Evidence-Based Nursing Practices for the Prevention of Newborn Procedural Pain in Neonatal Intensive Therapy—An Exploratory Study
Abstract
:1. Introduction
Aim
2. Methods
2.1. Design
2.2. Participants
2.3. Data Collection
2.4. Study Procedure
2.5. Inclusion and Exclusion Criteria
- Inclusion criteria: nurses/midwives authorized to perform their profession and working at neonatal intensive care units of secondary and tertiary referral levels; official permission from the CEO/president of a hospital taking part in the study; the respondent’s consent to take part in the project in the form of the voluntary and anonymous completion of the questionnaire.
- The study did not include persons who met any of the following exclusion criteria: a profession other than a nurse/midwife; a nurse/midwife not registered/not working at a neonatal intensive care unit; lack of consent from the hospital management; lack of the respondent’s consent to take part in the project.
2.6. Statistical Analysis
3. Results
3.1. Sociodemographic Characteristics
3.2. Medical Professionals’ Knowledge of Recommended Pharmacological and Non-Pharmacological Pain-Management Methods Applied in Medical Procedures
3.3. Application of Recommended Non-Pharmacological and Pharmacological Methods in Clinical Practices by Medical Personnel
3.4. Examination of the Role of Age, General Work Experience, Education Level and Years of Work of Medical Professionals at a Neonatal Ward, and the Referral Level of a Unit versus the Application of Pharmacological and Non-Pharmacological Methods
- Age
- Years of work
- Professional experience
- Education level
- Level of referral of a unit
4. Discussion
5. Study Limitations
6. Conclusions
7. Implications for Practice
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Level | Type of Pain | Pharmacological Actions | Non-Pharmacological Actions | Application |
---|---|---|---|---|
5 | Severe, chronic, long-lasting, moderate-to-strong pain. | Opioids (e.g., morphine, fentanil), sedatives (ketamine) and other tranquilizers, such as midazolam, dexmedetomidine. | Wrapping, massaging, positioning, elements of sensory stimulation. | Inserting a drain into the pleural cavity; surgical interventions; post-surgery pain; wound treatment; taken into consideration in the case of lumbar or central line puncture; intubation and mechanical ventilation. |
4 | Mild-to-moderate procedural pain. | Local infiltration anesthesia (lidocaine, bupivacaine, ropivacaine). | Oral administration of breast milk, glucose/sucrose, kangaroo care, massage, dummy, facilitated tucking, wrapping. | Peripheral and central arterial/venous access device placement; circumcision; inserting a drain into the pleural cavity. |
3 | Chronic/severe, procedural mild-to-moderate pain. | Acetaminophen | Kangaroo care, massage, dummy, facilitated tucking, wrapping. | Post-surgery pain; change of wound dressing; wound treatment; post-circumcision pain. |
2 | Mild/moderate procedural pain. | Local surface anesthetics: lidocaine, Emla cream, lignocaine. | Oral administration of breast milk, glucose/sucrose, kangaroo care, massage, dummy, facilitated tucking, wrapping. | Lumbar puncture; access to veins/arteries; central line placement; intramuscular injection or subcutaneous injection; respiratory physiotherapy; eye examination; pulmonary toilet; intubation; wound treatment. |
1 | Mild, procedural pain. | N/A ** | Oral administration of breast milk, glucose/sucrose, kangaroo care, massage, dummy, facilitated tucking, wrapping, sensory stimulation. | Removal of plaster; introducing a gastric tube; catheterization of navel vessels; catheterization of urinary bladder; removing a venous catheter; physical examination; replacement of a nappy. * Heel/finger puncture. |
Care foundations | Minimal handling, reduction in the frequency of painful procedures, application of non-invasive patient-monitoring methods (NIRS, pulse oximetry, capnography, patient monitors, transcutaneous bilirubin measurement, etc.). |
Characteristics of the Studied Group | N | % | |
---|---|---|---|
Age | Less than 30 years | 100 | 17.9 |
31–50 years | 244 | 43.7 | |
More than 50 years | 214 | 38.4 | |
Level of education | MSc in nursery/midwifery, specialist in neonatological nursing | 178 | 31.9 |
BSc in nursery/midwifery | 171 | 30.6 | |
Secondary (medical school of nursing or medical college) | 209 | 37.5 | |
General professional experience | Up to 5 years | 83 | 14.9 |
6–10 years | 54 | 9.7 | |
More than 10 years | 421 | 75.4 | |
Professional experience gained at neonatal care units | Less than 1 year | 42 | 7.5 |
1–10 years | 154 | 27.6 | |
More than 10 years | 362 | 64.9 | |
The hospital level due to the European Reference Network | Level II | 340 | 60.9 |
Level III | 218 | 39.1 |
Finger Puncture | |||
Correct answers % (n) | M | SD | |
Mother’s milk, >20% glucose | 71.9 (409) | 59.3 | 11.0 |
Wrapping/FT | 45.5 (254) | ||
Speaking quietly | 57.2 (319) | ||
Non-nutritive sucking | 62.7 (350) | ||
Heel puncture | |||
Mother’s milk, >20% glucose | 84.4 (471) | 68.4 | 12.9 |
Wrapping/FT | 53.6 (299) | ||
Speaking quietly | 64.2 (358) | ||
Non-nutritive sucking | 71.5 (399) | ||
Introducing a gastric tube | |||
Mother’s milk, >20% glucose | 28.5 (159) | 41.4 | 20.9 |
Wrapping/FT | 53.2 (297) | ||
Speaking quietly | 64.2 (364) | ||
Non-nutritive sucking | 19.5 (109) | ||
Plaster removal | |||
Mother’s milk, >20% glucose | 59.1 (330) | 56.3 | 7.8 |
Wrapping/FT | 44.4 (248) | ||
Speaking quietly | 59.7 (333) | ||
Non-nutritive sucking | 61.8 (345) | ||
Removing a venous catheter | |||
Mother’s milk, >20% glucose | 57.0 (318) | 51.2 | 7.8 |
Wrapping/FT | 39.8 (222) | ||
Speaking quietly | 54.8 (306) | ||
Non-nutritive sucking | 54.1 (302) | ||
Catheterization of navel vessels | |||
Mother’s milk, >20% glucose | 44.3 (247) | 33.0 | 9.0 |
Wrapping/FT | 22.4 (125) | ||
Speaking quietly | 33.0 (184) | ||
Non-nutritive sucking | 32.4 (181) | ||
Artery puncture | |||
Mother’s milk, >20% glucose | 69.5 (388) | 46.0 | 16.6 |
Wrapping/FT | 35.7 (199) | ||
Speaking quietly | 45.3 (253) | ||
Non-nutritive sucking | 53 (296) | ||
Emla cream | 26.3 (147) | ||
Vein puncture | |||
Mother’s milk, >20% glucose | 84.2 (470) | 57.8 | 21.2 |
Wrapping/FT | 47.8 (267) | ||
Speaking quietly | 59.9 (334) | ||
Non-nutritive sucking | 68.8 (384) | ||
Emla cream | 28.3 (168) | ||
Vein cannulation | |||
Mother’s milk, >20% glucose | 81.5 (455) | 53.5 | 20.2 |
Wrapping/FT | 38.9 (217) | ||
Speaking quietly | 54.8 (306) | ||
Non-nutritive sucking | 62.5 (349) | ||
Emla cream | 29.9 (167) | ||
Lumbar puncture | |||
Mother’s milk, >20% glucose | 46.4 (259) | 40.1 | 9.1 |
Wrapping/FT | 21.9 (122) | ||
Speaking quietly | 35.3 (197) | ||
Non-nutritive sucking | 38.4 (214) | ||
Emla cream | 40.5 (226) | ||
Subcutaneous injection | |||
Mother’s milk, >20% glucose | 78.1 (436) | 43.1 | 27.3 |
Wrapping/FT | 41.9 (234) | ||
Speaking quietly | 54.3 (303) | ||
Non-nutritive sucking | 60.9 (340) | ||
Emla cream | 18.8 (105) | ||
Lidocaine gel/spray | 4.8 (27) | ||
Intramuscular injection | |||
Mother’s milk, >20% glucose | 80.3 (448) | 44.5 | 26.8 |
Wrapping/FT | 43.2 (241) | ||
Speaking quietly | 54.3 (303) | ||
Non-nutritive sucking | 60.2 (336) | ||
Emla cream | 23.5 (131) | ||
Lidocaine gel/spray | 5.6 (31) | ||
ECC central puncture | |||
Mother’s milk, >20% glucose | 51.8 (289) | 25.4 | 16.2 |
Wrapping/FT | 23.7 (132) | ||
Speaking quietly | 33.9 (189) | ||
Non-nutritive sucking | 35.8 (200) | ||
Emla cream | 15.8 (88) | ||
Lidocaine gel/spray | 11.5 (64) | ||
Infiltrated lidocaine | 5.0 (28) | ||
Bronchial toilet | |||
Mother’s milk, >20% glucose | 17.9 (100) | 18.6 | 16.7 |
Wrapping/FT | 36.2 (202) | ||
Speaking quietly | 41.6 (232) | ||
Non-nutritive sucking | 6.5 (36) | ||
Lidocaine | 1.8 (10) | ||
Opioids and opioid derivative | 7.5 (42) | ||
Intubation for mechanical ventilation purposes | |||
Opioids and opioid derivative | 32.3 (180) | 29.7 | 17.5 |
Muscle relaxants | 34.1 (190) | ||
Sedatives | 46.6 (260) | ||
Atropine | 5.6 (31) | ||
Endotracheal intubation to administer surfactant | |||
Opioids and opioid derivative | 27.2 (152) | 17.5 | 11.6 |
Muscle relaxants | 20.6 (115) | ||
Atropine | 4.3 (24) |
Finger Puncture | |||
Correct Answers % (n) | M | SD | |
Mother’s milk, >20% glucose | 59.1 (330) | 49.3 | 11.6 |
Wrapping/FT | 34.1 (190) | ||
Speaking quietly | 46.4 (259) | ||
Non-nutritive sucking | 57.5 (321) | ||
Heel puncture | |||
Mother’s milk, >20% glucose | 72.9 (407) | 58.8 | 12.9 |
Wrapping/FT | 43.9 (245) | ||
Speaking quietly | 53 (296) | ||
Non-nutritive sucking | 65.2 (364) | ||
Introducing a gastric tube | |||
Mother’s milk, >20% glucose | 20.8 (116) | 35.3 | 20.4 |
Wrapping/FT | 42.5 (237) | ||
Speaking quietly | 60.9 (340) | ||
Non-nutritive sucking | 17 (95) | ||
Plaster removal | |||
Mother’s milk, >20% glucose | 41.8 (233) | 40.7 | 11.6 |
Wrapping/FT | 24.4 (136) | ||
Speaking quietly | 51.4 (287) | ||
Non-nutritive sucking | 45.3 (253) | ||
Removing a venous catheter | |||
Mother’s milk, >20% glucose | 40.7 (227) | 37.5 | 12.4 |
Wrapping/FT | 19.7 (110) | ||
Speaking quietly | 48.4 (270) | ||
Non-nutritive sucking | 41.4 (231) | ||
Catheterization of navel vessels | |||
Mother’s milk, >20% glucose | 35.3 (197) | 21.5 | 9.8 |
Wrapping/FT | 11.8 (66) | ||
Speaking quietly | 19.5 (109) | ||
Non-nutritive sucking | 19.5 (109) | ||
Artery puncture | |||
Mother’s milk, >20% glucose | 56.1 (313) | 31.6 | 20 |
Wrapping/FT | 22.9 (128) | ||
Speaking quietly | 37.5 (209) | ||
Non-nutritive sucking | 39.1 (218) | ||
Emla cream | 2.5 (14) | ||
Vein puncture | |||
Mother’s milk, >20% glucose | 75.3 (420) | 45 | 26.7 |
Wrapping/FT | 34.6 (193) | ||
Speaking quietly | 52 (290) | ||
Non-nutritive sucking | 58.4 (326) | ||
Emla cream | 5 (28) | ||
Vein cannulation | |||
Mother’s milk, >20% glucose | 69.4 (387) | 41.2 | 5.7 |
Wrapping/FT | 33.2 (185) | ||
Speaking quietly | 43 (240) | ||
Non-nutritive sucking | 54.5 (304) | ||
Emla cream | 5.7 (32) | ||
Lumbar puncture | |||
Mother’s milk, >20% glucose | 38.4 (214) | 25 | 9.4 |
Wrapping/FT | 12 (67) | ||
Speaking quietly | 24.4 (136) | ||
Non-nutritive sucking | 23.5 (131) | ||
Emla cream | 26.5 (148) | ||
Subcutaneous injection | |||
Mother’s milk, >20% glucose | 60.8 (339) | 32.2 | 25.5 |
Wrapping/FT | 30.5 (170) | ||
Speaking quietly | 48 (268) | ||
Non-nutritive sucking | 50 (279) | ||
Emla cream | 2.7 (15) | ||
Lidocaine gel/spray | 0.9 (5) | ||
Intramuscular injection | |||
Mother’s milk, >20% glucose | 62.4 (348) | 32.7 | 27.7 |
Wrapping/FT | 30.1 (168) | ||
Speaking quietly | 50 (279) | ||
Non-nutritive sucking | 50.5 (282) | ||
Emla cream | 2.9 (16) | ||
Lidocaine gel/spray | 0.4 (2) | ||
ECC central puncture | |||
Mother’s milk, >20% glucose | 39.4 (220) | 14.9 | 13.7 |
Wrapping/FT | 16.1 (90) | ||
Speaking quietly | 19.5 (109) | ||
Non-nutritive sucking | 21.5 (120) | ||
Emla cream | 2.7 (15) | ||
Lidocaine gel/spray | 3.6 (20) | ||
Infiltrated lidocaine | 1.3 (7) | ||
Bronchial toilet | |||
Mother’s milk, >20% glucose | 12.2 (68) | 12.7 | 12.6 |
Wrapping/FT | 23.1 (129) | ||
Speaking quietly | 32.4 (181) | ||
Non-nutritive sucking | 3 (17) | ||
Infiltrated lidocaine | 0.7 (4) | ||
Opioids and opioid derivative | 4.8 (27) | ||
Intubation for mechanical ventilation purposes | |||
Opioids and opioid derivative | 24.2 (135) | 20.5 | 12.5 |
Muscle relaxants | 21.5 (120) | ||
Sedatives | 33 (184) | ||
Atropine | 3.2 (18) | ||
Endotracheal intubation to administer surfactant | |||
Opioids and opioid derivative | 24.2 (126) | 13.8 | 9.8 |
Muscle relaxants | 15.6 (87) | ||
Atropine | 3.2 (18) |
Non-Pharmacological Actions vs. Age | N | M | SD | H | Df | p |
---|---|---|---|---|---|---|
Less than 30 years | 100 | 16.8 | 6.0 | |||
31–50 years | 244 | 16.2 | 6.4 | 14.7 | 2 | 0.001 * |
More than 50 years | 214 | 14.8 | 6.2 | |||
Pharmacological actions vs. age | ||||||
Less than 30 years | 100 | 4.3 | 3.7 | |||
31–50 years | 244 | 3.5 | 3.3 | 4.5 | 2 | 0.107 |
More than 50 years | 214 | 4.1 | 4.0 | |||
Non-pharmacological actions vs. general experience | ||||||
Up to 5 years | 83 | 16.7 | 5.9 | |||
6–10 years | 54 | 17.1 | 6.5 | 6.5 | 2 | 0.038 * |
More than 10 years | 421 | 15.1 | 6.5 | |||
Pharmacological Actions vs. general experience | ||||||
Up to 5 years | 83 | 4.4 | 3.7 | |||
6–10 years | 54 | 3.8 | 3.4 | 3.3 | 2 | 0.189 |
More than 10 years | 421 | 3.8 | 3.7 | |||
Non-pharmacological actions vs. professional experience at the NICU | ||||||
Less than 1 year | 42 | 15.0 | 6.8 | |||
1–10 years | 154 | 16.8 | 6.0 | 6.4 | 2 | 0.041 * |
More than 10 years | 361 | 15.0 | 6.5 | |||
Pharmacological actions vs. professional experience at the NICU | ||||||
Less than 1 year | 42 | 3.8 | 3.7 | |||
1–10 years | 154 | 4.2 | 4.0 | 1.6 | 2 | 0.443 * |
More than 10 years | 361 | 3.8 | 3.5 |
Non-Pharmacological Actions | N | M | SD | F | df | P |
---|---|---|---|---|---|---|
MSc in nursery/midwifery, specialist in neonatological nursing | 178 | 16.8 | 6.0 | |||
BSc in nursery/midwifery | 171 | 15.0 | 6.2 | 5.6 | 2.5 | 0.004 * |
Secondary (medical school of nursing or medical college) | 209 | 14.7 | 6.8 | |||
Pharmacological Actions | N | M | SD | F | df | P |
MSc in nursery/midwifery, specialist in neonatological nursing | 178 | 3.6 | 3.1 | |||
BSc in nursery/midwifery | 171 | 4.6 | 4.6 | 5.2 | 2.5 | 0.006 * |
Secondary (medical school of nursing or medical college) | 209 | 3.5 | 3.0 |
Non-Pharmacological Actions | N | M | SD | t | df | P |
---|---|---|---|---|---|---|
Level II | 330 | 14.2 | 6.0 | |||
Level III | 227 | 17.5 | 6.6 | 6.1 | 555 | 0.000 * |
Pharmacological Actions | N | M | SD | t | df | P |
Level II | 330 | 3.9 | 4.1 | |||
Level III | 227 | 3.9 | 2.8 | 0 | 555 | 0.974 |
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Popowicz, H.; Kwiecień-Jaguś, K.; Mędrzycka-Dąbrowska, W.; Kopeć, M.; Dyk, D. Evidence-Based Nursing Practices for the Prevention of Newborn Procedural Pain in Neonatal Intensive Therapy—An Exploratory Study. Int. J. Environ. Res. Public Health 2022, 19, 12075. https://doi.org/10.3390/ijerph191912075
Popowicz H, Kwiecień-Jaguś K, Mędrzycka-Dąbrowska W, Kopeć M, Dyk D. Evidence-Based Nursing Practices for the Prevention of Newborn Procedural Pain in Neonatal Intensive Therapy—An Exploratory Study. International Journal of Environmental Research and Public Health. 2022; 19(19):12075. https://doi.org/10.3390/ijerph191912075
Chicago/Turabian StylePopowicz, Hanna, Katarzyna Kwiecień-Jaguś, Wioletta Mędrzycka-Dąbrowska, Monika Kopeć, and Danuta Dyk. 2022. "Evidence-Based Nursing Practices for the Prevention of Newborn Procedural Pain in Neonatal Intensive Therapy—An Exploratory Study" International Journal of Environmental Research and Public Health 19, no. 19: 12075. https://doi.org/10.3390/ijerph191912075