The opinions of clinical staff regarding neonatal procedural pain in two Norwegian neonatal intensive care units

Abstract

Andersen RD. Greve-Isdahl M. Jylli L. The opinions of clinical staff regarding neonatal procedural pain in two Norwegian neonatal intensive care units. Aim:Neonates are subjected to numerous painful procedures without sufficient pain management. The aim of this study was to describe the opinions of Norwegian physicians, nurses and nurse assistants who care for neonates, regarding procedural pain in neonates.Methods: A replication of a previous questionnaire study (Porter FL et al) was conducted in two Norwegian neonatal intensive care units (NICU's). The questionnaire aimed at evaluating procedure painfulness, the current use of pharmacological agents and comfort measures and the optimal use of both.Results: Ninety members of the clinical staff participated, which is a response rate of 87%. Opinions on how procedural pain is currently and optimally managed differed significantly. Although most respondents rated a majority of the listed procedures as being more than moderately painful, pharmacological agents were rarely used, except for the insertion of a chest tube and endotracheal intubation. Comfort measures were also believed to be underutilized, but not to the same degree as pharmacological agents. Conclusion Methods Subjects and settingOne hundred and three of 111 clinical staff members were invited to participate (N=103). InstrumentThe survey is based on a questionnaire [10] which consists of a series of questions on pain and pain management in reference to twelve frequently performed procedures.In our study, ten of the procedures were included (table I). Circumcision and arterial or venous cutdown were excluded as they are never performed in the units being studied. The responses are in a Likert scale format, ranging from zero to four and the participants were asked to grade the painfulness of the 10 different procedures, the frequency of the actual use of pharmacological agents and comfort measures, and the optimal use of such (table I).The internal consistency was examined by computing Chronbach's α for each series of questions. The observed alphas ranged from .74 to .93, which demonstrates that the survey has a good reliability. ProcedureApproval was obtained from the Regional Ethics Committee. The survey was conducted in 2003 during three staff meetings at each hospital and after the attendants had received oral information about the study. Participants were encouraged not to discuss the questionnaire between meetings. A comparison of the answers showed no significant differences. 5 Statistical analysesRespondents were divided into groups based on profession. Differences between groups for the different procedures and for a sum score of each question have been calculated by the use of the Kruskal Wallis test. In cases where a significant difference between groups was found, a post hoc Mann Whitney U-test with Bonferroni correction was performed. Answers to the questions regarding current and optimal treatment of procedural pain were compared using the Wilcoxon paired groups test. P ≤ 0.05 wa...

Knowledge, attitudes and practices of neonatal staff concerning neonatal pain management

“…The range was found to be between 0.72 and 0.92 (ά < 1), indicating that the instrument has good reliability. This was consistent with Cronbach ά coefficients calculated for the Infant Pain Questionnaire by Porter et al (1997) and Andersen et al (2007) ranging from 0.74 to 0.93.…”

“…Johnston et al (1995) established that neonates perceive pain based on nociception developed in utero before the age of 24 weeks. The perceived pain stimulus is transmitted slowly from the periphery to the brain over non-myelinated nerve fibres before the age of 30 weeks and faster over myelinated nerve fibres beyond 30 weeks' gestation (Anand & Hickey 1987;Fitzgerald & Anand 1993;Johnston et al 1995;Evan 2001 Porter et al 1997;Rouzan 2001;Andersen et al 2007;Gradin & Eriksson 2010). In fact, neonatal patients still experience pain as a result of ineffective pain management (Anand & Hall 2008).…”

“…• Knowledge: Formal or informal education guiding practice (McLaughlin et al 1993;Porter et al 1997;Andersen et al 2007;Bellini & Damato 2009). …”

“…• Neonatal procedural pain: Includes acute and chronic pain induced and experienced as a result of named procedures (Porter et al 1997;Simons et al 2003;Dodds 2003;Carbajal et al 2008 (Porter et al 1997;Andersen et al 2007;Bellini & Damato 2009). …”

The opinion of clinical staff regarding painfulness of procedures in pediatric hematology-oncology: an Italian survey

“…A few studies investigated health professionals' concerns about pain in infants and children with cognitive impairment[17-20]. We would to evaluate hemato-oncology health professionals' beliefs about pediatric procedural pain.…”