Factors Influencing Neonatal Pain Management from the Perspectives of Nurses and Physicians in a Neonatal Intensive Care Unit: A Qualitative Study

Abstract

Background: Despite scientific advances on pain measurement and intervention, pain management for infants has remained a challenge for health teams. This is because infants are not able to talk and defend themselves when they are in pain. Prevention of pain is important, not only because it is an ethical expectation, but also because repeated painful exposures can have harmful consequences. The aim of this study was to explore factors influencing neonatal pain management from the perspectives of nurses and physicians in a neonatal intensive care unit (NICU). Methods: A qualitative content analysis study was carried out. The participants were the nurses and physicians working in the NICU of Alavi medical training center in Ardabil, Iran. Twenty-five nurses took part in focus group discussions and five physicians attended private interviews. Four focus group discussions and five interviews were carried out until data saturation was ensured. Data analysis was performed using conventional content analysis. All the participants were provided with information about the purpose and the nature of the study, and provided informed consent. Results: Data analyses indicated two effective themes about barriers of implementation of infant pain management, namely "Individual Factors" and "Organizational Factors". The first theme consisted of the categories "knowledge of the personnel" and "commitment of the personnel". The second theme included three categories namely "pain control policy", "work environment condition" and "management issues". Conclusions: Our findings indicated that lack of educational courses, absence of an infant pain management policy, and management issues were the main obstacles in the way of implementation of infant pain management by nurses and physicians at the NICU. Therefore, strategies are required to reduce or remove these barriers.

Knowledge and Practice of Nurses and Associated Factors in Managing Neonatal Pain at Selected Public Hospitals in Addis Ababa, Ethiopia, 2020

“…Similarly, a study conducted in Iran on pain management perceptions of the neonatal nurses in NICU and neonatal units revealed that the infant pain management policy was associated with practice of nurses in managing infant pain. 23 This implies that the presence of an infant pain management policy in the unit is a key point in the practice of neonatal pain management and results in effective managing of pain in neonates among nurses. As a result, the presence of an infant pain management policy and management issues was key to following good practice.…”

Neonatal pain management among nurses and midwives at two Kigali hospitals

“…These findings are consistent with other studies. [7,11,12,16,23] The findings of low knowledge on neonatal pain management were likely related to the lack of formal teaching in nursing school and lack of continuing professional education in the hospital. Furthermore, the neonatal units lacked a pain management protocol or pain assessment tool.…”

“…Several international studies, [11][12][13] reported that pain in neonates is often not recognised and undertreated. There are very few studies in Rwanda on patient pain management, and there were no published studies on neonatal pain in 2017 when this research was conducted.…”

The Indonesian version of the Premature Infant Pain Profile–Revised: Translation and adaptation of a neonatal pain assessment

“…There is no gold standard for the neonatal pain measurement in current medical services [6,7], however the Joint Commission on Accreditation of Health Care (JCAHO) recommends choosing a valid measuring instrument, reliable and in accordance with age; and at present, more emphasis is on the description of physical function due to pain [8,9]. The multidimensional scale of pain assessment in neonates that is most studied are Neonatal Infant Pain scale (NIPS), Premature Infant Pain Profile (PIPP) and Neonatal Facial Coding System (NFCS) [10]. Among the three measuring instruments, PIPP is more detailed in measuring physiological aspects.…”