1. Beal, Judy A. DNSc, RN

Article Content

Latimer, M. A., Johnston, C. C., Ritchie, J. A., Clarke, S. P., & Gilin, D. (2009).Journal of Obstetric, Gynecologic, & Neonatal Nursing, 38(2), 182-194.

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Despite the plethora of evidence that neonates do experience pain and that exposure to painful interventions contributes to stress and negative short and long-term health outcomes, nurses continue to underestimate and under-treat neonatal pain. Several neonatal pain management protocols and guidelines have been developed and integrated into hospital accreditation reviews. The authors of this study wondered if there were organizational barriers to nurses using their knowledge about neonatal pain. This well designed rigorous cross-sectional study examined the effects of factors influencing evidenced-based pain management by nurses in two Level III NICUs in two large Canadian tertiary care centers. It was posited that there is a relationship between the knowledge, education, and experience of the nurse, the age and acuity of the neonate, and the organizational factors of information, resources, and opportunity. A convenience sample of 93 RNs who performed 170 tissue-damaging neonatal procedures was obtained. All of the nurses spoke English and worked at least half-time in the unit for at least 6 months. Chart data were collected from neonates who were at least 28 weeks gestation and who had experienced the following procedures performed or assisted by a nurse: heel lance, arterial and intravenous access, lumbar puncture, oral/nasal/endotracheal suctioning, wound care, and chest tube insertion. In both settings, there was no difference in the educational level of the nurses and all nurses scored moderately high on their knowledge of pain care with some gaps in knowledge in assessment of facial pain expression and frequency of pain medication administration. There were no major significant differences among infant acuity in the settings. The most interesting and significant finding was that when nurses perceived that nurse-physician collaboration was higher, they were more likely to perform evidence-based procedural pain management. Also interesting (and conflicting with previous work) nurses who cared for more acutely ill neonates also provided more evidence-based care. Reassuring was the finding that when the nurses were busier, as measured by increases in patient assignment, they were also more likely to use evidence to guide their pain care. The authors concluded that in collaborative work-settings where information is regularly exchanged between physicians and nurses, that neonatal pain is more effectively managed. What a call to action for us all!!