Influence of risk of neurological impairment and procedure invasiveness on health professionals' management of procedural pain in neonates

Bonnie Stevens; Patrick McGrath; Marilyn Ballantyne; Janet Yamada; Annie Dupuis; Sharyn Gibbins; Linda Franck; G. Allen Finley; Alexandra Howlett; Celeste Johnston; Karel O'Brien; Arne Ohlsson

doi:10.1016/j.ejpain.2009.11.016

Influence of risk of neurological impairment and procedure invasiveness on health professionals' management of procedural pain in neonates

Bonnie Stevens, Patrick McGrath, Marilyn Ballantyne, Janet Yamada, Annie Dupuis, Sharyn Gibbins, Linda Franck, G. Allen Finley, Alexandra Howlett, Celeste Johnston, Karel O'Brien, Arne Ohlsson

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22 Citas (Scopus)

Resumen

Objectives: To describe how (i) risk of neurological impairment (NI) and (ii) procedure invasiveness influence health professionals' assessment and management of procedural pain in neonates in the Neonatal Intensive Care Unit (NICU). Design: Prospective observational study. Setting: Three tertiary level NICUs in Canada. Participants: 114 neonates, 25-40 weeks gestational age (GA) undergoing painful procedures. Main Outcome Measures: Physical and behavioural pain indicators and pharmacological and nonpharmacological pain interventions. Results: 114 neonates at high (Cohort A, n = 35), moderate (Cohort B, n = 25) and low (Cohort C, n = 54) risk of NI were observed during 254 painful procedures performed by 147 health professionals. Physical pain indicators were used more frequently by health professionals to assess pain with Cohorts A and B than C (p < .05). Behavioural pain indicators were used similarly across Cohorts. Nonpharmacological interventions were implemented most frequently for pain management. Physical interventions were used with 84% of procedures across Cohorts; particularly for the most invasive procedures. Infants with the highest NI risk (Cohort A) received the most behavioural interventions (p < .05) irrespective of procedural invasiveness. Pharmacological interventions were implemented with 23.2% of procedures; Cohort B received pharmacological interventions most frequently (Cohort B > A, B > C, p < .05) and for increasingly invasive procedures (p < .05). Conclusions: Health professionals use multidimensional indicators to assess neonatal pain. Nonpharmacological interventions dominate pain management. NI risk status and procedure invasiveness are important contextual factors in neonatal pain assessment and management.

Idioma original	English
Páginas (desde-hasta)	735-741
Número de páginas	7
Publicación	European Journal of Pain
Volumen	14
N.º	7
DOI	https://doi.org/10.1016/j.ejpain.2009.11.016
Estado	Published - ago. 2010
Publicado de forma externa	Sí

Nota bibliográfica

Funding Information:
This study was funded by a grant from the Canadian Institutes of Health Research ( MCT 63143 ). Dr. Stevens is funded by the Signy Hildur Eaton Chair in Pediatric Nursing Research at The Hospital for Sick Children. Dr. Patrick McGrath is a Canada Research Chair in Pediatric Pain. Marilyn Ballantyne and Janet Yamada are supported by a Canadian Institutes of Health PhD Research Fellowships . We also wish to acknowledge Joseph Beyene, Lynn Breau, Carol Camfield, and Patricia McKeever, Co-Investigators on this study, the staff at The Hospital for Sick Children, IWK Health Centre and Mount Sinai Hospital and parents of participating infants for enabling us to perform the study. Thank you also to Kim Caddell, Janet Narciso, Lucy Celetti, Felice Pettolino, and Annie Singh for data collection; Jasmine Lamba, Alison Dickson, Tricia Kavanagh, and Christine Chan for coding and data entry.

ASJC Scopus Subject Areas

Anesthesiology and Pain Medicine

PubMed: MeSH publication types

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

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10.1016/j.ejpain.2009.11.016

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Stevens, B., McGrath, P., Ballantyne, M., Yamada, J., Dupuis, A., Gibbins, S., Franck, L., Allen Finley, G., Howlett, A., Johnston, C., O'Brien, K., & Ohlsson, A. (2010). Influence of risk of neurological impairment and procedure invasiveness on health professionals' management of procedural pain in neonates. European Journal of Pain, 14(7), 735-741. https://doi.org/10.1016/j.ejpain.2009.11.016

Stevens, B, McGrath, P, Ballantyne, M, Yamada, J, Dupuis, A, Gibbins, S, Franck, L, Allen Finley, G, Howlett, A, Johnston, C, O'Brien, K & Ohlsson, A 2010, 'Influence of risk of neurological impairment and procedure invasiveness on health professionals' management of procedural pain in neonates', European Journal of Pain, vol. 14, n.º 7, pp. 735-741. https://doi.org/10.1016/j.ejpain.2009.11.016

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abstract = "Objectives: To describe how (i) risk of neurological impairment (NI) and (ii) procedure invasiveness influence health professionals' assessment and management of procedural pain in neonates in the Neonatal Intensive Care Unit (NICU). Design: Prospective observational study. Setting: Three tertiary level NICUs in Canada. Participants: 114 neonates, 25-40 weeks gestational age (GA) undergoing painful procedures. Main Outcome Measures: Physical and behavioural pain indicators and pharmacological and nonpharmacological pain interventions. Results: 114 neonates at high (Cohort A, n = 35), moderate (Cohort B, n = 25) and low (Cohort C, n = 54) risk of NI were observed during 254 painful procedures performed by 147 health professionals. Physical pain indicators were used more frequently by health professionals to assess pain with Cohorts A and B than C (p < .05). Behavioural pain indicators were used similarly across Cohorts. Nonpharmacological interventions were implemented most frequently for pain management. Physical interventions were used with 84% of procedures across Cohorts; particularly for the most invasive procedures. Infants with the highest NI risk (Cohort A) received the most behavioural interventions (p < .05) irrespective of procedural invasiveness. Pharmacological interventions were implemented with 23.2% of procedures; Cohort B received pharmacological interventions most frequently (Cohort B > A, B > C, p < .05) and for increasingly invasive procedures (p < .05). Conclusions: Health professionals use multidimensional indicators to assess neonatal pain. Nonpharmacological interventions dominate pain management. NI risk status and procedure invasiveness are important contextual factors in neonatal pain assessment and management.",

author = "Bonnie Stevens and Patrick McGrath and Marilyn Ballantyne and Janet Yamada and Annie Dupuis and Sharyn Gibbins and Linda Franck and {Allen Finley}, G. and Alexandra Howlett and Celeste Johnston and Karel O'Brien and Arne Ohlsson",

note = "Funding Information: This study was funded by a grant from the Canadian Institutes of Health Research ( MCT 63143 ). Dr. Stevens is funded by the Signy Hildur Eaton Chair in Pediatric Nursing Research at The Hospital for Sick Children. Dr. Patrick McGrath is a Canada Research Chair in Pediatric Pain. Marilyn Ballantyne and Janet Yamada are supported by a Canadian Institutes of Health PhD Research Fellowships . We also wish to acknowledge Joseph Beyene, Lynn Breau, Carol Camfield, and Patricia McKeever, Co-Investigators on this study, the staff at The Hospital for Sick Children, IWK Health Centre and Mount Sinai Hospital and parents of participating infants for enabling us to perform the study. Thank you also to Kim Caddell, Janet Narciso, Lucy Celetti, Felice Pettolino, and Annie Singh for data collection; Jasmine Lamba, Alison Dickson, Tricia Kavanagh, and Christine Chan for coding and data entry.",

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AU - Stevens, Bonnie

AU - McGrath, Patrick

AU - Ballantyne, Marilyn

AU - Yamada, Janet

AU - Dupuis, Annie

AU - Gibbins, Sharyn

AU - Franck, Linda

AU - Allen Finley, G.

AU - Howlett, Alexandra

AU - Johnston, Celeste

AU - O'Brien, Karel

AU - Ohlsson, Arne

N1 - Funding Information: This study was funded by a grant from the Canadian Institutes of Health Research ( MCT 63143 ). Dr. Stevens is funded by the Signy Hildur Eaton Chair in Pediatric Nursing Research at The Hospital for Sick Children. Dr. Patrick McGrath is a Canada Research Chair in Pediatric Pain. Marilyn Ballantyne and Janet Yamada are supported by a Canadian Institutes of Health PhD Research Fellowships . We also wish to acknowledge Joseph Beyene, Lynn Breau, Carol Camfield, and Patricia McKeever, Co-Investigators on this study, the staff at The Hospital for Sick Children, IWK Health Centre and Mount Sinai Hospital and parents of participating infants for enabling us to perform the study. Thank you also to Kim Caddell, Janet Narciso, Lucy Celetti, Felice Pettolino, and Annie Singh for data collection; Jasmine Lamba, Alison Dickson, Tricia Kavanagh, and Christine Chan for coding and data entry.

PY - 2010/8

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N2 - Objectives: To describe how (i) risk of neurological impairment (NI) and (ii) procedure invasiveness influence health professionals' assessment and management of procedural pain in neonates in the Neonatal Intensive Care Unit (NICU). Design: Prospective observational study. Setting: Three tertiary level NICUs in Canada. Participants: 114 neonates, 25-40 weeks gestational age (GA) undergoing painful procedures. Main Outcome Measures: Physical and behavioural pain indicators and pharmacological and nonpharmacological pain interventions. Results: 114 neonates at high (Cohort A, n = 35), moderate (Cohort B, n = 25) and low (Cohort C, n = 54) risk of NI were observed during 254 painful procedures performed by 147 health professionals. Physical pain indicators were used more frequently by health professionals to assess pain with Cohorts A and B than C (p < .05). Behavioural pain indicators were used similarly across Cohorts. Nonpharmacological interventions were implemented most frequently for pain management. Physical interventions were used with 84% of procedures across Cohorts; particularly for the most invasive procedures. Infants with the highest NI risk (Cohort A) received the most behavioural interventions (p < .05) irrespective of procedural invasiveness. Pharmacological interventions were implemented with 23.2% of procedures; Cohort B received pharmacological interventions most frequently (Cohort B > A, B > C, p < .05) and for increasingly invasive procedures (p < .05). Conclusions: Health professionals use multidimensional indicators to assess neonatal pain. Nonpharmacological interventions dominate pain management. NI risk status and procedure invasiveness are important contextual factors in neonatal pain assessment and management.

AB - Objectives: To describe how (i) risk of neurological impairment (NI) and (ii) procedure invasiveness influence health professionals' assessment and management of procedural pain in neonates in the Neonatal Intensive Care Unit (NICU). Design: Prospective observational study. Setting: Three tertiary level NICUs in Canada. Participants: 114 neonates, 25-40 weeks gestational age (GA) undergoing painful procedures. Main Outcome Measures: Physical and behavioural pain indicators and pharmacological and nonpharmacological pain interventions. Results: 114 neonates at high (Cohort A, n = 35), moderate (Cohort B, n = 25) and low (Cohort C, n = 54) risk of NI were observed during 254 painful procedures performed by 147 health professionals. Physical pain indicators were used more frequently by health professionals to assess pain with Cohorts A and B than C (p < .05). Behavioural pain indicators were used similarly across Cohorts. Nonpharmacological interventions were implemented most frequently for pain management. Physical interventions were used with 84% of procedures across Cohorts; particularly for the most invasive procedures. Infants with the highest NI risk (Cohort A) received the most behavioural interventions (p < .05) irrespective of procedural invasiveness. Pharmacological interventions were implemented with 23.2% of procedures; Cohort B received pharmacological interventions most frequently (Cohort B > A, B > C, p < .05) and for increasingly invasive procedures (p < .05). Conclusions: Health professionals use multidimensional indicators to assess neonatal pain. Nonpharmacological interventions dominate pain management. NI risk status and procedure invasiveness are important contextual factors in neonatal pain assessment and management.

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Influence of risk of neurological impairment and procedure invasiveness on health professionals' management of procedural pain in neonates

Resumen

Nota bibliográfica

ASJC Scopus Subject Areas

PubMed: MeSH publication types

Acceder al documento

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