NEONATAL PAIN MANAGEMENT PRACTICES AMONG NURSES WORKING IN NEWBORN UNITS IN NYANZA AND WESTERN KENYA

  • Teresa Kerubo Okiri Masinde Muliro University of Science and Technology Kenya
  • Mary Kipmerewo Masinde Muliro University of Science and Technology Kenya
  • Beatrice Mukabana Masinde Muliro University of Science and Technology Kenya
Keywords: Neonate, Neonatal pain, Nurses, Knowledge, Perception

Abstract

Background: Newborn babies in the Neonatal Intensive Care Units (NICU) and Newborn Units (NBUs) undergo several procedures that cause a significant amount of pain. Nurses play an essential role in the implementation of pain assessment and management measures in neonates. However, while it remains widely known that nurses play an important role in neonatal pain management, nurses’ practices on the management of pain in neonates admitted in Newborn care units have not been widely published within the nursing science. Objectives: To evaluate neonatal pain management practices among nurses working in newborn units in Nyanza and Western Kenya. Methods: A descriptive cross-sectional study using qualitative and quantitative approaches was used targeting 89 nurses. The collection of data was done through semi-structured, self-administered questionnaires with both closed and open –ended questions. Qualitative data was collected through in-depth interviews. Data obtained was analyzed using the statistical package for social science (SPSS) version 22.0 software. The study assumed a confidence level of 95% and a (p) value equal to or less than 0.05 was considered significant. Qualitative data was analyzed through logic checks to understand the emerging themes. Descriptive statistical analysis was done using frequencies, percentage and means. Results: The study established that a small percentage of the nurses practiced pain management in neonates through use of non-pharmacologic (34.8%) and pharmacologic (28.1%) strategies. The commonly used non-pharmacologic strategies include changing of nappies (71.9%) and repositioning (68.5). Pain assessment was however seldom done. Conclusion: Following the results, the study concluded that nurses practice pain management in neonates by implementing non-pharmacological and pharmacological strategies. The commonly used pain management strategy in neonates is utilization of non-pharmacological strategies such as change of nappies repositioning and kangaroo mother care. However, gaps exist in knowledge and competency on neonatal pain management aspects and practice. The study therefore recommended enhancement of awareness on aspects of neonatal pain among nurses to facilitate improved pain management practices in neonates. Further strengthening of nurses’ knowledge and skills on pain management in neonates through attending scheduled short courses, workshops and on job training is recommended.  

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References

American Academy of Pediatrics. (2017). Prevention and Management of Pain in the Neonate : An Update. Pediatrics, 118(5). https://doi.org/10.1542/peds.2006-2277

Avila-Alvarez, A., Carbajal, R., Courtois, E., Pertega-Diaz, S., Anand, K. J. S., & Muñiz-Garcia, J. (2016). Clinical assessment of pain in Spanish Neonatal Intensive Care Units. Anales de Pediatría (English Edition), 85(4), 181–188. https://doi.org/10.1016/j.anpede.2015.09.038

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Brummelte, S., Grunau, R. E., Chau, V., Poskitt, K. J., Brant, R., Vinall, J., Gover, A., Synnes, A. R., & Miller, S. P. (2012). Procedural Pain and Brain Development in Premature Newborns. https://doi.org/10.1002/ana.22267

Carlsen Misic, M., Andersen, R. D., Strand, S., Eriksson, M., & Olsson, E. (2021). Nurses’ perception, knowledge, and use of neonatal pain assessment. Paediatric and Neonatal Pain, 3(2), 59–65. https://doi.org/10.1002/pne2.12050

Costa, T., Rossato, L. M., Bueno, M., Secco, I. L., Sposito, N. P. B., Harrison, D., & de Freitas, J. S. (2017). Nurses’ knowledge and practices regarding pain management in newborns. Revista Da Escola de Enfermagem, 51, 1–7. https://doi.org/10.1590/S1980-220X2016034403210

Gursul, D., Hartley, C., & Slater, R. (2019). Nociception and the neonatal brain. Seminars in Fetal and Neonatal Medicine, 24(4), 101016. https://doi.org/10.1016/j.siny.2019.05.008

Hall, W Richard, K. J. S. A. (2015). NIH Public Access. 41(4), 895–924. https://doi.org/10.1016/j.clp.2014.08.010.Pain

Hanna Popowicz, Wioletta Medrzycka-Dabrowska, Kwiecie, Katarzyna, A. K. (2021). Knowledge and Practices in Neonatal Pain Management of Nurses Employed in Hospitals with Different Levels of. Healthcare, 9(48).

Hoarau, K., Payet, M. L., Zamidio, L., Bonsante, F., & Iacobelli, S. (2021). “Holding–Cuddling” and Sucrose for Pain Relief During Venepuncture in Newborn Infants: A Randomized, Controlled Trial (CÂSA). Frontiers in Pediatrics, 8(02803723). https://doi.org/10.3389/fped.2020.607900

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Mangat, A. K., Oei, J., Chen, K., Quah-smith, I., & Schmölzer, G. M. (2018). A Review of Non-Pharmacological Treatments for Pain Management in Newborn Infants. Children, 5, 1–12. https://doi.org/10.3390/children5100130

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Muteteli, C., Tengera, O., & Gowan, M. (2019b). Neonatal pain management among nurses and midwives at two Kigali hospitals Neonatal Pain Management among Nurses and Midwives at Two Kigali Hospitals. June 2021. https://doi.org/10.4314/rjmhs.v2i2.9

Pediatric Association Of Anesthesists. (2012). Pediatric Anesthesia Pediatric Anesthesia (Vol. 22, Issue July).

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Rocha VA, Silvada Silveira Cruz-Machado SMachado S, B. M. (2021). Painful procedures and pain management in newborns admitted to an intensive care unit *. Rev Esc Enferm USP, 55, 1–9.

Roga, E. Y., Bulto, G. A., Moti, B. E., Demisse, G. A., & Ejeta, M. T. (2023). Low neonatal pain management practices and associated factors among nurses and midwives working in governmental hospitals of central Ethiopia, 2021. Journal of Neonatal Nursing. https://doi.org/https://doi.org/10.1016/j.jnn.2023.02.007

Shiff, I., Bucsea, O., & Riddell, R. P. (2021). Psychosocial and Neurobiological Vulnerabilities of the Hospitalized Preterm Infant and Relevant Non-pharmacological Pain Mitigation Strategies. 9(October), 1–10. https://doi.org/10.3389/fped.2021.568755

Suleiman, Z. A., Kolawole, I. K., Adegboye, K. A., & Adeboye, M. A. (2019). Analgesia for procedural pain : Current practice among Nigerian paediatricians. 13(1), 13–18. https://doi.org/10.4103/phmj.phmj

Victoria, N. C., & Murphy, A. Z. (2017). Exposure to Early Life Pain: Long Term Consequences and Contributing Mechanisms. 61–68. https://doi.org/10.1016/j.cobeha.2015.11.015.Exposure

Wade, C., Frazer, J. S., Qian, E., Davidson, L. M., Dash, S., te Water Naudé, A., Ramakrishan, R., Aluvaala, J., Lakhoo, K., & English, M. (2020). Development of locally relevant clinical guidelines for procedure-related neonatal analgesic practice in Kenya: a systematic review and meta-analysis. The Lancet Child and Adolescent Health, 4(10), 750–760. https://doi.org/10.1016/S2352-4642(20)30182-6

Walker, S. M. (2019). Seminars in Fetal and Neonatal Medicine Long-term effects of neonatal pain. Seminars in Fetal and Neonatal Medicine, 24(4), 101005. https://doi.org/10.1016/j.siny.2019.04.005

Wari, G. (2021). Knowledge and Practice of Nurses and Associated Factors in Managing Neonatal Pain at Selected Public Hospitals in Addis Ababa , Ethiopia , 2020. 2275–2286.

Williams, M. D., & Lascelles, B. D. X. (2020). Early Neonatal Pain — A Review of Clinical and Experimental Implications on Painful Conditions Later in Life. 8(February). https://doi.org/10.3389/fped.2020.00030

American Academy of Pediatrics. (2017). Prevention and Management of Pain in the Neonate : An Update. Pediatrics, 118(5). https://doi.org/10.1542/peds.2006-2277 DOI: https://doi.org/10.1542/peds.2006-2277

Avila-Alvarez, A., Carbajal, R., Courtois, E., Pertega-Diaz, S., Anand, K. J. S., & Muñiz-Garcia, J. (2016). Clinical assessment of pain in Spanish Neonatal Intensive Care Units. Anales de Pediatría (English Edition), 85(4), 181–188. https://doi.org/10.1016/j.anpede.2015.09.038 DOI: https://doi.org/10.1016/j.anpede.2015.09.038

Bishop, B., & Bishop, B. (2020). ScholarWorks @ UARK An Extensive Literature Review on Neonatal Pain Assessment & Management.

Brummelte, S., Grunau, R. E., Chau, V., Poskitt, K. J., Brant, R., Vinall, J., Gover, A., Synnes, A. R., & Miller, S. P. (2012). Procedural Pain and Brain Development in Premature Newborns. https://doi.org/10.1002/ana.22267 DOI: https://doi.org/10.1002/ana.22267

Carlsen Misic, M., Andersen, R. D., Strand, S., Eriksson, M., & Olsson, E. (2021). Nurses’ perception, knowledge, and use of neonatal pain assessment. Paediatric and Neonatal Pain, 3(2), 59–65. https://doi.org/10.1002/pne2.12050 DOI: https://doi.org/10.1002/pne2.12050

Costa, T., Rossato, L. M., Bueno, M., Secco, I. L., Sposito, N. P. B., Harrison, D., & de Freitas, J. S. (2017). Nurses’ knowledge and practices regarding pain management in newborns. Revista Da Escola de Enfermagem, 51, 1–7. https://doi.org/10.1590/S1980-220X2016034403210 DOI: https://doi.org/10.1590/s1980-220x2016034403210

Gursul, D., Hartley, C., & Slater, R. (2019). Nociception and the neonatal brain. Seminars in Fetal and Neonatal Medicine, 24(4), 101016. https://doi.org/10.1016/j.siny.2019.05.008 DOI: https://doi.org/10.1016/j.siny.2019.05.008

Hall, W Richard, K. J. S. A. (2015). NIH Public Access. 41(4), 895–924. https://doi.org/10.1016/j.clp.2014.08.010.Pain DOI: https://doi.org/10.1016/j.clp.2014.08.010

Hanna Popowicz, Wioletta Medrzycka-Dabrowska, Kwiecie, Katarzyna, A. K. (2021). Knowledge and Practices in Neonatal Pain Management of Nurses Employed in Hospitals with Different Levels of. Healthcare, 9(48). DOI: https://doi.org/10.3390/healthcare9010048

Hoarau, K., Payet, M. L., Zamidio, L., Bonsante, F., & Iacobelli, S. (2021). “Holding–Cuddling” and Sucrose for Pain Relief During Venepuncture in Newborn Infants: A Randomized, Controlled Trial (CÂSA). Frontiers in Pediatrics, 8(02803723). https://doi.org/10.3389/fped.2020.607900 DOI: https://doi.org/10.3389/fped.2020.607900

Ishak, S., Nfe, F., Zakaria SZ, S., Adli, A., & Jaafar, R. (2019). Neonatal pain: Knowledge and perception among pediatric doctors in Malaysia. Pediatrics International, 61(1). https://doi.org/10.1111/ped.13724 DOI: https://doi.org/10.1111/ped.13724

Krowchuk, H. V. (2018). The Minimally Effective Dose of Sucrose for Procedural Pain Relief in Neonates: A Randomized Controlled Trial. MCN The American Journal of Maternal/Child Nursing, 43(5), 297. https://doi.org/10.1097/NMC.0000000000000457 DOI: https://doi.org/10.1097/NMC.0000000000000457

Liu, J., Fang, S., Wang, Y., Gao, L., Xin, T., & Liu, Y. (2022). The effectiveness of massage interventions on procedural pain in neonates: A systematic review and meta-analysis. Medicine (United States), 101(41), E30939. https://doi.org/10.1097/MD.0000000000030939 DOI: https://doi.org/10.1097/MD.0000000000030939

Mangat, A. K., Oei, J., Chen, K., Quah-smith, I., & Schmölzer, G. M. (2018). A Review of Non-Pharmacological Treatments for Pain Management in Newborn Infants. Children, 5, 1–12. https://doi.org/10.3390/children5100130 DOI: https://doi.org/10.3390/children5100130

Muteteli, C., Tengera, O., & Gowan, M. (2019a). Neonatal Pain Management among Nurses and Midwives at Two Kigali Hospitals. 2(2), 138–146.

Muteteli, C., Tengera, O., & Gowan, M. (2019b). Neonatal pain management among nurses and midwives at two Kigali hospitals Neonatal Pain Management among Nurses and Midwives at Two Kigali Hospitals. June 2021. https://doi.org/10.4314/rjmhs.v2i2.9 DOI: https://doi.org/10.4314/rjmhs.v2i2.9

Pediatric Association Of Anesthesists. (2012). Pediatric Anesthesia Pediatric Anesthesia (Vol. 22, Issue July).

Perry, M., Road, G., Chen, J., Xu, W., & Cong, X. S. (2019). Neonatal Pain: Perceptions and Current Practice. Crit Care Nurs Clin North Am., 30(4), 549–561. https://doi.org/10.1016/j.cnc.2018.07.013.Neonatal DOI: https://doi.org/10.1016/j.cnc.2018.07.013

Rocha VA, Silvada Silveira Cruz-Machado SMachado S, B. M. (2021). Painful procedures and pain management in newborns admitted to an intensive care unit *. Rev Esc Enferm USP, 55, 1–9. DOI: https://doi.org/10.1590/1980-220x-reeusp-2021-0232

Roga, E. Y., Bulto, G. A., Moti, B. E., Demisse, G. A., & Ejeta, M. T. (2023). Low neonatal pain management practices and associated factors among nurses and midwives working in governmental hospitals of central Ethiopia, 2021. Journal of Neonatal Nursing. https://doi.org/https://doi.org/10.1016/j.jnn.2023.02.007 DOI: https://doi.org/10.1016/j.jnn.2023.02.007

Shiff, I., Bucsea, O., & Riddell, R. P. (2021). Psychosocial and Neurobiological Vulnerabilities of the Hospitalized Preterm Infant and Relevant Non-pharmacological Pain Mitigation Strategies. 9(October), 1–10. https://doi.org/10.3389/fped.2021.568755 DOI: https://doi.org/10.3389/fped.2021.568755

Suleiman, Z. A., Kolawole, I. K., Adegboye, K. A., & Adeboye, M. A. (2019). Analgesia for procedural pain : Current practice among Nigerian paediatricians. 13(1), 13–18. https://doi.org/10.4103/phmj.phmj DOI: https://doi.org/10.4103/phmj.phmj_3_19

Victoria, N. C., & Murphy, A. Z. (2017). Exposure to Early Life Pain: Long Term Consequences and Contributing Mechanisms. 61–68. https://doi.org/10.1016/j.cobeha.2015.11.015.Exposure DOI: https://doi.org/10.1016/j.cobeha.2015.11.015

Wade, C., Frazer, J. S., Qian, E., Davidson, L. M., Dash, S., te Water Naudé, A., Ramakrishan, R., Aluvaala, J., Lakhoo, K., & English, M. (2020). Development of locally relevant clinical guidelines for procedure-related neonatal analgesic practice in Kenya: a systematic review and meta-analysis. The Lancet Child and Adolescent Health, 4(10), 750–760. https://doi.org/10.1016/S2352-4642(20)30182-6 DOI: https://doi.org/10.1016/S2352-4642(20)30182-6

Walker, S. M. (2019). Seminars in Fetal and Neonatal Medicine Long-term effects of neonatal pain. Seminars in Fetal and Neonatal Medicine, 24(4), 101005. https://doi.org/10.1016/j.siny.2019.04.005 DOI: https://doi.org/10.1016/j.siny.2019.04.005

Wari, G. (2021). Knowledge and Practice of Nurses and Associated Factors in Managing Neonatal Pain at Selected Public Hospitals in Addis Ababa , Ethiopia , 2020. 2275–2286. DOI: https://doi.org/10.2147/JMDH.S322903

Williams, M. D., & Lascelles, B. D. X. (2020). Early Neonatal Pain — A Review of Clinical and Experimental Implications on Painful Conditions Later in Life. 8(February). https://doi.org/10.3389/fped.2020.00030 DOI: https://doi.org/10.3389/fped.2020.00030

Published
2023-12-21
How to Cite
Okiri, T. K., Kipmerewo, M., & Mukabana, B. (2023). NEONATAL PAIN MANAGEMENT PRACTICES AMONG NURSES WORKING IN NEWBORN UNITS IN NYANZA AND WESTERN KENYA. Nurse and Health: Jurnal Keperawatan, 12(2), 252-264. https://doi.org/10.36720/nhjk.v12i2.599
Section
Original Research Article
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