019. The study used a nurses’ perceptions of neonatal pain questionnaire. Results: A total of 43 Polish hospitals and 558 respondents participated in the project. 60.9% (n = 340) and 39.1% (n = 218) of respondents were employed in secondary and tertiary referral departments, respectively. Conclusion: Our analyses indicate that despite the availability of pain assessment tools for neonatal patients, only a few centers use standardized tools. The introduction of strategies to promote and extend the personnel’s awareness of neonatal pain monitoring scales is necessary.
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Hua Y, Zhang Q, Ting W, Qiu R, Yao WY, Chen XL. Pediatric Nurse Practitioners' Knowledge and Attitudes Regarding Pain Management Study in Central China. J Contin Educ Nurs 2020; 50:275-281. [PMID: 31136671 DOI: 10.3928/00220124-20190516-08] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 01/08/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND Nurses' level of knowledge about pain management directly determines the steps of implementation of clinical pain policies. METHOD This study surveyed 2,882 pediatric nurse practitioners from six children's hospitals using demographics and pain management questionnaires, as well as the Chinese version questionnaire of the Pediatric Nurse Practitioners' Knowledge and Attitudes Survey Regarding Pain (PNKAS) via the WeChat application. RESULTS The total score on the PNKAS was 14.88 ± 3.58 for the pediatric nurse practitioners. Multiple regression results showed the main factors influencing the PNKAS score related to position, the frequency of receiving training pain-related knowledge, and working department, which could account for 35.1% of the total variance. CONCLUSION Pediatric nurse practitioners from pediatric hospitals were not found to have sufficient knowledge or an appropriate attitude regarding pain management. A new standardized training project of pain management that is closely related to clinical practice for children should be conducted in the future. [J Contin Educ Nurs. 2019;50(6):275-281.].
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Mohamed FA, El-Bana SM, Abd-Elaziz Mohamed E, Abolwafa NF. Effect of educational program on pediatric nurses' knowledge and practice regarding selected nonpharmacological techniques to relive pain in neonates. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.jnn.2019.04.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Perry M, Tan Z, Chen J, Weidig T, Xu W, Cong XS. Neonatal Pain: Perceptions and Current Practice. Crit Care Nurs Clin North Am 2019; 30:549-561. [PMID: 30447813 DOI: 10.1016/j.cnc.2018.07.013] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Neonates may experience more than 300 painful procedures throughout their hospitalizations. Prior to 1980, there was a longstanding misconception that neonates do not experience pain. Current studies demonstrate that not only do neonates experience pain but also, due to their immature nervous systems, they are hypersensitive to painful stimuli. Poorly treated pain may lead to negative long-term consequences. Proper assessment of neonate pain is vital. The use of nonpharmacologic treatments may be beneficial in alleviating neonate pain. Pharmacologic treatments in the neonate have been well established. Pharmacologic and nonpharmacologic interventions can be used in conjunction to increase the efficacy of analgesia.
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Affiliation(s)
- Mallory Perry
- School of Nursing, University of Connecticut, 231 Glenbrook Road, Unit 4026, Storrs, CT 06269, USA
| | - Zewen Tan
- Department of Molecular and Cell Biology, University of Connecticut, 91 North Eagleville Road, Unit 3125, Storrs, CT 06269-3125, USA
| | - Jie Chen
- School of Nursing, University of Connecticut, 231 Glenbrook Road, Unit 4026, Storrs, CT 06269, USA
| | - Tessa Weidig
- School of Nursing, University of Connecticut, 231 Glenbrook Road, Unit 4026, Storrs, CT 06269, USA
| | - Wanli Xu
- School of Nursing, University of Connecticut, 231 Glenbrook Road, Unit 4026, Storrs, CT 06269, USA
| | - Xiaomei S Cong
- Center for Advancement in Managing Pain, School of Nursing, University of Connecticut, 231 Glenbrook Road, Unit 4026, Storrs, CT 06269, USA.
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A Parent-Targeted and Mediated Video Intervention to Improve Uptake of Pain Treatment for Infants During Newborn Screening: A Pilot Randomized Controlled Trial. J Perinat Neonatal Nurs 2019; 33:74-81. [PMID: 30676466 DOI: 10.1097/jpn.0000000000000386] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Most newborns undergo newborn screening blood tests. Breastfeeding, skin-to-skin care, and sweet solutions effectively reduce pain; however, these strategies are inconsistently used. We conducted a 2-armed pilot randomized controlled trial in a mother-baby unit to examine the feasibility and acceptability of a parent-targeted and -mediated video demonstrating use of these pain-reducing strategies and to obtain preliminary effectiveness data on uptake of pain management. One hundred parent-newborn dyads were randomized to view the video or receive usual care (51 intervention and 49 control arm). Consent and attrition rates were 70% and 1%, respectively. All participants in the intervention arm received the intervention as planned and reported an intention to recommend the video and to use at least 1 pain treatment with breastfeeding or skin-to-skin care preferred over sucrose. In the intervention arm, 60% of newborns received at least 1 pain treatment compared with 67% in the control arm (absolute difference, -7%; 95% confidence interval, -26 to 12). The video was well accepted and feasible to show to parents. As there was no evidence of effect on the use of pain management, major modifications are required before launching a full-scale trial. Effective means to translate evidence-based pain knowledge is warranted.
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Chen YS, Tan YJ, Zhou LS. [Clinical effect of maternal voice stimulation in alleviating procedural pain in hospitalized neonates]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2019; 21:58-63. [PMID: 30675865 PMCID: PMC7390185 DOI: 10.7499/j.issn.1008-8830.2019.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 11/07/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To study the clinical effect of maternal voice stimulation in alleviating procedural pain in neonates during heel blood collection. METHODS A total of 72 neonates who were admitted to the neonate intensive care unit were randomly divided into an intervention group (n=35) and a control group (n=37). Heel blood collection was performed by the routine method in the control group. The intervention group listened to their mothers' voice from 1 minute before heel blood collection to the end of the procedure. Pain score, incidence of crying, and vital signs were recorded before and after heel blood collection. RESULTS Compared with the control group, the heart rate was significantly reduced, the blood oxygen saturation significantly increased, the incidence of crying and the pain score were significantly reduced in the intervention group during the procedure of heel blood collection (P<0.05). CONCLUSIONS Maternal voice stimulation helps to reduce procedural pain and maintain stable vital signs in neonates.
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Min H, Vincent C, Park CG, Matthews AK, McCreary LL, Latimer M. Factors affecting Korean neonatal nurses' pain care: Psychometric evaluation of three instruments. Jpn J Nurs Sci 2018; 16:125-135. [PMID: 29888526 DOI: 10.1111/jjns.12219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 04/09/2018] [Accepted: 04/16/2018] [Indexed: 11/29/2022]
Abstract
AIM The purpose of this study was to evaluate the psychometric properties of the Korean-language versions of Pain Knowledge and Use (PKU-K), Collaboration and Satisfaction About Care Decisions (CSACD-K), and Environmental Complexity Scale (ECS-K). METHODS A cross-sectional design was used with a convenience sample of 159 Korean nurses in seven neonatal intensive care units (NICUs). The data were collected by surveying the nurses with the PKU-K, CSACD-K, and ECS-K. Internal consistency reliability was assessed and Horn's parallel analysis, a confirmatory factor analysis, and a convergent construct validity test were conducted in order to evaluate the psychometric properties of the instruments. RESULTS The PKU-K, CSACD-K, and ECS-K exhibited strong internal consistency reliability. Horn's parallel analysis showed four factor structures for the PKU-K, one for the CSACD-K, and three for the ECS-K. The confirmatory factor analysis showed a good model fit for the PKU-K and CSACD-K, but the ECS-K model showed a poor fit. Most factor loadings were statistically significant. The CSACD-K's convergent validity was supported by significant correlations for collegial nurse-physician relations with a validated instrument. CONCLUSION The findings support the reliability and validity of the PKU-K, CSACD-K, and ECS-K for measuring nurses' knowledge about neonatal pain care, nurse-physician collaboration, and the work environment in NICUs. However, the ECS-K needs further refinement before it is applied to Korean NICU nurses.
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Affiliation(s)
- Haeyoung Min
- College of Nursing, Gyeongsang National University, Jinju, South Korea
| | - Catherine Vincent
- College of Nursing, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Chang G Park
- College of Nursing, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Alicia K Matthews
- College of Nursing, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Linda L McCreary
- College of Nursing, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Margot Latimer
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
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Collados-Gómez L, Camacho-Vicente V, González-Villalba M, Sanz-Prades G, Bellón-Vaquerizo B. Percepción del personal de enfermería sobre el manejo del dolor en neonatos. ENFERMERIA INTENSIVA 2018; 29:41-47. [DOI: 10.1016/j.enfi.2017.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 07/14/2017] [Accepted: 08/07/2017] [Indexed: 12/27/2022]
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Andersen RD, Munsters JMA, Vederhus BJ, Gradin M. Pain assessment practices in Swedish and Norwegian neonatal care units. Scand J Caring Sci 2017; 32:1074-1082. [PMID: 29282767 DOI: 10.1111/scs.12553] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 11/29/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND The use of measurement scales to assess pain in neonates is considered a prerequisite for effective management of pain, but these scales are still underutilised in clinical practice. AIM The aim of this study was to describe and compare pain assessment practices including the use of pain measurement scales in Norwegian and Swedish neonatal care units. METHODS A unit survey investigating practices regarding pain assessment and the use of pain measurement scales was sent to all neonatal units in Sweden and Norway (n = 55). All Norwegian and 92% of Swedish units responded. RESULTS A majority of the participating units (86.5%) assessed pain. Swedish units assessed and documented pain and used pain measurement scales more frequently than Norwegian units. The most frequently used scales were different versions of Astrid Lindgren's Pain Scale (ALPS) in Sweden and Echelle Douleur Inconfort Noveau-Ne (EDIN), ALPS and Premature Infant Pain Profile (PIPP) in Norway. Norwegian head nurses had more confidence in their pain assessment method and found the use of pain measurement scales more important than their Swedish colleagues. CONCLUSION The persisting difference between Swedish and Norwegian units in pain assessment and the use of pain measurement scales are not easily explained. However, the reported increased availability and reported use of pain measurement scales in neonatal care units in both countries may be seen as a contribution towards better awareness and recognition of pain, better pain management and potentially less suffering for vulnerable neonates.
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Affiliation(s)
- Randi Dovland Andersen
- Department of Child and Adolescent Health Services, Telemark Hospital, Skien, Norway.,Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Josanne M A Munsters
- Department of Women's and Children's Health, University Children's Hospital Uppsala, Uppsala, Sweden
| | | | - Maria Gradin
- Department of Paediatrics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Factors Influencing Neonatal Pain Management from the Perspectives of Nurses and Physicians in a Neonatal Intensive Care Unit: A Qualitative Study. IRANIAN JOURNAL OF PEDIATRICS 2017. [DOI: 10.5812/ijp.10015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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20
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Field T. Preterm newborn pain research review. Infant Behav Dev 2017; 49:141-150. [DOI: 10.1016/j.infbeh.2017.09.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 09/01/2017] [Accepted: 09/02/2017] [Indexed: 11/16/2022]
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21
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Validation of the Persian Version of Premature Infant Pain Profile-Revised in Hospitalized Infants at the Neonatal Intensive Care Units. IRANIAN JOURNAL OF PEDIATRICS 2017. [DOI: 10.5812/ijp.10056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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22
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Bellieni CV, Tei M, Cornacchione S, Di Lucia S, Nardi V, Verrotti A, Buonocore G. Pain perception in NICU: a pilot questionnaire. J Matern Fetal Neonatal Med 2017; 31:1921-1923. [PMID: 28514889 DOI: 10.1080/14767058.2017.1332038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
PURPOSE Neonatal pain management has made a great step forward over the last several years. Despite the drafting of International guidelines, an under-treatment of neonatal pain is still reported. MATERIALS AND METHODS Medical and paramedical personnel working in five Italian NICUs were asked to complete a questionnaire about pain management. The questionnaire was comprised of three sections: (i) brief explanation of the purpose; (ii) demographic information, including age, profession, religious beliefs, and hospital level; (iii) questionnaire about pain management and prevention. RESULTS One-hundred and forty caregivers participated in this study. Non-pharmacological analgesia during heel prick or venipuncture was used by 64% and 60% of them, respectively; topical analgesia was performed in 13% of venipunctures; no analgesia was used in 30% of cases for both heel prick and venipuncture. In the case of lumbar puncture, 35% of participants used topical analgesia, 15% non-pharmacological approach, 10% opioids, and 6% intravenous paracetamol. While 65% of participants gave a score of 4 out of 5 about the importance of pain treatment, 39% of them reported that in their department no pain scales were used. CONCLUSIONS Pain treatment in these NICUs is still far to be optimal. This nonetheless reflects a worldwide trend, which requires more attention on pain prevention, assessment, and treatment.
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Affiliation(s)
- C V Bellieni
- a Department of Paediatrics, Obstetrics and Reproductive Medicine , University of Siena , Siena , Italy
| | - M Tei
- a Department of Paediatrics, Obstetrics and Reproductive Medicine , University of Siena , Siena , Italy
| | - S Cornacchione
- a Department of Paediatrics, Obstetrics and Reproductive Medicine , University of Siena , Siena , Italy
| | - S Di Lucia
- a Department of Paediatrics, Obstetrics and Reproductive Medicine , University of Siena , Siena , Italy
| | - V Nardi
- b Department of Paediatrics , University of L'Aquila , L'Aquila , Italy
| | - A Verrotti
- b Department of Paediatrics , University of L'Aquila , L'Aquila , Italy
| | - G Buonocore
- a Department of Paediatrics, Obstetrics and Reproductive Medicine , University of Siena , Siena , Italy
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Costa T, Rossato LM, Bueno M, Secco IL, Sposito NPB, Harrison D, Freitas JSD. Nurses' knowledge and practices regarding pain management in newborns. Rev Esc Enferm USP 2017; 51:e03210. [PMID: 28403366 DOI: 10.1590/s1980-220x2016034403210] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 12/30/2016] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To analyze nurses' knowledge and practices regarding pain management of newborns admitted to Neonatal Intensive Care Units. METHOD A descriptive and cross-sectional study. Data were collected from 51 nurses based on an adapted questionnaire aimed at evaluating knowledge and practices regarding the management of neonatal pain in six hospitals in Curitiba and its Metropolitan Region. RESULTS For most nurses (86.0%), neonates feel pain. A total of 34.7% of the nurses reported never using pain assessment scales. Pain management was recorded by 84.3% of the nurses. Administered pharmacological measures were Paracetamol and Fentanyl (47.1%) and Morphine (17.6%); while non-pharmacological measures adopted were sweetened solution (68.6%), non-nutritive sucking (58.8%) and positioning (56.9%). CONCLUSION Nurses considered neonatal pain a real event; however, they do not perform pain assessment or treatment of newborns in a systematized way.It is necessary to implement knowledge translation strategiesin order to improve pain management in newborns. OBJETIVO Verificar o conhecimento e as práticasdos enfermeiros sobreo manejo da dor de recém-nascidos admitidos em Unidades de Tratamento Intensivo Neonatal. MÉTODO Estudo descritivo e transversal. Os dados foram coletados com 51 enfermeiros, a partir de um questionário adaptado que visa avaliar o conhecimento e as práticas sobre o manejo da dor neonatal, em seis hospitais de Curitiba e Região Metropolitana. RESULTADOS Para a maioria dos enfermeiros(86,0%), os neonatos sentem dor. Um total de 34,7% afirmaramnunca utilizar escalas de avaliaçãoda dor. O registro do manejo da dor foi realizado por 84,3% dos enfermeiros. As medidas farmacológicas realizadas foram Paracetamol e Fentanil (47,1%) e Morfina (17,6%);as não farmacológicas adotadas foram solução adocicada (68,6%), sucção não nutritiva (58,8%) e posicionamento (56,9%). CONCLUSÃO Os enfermeiros consideraram a dor neonatal como um evento real, porém não realizavam avaliação ou tratamento da dor no recém-nascido de modosistematizado. É necessário implementarestratégias de tradução do conhecimento paraaprimorar o manejo da dor de recém-nascidos.
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Affiliation(s)
- Taine Costa
- Universidade de São Paulo, Escola de Enfermagem, Programa de Pós-Graduação Interunidades, São Paulo, SP, Brazil
| | - Lisabelle Mariano Rossato
- Universidade de São Paulo, Escola de Enfermagem, Departamento de Enfermagem Materno-Infantil e Psiquiátrica, São Paulo, São Paulo, Brazil
| | - Mariana Bueno
- Universidade de São Paulo, Escola de Enfermagem, Departamento de Enfermagem Materno-Infantil e Psiquiátrica, São Paulo, São Paulo, Brazil
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Min H, Vincent C, Matthews AK, McCreary LL, Park CG, Latimer M. Factors Affecting Korean Neonatal Infant Pain Care: Translation and Validation of Three Instruments. West J Nurs Res 2017; 40:222-241. [PMID: 28322663 DOI: 10.1177/0193945917690124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study aimed to translate three English-language instruments-Pain Knowledge and Use (PKU), Collaboration and Satisfaction About Care Decisions (CSACD), and Environmental Complexity Scale (ECS)-into Korean and evaluate the equivalence of the instrument versions. Three Korean translators and two senior reviewers translated the instruments' 56 items using a committee approach. Eight Korean experts evaluated the cultural relevance of the translated instruments using a content validity index (CVI), and 12 Korean neonatal nurses were interviewed to assess their understanding of items. In an expert panel review, the item-CVI was less than 0.78 for 14 items. Based on cognitive interviews, four items were found to be unsuitable in Korea. Based on expert panel review and cognitive interviews, unsuitable items were modified or deleted. In another expert panel review, the scale-CVI was 1.00 for the final instruments. The findings support the validity of the Korean-language PKU, CSACD, and ECS for research application.
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Vazquez V, Cong X, DeJong A. Maternal and Paternal Knowledge and Perceptions Regarding Infant Pain in the NICU. Neonatal Netw 2017; 34:337-44. [PMID: 26803015 DOI: 10.1891/0730-0832.34.6.337] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate parents' knowledge, self-efficacy, and satisfaction about infant pain in the NICU. DESIGN AND SAMPLE A survey was conducted, and 80 parents (57 mothers and 23 fathers) participated in the study. MAIN OUTCOME VARIABLE A researcher-developed questionnaire composed of 3 dimensions: parents' knowledge about infant pain, perception of self-efficacy regarding infant pain, and satisfaction with infant pain management. RESULTS Most parents had adequate knowledge and moderate to high self-efficacy and were satisfied with infant pain management in the NICU. Mothers and fathers responded differently regarding self-efficacy and satisfaction, and parents' perceptions were correlated with infants' correct age and parents' own age. Most important, most parents wanted to be present and to be given the opportunity to comfort their infant during and after a painful procedure. Parents also preferred to receive formal/written information on infant pain.
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26
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Xu W, Walsh S, Cong XS. Development of Accumulated Pain/Stressor Scale (APSS) in NICUs: A National Survey. Pain Manag Nurs 2016; 17:354-362. [PMID: 27756592 DOI: 10.1016/j.pmn.2016.08.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 08/02/2016] [Accepted: 08/19/2016] [Indexed: 11/18/2022]
Abstract
High-risk neonates experience numerous painful/stressful procedures daily in neonatal intensive care units (NICUs). Accumulated pain and stress have a detrimental impact on infants' neurodevelopment. Few valid tools are available to measure accumulated pain/stressors among NICU infants. The aim of this study was to obtain nurses' perceptions about severity and acuity levels regarding each painful/stressful procedure that infants may experience in the NICU. The data will support developing a new instrument, the Accumulated Pain/Stressor Scale (APSS) in NICUs. A nationwide online survey was conducted through the U.S. National Association of Neonatal Nurses membership. Respondents were asked to rate the perceived severity of pain/stress associated with 68 procedures using a 5-point Likert scale and to categorize pain/stress as acute or chronic. Modal values were used to determine summary rankings among the procedures. Eighty-four neonatal nurses completed the survey. Among 68 procedures, nearly all were rated as painful/stressful to some degree. Five procedures (7%) had a modal value of five (extremely painful/stressful), nine (14%) had a value of four, 20 (29%) had a value of three, 30 (44%) a value of two, and four (6%) had a value of one (not painful/stressful). Forty-four procedures (65%) were perceived as acute, six (9%) as chronic, and 18 (26%) as both acute and chronic. Nurses' perceptions of pain severity and acuity regarding procedures in NICUs varied somewhat. Further studies are needed in developing and validating the scale. The development of the APSS can quantitatively measure the accumulated neonatal pain/stress.
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Affiliation(s)
- Wanli Xu
- University of Connecticut School of Nursing, Storrs, Connecticut
| | - Stephen Walsh
- University of Connecticut School of Nursing, Storrs, Connecticut
| | - Xiaomei S Cong
- University of Connecticut School of Nursing, Storrs, Connecticut.
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27
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Rochefort CM, Rathwell BA, Clarke SP. Rationing of nursing care interventions and its association with nurse-reported outcomes in the neonatal intensive care unit: a cross-sectional survey. BMC Nurs 2016; 15:46. [PMID: 27489507 PMCID: PMC4971656 DOI: 10.1186/s12912-016-0169-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 07/27/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evidence internationally suggests that staffing constraints and non-supportive work environments result in the rationing of nursing interventions (that is, limiting or omitting interventions for particular patients), which in turn may influence patient outcomes. In the neonatal intensive care unit (NICU), preliminary studies have found that discharge preparation and infant comfort care are among the most frequently rationed nursing interventions. However, it is unknown if the rationing of discharge preparation is related to lower perceptions of parent and infant readiness for NICU discharge, and if reports of increased rationing of infant comfort care are related to lower levels of perceived neonatal pain control. The purpose of this study was to assess these relationships. METHODS In late 2014, a cross-sectional survey was mailed to 285 Registered Nurses (RNs) working in one of 7 NICUs in the province of Quebec (Canada). The survey contained validated measures of care rationing, parent and infant readiness for discharge, and pain control, as well as items measuring RNs' characteristics. Multivariate regression was used to examine the association between care rationing, readiness for discharge and pain control, while adjusting for RNs' characteristics and clustering within NICUs. RESULTS Overall, 125 RNs completed the survey; a 44.0 % response rate. Among the respondents, 28.0 and 40.0 % reported rationing discharge preparation and infant comfort care "often" or "very often", respectively. Additionally, 15.2 % of respondents felt parents and infants were underprepared for NICU discharge, and 54.4 % felt that pain was not well managed on their unit. In multivariate analyses, the rationing of discharge preparation was negatively related to RNs' perceptions of parent and infant readiness for discharge, while reports of rationing of parental support and teaching and infant comfort care were associated with less favourable perceptions of neonatal pain control. CONCLUSIONS The rationing of nursing interventions appears to influence parent and infant readiness for discharge, as well as pain control in NICUs. Future investigations, in neonatal nursing care as well as in other nursing specialties, should address objectively measured patient outcomes (such as objective pain assessments and post-discharge outcomes assessed through administrative data).
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Affiliation(s)
- Christian M Rochefort
- School of Nursing, Faculty of Medicine, University of Sherbrooke, Campus Longueuil, 150 Place Charles-LeMoyne, Room 200, Longueuil, Quebec J4K 0A8 Canada ; Centre de recherche, Hôpital Charles-LeMoyne, 150 Place Charles-LeMoyne, Room 200, Longueuil, Quebec J4K 0A8 Canada ; Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Purvis Hall, 1020 Pine Avenue West, Montreal, Quebec H3A 1A2 Canada
| | - Bailey A Rathwell
- Ingram School of Nursing, McGill University, Wilson Hall, 3506 University Street, Montreal, Quebec H3A 2A7 Canada
| | - Sean P Clarke
- Ingram School of Nursing, McGill University, Wilson Hall, 3506 University Street, Montreal, Quebec H3A 2A7 Canada ; William F. Connell School of Nursing, Maloney Hall, Room 218, 140 Commonwealth Avenue, Chestnut Hill, MA 02467 USA ; McGill University Health Centre, Montréal, Canada
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Pölkki T, Laukkala H, Korhonen A. Nurses' and Parents' Perceptions of Parental Guidance on Using Nonpharmacological Pain-Relieving Methods Among Neonates in the NICU. Pain Manag Nurs 2016; 17:272-80. [PMID: 27287760 DOI: 10.1016/j.pmn.2016.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 02/11/2016] [Accepted: 04/13/2016] [Indexed: 11/15/2022]
Abstract
Despite growing knowledge of parents' important role in their infants' pain management, the extent to which nurses in neonatal intensive care units (NICUs) provide guidance to parents on nonpharmacological methods is unclear. This study aimed to describe and compare the perceptions of parental guidance in using nonpharmacological pain-relieving methods among neonates in NICUs from the viewpoints of nurses and parents, and to examine the participants' demographics related to the guidance. A cross-sectional, descriptive, correlational study using questionnaire surveys was conducted. Eight NICUs of 5 university hospitals in Finland. A total of 427 participants, including 294 nurses and 178 parents. The participants indicated that the methods of touching and holding were the most commonly introduced strategies in infants' pain alleviation, as they were given as an alternative "nearly always/always" (nurses 91%, 87% and parents 61%, 58%, respectively). In contrast, music and breast-feeding were the less commonly introduced nonpharmacological methods (nurses 11%, 6% and parents 1%, 6%, respectively). A significant difference (p < .001) was found between the parents' and nurses' perceptions of parental guidance; nurses reported providing more guidance about all nonpharmacological methods compared with parents. In addition, many demographic factors of the nurses, the parents, and their infants were related to the parental guidance. Our findings indicate that parental guidance should not be based on nurses' evaluations of their activities without taking into account parents' perspectives. When counseling parents to use nonpharmacological methods, neonatal nurses should actively interact with families and discuss parents' individual needs.
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Affiliation(s)
- Tarja Pölkki
- Institute of Health Sciences, University of Oulu, Oulu, Finland.
| | - Helena Laukkala
- Department of Research Methodology, University of Lapland, Rovaniemi, Finland
| | - Anne Korhonen
- Department of Pediatrics and Adolescence, Oulu University Hospital, Oulu, Finland
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Leng HY, Zheng XL, Zhang XH, He HY, Tu GF, Fu Q, Shi SN, Yan L. Combined non-pharmacological interventions for newborn pain relief in two degrees of pain procedures: A randomized clinical trial. Eur J Pain 2015; 20:989-97. [PMID: 26685099 DOI: 10.1002/ejp.824] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2015] [Indexed: 11/06/2022]
Abstract
BACKGROUND Non-pharmacological interventions are effective neonatal pain reduction strategies. We aimed to study the effects of non-nutritive sucking (NNS) and swaddling on infants' behavioural and physiological parameters during shallow or deep heel stick procedures. METHOD In this prospective, multi-centred, randomized controlled clinical trial, we enrolled 671 newborns. The infants undergoing shallow or deep heel stick procedures were randomized into four groups: oral sucrose (routine care, group S), oral sucrose combined with NNS (group NS), oral sucrose combined with swaddling (group SS) and oral sucrose combined with NNS and swaddling (group NSS). The behavioural responses were evaluated by the Revised Neonatal Facial Coding System and the physiological signals were monitored by electrocardiogram monitors. RESULTS A significant synergistic analgesic effect was observed between the NS and SS groups in both the shallow (F = 5.952, p = 0.015) and deep heel stick (F = 7.452, p = 0.007) procedure. NSS group exhibited the lowest pain score. For the deep heel stick procedure, the NS group had a significantly lower increase in heart rate (HR)% and decrease in SPO2 % than the S group (F = 17.540, p = 0.000, F = 10.472, p = 0.001), while this difference was not observed in the shallow heel stick procedure. No difference was found between the S and SS groups, in terms of different physiological parameters. CONCLUSION Non-nutritive sucking and swaddling had synergistic effects on pain relief when used with oral sucrose. For the deep heel stick procedure, oral sucrose combined with NNS and swaddling provided the best pain relief effect. For the shallow heel stick procedure, addition of NNS and swaddling did not improve the effects.
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Affiliation(s)
- H-Y Leng
- Department of PICU, Children's Hospital of Chongqing Medical University, Chongqing City, China
| | - X-L Zheng
- Department of PICU, Children's Hospital of Chongqing Medical University, Chongqing City, China
| | - X-H Zhang
- Department of PICU, Children's Hospital of Chongqing Medical University, Chongqing City, China
| | - H-Y He
- Department of PICU, Children's Hospital of Chongqing Medical University, Chongqing City, China
| | - G-F Tu
- Department of Nursing, Chengdu Women's & Children's Central Hospital, Chengdu City, China
| | - Q Fu
- Department of Nursing, Shenzhen Children's Hosptial, Shenzhen City, China
| | - S-N Shi
- Department of Nursing, Hunan Children's Hosptial, Changsha City, China
| | - L Yan
- Department of PICU, Children's Hospital of Chongqing Medical University, Chongqing City, China
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Neonatal Intensive Care Nurses' Perceptions of Parental Participation in Infant Pain Management: A Comparative Focus Group Study. J Perinat Neonatal Nurs 2015; 29:363-74. [PMID: 26505851 DOI: 10.1097/jpn.0000000000000136] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This comparative focus group study explored nurses' experiences and perceptions regarding parental participation in infant pain management in the neonatal intensive care unit (NICU). A total of 87 nurses from 7 NICUs in Finland, Sweden, and the United States participated in focus-group interviews (n = 25). Data were analyzed using deductive and inductive thematic analysis. Nurses' experiences and perceptions varied considerably, from nurses being in control, to nurses sharing some control with parents, to nurse-parent collaboration in infant pain management. When nurses controlled pain management, parents were absent or passive. In these cases, the nurses believed this led to better pain control for infants and protected parents from emotional distress caused by infant pain. When nurses shared control with parents, they provided information and opportunities for participation. They believed parent participation was beneficial, even if it caused nurses or parents anxiety. When nurses collaborated with parents, they negotiated the optimal pain management approach for an individual infant. The collaborative approach was most evident for the nurses in the Swedish NICUs and somewhat evident in the NICUs in Finland and the United States. Further research is needed to address some nurses' perceptions and concerns and to facilitate greater consistency in the application of evidence-based best practices.
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Cong X. Heel stick test for obtaining blood samples in neonates: both swaddling and heel warming may help, but heel warming appears to provide greater pain reduction. Evid Based Nurs 2015; 18:118. [PMID: 25883132 DOI: 10.1136/eb-2014-102048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Xiaomei Cong
- University of Connecticut, School of Nursing, Storrs, Connecticut, USA
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