Neonatal Nurse and Midwife Competence Regarding Pain Management in Neonates

Abstract

Background: Neonates in need of intensive care are often subjected to numerous painful procedures. Despite the growing scientific research, hospitalized neonates continue to experience unrelieved pain. Enhancing the competence of neonatal intensive care nurses is an integral component of effective pain management. Purpose: The purpose of this article is to identify and synthesize the existing evidence on nurses' and midwives' competence regarding neonatal pain management internationally. Methods/Search Strategy: The review was guided by Whittemore and Knafl's 5-stage framework, with 8 databases searched in June 2020 including PubMed, CINAHL Complete (via EBSCOhost), MEDLINE (via EBSCOhost), PsycINFO (via Ovid), EMBASE, Scopus, Cochrane Library, and Google Scholar. Reference lists of selected articles were also hand-searched. Studies were reviewed independently for methodology and inclusion and exclusion criteria. The initial search yielded 3037 articles; 19 met the inclusion criteria and were included for analysis: qualitative (n = 5) and quantitative (n = 14). Findings/Results: Nurses' and midwives' competence regarding neonatal pain management in the neonatal intensive care unit is discussed in relation to knowledge, attitudes, behaviors, and perceptions of competence by most studies. The barriers to effective neonatal pain management were found to relate to nurses' and midwives' factors, underutilized pain assessment tools, and organizational factors. Potential facilitators to effective neonatal pain management included clear evidence-based guidelines/protocols, adequate training, and the use of appropriate and accurate pain assessment tools. Parent involvement and a team approach to neonatal pain management were also identified. Implications for Practice and Research: These findings suggest that further research is necessary to address the barriers and promote facilitators to improve neonatal pain management.

Thai Nurses' and Midwives' Perceptions Regarding Barriers, Facilitators, and Competence in Neonatal Pain Management

“…Interviews were conducted at a mutually convenient time and used semistructured questions and prompts designed to elicit rich information about nurses' and midwives' perspectives on effective neonatal pain management in their units. The interview questions and prompts were informed by the research team's systematic reviews findings 17 and Gonczi's holistic conceptualization of competence 12 and were pilot tested with the RAs prior to interview. Participants were asked by the researcher (O.M.)…”

“…A recent systematic review of nurse and midwife competence regarding neonatal pain management highlighted both barriers and facilitators 17. The barriers identified related to nurses’ and midwives’ working experiences and their educational level, underutilized pain assessment tools, and organizational factors.…”

“…The barriers identified related to nurses’ and midwives’ working experiences and their educational level, underutilized pain assessment tools, and organizational factors. The facilitators included the use of clear evidence-based guidelines or protocols, adequate training, and using appropriate, reliable, and valid pain assessment tools 17. A parent-oriented and team approach were also identified as facilitators of effective neonatal pain management 17.…”

“…The mixing of both qualitative and quantitative data is reported elsewhere. 18,19 However, the research team decided to publish the qualitative findings separately in order to capture the richness and depth of the qualitative data. A convergent mixed-methods approach was used in which the researcher collected and analyzed 2 separate sources of data (quantitative and qualitative).…”

“…[14][15][16] A recent systematic review of nurse and midwife competence regarding neonatal pain management highlighted both barriers and facilitators. 17 The barriers identified related to nurses' and midwives' working experiences and their educational level, underutilized pain assessment tools, and organizational factors. The facilitators included the use of clear evidence-based guidelines or protocols, adequate training, and using appropriate, reliable, and valid pain assessment tools.…”