Nurses' knowledge and practices regarding pain management in newborns

Costa, Taine; Rossato, Lisabelle Mariano; Bueno, Mariana; Secco, Izabela Linha; Sposito, Natália Pinheiro Braga; Harrison, Denise; Freitas, Júnia Selma de

doi:10.1590/S1980-220X2016034403210

Brasil

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ORIGINAL ARTICLE • Rev. esc. enferm. USP 51 • 2017 • https://doi.org/10.1590/S1980-220X2016034403210 linkcopy

Nurses' knowledge and practices regarding pain management in newborns

Conocimiento y prácticas de enfermeros acerca del manejo del dolor en recién nacidos

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

OBJECTIVE To analyze nurses' knowledge and practices regarding pain management of newborns admitted to Neonatal Intensive Care Units.

METHOD A descriptive and cross-sectional study. Data were collected from 51 nurses based on an adapted questionnaire aimed at evaluating knowledge and practices regarding the management of neonatal pain in six hospitals in Curitiba and its Metropolitan Region.

RESULTS For most nurses (86.0%), neonates feel pain. A total of 34.7% of the nurses reported never using pain assessment scales. Pain management was recorded by 84.3% of the nurses. Administered pharmacological measures were Paracetamol and Fentanyl (47.1%) and Morphine (17.6%); while non-pharmacological measures adopted were sweetened solution (68.6%), non-nutritive sucking (58.8%) and positioning (56.9%).

CONCLUSION Nurses considered neonatal pain a real event; however, they do not perform pain assessment or treatment of newborns in a systematized way.It is necessary to implement knowledge translation strategiesin order to improve pain management in newborns.

Descriptors Pain; Pain Management; Infant, Newborn; Neonatal Nursing; Intensive Care Units, Neonatal

	D		PD		DK		PA		A
	n	%	n	%	n	%	n	%	n	%
1. PRNB feel pain	4	8.0	1	2.0	-	-	2	4.0	43	86.0
2. Full-termNBsfeel pain	4	8.0	-	-	-	-	5	10.0	41	82.0
3. Pain can affect newborn’s HR, RR, T, BP, SatO₂ and IP	-	-	-	-	-	-	3	5.9	48	94.1
4. Pain can affect newborn’s facial expressions, limb movements and crying	-	-	-	-	-	-	2	3.9	49	96.1
5. Light and noise may affect newborn’s reactions to pain	-	-	1	2.0	1	2.0	5	9.8	44	86.3
6. NB pain is not recognized by professionals	13	26.0	7	14.0	-	-	23	46.0	7	14.0
7. NB pain is not considered by researchers	21	41.2	12	23.5	1	2.0	17	33.3	-	-
8. NBs react to pain ina particular way	2	4.0	3	6.0	-	-	11	22.0	34	68.0
9. Pain is considered as one of the VS in NBs	-	-	1	2.0	2	3.9	7	13.7	41	80.4
10. Pain assessment in NBs must be systematized	-	-	-	-	-	-	5	9.8	46	90.2
11. Pain assessment should be part of the NP	-	-	-	-	-	-	1	2.0	50	98.0
12. NBs do not require painkillers due to immaturity of the nervous system	38	74.5	7	13.7	2	3.9	3	5.9	1	2.0
13. Neonatal pain can be assessed without the use of scales	20	39.2	10	19.6	1	2.0	8	15.7	12	23.5
14. The use of scales for pain assessment is important to the practice	-	-	-	-	-	-	7	13.7	44	86.3
15. It is important to record pain on the newborn’s chart	-	-	-	-	-	-	1	2.0	50	98.0
16. Recording pain assessment is a prerequisite to its control	-	-	-	-	-	-	4	7.8	47	92.2
17. Nurses have sufficient knowledge to assess pain in NBs	-	-	2	3.9	-	-	23	45.1	26	51.0
18. Pain management in NBs depends on its assessment	1	2.0	1	2.0	-	-	14	27.5	35	68.6
19. Recording newborn’s painassessment will result in relief	8	15.7	7	13.7	1	2.0	20	39.2	15	29.4
20. Having knowledge of NPMs for pain relief helps its relief	2	4.0	-	-	-	-	4	8.0	44	88.0
21. Using NPMs for pain relief is necessary	-	-	-	-	-	-	4	7.8	47	92.2
22. Parents can help pain management in NB	1	2.0	-	-	-	-	6	11.8	44	86.3
23. Despite feeling pain, NBs can sleep or not react to pain	11	21.6	2	3.9	3	5.9	20	39.2	15	29.4
24. NBs submitted to repeated painful procedures may have harmful effects on their development	3	6.0	1	2.0	5	10.0	8	16.0	33	66.0
25. The medical/clinical diagnosis of NBs influences pain management	2	3.9	3	5.9	1	2.0	11	21.6	34	66.7
26. Professional’s joint decisions are needed for pain management in NBs	-	-	1	2.0	-	-	1	2.0	49	96.1
27. Sedatives relieve pain in NBs	7	14.0	4	8.0	-	-	16	32.0	23	46.0
28. Opioid analgesics are appropriate to relieve pain in NBs	2	3.9	4	7.8	6	11.8	26	51.0	13	25.5
29. Opioid analgesics are suitable for NBsundergoingMV	1	2.0	-	-	9	17.6	17	33.3	24	47.1
30. Non-opioid analgesics are suitable for pain relief in NBs	-	-	1	2.0	8	15.7	18	35.3	24	47.1

	N		R		ST		M T		A
	n	%	n	%	n	%	n	%	n	%
1. I assess NB pain through crying	-	-	-	-	14	29.2	23	47.9	11	22.9
2. I assess NB pain through facial expressions	-	-	-	-	12	24.5	17	34.7	20	40.8
3. I assess NB pain throughbody movement and agitation	-	-	1	2.0	6	12.0	17	34.0	26	52.0
4. I assess NB pain through the VS	-	-	1	2.0	11	22.0	7	14.0	31	62.0
5. I use scales to assess pain in NBs	17	34.7	8	16.3	8	16.3	6	12.2	10	20.4
6. Irecord NBs pain scores on their medical chart	7	14.0	4	8.0	9	18.0	11	22.0	19	38.0
7. I communicate and discuss the pain scores in NBs with the team	3	5.9	4	7.8	5	9.8	14	27.5	25	49.0
8. I use NNS to relieve pain in NBs	-	-	-	-	8	15.7	19	37.3	24	47.1
9. I encourage breastfeeding to relieve the pain in NBs	9	17.6	10	19.6	20	39.2	5	9.8	7	13.7
10. I encourage skin-to-skin contactto relieve the pain in NBs	3	5.9	13	25.5	17	33.3	13	25.5	5	9.8
11. I offer oral glucose or sucrose to relieve NB pain prior to painful procedures	1	2.0	2	3.9	6	11.8	20	39.2	22	43.1
12. I offer oral glucose or sucrose to relieve NB pain during painful procedures	2	3.9	3	5.9	8	15.7	18	35.3	20	39.2
13. I position the NB to relieve their pain	-	-	1	2.0	6	11.8	17	33.3	27	52.9
14. I perform facilitated tuckingin NBs during painful procedures	3	5.9	2	3.9	11	21.6	21	41.2	14	27.5
15. Iswaddle NBs before painful procedures	2	4.0	5	10.0	11	22.0	18	36.0	14	28.0
16. I use more than one NPM to relieve the pain of NBs	3	5.9	4	7.8	7	13.7	24	47.1	13	25.5
17. I use PMs and NPMs combined to relieve pain in NBs	-	-	3	6.0	17	34.0	19	38.0	11	22.0
18. I discuss NPMs used for prevention and relief ofpain in NBs with the team	3	5.9	6	11.8	12	23.5	15	29.4	15	29.4
19. I record the pain scores on the newborn’s medical chart	6	11.8	3	5.9	5	9.8	16	31.4	21	41.2
20. I record NPMs for the prevention and relief of painon the newborn’s medical chart	6	11.8	5	9.8	9	17.6	9	17.6	22	43.1
21. I record the complications in administration of NPMs used onthe newborn’s medical chart	6	12.0	8	16.0	5	10.0	9	18.0	22	44.0
22. I inform parents/family about painful procedures to be performed	1	2.0	1	2.0	8	15.7	14	27.5	27	52.9
23. I ask parents/families to be part of the prevention and relief of pain in NBs	3	6.0	6	12.0	16	32.0	13	26.0	12	24.0
24. I administer opioid painkillers, prescribed IN, to relieve the pain of NBs	1	2.0	8	15.7	12	23.5	20	39.2	10	19.6
25. I administer opioid painkillers, prescribed IN, to NBs undergoingMV	1	2.0	7	14.3	20	40.8	12	24.5	9	18.4
26. I administer non-opioid painkillers, prescribed IN, for pain relief in NBs	1	2.0	10	20.0	19	38.0	13	26.0	7	14.0
27. I administer non-opioid painkillers, prescribed IN, for pain relief caused by painful procedures in NBs	2	3.9	10	19.6	21	41.2	10	19.6	8	15.7
28. I administer sedatives prescribed IN for pain management in NBs	10	19.6	14	27.5	13	25.5	9	17.6	5	9.8
29. I record the PMs used on the newborn’s medicalchart	1	2.0	3	5.9	2	3.9	6	11.8	39	76.5
30. I record the complications from administration of PMson the newborn’s medical chart	2	3.9	3	5.9	4	7.8	3	5.9	39	76.5
31. I discuss the PMs used with the team	5	9.8	2	3.9	8	15.7	16	31.4	20	39.2

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Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[TFN1] ^Notes
D= disagree;PD= partially disagree; DK= don´t know;PA= partially agree; A= agree; F= frequency; P= Percentage; NB= Newborn; PRNB= Pre-term newborn; HR= Heart rate; RR= Respiratory rate; T= Temperature; BP= Blood pressure; SatO₂ = Oxygen saturation; IP= Intracranial Pressure; VS= Vital signs; NP= Nursing prescription; NPM= Non-pharmacological measure; MV= Mechanical ventilation. (N= 51)