Managing procedural pain on the neonatal unit: Do inconsistencies still exist in practice?

Wallace, Helen M.; Jones, Tracey

doi:10.1016/j.jnn.2016.10.004

Cited by 14 publications

(12 citation statements)

References 58 publications

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“…74 Parents are rarely considered to be part of the interprofessional collaboration. 75,76 However, the give a better chance of producing a relevant intervention, feasible in practice that is adapted to its context and is ready for testing.…”

Section: Discussionmentioning

confidence: 99%

A complex interprofessional intervention to improve the management of painful procedures in neonates

Balice-Bourgois

Newman²,

Simonetti

et al. 2020

Paediatric and Neonatal Pain

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During hospitalization, neonates are exposed to a stressful environment and a high number of painful procedures. If pain is not treated adequately, short‐ and long‐term complications may develop. Despite evidence about neonatal pain and available guidelines, procedural pain remains undertreated. This gap between research and practice is mostly due to limited implementation of evidence‐based knowledge and time constraints. This study describes in detail the development process of a complex interprofessional intervention to improve the management of procedural pain in neonates called NEODOL© (NEOnato DOLore). The framework of the Medical Research Council (MRC) for the development and evaluation of complex interventions was used as a methodological guide for the design of the NEODOL© intervention. The development of the intervention is based on several steps and multiple methods. To report this process, we used the Criteria for Reporting the Development of Complex Interventions in Healthcare (CReDECI 2). Additionally, we evaluated the content of the intervention using a Delphi method to obtain consensus from experts, stakeholders, and parents. The complex interprofessional intervention, NEODOL©, is developed and designed for three groups: healthcare professionals, parents, and neonates for a level IIb neonatal unit at a regional hospital in southern Switzerland. A total of 16 panelists participated in the Delphi process. At the end of the Delphi process, the panelists endorsed the NEODOL© intervention as important and feasible. Following the MRC guidelines, a multimethod process was used to develop a complex interprofessional intervention to improve the management of painful procedures in newborns. Complex interprofessional interventions need theoretical bases, careful development, and integration of stakeholders to provide a comprehensive approach. The NEODOL intervention consists of promising components and has the potential to improve the management of painful procedures and should facilitate the knowledge translation into practice.

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Section: Discussionmentioning

confidence: 99%

A complex interprofessional intervention to improve the management of painful procedures in neonates

Balice-Bourgois

Newman²,

Simonetti

et al. 2020

Paediatric and Neonatal Pain

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“…Lack of knowledge, lack of prioritization of pain management, time constraints and uncertainty about the validity of available tools have been pointed out as reasons for their non-use (19) . Thus, it is essential to implement the pain assessment scales in NBs with a range of 4-6 hours as a low cost and high impact clinical tool in the identification of pain as the fifth vital sign (6,17) .…”

Section: Discussionmentioning

confidence: 99%

Assistance flowchart for pain management in a Neonatal Intensive Care Unit

et al. 2018

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Objective: To describe and discuss the process of developing a fl owchart collectively constructed by the health team of a Neonatal Intensive Care Unit for the management of neonatal pain. Method: This is a descriptive and an exploratory study with a qualitative approach that used Problem-Based Learning as a theoretical-methodological framework in the process of developing the assistance fl owchart for the management of neonatal pain. Results: Based on this methodology, there was training in service and the discussion of key points of pain management by the health team, which served as input for the construction of the fl owchart. Final considerations: The assistance fl owchart for pain management, based on scientifi c evidence, provided means to facilitate the decision-making of the health team regarding the pain of the newborn. It is suggested to use the fl owchart frequently to promote the permanent education of the team and identify possible points to be adjusted. Descriptors: Pain Management; Neonatal Intensive Care Units; Workfl ow; Neonatal Nursing; Newborn. RESUMO Objetivo: Descrever e discutir o processo de desenvolvimento de um fl uxograma construído coletivamente pela equipe de saúde de uma Unidade de Terapia Intensiva Neonatal para o manejo da dor neonatal. Método: Trata-se de um estudo descritivo, exploratório, com abordagem qualitativa que usou a Aprendizagem Baseada em Problemas como referencial teórico-metodológico no processo de desenvolvimento do fl uxograma assistencial do manejo da dor neonatal. Resultados: A partir desta metodologia ocorreu uma capacitação em serviço e a discussão de pontos chaves do manejo da dor pela equipe de saúde, que serviram de subsídios para construção do fl uxograma. Considerações fi nais: O fl uxograma assistencial do manejo da dor, construído a partir de evidências científi cas, forneceu meios para facilitar a tomada de decisão da equipe de saúde frente à dor do recém-nascido. Sugere-se a aplicação do fl uxograma com frequência para promover a educação permanente da equipe e identifi car possíveis pontos a serem ajustados. Descritores: Manejo da Dor; Unidades de Terapia Intensiva Neonatal; Fluxo de Trabalho; Enfermagem Neonatal; Recém-Nascido. RESUMENObjetivo: Describir y discutir el proceso de desarrollo de un diagrama de fl ujo construido colectivamente por el equipo de salud de una Unidad de Terapia Intensiva Neonatal para el manejo del dolor neonatal. Método: Se trata de un estudio descriptivo, exploratorio, con un abordaje cualitativo que utilizó el Aprendizaje Basado en Problemas como referencial teórico-metodológico en el proceso de desarrollo del diagrama de fl ujo asistencial del manejo del dolor neonatal. Resultados: A partir de esta metodología ocurrió una capacitación en servicio y la discusión de puntos claves del manejo del dolor por el equipo de salud, los cuales sirvieron de subsidios para la construcción del diagrama de fl ujo. Consideraciones fi nales: El fl ujograma asistencial del manejo del dolor, construido a partir de evidencias cie...

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“…Infants in intensive care units may need many negative effects on the infant. 11 These negative effects include decreased oxygenation, hemodynamic instability, and increased intracranial pressure, and they may lead to anxiety, increased sensitivity to pain, emotional effects, hyperactivity and inattention in the child in the future. The release of stress hormones due to lack of pain control can delay wound healing, cause infection, increase hospitalization, and even cause neonatal mortalities.…”

Section: Introductionmentioning

confidence: 99%

The Effect of Endotracheal Suctioning Using the Four-handed Care on Physiological Criteria and Behavioral Responses of the Preterm Infants: Randomized Crossover Clinical Trial

et al. 2022

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Introduction: Endotracheal suctioning is one of the procedures that can cause pain and stress for infants admitted to neonatal intensive care units (NICUs). Pain and stress can be manifested with physiological and behavioral responses. This study is a crossover randomized clinical trial design that aimed to investigate the effect of endotracheal suctioning, using four-handed care on the physiological criteria and behavioral responses of preterm infants. Methods: In this study, 40 infants were randomly divided into two groups of 20, one group was first suctioned by the routine method (two hands) and then with the four-handed method. The other group was first suctioned by the four-handed method and then with the routine one. The ALPS-Neo (Astrid Lindgren Children’s Hospital Pain Scale Neonates) was used to evaluate pain and stress in infants. One camera recorded facial expressions and body movements, and physiological data were recorded from the monitor simultaneously. Results: Repeated measures analysis of variance (ANOVA) showed no statistically significant difference in changes in arterial saturation, heart rate and behavioral response scores between the two methods, but there was a significant difference in the mean heart rate of infants during and two minutes after suctioning in four-handed method using independent t test. Data were analyzed using SPSS version 13. Conclusion: Four-handed suctioning method can prevent an increase in the heart rate during and two minutes after suctioning, but it does not seem to affect behavioral responses and oxygen saturation of the infants. Since one of the symptoms of pain and stress in infants is the change of vital signs, especially the heart rate, we recommend four-handed method for suctioning of endotracheal tube.

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Managing procedural pain on the neonatal unit: Do inconsistencies still exist in practice?

Cited by 14 publications

References 58 publications

A complex interprofessional intervention to improve the management of painful procedures in neonates

A complex interprofessional intervention to improve the management of painful procedures in neonates

Assistance flowchart for pain management in a Neonatal Intensive Care Unit

The Effect of Endotracheal Suctioning Using the Four-handed Care on Physiological Criteria and Behavioral Responses of the Preterm Infants: Randomized Crossover Clinical Trial

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