Original Article

Relief and care in the shade: A concept extracted from practices of neonatal nurses during pain management

Abstract

Background & Aim: Nowadays, despite the improvements in the knowledge and attitude of healthcare professionals, there are still obstacles against pain management in Neonatal Intensive Care Units (NICUs). Hence, it is necessary to know about the problems of pain management in NICUs. This research aimed to explore the pain management experiences of NICU nurses and neonatologists.
Methods & Materials: This content analysis study was conducted on six experienced NICU nurses and two neonatologists in one hospital affiliated to Shiraz University of Medical Sciences who were selected through purposive sampling which continued until saturation. The data were collected through semi-structured interviews and field notes. The data were simultaneously analyzed using inductive content analysis.
Results: Analysis of the data generated one theme and three categories and seven subcategories. The theme was “pain relief in the shade”. The categories were “responsibility versus ignorance”, “family caregiver as a barrier or facilitator”, and “newborn, sacrificed due to imbalanced context”. This study showed that professional caregivers managed pain on the margin of other cares. The effects of family care were identified as a paradox, helping, or disturbing. The participants also emphasized the impact of environmental disruptions on pain management.

Conclusion: The experiences of pain management in NICUs were identified at three levels of professional caregivers, family caregivers, and organizational atmosphere. Exploring this experience could help improve pain management and reduce its side effects in susceptible neonates. Hence, healthcare workers are recommended to ensure effective pain management in NICUs by ongoing monitoring and audit.

1. Lake SW. Barriers to Effective Pain Management in Preterm and Critically Ill Neonates: University of Kentucky UKnowledge, college of Nursing; 2013.
2. Verklan MT, Walden M. Core curriculum for neonatal intensive care nursing. Fifth ed: Elsevier Saunders; 2015: 316-330.
3. Nimbalkar AS, Dongara AR, Phatak AG, Nimbalkar SM. Knowledge and attitudes regarding neonatal pain among nursing staff of pediatric department: an Indian experience. Pain Management Nursing. 2014 Mar 1;15(1):69-75.
4. Martinez G. Factors that Influence Implementation of Pain Management Strategies in the Neonatal Intensive Care Unit: University of Central Florida; 2014.
5. Ontario RNao. Assessment and Management of Pain. Third ed. 2013.
6. Boxwell G. Neonatal intensive care nursing. 2nd ed. Routledge; 2010: 230-254.
7. Witt N, Coynor S, Edwards C, Bradshaw H. A guide to pain assessment and management in the neonate. Current emergency and hospital medicine reports. 2016 Mar 1;4(1):1-0.
8. Hall RW, Anand KJ. Pain management in newborns. Clinics in perinatology. 2014 Dec 1;41(4):895-924.
9. Jeong IS, Park SM, Lee JM, Choi YJ, Lee J. Perceptions on pain management among Korean nurses in neonatal intensive care units. Asian Nurs Res (Korean Soc Nurs Sci). 2014;8(4):261-6.
10. Cong X, Delaney C, Vazquez V. Neonatal nurses' perceptions of pain assessment and management in NICUs: a national survey. Adv Neonatal Care. 2013;13(5):353-60.
11. Mehrnoush N, Ashktorab T. Pain Management Perceptions of the Neonatal Nurses in NICUs and Neonatal Units in Ardebil, Iran. Iranian Journal of Neonatology IJN. 2016;7(4):23-9.
12. Tarjoman A, Vasigh A, Safari S, Borji M. Pain management in neonatal intensive care units: A cross sectional study of neonatal nurses in Ilam City. Journal of Neonatal Nursing. 2019;25(3):136-8.
13. Aziznejadroshan P, Alhani F, Mohammadi E. Challenges and Practical Solutions for Pain Management Nursing in ‎Pediatric Wards ‎. Babol-Jbums. 2015;17(12):57-64.
14. Mehrnoush N, Ashktorab T, Heidarzadeh M, Momenzadeh S, Khalafi J. Factors Influencing Neonatal Pain Management from the Perspectives of Nurses and Physicians in a Neonatal Intensive Care Unit: A Qualitative Study. Iranian Journal of Pediatrics. 2018;28(1).
15. Mohamadamini Z, Namnabati M, Marofi M, Barekatein B. Four components of pain management in Iranian neonatal Intensive Care Units: The nurses’ and physicians’ viewpoint. Journal of education and health promotion. 2017;6.
16. Polit DF, Beck CT. Nursing research: Generating and assessing evidence for nursing practice. Ninth ed: Lippincott Williams & Wilkins; 2012: 486-601
17. Elo S, Kyngäs H. The qualitative content analysis process. Journal of advanced nursing. 2008;62(1):107-15.
18. Elo S, Kääriäinen M, Kanste O, Pölkki T, Utriainen K, Kyngäs H. Qualitative content analysis: A focus on trustworthiness. SAGE open. 2014;4(1):2158244014522633.
19. Waltz CF, Strickland OL, Lenz ER. Measurement in nursing and health research. Fourth ed: Springer Publishing Company; 2010: 228.
20. Mehrnoush N, Ashktorab T, Heidarzadeh M, Momenzadeh S. Knowledge and Attitude of Personnel, Key Factors in Implementation of Neonatal Pain Management in NICU: A Qualitative Study. Journal of Clinical and Diagnostic Research. 2017;11(11):5-9.
21. Dequeker S, Van Lancker A, Van Hecke A. Hospitalized patients’ vs. nurses’ assessments of pain intensity and barriers to pain management. Journal of advanced nursing. 2018;74(1):160-71.
22. Byrd PJ, Gonzales I, Parsons V. Exploring barriers to pain management in newborn intensive care units: a pilot survey of NICU nurses. Advances in Neonatal Care. 2009;9(6):299-306.
23. Akuma AO, Jordan S. Pain management in neonates: a survey of nurses and doctors. Journal of advanced nursing. 2012;68(6):1288-301.
24. Wilson D, Wong DL, Hockenberry MJ. Wong's nursing Care of Infants and Children: Mosby/Elsevier; 2011: 8
25. Gibbins S. Pain Management: What is the Role of the Parent. Newborn and Infant Nursing Reviews. 2008;8(3):116-7.
26. Marfurt-Russenberger K, Axelin A, Kesselring A, Franck LS, Cignacco E. The experiences of professionals regarding involvement of parents in neonatal pain management. Journal of Obstetric, Gynecologic & Neonatal Nursing. 2016;45(5):671-83.
27. Mirlashari J, Brown H, Fomani FK, de Salaberry J, Zadeh TK, Khoshkhou F. The challenges of implementing family-centered care in NICU from the perspectives of physicians and nurses. Journal of pediatric nursing. 2019.
28. Shirazi ZH, Sharif F, Rakhshan M, Pishva N, Jahanpour F. The Obstacles against Nurse-Family Communication in Family-Centered Care in Neonatal Intensive Care Unit: a Qualitative Study. Journal of caring sciences. 2015;4(3):207.
29. Carbajal R, Rousset A, Danan C, Coquery S, Nolent P, Ducrocq S, et al. Epidemiology and treatment of painful procedures in neonates in intensive care units. Jama. 2008;300(1):60-70.
30. Soltanian M, Molazem Z, Mohammadi E, et al. Professional responsibility: an ethical concept extracted from practices of Iranian nurses during drug administration. International Journal of Pharmaceutical Research. 2018;10(3):346-53.
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IssueVol 7 No 3 (2020): Summer QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/npt.v7i3.3349
Keywords
pain management; neonatal intensive care unit; content analysis
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How to Cite
1.
Hadian Shirazi Z, Soltanian M, Sabet Sarvestani R. Relief and care in the shade: A concept extracted from practices of neonatal nurses during pain management. NPT. 2020;7(3):208-216.