Non-pharmacological methods for relief of discomfort and pain in newborns: a collective nursing construction

Abstract

This is a convergent care study with the aim to build, together with the nursing staff, a proposal for care protocol based on non-pharmacological methods for discomfort and pain management in newborns admitted to a neonatal intensive care unit. The study was carried out in a neonatal intensive care unit of a university hospital with 16 nursing staff professionals. Data were collected in two stages: first, a reflective-educational process was performed and, afterwards, a participant observation during the different work shifts of the nursing staff. The care protocol proposal will enable the standardization of care strategies for pain management in newborns using non-pharmacological methods. Furthermore, it will contribute to provide better care in the neonatal unit, reducing pain and discomfort experienced during hospitalization, as well as resulting in fewer consequences and better quality of life for the newborns and their families.

Influence of stress factors on the vital signs of neonates under intensive care

“…The significant difference evidenced in all vital signs and NIPS score, when compared the higher and lower exposition to the studied stress factors, are in accordance with the literature that confirms the deleterious effects of high levels of sound pressure, illuminance, procedures, isolated or associated to pain sensation, over the physiological stability, of hospitalized neonates. [5][6][7][8]13 The immediate physiological effects of elevated sound pressure on neonates include: increase of HR and RR, diminution of SpO 2 , increase of blood pressure, apnea and alterations in the sleep-vigil state. 23 Although the elevated levels of sound pressure in the NICU can be generated by the noise produced by the use of innumerous life support equipment, we believe that, in this study, the main source was the conversation between professionals and activities realized by the health team in the assistance of neonates.…”

“…4 Stressful factors such as: elevated levels of sound pressure, illuminance, and procedures, individually or associated to pain sensation can cause the disorganization of different systems, contributing, therefore, to changes in the physiological and behavioral parameters that interfere in a negative way in the neurobehavioral development of hospitalized neonates. 3,[5][6][7][8] Neonates hospitalized in the NICU are constantly exposed to stress factors causing important reactions to their vital signs. While in a stress situation, the neonate is submitted to alterations in blood pressure, heart rate (HR), respiratory rate (RR) and oxygen peripheral saturation (SpO 2 ).…”

“…While in a stress situation, the neonate is submitted to alterations in blood pressure, heart rate (HR), respiratory rate (RR) and oxygen peripheral saturation (SpO 2 ). 8 Besides, the liberation of hormones indicators of stress, such as cortisol, adrenaline and noradrenaline also take place. 9 The maintenance of regular development and maturation of the Central Neural System of the neonate in the first year, associated to the environmental conditions in which he is inserted, justify the scientific relevance of this research.…”

Assistance flowchart for pain management in a Neonatal Intensive Care Unit

“…Containment and positioning can help you get organized and should be maintained for 10 minutes after the procedure or until it is stable, recovering physiological parameters and behavioral status (34) . A meta-analysis of 51 studies on non-pharmacological interventions for pain relief, used during calcaneal puncture and intravenous catheter insertion, pointed out that measures such as facilitated restraint and winding are beneficial for full-term newborns (35) . It is important to always consider the use of nonpharmacological strategies with or without sweetened solution for painful procedures of mild to moderate pain (6) .…”

“…Strategies to reduce noise in the unit, such as: prompt attention to alarms, prohibition of cell phone use, adaptation of more modern equipment with self-management of noise, reduction of conversations and tone of voice can be encouraged to maintain the calmer environment. As far as possible, the luminosity of the unit should also be controlled, reducing the exposure of NBs to direct light, facilitating the circadian cycle (35) . These environmental measures are described as a kind of neuroprotective care for premature NBs and are included in management programs focused on neurodevelopmental care.…”