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Zhu N, Long B, Zhan X, Zhang L, Wang Z, Wang L, Huang Y, Chen J, Huang C, Xiong L, Fu Z, Deng R. Development of the neonatal pain response variable set: a mixed methods consensus process. Eur J Pediatr 2024:10.1007/s00431-024-05559-7. [PMID: 38850331 DOI: 10.1007/s00431-024-05559-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/31/2024] [Accepted: 04/04/2024] [Indexed: 06/10/2024]
Abstract
While over 40 neonatal pain assessment scales have been published, owing to a lack of consensus and standardized metrics, there are more than 100 assessment indicators with varying descriptors and quality differences. This study aims to reach a consensus on optimal and comprehensive variables for neonatal pain assessment, leading to the development of a multidimensional neonatal pain response variable set. This study consisted of three phases: (1) A literature review was conducted to identify influencing factors and assessment indicators of neonatal pain response. (2) Panel meetings involving neonatal healthcare professionals evaluated and screened factors and indicators to develop an initial draft of the variable set. (3) Through two rounds of Delphi study achieved consensus, and determined the neonatal pain response variable set. Through a literature review and a panel meeting, the identified factors and indicators were categorized into contextual, physiological, and behavioral variables, forming an initial draft of the variable set. Sixteen professionals participated in two rounds of the Delphi study, with response rates exceeding 70%, and authority coefficients surpassing 0.7 in both rounds. The final iteration of the variable set includes 9 contextual variables, 2 physiological variables, and 5 behavioral variables. Conclusion: Neonatal pain response variable set developed in this study is scientific, comprehensive, and multidimensional, aligning with the characteristics of neonatal pain response and clinically applicable. The inclusion of contextual variables enhances the ability to confront the complexity of clinical environments and individual differences. It can provide a practical and theoretical basis for clinical research on neonatal pain assessment. What is Known: • Neonatal pain assessment relies on scales used by healthcare professionals currently. But there is no "gold standard" for neonatal pain assessment. • While over 40 neonatal pain assessment scales have been published, owing to a lack of consensus and standardized metrics, there are more than 100 assessment indicators with varying descriptors and quality differences. Most of scales overlook the clinical environment complexity individual differences in pain responses, diminishing the accuracy and applicability. What is New: • In addition to the commonly used physiological and behavioral variables in the scales, we have incorporated contextual variables to better address the complexity of clinical environments and individual differences in pain responses. • Through an evidence-based approach, developed a neonatal pain response variable set comprising 9 contextual variables, 2 physiological variables, and 5 behavioral variables.
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Affiliation(s)
- Nanxi Zhu
- Department of Nursing, Affiliated Hospital of Zunyi Medical University, Zunyi, China
- Nursing School, Zunyi Medical University, Zunyi, China
| | - Bingjie Long
- Department of Nursing, Affiliated Hospital of Zunyi Medical University, Zunyi, China
- Nursing School, Zunyi Medical University, Zunyi, China
| | - Xinling Zhan
- Department of Nursing, Affiliated Hospital of Zunyi Medical University, Zunyi, China
- Nursing School, Zunyi Medical University, Zunyi, China
| | - Lanxin Zhang
- Department of Nursing, Affiliated Hospital of Zunyi Medical University, Zunyi, China
- Nursing School, Zunyi Medical University, Zunyi, China
| | - Zechuan Wang
- Department of Nursing, Affiliated Hospital of Zunyi Medical University, Zunyi, China
- Nursing School, Zunyi Medical University, Zunyi, China
| | - Lianhong Wang
- Department of Nursing, Affiliated Hospital of Zunyi Medical University, Zunyi, China
- Nursing School, Zunyi Medical University, Zunyi, China
| | - Yi Huang
- Department of Nursing, Affiliated Hospital of Zunyi Medical University, Zunyi, China.
| | - Juan Chen
- Department of Neonatology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Chi Huang
- Department of Neonatology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Lu Xiong
- Department of Neonatology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Zhenyan Fu
- Department of Neonatology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Renli Deng
- Department of Nursing, Affiliated Hospital of Zunyi Medical University, Zunyi, China.
- Nursing School, Zunyi Medical University, Zunyi, China.
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Agakidou E, Kontou A, Stathopoulou T, Farini M, Thomaidou A, Tsoni K, Chotas W, Sarafidis K. Intertemporal Improvement in Physicians' Perceptions of the Short-Term Adverse Outcomes of Neonatal Pain: Results of a Two-Time-Point National Survey. CHILDREN (BASEL, SWITZERLAND) 2024; 11:471. [PMID: 38671688 PMCID: PMC11049171 DOI: 10.3390/children11040471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 04/07/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024]
Abstract
Pain in early life may seriously impact neonatal outcomes. This study aimed to evaluate whether the perceptions of physicians working in neonatal intensive care units (NICUs) of the short-term adverse outcomes associated with neonatal pain have changed over a 20-year period. Self-administered questionnaires were distributed to 117 and 145 neonatologists, pediatricians, and fellows working in level III NICUs in 2000 (T1) and 2019 (T2), respectively. The questionnaire consisted of four domains, including the central nervous, cardiovascular, and respiratory systems, as well as "other systems" (metabolic/endocrine system, growth, and general condition), with 21 total items overall. Although the proportion of positive (correct) responses to the total and system-specific domain scores was significantly higher at T2 than T1, the knowledge of certain short-term adverse outcomes was suboptimal even at T2. Adjustment for cofactors confirmed the independent association of the survey time-point with the total and system-specific domain scores. Moreover, NICU type was an independent significant factor associated with the adjusted total and central nervous system scores, while young doctors had a better knowledge of adverse cardiovascular effects. Conclusions: The perceptions of NICU physicians concerning the short-term outcomes associated with neonatal pain have significantly improved over the past 20 years, although remaining knowledge gaps mandate ongoing efforts to achieve an improvement in neonatal care.
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Affiliation(s)
- Eleni Agakidou
- Department of Neonatology and Neonatal Intensive Care, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Hippokrateion General Hospital, 54642 Thessaloniki, Greece; (A.K.); (M.F.); (K.S.)
| | - Angeliki Kontou
- Department of Neonatology and Neonatal Intensive Care, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Hippokrateion General Hospital, 54642 Thessaloniki, Greece; (A.K.); (M.F.); (K.S.)
| | - Theodora Stathopoulou
- Department of Neonatology and Neonatal Intensive Care, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Hippokrateion General Hospital, 54642 Thessaloniki, Greece; (A.K.); (M.F.); (K.S.)
| | - Maria Farini
- Department of Neonatology and Neonatal Intensive Care, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Hippokrateion General Hospital, 54642 Thessaloniki, Greece; (A.K.); (M.F.); (K.S.)
| | - Agathi Thomaidou
- Department of Neonatology and Neonatal Intensive Care, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Hippokrateion General Hospital, 54642 Thessaloniki, Greece; (A.K.); (M.F.); (K.S.)
| | - Konstantina Tsoni
- Department of Neonatology and Neonatal Intensive Care, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Hippokrateion General Hospital, 54642 Thessaloniki, Greece; (A.K.); (M.F.); (K.S.)
| | - William Chotas
- Department of Neonatology, University of Vermont, Burlington, VT 05405, USA
| | - Kosmas Sarafidis
- Department of Neonatology and Neonatal Intensive Care, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Hippokrateion General Hospital, 54642 Thessaloniki, Greece; (A.K.); (M.F.); (K.S.)
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Luo F, Zhu H, Mei L, Shu Q, Cheng X, Chen X, Zhao Y, Chen S, Pan Y. Evaluation of procedural pain for neonates in a neonatal intensive care unit: a single-centre study. BMJ Paediatr Open 2023; 7:e002107. [PMID: 37821124 PMCID: PMC10582867 DOI: 10.1136/bmjpo-2023-002107] [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: 05/31/2023] [Accepted: 08/16/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND To evaluate the procedural pain experienced by neonates in a neonatal intensive care unit (NICU) setting and determine the corresponding pain grades. METHODS Two experienced nurses independently used the Neonatal Infant Pain Scale (NIPS) to evaluate the neonatal pain during procedures taking place in the tertiary NICU and two level-two neonatal care units in the Children's Hospital of Zhejiang University School of Medicine. The mean and distribution of NIPS pain scores and the corresponding pain grades of participants when experiencing clinical painful procedures were analysed. RESULTS A total of 957 neonates exposed to 15 common clinical painful procedures were included in the study. The clinical painful procedures experienced by 957 participants could be divided into three groups: severe pain (NIPS score 5-7: peripheral intravenous cannulation, arterial catheterisation, arterial blood sampling, peripherally inserted central catheter placement and nasopharyngeal suctioning), mild to moderate pain (NIPS score 3-4: finger prick, intramuscular injection, adhesive removal, endotracheal intubation suctioning, heel prick, lumbar puncture and subcutaneous injection) and no pain to mild pain (NIPS score 0-2: gastric tube insertion, enema and intravenous injection). CONCLUSIONS The neonatal pain response to clinical procedures in NICU had certain pattern and preintervention drug analgesia could be taken for painful procedures with clustered high NIPS pain scores. Meanwhile, full coverage non-drug pain relief measures could be taken for procedures that are with scattered pain scores, and real-time pain evaluation should be provided to determine whether further drug analgesia is required.
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Affiliation(s)
- Feixiang Luo
- Neonatal Intensive Care Unit, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
| | - Huaiyu Zhu
- College of Information Science and Electronic Engineering, Zhejiang University, Hangzhou, Zhejiang, China
| | - Lingli Mei
- Administration Department of Nosocomial Infection, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Qi Shu
- Administration Department of Nosocomial Infection, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Xiaoying Cheng
- Quality Improvement Office, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Xiaofei Chen
- Gastroenterology Department, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Yisheng Zhao
- College of Information Science and Electronic Engineering, Zhejiang University, Hangzhou, Zhejiang, China
| | - Shuohui Chen
- Administration Department of Nosocomial Infection, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Yun Pan
- College of Information Science and Electronic Engineering, Zhejiang University, Hangzhou, Zhejiang, China
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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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Zhou X, Zhou K, Yang M, Wu H, Chen Q, Li T, Zeng J, Li D, Ou Y, Wu Y. Assessment and management of neonatal pain: a best practice implementation project. JBI Evid Implement 2023; 21:68-77. [PMID: 36374976 DOI: 10.1097/xeb.0000000000000354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND AIMS Neonates are exposed to varying degrees of pain during their hospitalization, which are going to have a profound impact on their lives. Interventions to alleviate neonatal pain are inadequate and inconsistent. The project aims to promote evidence-based practice (EBP) for the assessment and management of neonatal patients with acute pain and to evaluate the impact of these practices on neonatal pain in hospital. METHODS The current project was conducted in the neonatal department of a tertiary hospital in China. Five audit criteria were developed for baseline and follow-up audits. The project used the JBI PACES software and JBI's Getting Research into Practice audit and feedback tool to take evidence-based healthcare into practice. A total of 100 neonates with acute pain procedures were evaluated at baseline and follow-up audit. RESULTS The results showed a poor compliance of the five audit indicators in the baseline audit and a significantly improved compliance of the five audit indicators in the follow-up audit. Compared to the baseline audit, audit criterion 1 increased from 0% to 86.1%, audit criterion 2 increased from 36.1% to 82.5%, audit criterion 3 increased from 12% to 61%, audit criterion 4 increased from 0% to 66%, and audit criterion 5 increased from 6% at baseline to 71% in the follow-up audit. CONCLUSION The project found that EBP can help nursing staff effectively manage neonatal patients who are experiencing acute painful operations. Further studies are necessary to ensure the sustainability of the criteria in the project.
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Affiliation(s)
- Xuan Zhou
- Nanfang Hospital, Southern Medical University
- School of Nursing, Southern Medical University
| | - Kai Zhou
- Nanfang Hospital, Southern Medical University
| | - Ming Yang
- Nanfang Hospital, Southern Medical University
| | - Hongli Wu
- Zengcheng Branch of Nanfang Hospital, Southern Medical University, Guangzhou, PR China
| | - Qiuan Chen
- Zengcheng Branch of Nanfang Hospital, Southern Medical University, Guangzhou, PR China
| | - Ting Li
- Zengcheng Branch of Nanfang Hospital, Southern Medical University, Guangzhou, PR China
| | - Jiali Zeng
- Zengcheng Branch of Nanfang Hospital, Southern Medical University, Guangzhou, PR China
| | - Dan Li
- Zengcheng Branch of Nanfang Hospital, Southern Medical University, Guangzhou, PR China
| | - Yulan Ou
- Zengcheng Branch of Nanfang Hospital, Southern Medical University, Guangzhou, PR China
| | - Yanni Wu
- Nanfang Hospital, Southern Medical University
- Nanfang Nursing Centre for Evidence-based Practice: A JBI Centre of Excellence
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Zhao T, Starkweather AR, Matson A, Lainwala S, Xu W, Cong X. Nurses’ experiences of caring for preterm infants in pain: A meta-ethnography. Int J Nurs Sci 2022; 9:533-541. [PMID: 36285076 PMCID: PMC9587390 DOI: 10.1016/j.ijnss.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/25/2022] [Accepted: 09/08/2022] [Indexed: 11/28/2022] Open
Abstract
Objective Preterm infants are subjected to numerous painful procedures during their neonatal intensive care unit (NICU) hospitalization. Despite advancements in pain alleviation, nurses remain challenged to provide timely and effective pain management for preterm infants. Greater understanding of the lived experience of nurses caring for preterm infants in pain could provide novel insights to improve pain management for this vulnerable population. The aim of this meta-ethnography was to synthesize and interpret qualitative findings of nurses’ experiences of taking care of preterm infants in pain. Methods An extensive literature search in PubMed, CINAHL, PsycINFO, Scopus, BIOSIS and ProQuest Dissertation and Theses Database was conducted, including studies within the past 10 years. Two nursing researchers conducted data extraction and analysis independently. Inclusion criteria were applied to search for qualitative studies of nurse participants who worked in the NICU taking care of preterm infants. Studies published in a language other than English, articles that did not include qualitative data and qualitative data that could not be extracted from the findings or did not discuss nurses’ experiences were excluded. Critical Appraisal Skills Programme was used for literature quality evaluation. Results Eight studies remained after further screening according to inclusion and exclusion criteria. These eight studies were conducted from 2013 to 2018 and totally enrolled 205 nurses from Iran, Canada, the United States, Finland, Sweden, Switzerland, and Australia. Five themes emerged on the nurses’ perspectives of taking care of preterm infants in pain: 1) They sense the neonatal pain; 2) Adverse consequences of unrelieved pain; 3) Barriers of managing pain; 4) Concerns of available approaches for pain relief; 5) Failure to work with parents. Conclusions This meta-ethnography identified nurses’ understanding of pain in preterm infants that can be assessed, and they acknowledged that unrelieved pain could cause developmental deficits in infants. The barriers are lack of training and support on pain assessment and intervention in preterm infants. Optimizing workload and environment, developing age-specified pain assessment and intervention, receiving emotional support and training, and building up a rapport with parents are urgent needs for nurses to provide better care to infants having pain.
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Affiliation(s)
- Tingting Zhao
- School of Nursing, University of Connecticut, Storrs, CT, USA
| | | | - Adam Matson
- Division of Neonatology, Connecticut Children’s Medical Center, Hartford, CT, USA
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Shabnam Lainwala
- Division of Neonatology, Connecticut Children’s Medical Center, Hartford, CT, USA
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Wanli Xu
- School of Nursing, University of Connecticut, Storrs, CT, USA
| | - Xiaomei Cong
- School of Nursing, University of Connecticut, Storrs, CT, USA
- School of Nursing, Yale University, Orange, CT, USA
- Corresponding author. School of Nursing, University of Connecticut, Storrs, CT, USA.
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Nurses' Perception of Preterm Infants' Pain and the Factors of Their Pain Assessment and Management. J Perinat Neonatal Nurs 2022; 36:312-326. [PMID: 35894730 DOI: 10.1097/jpn.0000000000000676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
In the neonatal intensive care unit, preterm infants undergo many painful procedures. Although these can impair their neurodevelopment if not properly managed, only half of the painful procedures are optimally handled. This cross-sectional study aimed to evaluate nurses' perceptions of preterm infants' pain, to evaluate nurses' pain assessment and management practices, as well as to identify the individual and contextual factors that influence nurses' assessments and interventions for pain management. Secondary analyses, including a mixed-model analysis, were performed with data from a larger study (n = 202 nurses). Nurses were found to have attitudes and perceptions in favor of preterm infants' pain management, although they reported using few standardized instruments to assess pain. Nurses stated that they widely used sucrose, non-nutritive sucking, and positioning as pain management interventions, while skin-to-skin contact was rarely practiced. Nurses' attitudes and perceptions influenced their pain assessment practices, which predicted their implementation of interventions. Several contextual (country, level of care, and work shift) and individual factors (age, level of education, had a preterm infant, perceptions of family-centered care, and skin-to-skin contact) also predicted nurses' pain assessment and management practices.
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Cheng C, Tabbara N, Cheng C, Shah V. Intranasal Fentanyl for Procedural Analgesia in Preterm Infants. FRONTIERS IN PAIN RESEARCH 2022; 2:815014. [PMID: 35295509 PMCID: PMC8915696 DOI: 10.3389/fpain.2021.815014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 12/27/2021] [Indexed: 11/22/2022] Open
Abstract
Background Despite the availability of evidence-based analgesic strategies, neonatal pain management continues to be suboptimal. Intranasal (IN) fentanyl is an alternative pharmacotherapy for procedural pain in neonatal units. The objective was to evaluate the effectiveness and safety of IN fentanyl for procedural pain in preterm infants. Methods A retrospective cohort study was conducted in infants who received IN fentanyl between May 2019 and December 2020 at an academic neonatal intensive care unit. Main outcome measures were pain responses, physiological parameters before and up to 60 min after IN fentanyl administration, and adverse events. Paired t-test and analysis of variance were used to compare pain scores and physiological parameters, respectively. Results Thirteen infants received IN fentanyl on 22 occasions. Median (interquartile range [IQR]) gestational age and birthweight were 27 (25, 27.6) weeks and 850 (530, 1,030) grams, while median (IQR) post-menstrual age and weight were 30.9 (28.9, 32.9) weeks and 1,280 (945, 1,623) grams at the time of IN fentanyl administration. IN fentanyl was most used for lumbar puncture (55%) followed by insertion of epicutaneo-caval catheters (27%). There was a difference between the mean pre- and post-procedure Premature Infant Pain Profile scores of 1.3 (95% CI = 0.07, 2.5; p = 0.04). Physiological parameters did not differ before and up to 60 min post IN fentanyl administration (p > 0.05). Two adverse events (one apnea and one desaturation) were noted. Conclusion In our limited experience, IN fentanyl appears to be an alternative pharmacotherapy for procedural pain management in the absence of intravenous access in preterm infants.
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Affiliation(s)
- Charles Cheng
- Department of Pediatrics, Mount Sinai Hospital, Toronto, ON, Canada
| | - Najla Tabbara
- Department of Pharmacy, Mount Sinai Hospital, Toronto, ON, Canada
| | - Carol Cheng
- Department of Nursing, Mount Sinai Hospital, Toronto, ON, Canada
| | - Vibhuti Shah
- Department of Pediatrics, Mount Sinai Hospital, Toronto, ON, Canada
- *Correspondence: Vibhuti Shah
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Carlsen Misic M, Andersen RD, Strand S, Eriksson M, Olsson E. Nurses' perception, knowledge, and use of neonatal pain assessment. PAEDIATRIC & NEONATAL PAIN 2021; 3:59-65. [PMID: 35547593 PMCID: PMC8975217 DOI: 10.1002/pne2.12050] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 03/21/2021] [Accepted: 04/11/2021] [Indexed: 01/10/2023]
Abstract
Preterm and sick newborn infants undergo several painful procedures during their hospital stay, potentially leading to short‐ and long‐term negative consequences. Pain assessment should be performed regularly to provide optimal pain management. Nurses' knowledge of and attitude toward neonatal pain assessment affect how pain is assessed and managed in the clinical situation. The aim of this study was to explore Swedish nurses' perception, knowledge, and use of neonatal pain assessment. This descriptive, cross‐sectional questionnaire study was conducted across all Swedish neonatal units (n = 38). Respondents were chosen through convenience sampling by the head nurses at each unit. Ten nurses from each unit were asked to complete the survey, which contained both closed and open questions. A majority of the units (30/38; 79%) participated and 232 surveys were returned, a response rate of 61%. Of the nurses, 91% thought that neonatal pain assessment was important. Many nurses mentioned various difficulties with pain assessment and concerns that the scales used might not assess pain correctly. About half of the nurses considered themselves to have enough knowledge of neonatal pain assessment. Those who reported having enough knowledge of pain assessment viewed the pain scales used at their units more positively. Of the nurses, 74% reported using a pain assessment scale several times per work shift. Pain management guidelines were available according to 75% of nurses, but only 53% reported that the guidelines were followed. Although nurses in general expressed a positive attitude toward pain assessment scales, this was not necessarily evident in their clinical practice. Lack of knowledge, available or accessible guidelines, or concerns regarding the validity of available pain scales seemed to limit their use.
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Affiliation(s)
- Martina Carlsen Misic
- Department of Pediatrics Faculty of Medicine and Health School of Health Sciences Örebro University Örebro Sweden.,Faculty of Medicine and Health School of Health Sciences Örebro University Örebro Sweden
| | - Randi Dovland Andersen
- Faculty of Medicine and Health School of Health Sciences Örebro University Örebro Sweden.,Department of Research Telemark Hospital Trust Skien Norway
| | - Sofia Strand
- Faculty of Medicine and Health School of Health Sciences Örebro University Örebro Sweden
| | - Mats Eriksson
- Faculty of Medicine and Health School of Health Sciences Örebro University Örebro Sweden
| | - Emma Olsson
- Department of Pediatrics Faculty of Medicine and Health School of Health Sciences Örebro University Örebro Sweden.,Faculty of Medicine and Health School of Health Sciences Örebro University Örebro Sweden
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De Clifford-Faugère G, Laporte G, Gélinas C, Lavallée A, Fontaine G, Feeley N, Colson S, Aita M. French Translation, Adaptation, and Initial Validation of the Nurses' Attitudes and Perceptions of Pain Assessment in Neonatal Intensive Care Questionnaire (NAPPAQ). Pain Manag Nurs 2021; 23:204-211. [PMID: 34045150 DOI: 10.1016/j.pmn.2021.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/15/2021] [Accepted: 04/03/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of this study was to translate, adapt and conduct initial psychometric validation of the French version of the Nurses' Attitudes and Perceptions of Pain Assessment in neonatal intensive care Questionnaire (NAPPAQ) developed by Polkki in 2010. BACKGROUND Assessing nurses' perceptions, attitudes and knowledge about pain management in preterm infants is important to improve neonatal practices. METHODS A sample of French-speaking nurses (n = 147) from Quebec and France working in neonatal intensive care was selected to validate the 46-item questionnaire. A French translation of the NAPPAQ, which includes Part I and II, was undertaken prior to its administration. The FIPM questionnaire was added as a Part III. Internal consistency and instrument structure were examined using Cronbach's alphas, inter-item and inter-scale correlations and exploratory factor analysis. RESULTS The NAPPAQ-FIPM is divided into three parts. Part I of the French version had a Cronbach's alpha of 0.64 and was composed of five factors. Part II had good total internal consistency (0.79) and adequate structure, established by inter-item correlations. Part III had good total internal consistency (0.76), and factor analysis findings suggested the presence of five factors. CONCLUSIONS The NAPPAQ-FIPM can be used for research purposes. Parts II and III obtained adequate psychometrics results. However, further refinement of Part I could improve its content and internal structure.
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Affiliation(s)
- Gwenaëlle De Clifford-Faugère
- Faculty of Nursing, Université de Montréal, Montréal, QC, Canada; CHU Sainte-Justine Research Centre, Montréal, QC, Canada; EA3279-CEReSS, School of Nursing, Faculty of Medical and Paramedical Sciences, Aix-Marseille Université, Marseille, France.
| | - Geneviève Laporte
- Faculty of Nursing, Université de Montréal, Montréal, QC, Canada; CHU Sainte-Justine Research Centre, Montréal, QC, Canada
| | - Céline Gélinas
- Ingram School of Nursing, McGill University, Montréal, QC, Canada; Quebec Network on Nursing Intervention Research (RRISIQ), Montréal, QC, Canada; Centre for Nursing Research and Lady Davis Institute, Jewish General Hospital - CIUSSS West-Central-Montreal Montréal, QC, Canada
| | - Andréane Lavallée
- Faculty of Nursing, Université de Montréal, Montréal, QC, Canada; CHU Sainte-Justine Research Centre, Montréal, QC, Canada
| | - Guillaume Fontaine
- Faculty of Nursing, Université de Montréal, Montréal, QC, Canada; Research Centre, Montreal Heart Institute, Montreal, Canada
| | - Nancy Feeley
- Ingram School of Nursing, McGill University, Montréal, QC, Canada; Quebec Network on Nursing Intervention Research (RRISIQ), Montréal, QC, Canada; Centre for Nursing Research and Lady Davis Institute, Jewish General Hospital - CIUSSS West-Central-Montreal Montréal, QC, Canada
| | - Sébastien Colson
- EA3279-CEReSS, School of Nursing, Faculty of Medical and Paramedical Sciences, Aix-Marseille Université, Marseille, France
| | - Marilyn Aita
- Faculty of Nursing, Université de Montréal, Montréal, QC, Canada; CHU Sainte-Justine Research Centre, Montréal, QC, Canada; Quebec Network on Nursing Intervention Research (RRISIQ), Montréal, QC, Canada
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11
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Assessment of four pain scales for evaluating procedural pain in premature infants undergoing heel blood collection. Pediatr Res 2021; 89:1724-1731. [PMID: 32599608 DOI: 10.1038/s41390-020-1034-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 06/11/2020] [Accepted: 06/15/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND Procedural pain is underestimated in hospitalized preterm infants. The aim of this study was to assess the reliability, validity, and clinical utility of the Neonatal Facial Coding System (NFCS), Douleur Aiguë du Nouveau-né (DAN) scale, Neonatal Infant Pain Scale (NIPS), and Premature Infant Pain Profile (PIPP) in premature infants undergoing heel blood collection. We assume that the four scales were similar in reliablility and validity (but different in clinical utility). METHODS The pain assessments were performed on 111 premature infants using the four scales. Internal consistency was determined by Cronbach's α, and the reliability was determined by the intraclass correlation coefficients. Concurrent validity was evaluated by Spearman's rank correlations. Bland-Altman plots were used to investigate the convergent validity. RESULTS The internal consistency and their reliability of the scales were high (p < 0.001). Scores were significantly higher at the time of blood collection (p < 0.001). Mean scores of clinical utility of PIPP were significantly higher than NFCS and DAN (p < 0.05) but not higher than the NIPS (p > 0.05). CONCLUSIONS The four scales were reliable and valid. This study suggests that the PIPP and NIPS has good clinical utility and are better choice for evaluating procedural pain in premature infants. IMPACT The aim of this study was to assess the reliability, validity, and clinical utility of NFCS, DAN, NIPS, and PIPP in premature infants undergoing heel blood collection. The results showed that the four scales have high reliability and internal consistency; the PIPP and NIPS have good clinical utility and are better choice for evaluating procedural pain in premature infants. Our study results provided a reference for clinical workers in choosing pain assessment scales and conduction intervention.
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Ilhan E, Pacey V, Brown L, Spence K, Gray K, Rowland JE, White K, Hush JM. Neonates as intrinsically worthy recipients of pain management in neonatal intensive care. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2021; 24:65-72. [PMID: 33034802 DOI: 10.1007/s11019-020-09982-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/01/2020] [Indexed: 06/11/2023]
Abstract
One barrier to optimal pain management in the neonatal intensive care unit (NICU) is how the healthcare community perceives, and therefore manages, neonatal pain. In this paper, we emphasise that healthcare professionals not only have a professional obligation to care for neonates in the NICU, but that these patients are intrinsically worthy of care. We discuss the conditions that make neonates worthy recipients of pain management by highlighting how neonates are (1) vulnerable to pain and harm, and (2) completely dependent on others for pain management. We argue for a relational account of ethical decision-making in the NICU by demonstrating how an increase in vulnerability and dependence may be experienced by the healthcare community and the neonate's family. Finally, an ethical framework for decisions around neonatal pain management is proposed, focussing on surrogate decision-making and the importance of compassionate action through both a reflective and an affective empathy. As empathy can be highly motivating against pain, we propose that, in addition to educational programs that raise awareness and knowledge of neonatal pain and pain management, healthcare professionals must cultivate empathy in a collective manner, where all members of the NICU team, including parents, are compassionate decision-makers.
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Affiliation(s)
- Emre Ilhan
- Faculty of Medicine, Health and Human Sciences, Department of Health Professions, Macquarie University, Sydney, NSW, Australia.
- Faculty of Medicine, Health and Human Sciences, Department of Health Professions, Macquarie University, Ground Floor, 75 Talavera Road, Sydney, NSW, 2109, Australia.
| | - Verity Pacey
- Faculty of Medicine, Health and Human Sciences, Department of Health Professions, Macquarie University, Sydney, NSW, Australia
| | - Laura Brown
- Faculty of Medicine, Health and Human Sciences, Department of Health Professions, Macquarie University, Sydney, NSW, Australia
| | - Kaye Spence
- Children's Hospital at Westmead, Grace Centre for Newborn Intensive Care, Sydney, NSW, Australia
- School of Nursing and Midwifery, Western Sydney University, Parramatta, NSW, Australia
| | - Kelly Gray
- Faculty of Medicine, Health and Human Sciences, Department of Health Professions, Macquarie University, Sydney, NSW, Australia
| | - Jennifer E Rowland
- Faculty of Medicine, Health and Human Sciences, Department of Health Professions, Macquarie University, Sydney, NSW, Australia
| | - Karolyn White
- Research Ethics and Integrity, Macquarie University, Sydney, NSW, Australia
| | - Julia M Hush
- Faculty of Medicine, Health and Human Sciences, Department of Health Professions, Macquarie University, Sydney, NSW, Australia
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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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Kassab M, Joseph R, Alhammad N, Mohammad KI. Oral Sucrose for Neonatal Pain: Perception of Jordanian Nurses. Neonatal Netw 2021; 40:25-30. [PMID: 33479008 DOI: 10.1891/0730-0832/11-t-663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Neonatal pain management using sucrose has been an established practice in Western countries. However, in the developing world, the practice is still not widely accepted. Neonatal nurses' perceptions about the neonatal pain experience and efficacy of oral sucrose may influence that decision. PURPOSE To investigate Jordanian neonatal nurses' perceptions about the use of oral sucrose for neonatal pain. DESIGN AND SAMPLE A cross-sectional descriptive design was used to collect data from 191 neonatal nurses working in 3 different hospital settings in northern and middle central Jordan. MAIN OUTCOME VARIABLES Knowledge and perception of Jordanian nurses about neonatal pain and oral sucrose and their relationship to demographic variables. RESULTS More than half of nurses had knowledge deficit about pain management. Fifty-five percent of the nurses had a positive perception toward pain assessment tools, and the majority indicated positive opinion toward oral sucrose usage. Demographic factors can impact their perceptions.
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15
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Campelia GD, Kett JC, Wightman A. Relational suffering and the moral authority of love and care. THEORETICAL MEDICINE AND BIOETHICS 2020; 41:165-178. [PMID: 33284391 PMCID: PMC7720443 DOI: 10.1007/s11017-020-09530-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Suffering is a ubiquitous yet elusive concept in health care. In a field devoted to the pursuit of objective data, suffering is a phenomenon with deep ties to subjective experience, moral values, and cultural norms. Suffering's tie to subjective experience makes it challenging to discern and respond to the suffering of others. In particular, the question of whether a child with profound neurocognitive disabilities can suffer has generated a robust discourse, rooted in philosophical conceptualizations of personhood as well as the academic and experiential expertise of practiced health-care professionals. The issue remains unresolved because it is difficult, perhaps impossible, to ever truly know an infant's lived experience. But what if this is not the best question? What if instead of asking "can this infant suffer?" the discourse is broadened to ask "is there suffering here?" This latter question demands attention to patients' subjective experiences of suffering, but also to the web of relationships that envelop them. Without losing sight of the importance of patients' experiences, consideration of their relationships may elucidate the presence of suffering when the patients themselves are unable to provide the same clarity. In this essay, care ethics frames an examination of how suffering manifests in the loving and caring relationships that surround an infant with profound neurocognitive disabilities, changing those relationships and affecting the individuals within them. Exploring suffering through these relationships may offer clarity on the presence and content of suffering for infants with profound cognitive disabilities, in turn offering moral guidance for responding to suffering and supporting flourishing in this context.
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Affiliation(s)
- Georgina D. Campelia
- Department of Bioethics and Humanities, University of Washington School of Medicine, Seattle, WA USA
- Clinical Ethics Consultation Service, University of Washington School of Medicine, Seattle, WA USA
| | - Jennifer C. Kett
- Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Research Institute, Seattle, WA USA
- Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA USA
| | - Aaron Wightman
- Department of Bioethics and Humanities, University of Washington School of Medicine, Seattle, WA USA
- Treuman Katz Center for Pediatric Bioethics, Seattle Children’s Research Institute, Seattle, WA USA
- Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA USA
- Division of Pediatric Nephrology, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA USA
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Implementation of an opioid weaning protocol to improve pain management, and to prevent or decrease iatrogenic withdrawal syndrome in the neonatal intensive care. INT J EVID-BASED HEA 2020; 17:147-156. [PMID: 31162272 DOI: 10.1097/xeb.0000000000000169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM The aim of this evidence implementation project was to improve pain assessment and management of the neonate receiving an opioid infusion, and to prevent or decrease the incidence of iatrogenic withdrawal syndrome (IWS). METHODS The current project was carried out in two intensive care areas of a 79 bed tertiary Neonatal Unit in Australia. A pre/postaudit design was utilized. Patient charts were reviewed to collect baseline audit data on pain assessments and titration of opioids. A weaning protocol was developed and implemented along with targeted staff education to align current practice with best practice recommendations. A postimplementation audit was then conducted to evaluate changes in practice. RESULTS A total of 32 charts (13 pre/19 post) were reviewed to evaluate pain assessment, titration of opioids, and the identification of any signs and symptoms of IWS. The results demonstrated an improvement in the completion of pain assessments by 34%, and 100% compliance to withdrawal assessment following the introduction of an IWS assessment tool. For neonates receiving analgesics for less than 4 days, adherence to the weaning schedule occurred in 75%. No clinical signs of IWS were seen in this cohort. For neonates receiving analgesics for greater than 4 days, adherence to the weaning schedule occurred in only 55%. Of those neonates where the protocol was not followed, 67% developed clinical signs of IWS. CONCLUSION Although this project demonstrated improvements in pain assessment and the identification of IWS, lack of adherence to the pain management policy and weaning tool has increased awareness of the importance of collaboration within the multidisciplinary team to improve outcomes. Several barriers were identified prior to implementation and various methods were employed to overcome these. Despite this, consistency of practice and change-management remain a challenge in clinical care.
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17
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Razaghi N, Aemmi SZ, Sadat Hoseini AS, Boskabadi H, Mohebbi T, Ramezani M. The effectiveness of familiar olfactory stimulation with lavender scent and glucose on the pain of blood sampling in term neonates: A randomized controlled clinical trial. Complement Ther Med 2020; 49:102289. [DOI: 10.1016/j.ctim.2019.102289] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 12/20/2019] [Accepted: 12/20/2019] [Indexed: 11/28/2022] Open
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18
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Buyuk E. The effect of video-assisted training given to midwifery and nursing students about pain and its management in newborns on students' level of knowledge. JOURNAL OF NURSING AND MIDWIFERY SCIENCES 2020. [DOI: 10.4103/jnms.jnms_56_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Cheng D, Liu D, Philpotts LL, Turner DP, Houle TT, Chen L, Zhang M, Yang J, Zhang W, Deng H. Current state of science in machine learning methods for automatic infant pain evaluation using facial expression information: study protocol of a systematic review and meta-analysis. BMJ Open 2019; 9:e030482. [PMID: 31831532 PMCID: PMC6924806 DOI: 10.1136/bmjopen-2019-030482] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 11/18/2019] [Accepted: 11/18/2019] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Infants can experience pain similar to adults, and improperly controlled pain stimuli could have a long-term adverse impact on their cognitive and neurological function development. The biggest challenge of achieving good infant pain control is obtaining objective pain assessment when direct communication is lacking. For years, computer scientists have developed many different facial expression-centred machine learning (ML) methods for automatic infant pain assessment. Many of these ML algorithms showed rather satisfactory performance and have demonstrated good potential to be further enhanced for implementation in real-world clinical settings. To date, there is no prior research that has systematically summarised and compared the performance of these ML algorithms. Our proposed meta-analysis will provide the first comprehensive evidence on this topic to guide further ML algorithm development and clinical implementation. METHODS AND ANALYSIS We will search four major public electronic medical and computer science databases including Web of Science, PubMed, Embase and IEEE Xplore Digital Library from January 2008 to present. All the articles will be imported into the Covidence platform for study eligibility screening and inclusion. Study-level extracted data will be stored in the Systematic Review Data Repository online platform. The primary outcome will be the prediction accuracy of the ML model. The secondary outcomes will be model utility measures including generalisability, interpretability and computational efficiency. All extracted outcome data will be imported into RevMan V.5.2.1 software and R V3.3.2 for analysis. Risk of bias will be summarised using the latest Prediction Model Study Risk of Bias Assessment Tool. ETHICS AND DISSEMINATION This systematic review and meta-analysis will only use study-level data from public databases, thus formal ethical approval is not required. The results will be disseminated in the form of an official publication in a peer-reviewed journal and/or presentation at relevant conferences. PROSPERO REGISTRATION NUMBER CRD42019118784.
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Affiliation(s)
- Dan Cheng
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Dianbo Liu
- Computer Science and Artificial Intelligence Laboratory, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | | | - Dana P Turner
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Timothy T Houle
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lucy Chen
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Miaomiao Zhang
- Department of Engineering, University of Virginia, Charlottesville, Virginia, USA
| | - Jianjun Yang
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Wei Zhang
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Hao Deng
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
- DRPH Program, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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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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Abstract
Hospitalized newborn infants experience pain that can have negative short- and long-term consequences and thus should be prevented and treated. National and international guidelines state that adequate pain management requires valid pain assessment. Nociceptive signals cause a cascade of physical and behavioral reactions that alone or in combination can be observed and used to assess the presence and intensity of pain. Units that are caring for newborn infants must adopt sufficient pain assessment tools to cover the gestational ages and pain types that occurs in their setting. Pain assessment should be performed on a regular basis and any detection of pain should be acted on. Future research should focus on developing and validating pain assessment tools for specific situations.
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Affiliation(s)
- Mats Eriksson
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, S-701 85, Örebro, Sweden.
| | - Marsha Campbell-Yeo
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, S-701 85, Örebro, Sweden; School of Nursing, Faculty of Health, Departments of Pediatrics, Psychology & Neuroscience, Dalhousie University, 5850/5890 University Ave, Halifax, NS, B3K 6R8, Canada; Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Canada.
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22
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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: 68] [Impact Index Per Article: 13.6] [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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McCarley RM, Dowling DA, Dolansky MA, Bieda A. Implementing a Systematic Process for Consistent Nursing Care in a NICU: A Quality Improvement Project. Neonatal Netw 2018; 37:96-104. [PMID: 29615157 DOI: 10.1891/0730-0832.37.2.96] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
AIM The global aim of this quality improvement project was to develop and implement a systematic process to assign and maintain consistent bedside nurses for infants and families. METHODS A systematic process based on a primary care nursing model was implemented to assign consistent care for a 48-bed, single-family room NICU. RESULTS Four PDSA cycles were necessary to obtain agreement from the nursing staff as to the best process for assigning primary nurses. Post-intervention data revealed a 9.5 percent decrease of consistent caregivers for infants in the NICU ≤ 28 days and a 2.3 percent increase of consistent caregivers for infants in the NICU ≥ 29 days. CONCLUSION Although these findings did not meet the goal of the specific aim, a systematic process was created to assign bedside nurses to infants. Further PDSAs will be needed to refine the process to reach the aim.
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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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Staveski SL, Wu M, Tesoro TM, Roth SJ, Cisco MJ. Interprofessional Team's Perception of Care Delivery After Implementation of a Pediatric Pain and Sedation Protocol. Crit Care Nurse 2018; 37:66-76. [PMID: 28572103 DOI: 10.4037/ccn2017538] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Pain and agitation are common experiences of patients in pediatric cardiac intensive care units. Variability in assessments by health care providers, communication, and treatment of pain and agitation creates challenges in management of pain and sedation. OBJECTIVES To develop guidelines for assessment and treatment of pain, agitation, and delirium in the pediatric cardiac intensive unit in an academic children's hospital and to document the effects of implementation of the guidelines on the interprofessional team's perception of care delivery and team function. METHODS Before and after implementation of the guidelines, interprofessional team members were surveyed about the members' perception of analgesia, sedation, and delirium management RESULTS: Members of the interprofessional team felt more comfortable with pain and sedation management after implementation of the guidelines. Team members reported improvements in team communication on patients' comfort. Members thought that important information was less likely to be lost during transfer of care. They also noted that the team carried out comfort management plans and used pharmacological and nonpharmacological therapies better after implementation of the guidelines than they did before implementation. CONCLUSIONS Guidelines for pain and sedation management were associated with perceived improvements in team function and patient care by members of the interprofessional team.
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Affiliation(s)
- Sandra L Staveski
- Sandra L. Staveski is an assistant professor at Cincinnati Children's Hospital Medical Center, Department of Research in Patient Services, and the Heart Institute, Cincinnati, Ohio. .,May Wu is a clinical pharmacist at Lucile Packard Children's Hospital Stanford, Palo Alto, California. .,Tiffany M. Tesoro is a clinical pharmacist in the cardiovascular intensive care unit and coordinates the PGY-1 pharmacy residency program at Lucile Packard Children's Hospital-Stanford. She is also an assistant clinical professor, School of Pharmacy, University of California, San Francisco, California. .,Stephen J. Roth is chief of the division of pediatric cardiology and professor of pediatrics (cardiology), Stanford University School of Medicine, Stanford, California, and the director of the children's heart center at Lucile Packard Children's Hospital Stanford. .,Michael J. Cisco is a clinical assistant professor of pediatrics, Pediatric Critical Care Medicine, University of San Francisco School of Medicine, San Francisco, California, and an attending physician in the pediatric cardiac intensive care unit, University of California San Francisco-Benioff Children's Hospital, San Francisco, California.
| | - May Wu
- Sandra L. Staveski is an assistant professor at Cincinnati Children's Hospital Medical Center, Department of Research in Patient Services, and the Heart Institute, Cincinnati, Ohio.,May Wu is a clinical pharmacist at Lucile Packard Children's Hospital Stanford, Palo Alto, California.,Tiffany M. Tesoro is a clinical pharmacist in the cardiovascular intensive care unit and coordinates the PGY-1 pharmacy residency program at Lucile Packard Children's Hospital-Stanford. She is also an assistant clinical professor, School of Pharmacy, University of California, San Francisco, California.,Stephen J. Roth is chief of the division of pediatric cardiology and professor of pediatrics (cardiology), Stanford University School of Medicine, Stanford, California, and the director of the children's heart center at Lucile Packard Children's Hospital Stanford.,Michael J. Cisco is a clinical assistant professor of pediatrics, Pediatric Critical Care Medicine, University of San Francisco School of Medicine, San Francisco, California, and an attending physician in the pediatric cardiac intensive care unit, University of California San Francisco-Benioff Children's Hospital, San Francisco, California
| | - Tiffany M Tesoro
- Sandra L. Staveski is an assistant professor at Cincinnati Children's Hospital Medical Center, Department of Research in Patient Services, and the Heart Institute, Cincinnati, Ohio.,May Wu is a clinical pharmacist at Lucile Packard Children's Hospital Stanford, Palo Alto, California.,Tiffany M. Tesoro is a clinical pharmacist in the cardiovascular intensive care unit and coordinates the PGY-1 pharmacy residency program at Lucile Packard Children's Hospital-Stanford. She is also an assistant clinical professor, School of Pharmacy, University of California, San Francisco, California.,Stephen J. Roth is chief of the division of pediatric cardiology and professor of pediatrics (cardiology), Stanford University School of Medicine, Stanford, California, and the director of the children's heart center at Lucile Packard Children's Hospital Stanford.,Michael J. Cisco is a clinical assistant professor of pediatrics, Pediatric Critical Care Medicine, University of San Francisco School of Medicine, San Francisco, California, and an attending physician in the pediatric cardiac intensive care unit, University of California San Francisco-Benioff Children's Hospital, San Francisco, California
| | - Stephen J Roth
- Sandra L. Staveski is an assistant professor at Cincinnati Children's Hospital Medical Center, Department of Research in Patient Services, and the Heart Institute, Cincinnati, Ohio.,May Wu is a clinical pharmacist at Lucile Packard Children's Hospital Stanford, Palo Alto, California.,Tiffany M. Tesoro is a clinical pharmacist in the cardiovascular intensive care unit and coordinates the PGY-1 pharmacy residency program at Lucile Packard Children's Hospital-Stanford. She is also an assistant clinical professor, School of Pharmacy, University of California, San Francisco, California.,Stephen J. Roth is chief of the division of pediatric cardiology and professor of pediatrics (cardiology), Stanford University School of Medicine, Stanford, California, and the director of the children's heart center at Lucile Packard Children's Hospital Stanford.,Michael J. Cisco is a clinical assistant professor of pediatrics, Pediatric Critical Care Medicine, University of San Francisco School of Medicine, San Francisco, California, and an attending physician in the pediatric cardiac intensive care unit, University of California San Francisco-Benioff Children's Hospital, San Francisco, California
| | - Michael J Cisco
- Sandra L. Staveski is an assistant professor at Cincinnati Children's Hospital Medical Center, Department of Research in Patient Services, and the Heart Institute, Cincinnati, Ohio.,May Wu is a clinical pharmacist at Lucile Packard Children's Hospital Stanford, Palo Alto, California.,Tiffany M. Tesoro is a clinical pharmacist in the cardiovascular intensive care unit and coordinates the PGY-1 pharmacy residency program at Lucile Packard Children's Hospital-Stanford. She is also an assistant clinical professor, School of Pharmacy, University of California, San Francisco, California.,Stephen J. Roth is chief of the division of pediatric cardiology and professor of pediatrics (cardiology), Stanford University School of Medicine, Stanford, California, and the director of the children's heart center at Lucile Packard Children's Hospital Stanford.,Michael J. Cisco is a clinical assistant professor of pediatrics, Pediatric Critical Care Medicine, University of San Francisco School of Medicine, San Francisco, California, and an attending physician in the pediatric cardiac intensive care unit, University of California San Francisco-Benioff Children's Hospital, San Francisco, California
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Bueno M, Costa RN, de Camargo PP, Costa T, Harrison D. Evaluation of a parent-targeted video in Portuguese to improve pain management practices in neonates. J Clin Nurs 2018; 27:1153-1159. [PMID: 29076203 DOI: 10.1111/jocn.14147] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2017] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To assess parents' knowledge on breastfeeding, skin to skin care and sweet solutions as neonatal analgesic strategies, and to evaluate parents' perception on the feasibility, acceptability and usefulness of the Portuguese version of the "Be Sweet to Babies" video. BACKGROUND Neonatal pain management during blood sampling is suboptimal, and knowledge translation strategies are needed to improve clinical practices. The "Be Sweet to Babies" video is a parent-targeted knowledge translation tool that shows the effectiveness of breastfeeding, skin to skin contact and sweet solutions for procedural pain relief. DESIGN Cross-sectional study. METHODS Parents of infants hospitalised in an intensive care unit watched the video during their infants' hospitalisation and then answered a survey. Descriptive analyses of the data were performed. RESULTS Hundred parents were included. The majority did not know about the analgesic effects of breastfeeding (80%), skin to skin contact (69%) and sweet solutions (93%), and a limited number of parents stated their infants had received the strategies during painful procedures (7%, 11%, 2%, respectively). After watching the video, all (100%) parents intended to use or to advocate for one of the strategies; most (90%) of the parents would use any of the methods. All parents (100%) would recommend the video and considered the video useful, easy to understand, easy to apply in real scenarios. Length of the video was considered as ideal by 92%. CONCLUSIONS The Portuguese version of the "Be Sweet to Babies" video is feasible, acceptable and useful for parental education and is a persuasive knowledge translation tool. Further studies are needed to evaluate the effects of this parent-targeted intervention on the implementation of the analgesic strategies during clinical care. RELEVANCE TO CLINICAL PRACTICE This article highlights the importance of exploring evidence-based knowledge translation tools for improving neonatal care and outcomes.
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Affiliation(s)
| | - Rebeca Nogueira Costa
- Faculty of Medicine, Clinics Hospital, Children's Institute, University of São Paulo, São Paulo, SP, Brazil
| | - Patrícia Ponce de Camargo
- Faculty of Medicine, Clinics Hospital, Children's Institute, University of São Paulo, São Paulo, SP, Brazil
| | - Taine Costa
- School of Nursing, University of São Paulo, São Paulo, SP, Brazil
| | - Denise Harrison
- University of Ottawa and Children's Hospital of Eastern Ontario (CHEO), Ottawa, ON, Canada
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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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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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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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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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Akcan E, Polat S. Comparative Effect of the Smells of Amniotic Fluid, Breast Milk, and Lavender on Newborns' Pain During Heel Lance. Breastfeed Med 2016; 11:309-314. [PMID: 27315487 DOI: 10.1089/bfm.2015.0174] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION The aim of this randomized controlled experimental study was to evaluate the effect of the smells of amniotic fluid, breast milk, and lavender on the pain of newborns during heel lance. METHODS The sample of the study consisted of 102 newborn infants who complied with the sampling criteria between August and November, 2011. The newborns smelled the samples (lavender, breast milk, amniotic fluid, and distilled water) for 5 minutes before the heel lance until 5 minutes afterward. The Neonatal Infant Pain Scale (NIPS), heart rate, and oxygen saturation were evaluated 1 minute before, during, and 1 minute after the heel lance. Data were evaluated by descriptive statistics, chi-square, intraclass correlation analysis, Spearman's rho correlation, Bonferroni's advanced analysis, Shapiro-Wilk, Kruskal-Wallis, Mann-Whitney U, Friedman, and Dunnett's tests. RESULTS The newborns in the control group had severe pain and the newborns in the breast milk, amniotic fluid, and lavender groups had moderate pain during the heel lance (p < 0.05). While the NIPS score of the newborns in the lavender group was lower than the breast milk and amniotic fluid groups during the heel lance, it was lower in the breast milk and amniotic fluid groups than the lavender group afterward. The lowest falls in oxygen saturation and increased in heart rate were in the breast milk and lavender groups during heel the lance. CONCLUSION The smells of lavender and breast milk prevent the increased heart rates, NIPS, falling oxygen saturation, and reduced pain during the invasive procedures in newborns more than amniotic fluid or control group.
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Affiliation(s)
- Esma Akcan
- 1 Department of Pediatric Nursing, Faculty of Kumluca Health Sciences, Akdeniz University , Antalya, Turkey
| | - Sevinç Polat
- 2 Department of Pediatric Nursing, School of Health, Bozok University , Yozgat, Turkey
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Staff Nurse Utilization of Kangaroo Care as an Intervention for Procedural Pain in Preterm Infants. Adv Neonatal Care 2016; 16:229-38. [PMID: 27148835 DOI: 10.1097/anc.0000000000000262] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Skin-to-skin contact between mother and infant, commonly referred to as Kangaroo Care (KC), has demonstrated efficacy as a pain-relieving strategy for infants, yet, it remains underutilized in clinical practice. PURPOSE To evaluate changes in neonatal intensive care unit staff nurse beliefs, utilization, and challenges related to practice change in implementing KC as an intervention for management of procedural pain in preterm infants between 2 time points. METHODS Nurses who participated in a larger clinical trial examining the sustained efficacy of KC were asked to complete a questionnaire at 2 time points: 1- and 6 month(s) following study initiation. Identified benefits, expectations, frequency of use, and challenges related to practice change uptake were described using frequencies and percentages. Data from the 2 different time points were compared using χ analysis. RESULTS Of the 40 nurses approached, all completed the questionnaire (19 at the 1-month and 21 at the 6-month time point). Of the sample (n = 40), 97% of participants indicated that they expected KC to provide good pain relief or better. Staff nurses reported significantly improved preconceived ideas (χ = 22.68, P < .01) and significantly fewer concerns (χ = 22.10, P = .01) related to using KC as a pain-relieving intervention between the 2 time points. No significant differences were seen in the frequency of using KC as an intervention between time points. IMPLICATIONS FOR RESEARCH AND PRACTICE Despite increasingly positive preconceived ideas and reduced concerns, the frequency of using KC for procedural pain relief remained unchanged. Further research addressing ways to overcome barriers to utilizing KC as an intervention for procedural pain is warranted.
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Abdel Razeq NM. Barriers That Impede the Provision of Pain Care to Neonates by Nurses in Jordan. J Obstet Gynecol Neonatal Nurs 2016; 45:371-7. [DOI: 10.1016/j.jogn.2016.01.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2016] [Indexed: 10/22/2022] Open
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Status of Neonatal Pain Assessment and Management in Jordan. Pain Manag Nurs 2016; 17:239-48. [PMID: 27108085 DOI: 10.1016/j.pmn.2016.02.050] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Revised: 02/02/2016] [Accepted: 02/03/2016] [Indexed: 11/22/2022]
Abstract
Current pain assessment and management in neonates need to be fully described before neonatal pain care can be optimized. This study's purpose was to report neonatal nurses' knowledge, existing pain assessment practice, and pharmacological pain management of neonates in Jordan. A cross-sectional descriptive study was conducted. Eighteen neonatal intensive care units in Jordan were included in the study. One hundred eighty-four neonatal nurses participated. Questionnaires were distributed by and returned to the neonatal intensive care units' managers between June and August 2014. Descriptive and inferential statistics were used to present study results. Of 240 questionnaires distributed, 184 useable responses were returned. Nurses' knowledge regarding neonates' neurological development, nociception, and need for neonatal pain management was suboptimal. The analgesics most commonly used to treat neonatal pain were acetaminophen (52%) and lidocaine (45%). Benzodiazepines, phenobarbitone, and muscles relaxants were also used. Most nurses (54%-97%) reported that pain emanating from most painful procedures was never or rarely treated. Circumcision, lumbar punctures, and chest tube insertion were assigned the highest pain scores (≥9), but were rarely accompanied by analgesia. Pain assessment scales were more likely to be used, and procedural pain was more likely to be treated, in private hospitals than public hospitals. Neonates who require special care still suffer unnecessary pain that could be avoided and managed by following best practice recommendations. Disparities between developed and developing countries in quality of neonatal pain care appear to exist. Resources for education and routine care are needed to address these discrepancies.
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Harrison D, Reszel J, Wilding J, Abdulla K, Bueno M, Campbell-Yeo M, Dunn S, Harrold J, Nicholls S, Squires J, Stevens B. Neuroprotective Core Measure 5: Minimizing Stress and Pain—Neonatal Pain Management Practices During Heel Lance and Venipuncture in Ontario, Canada. ACTA ACUST UNITED AC 2015. [DOI: 10.1053/j.nainr.2015.06.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Krokmyrdal KA, Andenæs R. Nurses' competence in pain management in patients with opioid addiction: A cross-sectional survey study. NURSE EDUCATION TODAY 2015; 35:789-794. [PMID: 25779029 DOI: 10.1016/j.nedt.2015.02.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 02/17/2015] [Accepted: 02/19/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND There may be up to 21 million opioid abusers in the world. Drug abuse and associated health-related problems are increasing. Opioid addiction can cause serious bacterial infection, injury and trauma, conditions that can trigger pain. Opioid abusers experience pain differently from non-addicts. There is limited research on nurses' competence to provide pain treatment to patients with opioid addiction. OBJECTIVE To report on a Norwegian pilot study examining nurses' knowledge about pain and competence in treating pain in patients who abuse opioids. DESIGN A descriptive cross-sectional survey design was employed. PARTICIPANTS Nurses at medical (n=64) and orthopaedic (n=34) units at two urban, public Norwegian hospitals. METHODS Data were collected in January 2010 using a self-administered questionnaire. Sample selection was determined by purposive sampling. The response rate was 54%. RESULTS Eighty-eight percent of nurses did not have sufficient knowledge about pain treatment in patients with opioid addiction. Eight-eight percent and seventy-seven percent regarded work-place experience and colleagues as the primary contributors to their knowledge about pain treatment, respectively. Work-place experience contributed most to nurses' competence. Ninety percent, 70% and 84% of nurses responded that education, literature and information technology, respectively, played a minor role in obtaining knowledge about pain management. Sixty-five percent of the respondents had basic skills for evaluating pain, although 54% could not evaluate the degree of pain. Almost 62% of nurses did not trust the pain experience self-reported by patients who were opioid abusers. CONCLUSION Our study shows shortcomings in the nurses' competence to evaluate and treat pain, suggesting that patients with opioid addiction may not receive adequate pain management. Nurses' competence to offer pain treatment to opioid abusers could be characterized as experience-based rather than evidence-based.
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Affiliation(s)
- Kurt A Krokmyrdal
- Faculty of Health Studies, Sogn og Fjordane University College, P. O. Box 523, N-6803 Førde, Norway.
| | - Randi Andenæs
- Faculty of Health Science, Department of Nursing, Oslo and Akershus University College of Applied Sciences, Norway
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Abstract
As a standard of care for preterm/term newborns effective pain management may improve their clinical and neurodevelopmental outcomes. Neonatal pain is assessed using context-specific, validated, and objective pain methods, despite the limitations of currently available tools. Therapeutic approaches reducing invasive procedures and using pharmacologic, behavioral, or environmental measures are used to manage neonatal pain. Nonpharmacologic approaches like kangaroo care, facilitated tucking, non-nutritive sucking, sucrose, and others can be used for procedural pain or adjunctive therapy. Local/topical anesthetics, opioids, NSAIDs/acetaminophen and other sedative/anesthetic agents can be incorporated into NICU protocols for managing moderate/severe pain or distress in all newborns.
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Abstract
Pain assessment and measurement are the cornerstones of pain management. Pain assessment connotes a comprehensive multidimensional description. Conversely, pain measurement provides a numeric quantitative description of each factor illustrating pain qualities. Pain scales provide a composite score used to guide practice and research. The type of infant pain instrument chosen is a significant factor in guiding pain management practice. The purpose of this review was to summarize current infant pain measures by introducing a conceptual framework for pain measurement. Although more than 40 infant pain instruments exist, many were devised solely for research purposes; several of the newly developed instruments largely overlap with existing instruments. Integration of pain management into daily practice remains problematic. Understanding how each instrument measures infant pain allows clinicians to make better decisions about what instrument to use with which infant and in what circumstances. In addition, novel new measurement techniques need further testing.
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