Neonatal nurses’ self-reported practices, knowledge and attitudes toward premature infant pain assessment and management

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Abstract

Aim

To identify neonatal nurses’ self-reported practices, knowledge and attitudes toward premature infant pain assessment and management.

Method

An exploratory cross sectional mixed methods survey.

Findings

Of the 127 surveys distributed, 86 were returned (68% response rate). Those with postgraduate education had higher knowledge and reported more positive attitudes. Comfort measures and analgesia for painful procedures were reported as used more often in term infants. Analgesia was not used for endotracheal intubation. This was attributed to non-prescribing of analgesia by doctors.

Conclusion

Nurses reported a positive attitude toward infant pain assessment and management but a low level of knowledge about premature infants’ response to pain. The non-use of analgesia for painful procedures presents a formidable challenge to changing practice. Evidenced based strategies may overcome barriers.

Introduction

Premature infants in Neonatal Intensive Care Units (NICU) are subjected to prolonged and repetitive exposure to painful stimuli, inducing adverse long-term physiological, behavioural and hormonal complications (Gitto et al., 2012; Lago et al., 2009, 2012; New South Wales Government, 2004; Pasek and Huber, 2012). A heightened perception to pain and continuous noxious stimuli results in the infant entering a withdrawn state over time, to conserve energy (Badr et al., 2010; Evans, 2001; Grunau et al., 2006). These changes potentially have detrimental developmental and psychological consequences lasting into adulthood (Gitto et al., 2012; Polkki et al., 2010; Stevens et al., 2008). Often healthcare professionals are unaware of the infants’ response to pain and continue painful procedures with little knowledge of the long-term effects (Byers and Thornley, 2004).

Pain should be routinely monitored, assessed, documented and communicated to facilitate best practice pain management (Herr et al., 2006). Premature infants are unable to verbalise pain and the neonatal nurse plays an advocacy role for patient comfort, quality and safety of care (Australian Commission on Safety and Quality in Health Care, 2014). Nurses’ accurate pain assessment is the cornerstone for optimal pain management.

Complexities of pain assessment in NICU environments are further compounded by premature infants' inability to self-report pain (New South Wales Government, 2004; Stevens et al., 2010). Non-systematic documentation and varying opinions about pain assessment were reported in the Australian setting (Byers and Thornley, 2004; Polkki et al., 2010). This may be attributed to differences in nurses' knowledge, attitudes and interpretation of pain (Harrison et al., 2009). In a large Neonatal Unit in Western Australia, pain assessment practice guidelines were developed and implemented in 2013 (Government of Western Australia Department of Health, 2006). It was unknown whether neonatal nurses' practice was consistent with the policy. The purpose of this project was to identify nurses’ self-reported practices, knowledge and attitudes toward premature infant pain assessment and management.

Section snippets

Method

A quality improvement project was undertaken using a self-report cross sectional mixed methods survey. Data were collected in July 2014.

Results

Of 127 surveys distributed, 86 participants responded (68% response rate). All surveys were included; some had sections that were incomplete. Note: there are differing numbers of response for certain survey items. Participants’ mean years of nursing experience was 15 years (SD ± 11.1) with a mean of almost 10 years (SD 7.3) NICU experience. Approximately half of the participants (52.3%) had children of their own. Forty three (50%) participants held a postgraduate qualification with 26 (30.3%)

Discussion

The aim of the project was to identify neonatal nurses' self-reported practices, knowledge and attitudes toward premature infant pain assessment and management. The key finding was that attitudes were positive toward premature infant pain assessment and management. There was low level of awareness of premature infants’ heightened sense of pain and the withdrawn state exhibited when undergoing painful procedures; a result previously reported by Efe et al. (2013), Nimbalkar et al. (2014) and

Conclusion

In the Australian setting neonatal nurses' attitudes were positive toward premature infant pain assessment and management, with agreement that neonates experience pain and require analgesia. Nurses with postgraduate qualifications demonstrated an increased knowledge about premature infants' hypersensitivity, responses to pain and pain pathways. Nurses without postgraduate qualifications had less knowledge about premature infants’ perception of and expression of pain. The reported infrequent use

Acknowledgements

With thanks to all the Nurses and Midwives of the Neonatal Directorate of King Edward Memorial Hospital who participated in this project.

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