1
|
Mekonen WM, Muhye AB, Gobeza MB. Nurses' knowledge and practice about neonatal pain management in public hospitals in West Oromia, Ethiopia, 2022: multi-centered cross-sectional study. BMC Nurs 2024; 23:292. [PMID: 38724983 PMCID: PMC11080202 DOI: 10.1186/s12912-024-01972-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/24/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND In low-and middle-income countries inadequate neonatal pain management persists as a significant public health issue despite the availability of guidelines. Newborns often experience pain from routine medical and surgical procedures, with limited nurses' knowledge and suboptimal practices posing common obstacles to effective neonatal pain management in hospital settings. Hence, this study aimed to evaluate nurses' knowledge and practices related to neonatal pain management and the factors influencing them in public hospitals in West Oromia, Ethiopia, in 2022. METHODS A multicenter cross-sectional study was conducted among 203 nurses working in public hospitals in West Oromia from 8th May-6th June 2022. Data was gathered using structured, self-administered questionnaire and sampled through simple random sampling. The collected data were coded and entered into a computer using Epi-Data version 4.6 Statistical Software. They were analyzed using the Statistical Package for Social Science (SPSS; IBM Corporation) version 26. Binary logistic regression was used to identify significant independent variables at p < 0.05. FINDINGS In this study, 127 (62.6%) exhibited adequate knowledge, while 33 (16.3%) nurses demonstrated good practice in neonatal pain management. Attending lectures or receiving training about neonatal pain management was found to be significantly associated with nurses' knowledge of neonatal pain management [AOR, 2.31, 95%CI; 1.29-4.27]. On the other, having adequate knowledge of neonatal pain management [AOR, 3.3, 95%CI; 1.14-9.32]; the presence of a pain management policy in place [AOR, 5.44, 95% CI; 1.92-15.37] and attending lectures on neonatal pain management [AOR, 2.55, 95% CI; 1.09-5.97] were found to be significantly associated to nurses' practices. CONCLUSION Given the substandard level of nurses' practice in neonatal pain management. It is suggested to enhance the nurses' knowledge and practice about neonatal pain management by providing refreshment courses, training sessions, or facilitating nurses' opportunity access to reading resources about neonatal pain management.
Collapse
Affiliation(s)
- Wandimu Muche Mekonen
- Department of Pediatrics & Neonatal Nursing, School of Nursing and Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia.
| | - Addis Bilal Muhye
- Department of Pediatrics & Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mengistu Berhanu Gobeza
- Department of Pediatrics & Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| |
Collapse
|
2
|
Hausmann J, Salekin MS, Zamzmi G, Mouton PR, Prescott S, Ho T, Sun YU, Goldgof D. Accurate Neonatal Face Detection for Improved Pain Classification in the Challenging NICU Setting. IEEE ACCESS : PRACTICAL INNOVATIONS, OPEN SOLUTIONS 2024; 12:49122-49133. [PMID: 38994038 PMCID: PMC11238607 DOI: 10.1109/access.2024.3383789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/13/2024]
Abstract
There is a tendency for object detection systems using off-the-shelf algorithms to fail when deployed in complex scenes. The present work describes a case for detecting facial expression in post-surgical neonates (newborns) as a modality for predicting and classifying severe pain in the Neonatal Intensive Care Unit (NICU). Our initial testing showed that both an off-the-shelf face detector and a machine learning algorithm trained on adult faces failed to detect facial expression of neonates in the NICU. We improved accuracy in this complex scene by training a state-of-the-art "You-Only-Look-Once" (YOLO) face detection model using the USF-MNPAD-I dataset of neonate faces. At run-time our trained YOLO model showed a difference of 8.6% mean Average Precision (mAP) and 21.2% Area under the ROC Curve (AUC) for automatic classification of neonatal pain compared with manual pain scoring by NICU nurses. Given the challenges, time and effort associated with collecting ground truth from the faces of post-surgical neonates, here we share the weights from training our YOLO model with these facial expression data. These weights can facilitate the further development of accurate strategies for detecting facial expression, which can be used to predict the time to pain onset in combination with other sensory modalities (body movements, crying frequency, vital signs). Reliable predictions of time to pain onset in turn create a therapeutic window of time wherein NICU nurses and providers can implement safe and effective strategies to mitigate severe pain in this vulnerable patient population.
Collapse
Affiliation(s)
- Jacqueline Hausmann
- Department of Computer Science and Engineering, College of Engineering, University of South Florida, Tampa, FL 33620, USA
| | - Md Sirajus Salekin
- Department of Computer Science and Engineering, College of Engineering, University of South Florida, Tampa, FL 33620, USA
| | - Ghada Zamzmi
- Department of Computer Science and Engineering, College of Engineering, University of South Florida, Tampa, FL 33620, USA
| | | | - Stephanie Prescott
- College of Nursing, USF Health, University of South Florida, Tampa, FL 33620, USA
| | - Thao Ho
- Department of Pediatrics, College of Medicine, University of South Florida, Tampa, FL 33606, USA
| | - Y U Sun
- Department of Computer Science and Engineering, College of Engineering, University of South Florida, Tampa, FL 33620, USA
| | - Dmitry Goldgof
- Department of Computer Science and Engineering, College of Engineering, University of South Florida, Tampa, FL 33620, USA
| |
Collapse
|
3
|
Ulmer M, Martakis K, Scholten N, Kuntz L. Existence and perceived application of pain management protocols in German neonatal intensive care units. PAEDIATRIC & NEONATAL PAIN 2022; 4:149-157. [PMID: 36618511 PMCID: PMC9798041 DOI: 10.1002/pne2.12089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 09/09/2022] [Accepted: 09/22/2022] [Indexed: 11/06/2022]
Abstract
We explored the existence and application of standard operating procedures (SOPs) for pain management (PM) in German neonatal intensive care units (NICUs), and identified the factors associated with their application in practice. This study was part of the Safety4NICU project, a cross-sectional survey conducted from 2015 to 2016. All 224 German NICUs were invited to participate, providing written consent from the head neonatologist and head nurse. We distributed questionnaires to the head neonatologist, the head nurse, and the NICU staff (physicians and nurses). We asked the head neonatologist whether written SOPs for PM existed, and we asked the staff whether these SOPs were applied in their daily routine. We received evaluable responses from 468 physicians and 1251 nurses from 76 NICUs. Of these 76 NICUs, the head neonatologists from 54 NICUs (71.1%) reported that written SOPs for PM exist. However, only 48.5% of the physicians and 53.7% of the nurses declared that these existing SOPs were also applied. We found various predictors for the existing SOPs as being applied, depending on the profession. For physicians, clinical training was important (OR: 2.482, p ≤ 0.05), while for nurses their working experience was a decisive predictor (OR: 1.265, p ≤ 0.05). For both, a high level of perceived cooperative norms between physicians and nurses increased the probability that SOPs for PM were applied, whereas a high bed turnover rate decreased that probability. According to the responses from head neonatologists, written SOPs for PM were common in German NICUs. However, if management strategies on pain existed, this did not mean that these were directly applied in the daily routine. Clinical training of the staff, the promotion of adequate interprofessional cooperation, as well as allowing time to deal with these SOPs might be all essential measures to strengthen the application.
Collapse
Affiliation(s)
- Melissa Ulmer
- Department of Business Administration and Health Care Management, Faculty of Management, Economics and Social SciencesUniversity of CologneCologneGermany
| | - Kyriakos Martakis
- Department of Pediatrics, University Hospital, Faculty of MedicineUniversity of CologneCologneGermany,Department of Pediatric Neurology, University Children's Hospital (UKGM), Faculty of MedicineJustus Liebig University of GiessenCologneGermany
| | - Nadine Scholten
- Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Faculty of Human Sciences and Faculty of MedicineUniversity of CologneCologneGermany
| | - Ludwig Kuntz
- Department of Business Administration and Health Care Management, Faculty of Management, Economics and Social SciencesUniversity of CologneCologneGermany
| |
Collapse
|
4
|
Popowicz H, Kwiecień-Jaguś K, Mędrzycka-Dąbrowska W, Kopeć M, Dyk D. Evidence-Based Nursing Practices for the Prevention of Newborn Procedural Pain in Neonatal Intensive Therapy-An Exploratory Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12075. [PMID: 36231377 PMCID: PMC9566416 DOI: 10.3390/ijerph191912075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/09/2022] [Accepted: 09/21/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Due to the progress in neonatology, in particular, in the past three decades, the mortality rate among patients of intensive care units has decreased. However, this is connected not only with newborns needing to stay longer in the unit, but also with the exposure of newborns to many painful procedures and stresses. Lack of or insufficient pain prevention has a negative impact on the sensory or locomotor development of newborns. Despite the presence of guidelines based on scientific evidence, the use of pharmacological and non-pharmacological pain-management methods in newborns is still insufficient. AIM The aim of the study was to: identify the knowledge nurses/midwives have of recommended non-pharmacological and/or pharmacological methods, in particular, in relation to medical intervention procedures; assess the interventions for pain relief applied by midwives/nurses most often in their clinical practice; examine the role of age, general work experience, education level and years of work of medical professionals on a neonatal ward, as well as the referral level of a unit, versus the application of pharmacological and non-pharmacological methods. METHODS A descriptive and quantitative study conducted in 2019 among Polish nurses/midwives working at neonatal intensive care units. RESULTS The analysis of the material reflected the deficit of knowledge and the insufficient daily use of recommended pain-relief measures among the respondents. CONCLUSIONS The interpretation of data indicates that despite the clear and easily available recommendations of scientific societies concerning the mode of conduct in particular medical procedures, medical personnel do not apply those recommendations in their everyday practice. It is necessary to plan and implement education strategies for nurses/midwives on standard pain-management interventions during painful medical procedures.
Collapse
Affiliation(s)
- Hanna Popowicz
- Department of Obstetric and Gynecological Nursing, Medical University of Gdańsk, 80-211 Gdansk, Poland
| | - Katarzyna Kwiecień-Jaguś
- Department of Anesthesiology Nursing and Intensive Care, Medical University of Gdańsk, 80-211 Gdansk, Poland
| | | | - Monika Kopeć
- Department of Human Nutrition, University of Warmia and Mazury, 10-718 Olsztyn, Poland
| | - Danuta Dyk
- Department of Anesthesiology and Intensive Care Nursing, Poznań University of Medical Sciences, 60-806 Poznan, Poland
| |
Collapse
|
5
|
Bruschettini M, Olsson E, Persad E, Garratt A, Soll R. Clinical rating scales for assessing pain in newborn infants. Hippokratia 2022. [DOI: 10.1002/14651858.mr000064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Matteo Bruschettini
- Department of Clinical Sciences Lund, Paediatrics; Lund University, Skåne University Hospital; Lund Sweden
- Cochrane Sweden; Lund University, Skåne University Hospital; Lund Sweden
| | - Emma Olsson
- Department of Pediatrics, Faculty of Medicine and Health; Örebro University; Örebro Sweden
| | - Emma Persad
- Cochrane Austria, Department for Evidence-based Medicine and Evaluation; Danube University Krems; Krems Austria
| | - Andrew Garratt
- Division for Health Services; Norwegian Institute of Public Health; Oslo Norway
| | - Roger Soll
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics; Larner College of Medicine at the University of Vermont; Burlington Vermont USA
| |
Collapse
|
6
|
Llerena A, Tran K, Choudhary D, Hausmann J, Goldgof D, Sun Y, Prescott SM. Neonatal pain assessment: Do we have the right tools? Front Pediatr 2022; 10:1022751. [PMID: 36819198 PMCID: PMC9932268 DOI: 10.3389/fped.2022.1022751] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 12/30/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The assessment and management of neonatal pain is crucial for the development and wellbeing of vulnerable infants. Specifically, neonatal pain is associated with adverse health outcomes but is often under-identified and therefore under-treated. Neonatal stress may be misinterpreted as pain and may therefore be treated inappropriately. The assessment of neonatal pain is complicated by the non-verbal status of patients, age-dependent variation in pain responses, limited education on identifying pain in premature infants, and the clinical utility of existing tools. OBJECTIVE We review research surrounding neonatal pain assessment scales currently in use to assess neonatal pain in the neonatal intensive care unit. METHODS We performed a systematic review of original research using PRISMA guidelines for literature published between 2016 and 2021 using the key words "neonatal pain assessment" in the databases Web of Science, PubMed, and CINAHL. Fifteen articles remained after review, duplicate, irrelevant, or low-quality articles were eliminated. RESULTS We found research evaluating 13 neonatal pain scales. Important measurement categories include behavioral parameters, physiological parameters, continuous pain, acute pain, chronic pain, and the ability to distinguish between pain and stress. Provider education, inter-rater reliability and ease of use are important factors that contribute to an assessment tool's success. Each scale studied had strengths and limitations that aided or hindered its use for measuring neonatal pain in the neonatal intensive care unit, but no scale excelled in all areas identified as important for reliably identifying and measuring pain in this vulnerable population. CONCLUSION A more comprehensive neonatal pain assessment tool and more provider education on differences in pain signals in premature neonates may be needed to increase the clinical utility of pain scales that address the different aspects of neonatal pain.
Collapse
Affiliation(s)
- Amelia Llerena
- Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Krystal Tran
- Biobehavioral Lab, College of Nursing, University of South Florida, Tampa, FL, United States
| | - Danyal Choudhary
- Department of Chemistry, College of Arts and Sciences, University of South Florida, Tampa, FL, United States
| | - Jacqueline Hausmann
- Department of Computer Science and Engineering, University of South Florida, Tampa, FL, United States
| | - Dmitry Goldgof
- Department of Computer Science and Engineering, University of South Florida, Tampa, FL, United States
| | - Yu Sun
- Department of Computer Science and Engineering, University of South Florida, Tampa, FL, United States
| | - Stephanie M Prescott
- Morsani College of Medicine, University of South Florida, Tampa, FL, United States.,Biobehavioral Lab, College of Nursing, University of South Florida, Tampa, FL, United States.,College of Nursing, University of South Florida, Tampa, FL, United States
| |
Collapse
|