Factors Affecting Delivery of Evidence-Based Procedural Pain Care in Hospitalized Neonates

Abstract

Objective-To examine the effects of nurse, infant, and organizational factors on delivery of collaborative and evidence-based pain care by nurses. Design-Cross sectional.Setting-Two Level III neonatal intensive care units in 2 large tertiary care centers in Canada.Participants-A convenience sample of 93 nurses completed survey data on procedures they performed on ill neonates. The 93 nurses performed a total of 170 pain producing procedures on 2 different shifts.Main Outcome-Nurse use of evidence-based protocols to manage procedure related pain using a scorecard of nurses' assessment, management, and documentation.Results-Procedural pain care was more likely to meet evidence-based criteria when nurse participants rated nurse-physician collaboration higher (odds ratio, 1.44; 95% confidence intervals 1.05-1.98), cared for higher care intensity infants (odds ratio, 1.21; 95% confidence intervals, 1.06-1.39), and experienced unexpected increases in work assignments (odds ratio, 1.55; 95% confidence intervals, 1.04-2.30). Nurses' knowledge about the protocols, educational preparation and experience were not significant predictors of evidence-based care for the most common procedures: heel lance and intravenous initiation.Conclusion-Nurse-physician collaboration and nurses' work assignments were more predictive of evidence-based care than infant and nurse factors. Nurses' knowledge regarding evidence-based care was not a predictor of implementation of protocols. In the final statistical modeling, collaboration with physicians, a variable amenable to intervention and further study, emerged as a strong predictor. The results highlight the complex issue of translating knowledge to practice, however, specific

Factors Affecting Nursing Interventions for Pain among Nurses in Neonatal Intensive Care Unit

“…Nurses were exposed to pain and detected pain more often using facial cues compared with the non-nurse control group. These findings support other research demonstrating that clinicians possess greater knowledge and empathy levels regarding infant pain cues (2,(4)(5)(6)24), yet we continue to be perplexed as to why these attributes do not translate to more effective pain care practice. Higher nurse scores on their own sensitivity for pain estimates and in relation to infants' pain may occur as a result of increased attentiveness and chronic exposure to the pain felt by others.…”

“…However, it does not appear that overestimations of pain and an overprotective nature translate to increased pain care. In this circumstance, nurse participants were more frequently exposed to pain and rated the neonates' pain higher; however, consistent and reliable research demonstrates that these fragile patients repeatedly endure procedures without the benefit of any pain management (2,3,5,6).…”

“…In a recent study (3), a total of 18,929 painful procedures were recorded from 3822 children's charts in eight pediatric centres; only 844 (28.3%) children received one or more pain management interventions administered and documented specifically for a procedure. Even when nurses demonstrate that they have the theoretical knowledge to assess and manage pain, discrepancies exist between this knowledge and the degree of adequate pain care provided (4)(5)(6).…”

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

“…A study in Finland showed that even apparently knowledgeable nurses had no knowledge about higher pain sensitivity of premature infants in comparison with term infants (23). In addition, a study in Canada showed that less than 10% of the nurses used interventions to deal with pain management in the infants (17). A survey study on nurses and physicians in the USA showed that, although the personnel knew that infants can feel pain, the patients were rarely provided with pharmacological and non-pharmacological intervention while they were experiencing several painful procedures (8).…”

“…Another study showed that the majority of Australian NICUs had no articulated policy for pain management (16). Nursephysician collaboration and nurses' work assignments may also predict evidence-based pain care in Canada (17). Less than one half of interviewed nurses in the USA reported that pain was well managed and that pain protocols were evidence-based (13).…”