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العنوان
Assessment of Nurses’ Performance Related to Neonatal Pain in Different Nursing Procedures /
المؤلف
Abd El-Moniem, Nourhan Mohamed.
هيئة الاعداد
باحث / نورهان محمد عبد المنعم محمد
مشرف / إيمان إبراهيم عبد المنعم
مشرف / فاطمة محمد محمد
تاريخ النشر
2021.
عدد الصفحات
204 p. :
اللغة
الإنجليزية
الدرجة
ماجستير
التخصص
طب الأطفال
تاريخ الإجازة
1/1/2021
مكان الإجازة
جامعة عين شمس - كلية التمريض - تمريض الأطفال
الفهرس
Only 14 pages are availabe for public view

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from 204

Abstract

Neonates cannot verbally communicate their discomfort, however evidence suggests that neonates do experience pain but lack the adaptive mechanisms that modulate painful stimuli in older children. They express their vulnerability to pain and stress through specific behaviors and with physiological and biochemical responses to pain (Anand et al., 2017).
Neonates are frequently exposed to acute, repetitive, and chronic pain within the NICU setting because of procedures, surgeries, and disease processes. Preterm neonates, especially those <30 weeks’ gestation, are exposed to 10-15 painful procedures per day at a time when pain is developmentally unexpected (Ranger & Grunau, 2014).
Prevention of pain in neonates is an expectation of parents. However, there are major gaps in our knowledge regarding the most effective way to accomplish this. Although it may not be possible to completely eliminate pain in neonates, much can be done to reduce the amount and intensity of pain. The prevention of pain is important not only because it is an ethical expectation but also because repeated painful exposures can have deleterious consequences. These consequences include altered pain sensitivity (which may last into adolescence) and permanent neuroanatomical and behavioral abnormalities. It seems that altered pain sensitivity can be ameliorated if effective pain relief is provided (Radwan et al., 2014).
Therapeutic approaches reducing invasive procedures and using pharmacologic, behavioral, or environmental measures are used to manage neonatal pain. Non pharmacologic approaches like kangaroo care, facilitated tucking, non-nutritive sucking, sucrose, and others can be used for procedural pain (Morton et al., 2016).
Aim of the study
The aim of this study is to assess nurses’ performance related to neonatal pain in different nursing procedures.
Research Question:
1. What are nurses’ knowledge regarding neonatal pain?
2. What are measures undertaken by nurses to relieve neonatal pain?
Research Design:
A descriptive-analytical design used to conduct this study.
Setting:
This study was conducted at the NICU affiliated to Benha Children Hospital affiliated to Specialized Medical Centers.
Subjects:
A purposive sample composed of 100 nurses who working in the previously mentioned setting were invited to participate in this study regardless of their age, sex, experience, level of education and position. Also all available neonates admitted to the NICU during the study period were included in the study regardless of their gestational age.
Data collection tools:
The following tools used to collect the needed data for the current study:
Pre-designed Questionnaire Sheet: it was designed in the simple Arabic language by the researcher after reviewing the relevant literature. It was consisted of two parts:
Part I: it was concerned with the concerned with nurses’ characteristics such as, gender, level of education, marital status, residence, years of experience and attending training related to neonates pain management.
Part II: it was related to nurses’ knowledge regarding pain management practices such as swaddling, nonnutritive sucking, oral sweet solution, skin to skin contact.

Scoring system:
According to the response obtained from nurses, a scoring system was follow to assessed nurses knowledge each question scored one (1) for correct answer, and each incorrect answer scored zero (0). These scores were convert dinto a percent as the following:
• Score <50% referred to poor level of knowledge.
• Score from 50% to 75 % referred to average level of knowledge.
• Score from 75% to 100 % referred to good level of knowledge
Covers Pain Assessment Scale: it was adopted from (Hand et al., 2010) and was used to assess nurses’ practice in relation to non-pharmacological management of neonatal pain associated with daily routine care such as swaddling, nonnutritive sucking, oral sweet solution, skin to skin contact.
Scoring system:
A checklist of nurses’ pain management practices composed of (6 items) with total score ranging from 0 -10 and examined the modality and type of interventions for pain relief; nurses’ knowledge in pain management (26 true/false questions) scoring from 0 -26; the right step will score one (1) and the wrong step will scored zero (0). These scores will converted into a percent as the following:
• < 85% incompetent practice.
• >85% competent practice.
Neonates’ Assessment Sheet: this tool designed by the researcher to collect data about:
• Characteristics of the studied neonates including; gender, gestational age and the child’s ranking.
• Diagnosis and hospital length of stay.
Operational Design
Preparatory phase:
The researcher reviewed the related literature and using books, articles, journals and related studies to be acquainted with the researcher problem and to develop the study tools.
Ethical consideration:
Approval obtained from the ethical committee of the Faculty of Nursing at Ain Shams University to conduct this study. The researcher explained the study aim in a simple and clear manner to be understood by eligible nurses. Each nurse obtained verbal consent before collecting any data. Nurses informed about their right to withdraw from the study at any time without giving any reason. Data were considered confidential and not be used outside this study without nurses approval.
Face and content validity:
The tools were tested and evaluated for their face and content validity, by a jury group consists of five experts in the field of pediatric nursing to test the content validity and modifications of the tools done according to the panel judgment on the clarity of sentences, appropriateness of content and sequence of items.
Reliability:
The reliability of the study tools assessed by measuring their internal consisted of Cronbach’s Alpha coefficient test (0.92).
Pilot study:
The pilot study included 10% of the study subjects fulfilling the previously mentioned criteria; it was conducted to evaluate the simplicity, practicability, legibility, understandability, feasibility of the tool, it was also used to find the possible problems that might face the researcher and interfere with data collection to estimate the time needed to fill in the sheets, this turned to be about 20-30 minutes. According to the results of the pilot study, the necessary modifications in which some items omitted and added. Those who shared in the pilot study were not included in the main study nurses.
Fieldwork:
Once permission granted to proceed with the study, actual data collection carried out in the period from September 2019 to December 2019. The researcher visited the study settings and met with nurses who were working in the previously mentioned setting. The purpose of the study explained to nurses. The researcher started the interview with each nurse individually using the data collection tools. The researcher explained the aim of the study and the expected outcome. Nurses were asked and fulfill the study tools by themselves. The time consumed to fill out the full study tools ranged from 20 to 30 minutes for one questionnaire, the researcher was available two days /week (Sunday/ Wednesday) in morning shift (from 8 A.M - 2 P.M) in previously mentioned setting. Data collection lasted for 3 months.
Administrative Design
An official letter requesting permission to conduct the study submitted from the Dean of Faculty of Nursing, Ain Shams University and obtained permission from the director of the NICU affiliated to Benha Children Hospital affiliated to Specialized Medical Centers to collect the data of the study.
Statistical Design
All Data collected, tabulated and subjected to statistical analysis. Statistical analysis is performed by SPSS in general (version 22), also Microsoft office Excel was used for data handling and graphical presentation. Quantitative variables described by the mean, standard deviation (SD), while qualitative categorical variables described by proportions and percentages.
The study was conducted at neonatal care unit of Benha children’s hospitals. The selected hospital are of the highest of nurses working at neonatal care units.
Results
More than half (51%) of studied nurses their age ranging between 25 to less than 35 years and the mean age of them is 32.12±1.56years and 77% of them were females. Regarding the level of education more than one third (39%) of nurses have diploma degree in nursing education Also, it is found that more than two third (68%) of studied nurses were from rural areas.
Almost half (47%) of studied nurses are married and (39%)of them are single
Almost half (41%) of studied nurses have more than 10 years of experience.
More than half (53%) of the studied nurses received training courses on nursing care for newborn babies. Regarding the useful of the training courses.
More than three quarters (81.1%) of studied nurses answer yes and the majority (97%) of studied nurses did not participate in newborns pain management.
Almost two thirds (60.4%) of the studied nurses received training courses at the hospital. (44%) of them their gestational age ranged between 32 < 34 week with mean 33.2± 1.1. Moreover nearly two thirds (62%) of them were delivered through normal delivery. Regarding the diagnosis of studied neonates more than half (58%) of the studied neonates were preterm and (30%) of them were ranked as the third child in the family.
More than half (58%) of the studied neonates were males and (42%) of them females (32%) and (30%) of the studied neonates ranked as a first and third child in their family (37%) of the studied nurses were disagree about concept of pain for the neonates, while (35%) of them were adequae knowledge and (28 %)of them were strongly agree about concept of pain for the neonates (38%) of the studied nurses were adequate knowledge about neonatal pain assessment, while (35%) of them were disagree and (29%) of them were strongly agree about neonatal pain assessment.
(42%) of the studied nurses were adequate about neonatal pain management, while (30%) of them were disagree and 28 % of them were strongly agree about neonatal pain management.
(35%) of the studied nurses were disagree about biochemical changes due to pain in neonates, while (33%) of them were adequate knowledge and (32 %) of them were strongly agree about biochemical changes due to pain in neonates.
(37%) of the studied nurses were disagree about physiological changes due to pain in neonates, while (34%) of them were adequate knowledge and (29 %) of them were strongly agree about physiological changes due to pain in neonates.
(38%) of the studied nurses were adequate knowledge about behavior changes due to pain in neonates, while (33%) of them were disagree and (29 %) of them were strongly agree about behavior changes due to pain in neonates.
(38%) of the studied nurses were adequate accept to child pain in different situations, while (32%) of them were disagree to child pain in different situations and (30 %) of them were strongly agree accept to child pain in different situations.
(36%) of the studied nurses were adequate agree about non-drug methods to relieve the child’s pain, while (34%) of them were disagree about non-drug methods to relieve the child’s pain and (30 %) of them were strongly agree about opinion about non-drug methods to relieve the child’s pain.
(42%) of the studied nurses were know the nursing procedure are very painful for neonates d, while (30%) of them were know the nursing procedure are painful for neonates and (28 %) of them were know the nursing procedure not painful for neonates.
(38%) of the studied nurses had average knowledge about neonatal pain, while (34%) of them had poor knowledge and (28%) of them had good knowledge about neonatal pain.
(70%) of the studied nurses incompetent practices regarding positioning to relieve neonatal pain during different nursing procedures.
(64%) of the studied nurse’s incompetent practices regarding touch technique to relieve neonatal pain during different nursing procedures.
(70%) of the studied nurse’s incompetent practices regarding distraction and heat to relieve neonatal pain during different nursing procedures.
(73%) of the studied nurse’s incompetent practices regarding pacifier/sweet solution (nonnutritive sucking) to relieve neonatal pain during different nursing procedures.
(62%) of the studied nurse’s incompetent practices regarding modification of environmental stimuli to relieve neonatal pain during different nursing procedures.
(64%) of the studied nurse’s incompetent practices regarding non pharmacologic pain management in routine care in neonates.
(68%) of the studied nurses were incompetent to relieve neonatal pain, while (32%) of them were competent to relieve neonatal pain.
There is strong positive correlation (r=0.71) between nurse’s knowledge scores and their practices score about neonatal pain and relieve neonatal pain.
Conclusion
The study concluded that majority of nurses have lack of knowledge and practices regarding pain management in NCUs. Generally, there was a limited use of a different non pharmacological measures used by nurses to relieve neonatal pain. But, gentle skin to skin touch and positioning the neonate in a proper body alignment were the most common non pharmacological measures they already know and actually done.
Therefore, it was recommended that:
Periodical and in-service training program for nurses working in NCUs about neonatal pain assessment should be conducted to improve their knowledge and practice.
On the light of the findings of the current study the following recommendations are suggested:
Periodical and in-service training programs for nurses working in NCUs about neonatal pain assessment and management should be conducted to improve their knowledge and practice. Regular meetings and effective communication between academics(medical/nursing staff) and the nurse in NICUs about neonatal pain management should be followed.
Nursing curriculum should contain the concepts related to pain its management especially in children in all ages. Guidelines for neonatal pain management should be followed and establishing a team to guide would be valuable. Care protocols for neonates should incorporate the principle of minimizing the number of painful procedures as much possible.
Only expert nurses should be allowed to carry out painful procedures. Nurses should use appropriate non pharmacological intervention to reduce or eliminate pain of neonates. Pain flow sheet should be included in the neonate’s nursing documentation and regularly revised as vital signs before and after procedures.
Further research is in needed to understand the detail of how and when to best apply these interventions.