Differences in Pediatric Pain Management by Unit Types

Effects of endotracheal suctioning duration cerebral oxygenation in preterm infants

AIM

This study evaluates the effects of endotracheal suctioning duration on cerebral oxygenation and physiological parameters in preterm infants in intensive care.

DESIGN

Prospective and observational s tudy.

METHOD

In this study, 51 preterm infants born at 28-34 weeks of gestation in NICU were evaluated. Cerebral oxygenation was measured before, during, and after endotracheal suctioning with near-infrared spectroscopy. Pain levels of the infants were with N-PASS scale.

RESULTS

A negative correlation was found between the lowest cerebral oxygenation value during endotracheal suctioning and the duration of endotracheal suctioning. Cerebral oxygenation levels during endotracheal suctioning were lower than pre- and post-endotracheal suctioning levels. Higher cerebral oxygenation was observed in infants whose endotracheal aspiration time was less than 13 s. The duration of endotracheal suctioning was positively correlated with pain and cerebral oxygenation stabilization time.

CONCLUSION

Prolonged endotracheal suctioning duration negatively affects cerebral oxygenation in preterm infants. The study suggests an optimal endotracheal suctioning duration under 13 s.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Properly executed endotracheal suctioning, with the correct technique and knowledge, can alleviate the adverse physiological effects observed in preterm infants and contribute to routine nursing care in intensive care units.

REPORTING METHOD

This study has been reported in line with STROBE checklists.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution was required to design or undertake this research. Patients contributed only to the data collection.

IMPACT

This study contributes to defining the ideal endotracheal aspiration duration, as there is not enough data so far. It showed the effect of prolonged endotracheal aspiration time on cerebral oxygenation, pain and physiological parameters in preterm infants.

The perceptions and practices of parents and children on acute pain management among hospitalized children in two Botswana referral hospitals

BACKGROUND

Perceptions and practices of parties in pediatric pain are critical in children's access to adequate acute pain management. The personal factors of the child and parents have been shown to be central to pediatric pain management by the Symptom Management Theory.

AIM

To describe children and parents/guardians' perceptions (knowledge, attitudes and beliefs) and practices regarding pediatric acute pain management and explain the influence of socio-cultural and environmental factors on those perceptions and practices.

METHODS

Descriptive cross-sectional survey using modified versions of the American Pain Society Patient Outcome Questionnaire-Revised among parents/guardians and children.

RESULTS

A convenience sample of 275 parents/guardians and 42 children aged 8 to 13 years admitted between date November 2018 and February 2019 to two Botswana tertiary hospitals completed the surveys. Forty-seven percent (n = 129) of parents/guardians reported the child to be in moderate-severe pain, while 38% (n = 16) of children reported pain as moderate-severe at the time of the survey. The children mean scores for cm-APS-POQ-R were 113(33) while parents/guardian's guardians for m-APS-POQ-R were 123(26). The subscales except for the parents/'guardians' pain interference (p = .96) were statistically significant (p = .000), showing adequate knowledge, positive attitudes and high pain intensity for both parents/guardians and children.

CONCLUSION

Parent/guardians and children reported a high incidence of acute pain, were content with pain management services, and showed adequate knowledge of pediatric pain and its management. The incongruence between the intensity of pain, satisfaction on the adequacy of pain management and knowledge and attitudes demonstrated in this study need further inquiry.

Agreement of the Neonatal Pain, Agitation, and Sedation Scale (N-PASS) With NICU Nurses' Assessments

BACKGROUND

Objective assessment tools should standardize and reflect nurses' expert assessments. The Neonatal Pain, Agitation, and Sedation Scale (N-PASS) and the Neonatal Infant Pain Scale (NIPS) are valid measures of pain. The N-PASS also provides a sedation subscale.

PURPOSE

The objective of this study was to determine N-PASS clinical validity and utility by evaluating agreement of N-PASS scores with bedside nurses' assessments of pain/agitation and sedation in a 64-bed tertiary neonatal intensive care unit.

METHODS

Fifteen bedside nurses trained to use the N-PASS and the NIPS prospectively completed 202 pain/agitation and sedation assessments from a convenience sample of 88 infants, including chronically ventilated, medically fragile infants. N-PASS and NIPS scores were obtained simultaneously but independently of nurse investigators. Bedside nurses also made recommendations about infants' pain and sedation management.

RESULTS

There was moderate agreement between N-PASS pain scores and nurses' recommendations (κ= 0.52), very strong agreement between N-PASS sedation scores and nurses' recommendations (κ= 0.99), and very strong associations between N-PASS pain and NIPS scores (P< .001). Bedside nurse and independent investigator interrater reliability was good for N-PASS pain and NIPS scores (intraclass correlation coefficient [ICC] = 0.83, ICC = 0.85) and excellent for N-PASS sedation (ICC = 0.94). During 93% of assessments, bedside nurses reported that the N-PASS reflected the level of infant sedation well or very well.

IMPLICATIONS FOR PRACTICE AND RESEARCH

The N-PASS provides an easy-to-use, valid, and reliable objective measure of pain and sedation that reflects nurses' assessments. Additional studies using the N-PASS are needed to verify results and the influence of the N-PASS on pain and sedation management for medically fragile infants with chronic medical conditions.

Evaluating the impact of a multimedia training versus lecture training on attitudes and practices in paediatric nurses in children pain management: A randomized controlled trial

Aim

The aim of this study was to evaluate the effect of a multimedia training on pain management attitudes and practices of paediatric nurses.

Design

A single-blind randomized trial.

Methods

Paediatric nurses (N = 120) from a public hospital randomly allocated into two groups, lecturing and multimedia training groups. Nurses in the control group received four one-hour training sessions. In the intervention group, the same educational content was used as a film with text, audio and animation and presented as a multimedia CD. In both groups, using a questionnaire, we measured pain management attitudes and skills at baseline and then 1 week and 1 month after the training over. Data were analysed in SPSS20 software, and p < .05 was considered statistically significant.

Results

The mean of attitude scores of the lecturing group was 104.74 one week after the study and 109.40 one month later versus 74.72. The above-mentioned scores in the multimedia group were 112.72 and 115.04, respectively, versus 78.70 (p < .001). Also, the mean scores of nurses' performance in the lecturing group before, 1 week and 1 month after the study were 12.48, 26.60 and 28.22, respectively, versus 12.58, 28.68 and 28.98, in multimedia group; this difference was statistically significant (p < .05).

Short-Term Effects of Hydrokinesiotherapy in Hospitalized Preterm Newborns

Background. In the neonatal intensive care unit (NICU) environment, preterm newborns are subject to environmental stress and numerous painful interventions. It is known that hydrokinesiotherapy promotes comfort and reduces stress because of the physiological properties of water. Objective. To evaluate the short-term effects of hydrokinesiotherapy on reducing stress in preterm newborns admitted to the NICU. Materials and Methods. Fifteen preterm newborns underwent salivary cortisol measurement, pain evaluation using the Neonatal Infant Pain Scale (NIPS), and heart rate, respiratory rate, and peripheral oxygen saturation measurements before and after the application of hydrokinesiotherapy. Results. The mean gestational age of the newborns was 34.2 ± 1.66 weeks, and the mean weight was 1823.3 ± 437.4 g. Immediately after application of hydrokinesiotherapy, a significant reduction was observed in salivary cortisol (p = 0.004), heart rate (p = 0.003), and respiratory rate (p = 0.004) and a significant increase was observed in peripheral oxygen saturation (p = 0.002). However, no significant difference was observed in the NIPS score (p > 0.05). Conclusion. In the present study, neonatal hydrotherapy promoted short-term relief from feelings of stress. Neonatal hydrokinesiotherapy may be a therapeutic alternative. However, this therapy needs to be studied in randomized, crossover, and blinded trials. This trial is registered with NCT02707731.