Developing a model of neonatal nurse‐controlled analgesia: A Delphi study

Abstract

AimTo develop a nurse‐led model of analgesia to manage post‐operative pain in the surgical neonate.DesignA four‐round e‐Delphi study was conducted from March to December 2022.MethodsAn e‐Delphi method was used seeking a consensus of 70% or greater. Fifty‐one experts were invited to join the panel. Members consisted of multi‐disciplinary healthcare professionals who work in areas associated with neonatal care. In round 1, 49 statements relative to neonatal pain assessment and management were distributed to the panel. Panel members were asked to rate their level of agreeance on a Likert scale from 1 to 5 (1 = strongly disagree to 5 = strongly agree). Ratings equal to or greater than 4 represented agreement, 3 indicated uncertainty and 2 or less disagreement with the proposed statement. An opportunity for free‐text responses after each statement was provided. This iterative process continued for three rounds. In the fourth and final round, the completed model of neonatal nurse‐controlled analgesia was presented along with a further opportunity to provide feedback on the final version.ResultsFour rounds of statements and voting were required to reach consensus on a model of neonatal nurse‐controlled analgesia. The model consists of criteria for use, over‐arching guidelines and three separate pathways based on an individual baby's pain assessment scores, need for pain relieving interventions and time‐lapsed post‐surgical procedure.ConclusionA comprehensive model of neonatal nurse‐controlled analgesia, applicable to the Australasian context, was developed in collaboration with a group of neonatal experts.ImpactThis study provides a multi‐modal family‐integrated model to manage neonatal post‐operative pain. By providing nurses with increased autonomy to assess and manage acute pain, this model has the potential to not only provide a more responsive and individualized approach to alleviate discomfort, but highlights the integral role of parent partnerships in the neonatal intensive care.Reporting MethodThis study was reported in line with the Conducting and REporting of DElphi studies (CREDE) guidance on Delphi studies.Patient or Public ContributionNo patient or public contribution was utilized for this study.

Parent-led neonatal pain management—a narrative review and update of research and practices

“…Parental advocacy addresses parents' perspectives on advocating for themselves to participate in pain management or advocating for their infant to have their pain managed ( 78 ). Advocating for their infant's needs, being involved in shared decision making and having opportunities to provide parent-led non-pharmacological measures, empowers parents to take a more active role in the prevention, assessment and management of their infant's pain and discomfort ( 79 ). Consequently, prerequisites for parent-led pain management and equal partnership in the infant's pain care, are parental presence in the NICU and proximity to the infant as well as a trusting and updated staff, and access to information and guidance ( 5 , 78 – 86 ).…”