Pain assessment and management in the NICU: analysis of an educational intervention for health professionals

Aymar, Carmen L.G. de; Lima, Luciane S. de; Santos, Cândida M.R. dos; Moreno, Emilly A.C.; Coutinho, Sônia B.

doi:10.1016/j.jped.2013.09.008

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Original articles • J. Pediatr. (Rio J.) 90 (02) • May-Jun 2014 • https://doi.org/10.1016/j.jped.2013.09.008 copy

Pain assessment and management in the NICU: analysis of an educational intervention for health professionals^☆ ☆ Please cite this article as: de Aymar CL, de Lima LS, dos Santos CM, Moreno EA, Coutinho SB. Pain assessment and management in the NICU: analysis of an educational intervention for health professionals. J Pediatr (Rio J). 2014;90:308-15. ,^☆☆ ☆☆ Study realized at Post-Graduation Program in Child and Adolescent Health, Universidade Federal de Pernambuco (UFPE), Recife, PE, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVE:

to study the perception of a Neonatal Intensive Care team on pain assessment and management before and after an educational intervention created and implemented in the unit.

METHODS:

intervention study developed as action research, in three phases. In Phase 1, a quantitative study was performed to identify how professionals perceive pain management in the unit. In Phase 2, an educational intervention was carried out, using the Operational Group (OG), which defined strategies to be adopted to seek improvements in pain assessment and management. In Phase 3, the initial questionnaire was reapplied to assess professionals' perceptions about the subject after the intervention. All professionals directly working in newborn care were included.

RESULTS:

the perception of professionals about pain management and assessment in the unit showed a statistically significant difference between the two phases of research, highlighting the increase in frequency of reference for evaluation and use of some method of pain relief procedures for most analyzed procedures. Participation in training (one of the strategies defined by the operational group) was reported by 86.4% of the professionals. They reported the use of scales for pain assessment, established by the protocol adopted in the service after the intervention, with a frequency of 94.4%. Changes in pain assessment and management were perceived by 79.6% of the participants.

CONCLUSION:

the professionals involved in the educational intervention observed changes in pain management in the unit and related them to the strategies defined and implemented by the OG.

Pain; Analgesia; Neonatal Intensive Care Units; Health education; Professional practice

Variables	Baseline		Reassessment		p-value
	n	%	n	%
College/university level
Age (years)
< 40	21	51.2	15	45.5	0.795 ^a
≥ 40	20	48.8	18	54.5
Number of children
0	13	31.7	7	21.2	0.479 ^b
1 - 2	23	56.1	23	69.7
3 or more	5	12.2	3	9.1
History of ICU admission
Yes	3	7.3	3	9.1	1.000 ^b
No	38	92.7	30	90.9
Close relative or friend in ICU
Yes	29	70.7	23	69.7	1.000 ^a
No	12	29.3	10	30.3
History of chronic pain
Yes	19	46.3	20	60.6	0.323 ^a
No	22	53.7	13	39.4
Time since graduation
< 15 years	21	51.2	18	54.5	0.775 ^b
> 15 years	20	48.8	15	45.5
Time working in neonatology
< 15 years	24	61.5	19	59.4	0.852 ^b
> 15 years	15	38.5	13	40.6

Technical level
Age (years)
< 40	14	51.9	9	34.6	0.323 ^a
≥ 40	13	48.1	17	65.4
Number of children
0	11	37.9	8	30.8	0.802 ^a
1 - 2	13	44.9	12	46.1
3 or more	5	17.2	6	23.1
History of ICU admission
Yes	3	10.3	3	11.1	1.000 ^b
No	26	89.7	24	88.9
Close relative or friend in ICU
Yes	9	34.6	12	44.4	0.652 ^a
No	17	65.4	15	55.6
History of chronic pain
Yes	15	53.6	15	57.7	0.976 ^a
No	13	46.4	11	42.3
Time since graduation
< 15 years	17	60.7	13	48.1	0.349 ^b
> 15 years	11	39.3	14	51.9
Time working in neonatology
< 15 years	23	82.1	22	84.6	0.807 ^b
> 15 years	5	17.9	4	15.4

	Phase 1		Phase 3		p-value
	n	%	n	%
College/university level
Recollection of pain occurrence in the neonate
Always/frequently	21	51.2	26	81.2	0.016 ^a
Never/rarely	20	48.8	6	18.8
Pain assessment in the neonate (scales or other methods)
Always/frequently	9	22.5	21	65.6	0.001 ^b
Never/rarely	26	65.0	9	28.1
Does not know	5	12.5	2	6.3
Use of methods for pain relief
Always/frequently	12	30.8	25	75.7	< 0.001^b
Never/rarely	22	56.4	6	18.2
Does not know	5	12.8	2	6.1
Existence of standards and routines for pain assessment and management
Yes	3	7.3	25	78.1	< 0.001^b
No	35	85.4	5	15.6
Does not know	3	7.3	2	6.3

Technical level
Recollection of pain occurrence in the neonate
Always/frequently	16	57.1	18	75.0	0.291 ^a
Never/rarely	12	42.9	6	25.0
Pain assessment in the neonate (scales or other methods)
Always/frequently	10	35.7	19	76.0	0.008 ^a
Never/rarely	18	64.3	6	24.0
Use of methods for pain relief
Always/frequently	9	36.0	15	65.3	0.091 ^b
Never/rarely	15	60.0	7	30.4
Does not know	1	4.0	1	4.3
Existence of standards and routines for pain assessment and management
Yes	5	22.7	23	92.0	< 0.001^a
No	17	77.3	2	8.0

Procedure/clinical situation	Phase 1		Phase 3		p-value
	n	%	n	%
College/university level
Chest drainage
Always/frequently	26	65.0	28	87.4	0.030 ^a
Never/rarely	12	30.0	2	6.3
Does not know	2	5.0	2	6.3
Necrotizing enterocolitis
Always/frequently	24	58.5	26	81.2	0.023 ^a
Never/rarely	15	36.6	3	9.4
Does not know	2	4.9	3	9.4
Arterial puncture
Always/frequently	1	2.6	15	46.8	< 0.001
Never/rarely	37	94.8	14	43.8
Does not know	1	2.6	3	9.4
Peripheral puncture
Always/frequently	0	0.0	13	50.0	< 0.001
Never/rarely	40	100.0	13	50.0
Insertion of PICI
Always/frequently	5	12.8	19	61.3	< 0.001
Never/rarely	20	51.3	5	16.1
Does not know	14	35.9	7	22.6
Upper airway aspiration
Always/frequently	2	5.0	13	40.6	< 0.001
Never/rarely	37	92.5	16	50.0
Not necessary	1	2.5	3	9.4
Tracheal tube aspiration
Always/frequently	4	10.3	14	43.8	0.001 ^a
Never/rarely	34	87.1	15	46.8
Does not know	1	2.6	3	9.4
CSF sampling
Always/frequently	6	15.0	21	63.6	< 0.001
Never/rarely	30	75.0	5	15.2
Does not know	4	10.0	7	21.2

Technical level
Blood collection
Always/frequently	2	7.0	15	60.0	< 0.001 ^b
Never/rarely	25	92.6	10	40.0
Peripheral venous access
Always/frequently	12	41.4	19	76.0	0.022 ^b
Never/rarely	17	58.6	6	24.0
Upper airway aspiration
Always/frequently	2	7.1	12	48.0	0.001 ^a
Never/rarely	25	89.3	11	44.0
Not necessary	1	3.6	2	8.0
Tracheal tube aspiration
Always/frequently	3	11.1	12	50.0	< 0.002 ^b
Never/rarely	24	88.9	9	37.5

	n	%
Participation in training ^a
Yes	51	86.4
No	8	13.6

Change perception after educational intervention ^a
Yes	47	79.6
No	10	16.9
Does not know	2	3.5

Compliance with the protocol used
Always/frequently	34	56.7
Never/rarely	17	28.3
Does not know	9	15.0
Use of pain assessment scales NIPS/NFCS^b
Yes	51	94.4
No	3	5.6

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[1] * Corresponding author. claymar@globo.com