Effects of a tripartite intervention on biological stress in preterm infants during heel pricks for newborn screening: A randomized controlled trial.

This prospective randomized trial examined the effects of a tripartite intervention (behavioral state modulation + nonnutritive sucking + tucking) on stress from procedural pain during heel pricks. Blood samples for routine screening were collected by heel pricks 48 h after birth (Stage 1) and at ≥37 weeks' gestation (Stage 2); salivary cortisol levels (SCLs) pre-prick (T0) and 20 min post-prick (T1) assessed stress. Preterm infants (n = 64) sampled by convenience at Level III neonatal care units were randomly assigned to the control condition (usual care) or intervention condition (tripartite intervention). Generalized estimating equations examined differences in salivary cortisol between conditions. After adjusting for effects of gestational age, postmenstrual age, and baseline SCLs, (1) at Stage 1, the change in salivary cortisol from T0 to T1 in preterm infants who received the tripartite intervention was, on average, significantly lower by 0.431 units (log scale) than the change in preterm infants who received the control condition (p < 0.001); (2) in the tripartite intervention condition, the difference between the change in mean SCLs from T0 to T1 at Stages 1 and 2 was significantly lower by 0.287 units (log scale), on average than between the change at Stages 1 and 2 in the control condition (p = 0.026). The provision of a tripartite intervention during heel prick significantly decreased the raise of SCLs compared with infants receiving usual care, suggesting lower stress. Clinicians could easily implement the tripartite intervention for heel-stick support; however, replication is needed before recommending its incorporation into routine heel stick and other stressful procedures.

Factors influencing the occurrence of neonatal procedural pain.

OBJECTIVES: The objective of this study was to describe the occurrence of neonatal procedural pain and explore the factors that influence the frequency of painful procedures. DESIGN: A descriptive prospective epidemiologic study. SETTING: NICU at a general hospital in China. METHODS: A demographic and diagnosis or illness information questionnaire and an occurrence of procedural pain questionnaire specifically designed for this study were used to record the current status of neonatal procedural pain. The neonatal infant pain scale (NIPS) was used to measure pain intensity. A multiple linear regression model was used to explore the factors influencing the frequency of painful procedures. RESULTS: One hundred and twenty neonates experienced a total of 16,840 painful procedures. Each neonate was exposed to a median (IQR) of 66.5(27,154.75) painful procedures during hospitalization and a median (IQR) of 13(11, 19) painful procedures. All 27 different procedures were considered painful, and 70.37% (19/27) of these procedures caused severe pain. Overall, the mean NIPS score of the 27 procedures was 5.04 ± 1.52 with a range from 0 to 7. Respiratory support, age, and length of hospital stay were factors influencing the frequency of painful procedures. CONCLUSIONS: NICU neonates experience pain at a high frequency and intensity during hospitalization. Respiratory support, age, and length of hospital stay were factors influencing the frequency of painful procedures. Strategies are needed to bridge the gap between practice and the evidence-based guidelines.

Intervenções de enfermagem para gerir a dor da canulação da fístula arteriovenosa do doente em hemodiálise / Nursing interventions to manage the cannulation pain of the arteriovenous fistula of the patient on hemodialysis

A Doença Renal Crónica (DRC) é considerada um problema de saúde pública, apresentando altas taxas de morbilidade e mortalidade. Existem hoje em dia, aproximadamente, 37 milhões de adultos em risco de contrair DRC. A realidade portuguesa, é ligeiramente diferente dos restantes países, visto que, apresenta uma prevalência ligeiramente superior à média europeia. O avanço da DRC leva a que muitos clientes alcancem o quinto estadio da doença e tenham necessidade de recorrer a uma técnica de substituição da função renal (TSFR). A modalidade de TSFR mais prevalente em Portugal e no mundo é a Hemodiálise (HD) e, segundo a Sociedade Portuguesa de Nefrologia (SPN), no ano de 2018, de todos os clientes que iniciaram técnica, 58,9% encontram-se em programa regular de HD. Para que se realize este tratamento, é necessário um acesso vascular (AV) que permita um fluxo de sangue adequado. O AV de eleição e mais comum no nosso país é a fistula arteriovenosa (FAV), sendo necessário realizar uma canulação, de modo a que exista um circuito de sangue extracorporal. A canulação, como procedimento invasivo, tem a particularidade de causar dor e a sua gestão é uma das preocupações do enfermeiro. Este trabalho foi realizado durante os estágios, que permitiram o desenvolvimento e aquisição de competências de enfermeiro especialista na área nefrológica, culminando na realização de uma revisão scoping com o título: "Intervenções de enfermagem para gerir a dor da canulação da fistula arteriovenosa do doente em hemodiálise". As conclusões deste estudo mostram que o enfermeiro especialista em nefrologia tem um papel fundamental no que diz respeito à gestão e controlo da dor, visto existirem intervenções farmacológicas e não farmacológicas à sua disposição. As intervenções não farmacológicas, como a crioterapia aplicada no ponto Hegu, é aquela que apresenta melhores resultados, menos efeitos secundários e menos impacto na vida socioeconómica do cliente, sendo por isso uma intervenção válida. Cabe ao enfermeiro trabalhar em parceria com o cliente, para que este seja um agente de mudança, e dessa forma utilizar a intervenção de enfermagem que melhor se adapte ao cliente e deste modo diminuir a dor à canulação da FAV.

Chronic Kidney Disease (CKD) is considered a public health disease, presenting high rates of morbidity and mortality. Currently there are an estimated 37 million adults at risk of contracting CKD. The Portuguese reality is slightly different to that of other countries, with a slightly higher prevalence then the European average. The quick advancement of CKD means many affected individuals will reach the fifth stage of the disease and require renal replacement therapy (RRT). The most prevelant RRT modality in Portugal and the world is hemodialysis (HD) and, according to the Portuguese Society of Nephrology, in 2018, from all clients that started this technique, 58,9% are on a regular hemodialysis program. In order to carry out this treatment, vascular access (VA) is necessary to allow an adequate blood flow. The VA of choice and most common in our country is the arteriovenous fistula access (AVF), where a cannulation is necessary, so that there is an extracorporal blood circuit. Cannulation, as an invasive procedure, has the particularity of causing pain and its management is one of the nurse's concerns. This work was carried out during clinical placement which allowed for the development and acquisition of skills of the specialist nurse, culminating in the creation of a scoping review with the title: "Nursing interventions to manage the pain from cannulation of the arteriovenous fistula of the patient on hemodialysis". The conclusion of this study shows that the specialist nurse in nephrology has a fundamental role regarding pain management, as there are pharmacological and nonpharmacological interventions available. The non-pharmacological interventions, like cryotherapy applied at the Hegu point presents better results, fewer side effects and less impact on the client's socio-economic life, making it a valid intervention. It is up to the nurse to work in partnership with the client, so that the client can become an agent for change and use the nursing intervention that best adapts in the way reduce the pain of AVF cannulation

Assessment and Management of Procedural Pain During the Entire Neonatal Intensive Care Unit Hospitalization.

BACKGROUND: Despite strong evidence that repeated pain exposure in neonates is associated with adverse outcomes, pain assessment and management continues to be less than optimal in most neonatal intensive care units (NICUs). AIMS: To evaluate current pain assessment and management practices, and identify factors associated with optimal treatment throughout a cohort of preterm neonates over the entire hospital stay. DESIGN: A secondary analysis of study data collected from 2012 to 2016 as part of a larger clinical trial and supplemental chart review. SETTINGS: Tertiary level neonatal intensive care unit. PARTICIPANTS/SUBJECTS: 242 stable preterm neonates born at less than 37 weeks gestational age. METHODS: Data were analyzed quantitatively using R for statistics. RESULTS: The 242 neonates underwent a total of 10,469 painful procedures (4,801 tissue breaking and 5,667 non-tissue breaking, with only 56.6% and 12.2% having a documented pain score using the Premature Infant Pain Profile, respectively). Average pain exposure was 43 with a median of 32(10-576) per entire hospital stay. Documented pain score and greater postnatal age were associated with higher use of a pain reducing intervention and lower gestational age, first day, first week, higher illness severity, non tissue breaking and night time procedures were associated with lower. Use of a pain relieving intervention was documented in 58.5% of procedures. Sucrose was most commonly used pharmacologic and non nutritive sucking the most common non pharmacologic interventions. CONCLUSIONS: Increased efforts are needed to promote consistent pain assessment and management to ensure optimal outcomes for vulnerable at risk neonates.

The Pediatric Procedural Holistic Comfort Assessment: A Feasibility Study.

INTRODUCTION: Holistic comfort is an essential component of pediatric procedural care. However, a main gap in the literature is the ability to measure this. In this study, researchers report the feasibility of implementing a newly developed psychosocial measurement instrument in clinical practice. METHOD: This mixed methods study was guided by Kolcaba's holistic comfort theory. Descriptive and inferential statistics and a qualitative descriptive approach to cognitive interviewing were used. Children aged 4 to 8 years (n = 16) experiencing a nonurgent needle procedure and registered nurses (n = 14) who administered the instrument were recruited. RESULTS: Eight qualitative themes of feasibility and comprehensibility were identified. Perspectives of children and nurses were not significantly associated with any demographic variable. The Pediatric Procedural Holistic Comfort Assessment is a feasible instrument to implement but will benefit from minor revisions. DISCUSSION: This study has implications for nursing practice, research methodology, and future research. The Pediatric Procedural Holistic Comfort Assessment can be successfully implemented by nurses in health care settings.

Efficacy of the Buzzy System for pain relief during venipuncture in children: a randomized controlled trial.

BACKGROUND AND AIM OF THE WORK: procedural pain is a significant issue for paediatric patients. In particular, needle pain is amongst the most stressful for children. Studies revealed that a large number of children do not receive adequate pain prevention during the procedures. Neglecting the prevention of needle pain can cause several psychological effects such as anxiety and phobias, and increase perceptions of pain in the future. We aimed to verify the efficacy of Buzzy System in reducing pain during venipuncture. METHODS: A randomized control trial was conducted among 72 children aged 3 to 10 years undergoing venipuncture. Children were randomly assigned to The Buzzy with distraction cards group (experimental group) or to "magic gloves" group (control group). Perception of pain was measured through the Visual Analogue Scale (VAS), the Wong-Baker Scale (WBS) and the Numeric Rating Scale (NRS). RESULTS: Sixty-four children participated in the study, 34 in the experimental group and 30 in the control group. The experimental group showed significantly lower levels of pain (p=.039; 95% CI: -2,11; -0,06) in terms of the mean=3.65±2.011; median=3, compared to the control group (mean: 4.67±2.14, median=4). Caregivers were satisfied with the Buzzy System. CONCLUSION: The Buzzy System combined to distraction cards showed a greater reduction of perceived pain than "magic glove" technique. This study underlines the importance of active involvement of caregivers during procedural pain in children. Pediatric nurses have an important role in empowering children and caregivers to be interactive during venipunctures.

Be Sweet to Babies: evaluation of an instructional video on neonatal pain management by nurses. / Seja Doce com os Bebês: avaliação de vídeo instrucional sobre manejo da dor neonatal por enfermeiros.

OBJECTIVE: To describe the profile of nurses who work in hospital units that care for newborns; to verify nurses' prior knowledge on breastfeeding, skin-to-skin care and sweet tasting solutions for neonatal procedural pain relief; and to evaluate nurses' perceptions on the feasibility, acceptability and usefulness of the Portuguese version of the "Be Sweet to Babies" video. METHOD: A cross-sectional study conducted in four units of a university affiliated hospital in São Paulo. Forty-five (45) nurses who answered the questionnaire and watched the video were included. Thirty-eight (38) nurses subsequently evaluated the video. Descriptive statistics were used to analyze the variables, in addition to content analysis of the open question. RESULTS: Forty-five (45) nurses participated in the study; 97.4% were aware of the analgesic strategies, and after watching the video nurses reported that they intend to use or encourage the use of these strategies during painful procedures. All participants would recommend the video to other professionals, and considered the resource as useful, easy to understand and easy to apply in real situations. CONCLUSION: Nurses are aware of the analgesic strategies and they considered the video as a feasible, acceptable and useful tool for knowledge translation to health care providers, which can also favor parental involvement in their children's pain management.

Validation of Greek Versions of the Neonatal Infant Pain Scale and Premature Infant Pain Profile in Neonatal Intensive Care Unit.

BACKGROUND: The Neonatal Infant Pain Scale and the Premature Infant Pain Profile have been used widely in neonatal intensive care units for pain assessment. AIM: This study reports the evaluation and validation of these scales in full-term newborns who were hospitalized in two Greek neonatal intensive care units. Evaluation and validation of the Neonatal Infant Pain Scale and the Premature Infant Pain Profile in full-term newborns who were hospitalized in two Greek neonatal intensive care units. MATERIALS AND METHODS: This is a cross-sectional study. Two neonatal intensive care units at a large General Children's Hospital in Greece. A total of 81 full-term newborns. This cross-sectional study was conducted in two neonatal intensive care units at a large General Children's Hospital in Greece. We studied 81 full-term newborns, who were exposed to various painful routine procedures. A single measurement was taken from each neonate. Two observers were present during each procedure and evaluated pain using both the Neonatal Infant Pain Scale and Premature Infant Pain Profile. Internal consistency coefficient Cronbach's α, internal class agreement coefficient, and κ factor were appropriately measured. RESULTS: The weighting of the Neonatal Infant Pain Scale and Premature Infant Pain Profile pointed out an excellent coherence between the two scales and agreement among the researchers. The internal consistency coefficient Cronbach's α was >.8 and the internal class agreement coefficient was >.98 for both scales, which indicates an excellent consistency between scales. The κ factor for Neonatal Infant Pain Scale was >.73 and for the Premature Infant Pain Profile it was >.6, which indicates a significant agreement among investigators. CONCLUSIONS: The Neonatal Infant Pain Scale and Premature Infant Pain Profile were successfully adjusted in Greek standards with reliability between the scales and among the researchers. Moreover, they constitute reliable tools for the evaluation of neonatal procedural pain in full-term newborns in Greece.

Intrauterine contraception insertion pain: nursing interventions to improve patient experience.

AIMS AND OBJECTIVES: To examine factors which contribute to the individual's experience of pain in relation to intrauterine contraception insertion and determine evidence-based nursing strategies to best assess and manage this pain. BACKGROUND: Nurses are increasingly involved in consultations regarding intrauterine contraception. However, concerns regarding painful or difficult insertion may inhibit uptake and discourage nurses from promoting or inserting intrauterine contraception. DESIGN: Integrative review. METHODS: Database searches of CINAHL, PubMed, Wiley Online Library and the Cochrane Collaboration for relevant literature. Eight papers met the inclusion criteria and were analysed using an integrative review process. RESULTS: Physical causes and pharmacological interventions for insertion pain have been thoroughly investigated. Absence of previous vaginal delivery and anxiety may increase the likelihood of procedural pain. The literature fails to conclusively determine any universally effective prophylactic analgesia. Cervical anaesthesia may be beneficial in some cases and oral analgesia may relieve postprocedural pain. Distraction in the form of conversation, music or television can be effective in reducing anxiety. CONCLUSIONS: A combination of physical, psychological and environmental factors contribute to the individual's pain experience. Nurses have the potential to make a significant impact on pain outcomes by demonstrating clinical expertise and creating a trustful environment. Giving reliable information, acknowledging the significance of anxiety and providing reassurance and distraction are effective pain reducing strategies. Research into nonpharmacological approaches is warranted, especially those which reduce anxiety. RELEVANCE TO CLINICAL PRACTICE: Increasing uptake of long-acting reversible contraception is a public health goal. Providing effective pain management strategies to improve patient experience may encourage more nurses to recommend, or enhance their scope of practice to include, intrauterine contraception insertion.

Comparison of Two Different Distraction Methods Affecting the Level of Pain and Anxiety during Extracorporeal Shock Wave Lithotripsy: A Randomized Controlled Trial.

BACKGROUND: Extracorporeal shock wave lithotripsy can cause pain and anxiety for patients. Despite the use of many distraction methods to reduce pain and anxiety, there is no study on the use of stress balls during lithotripsy. AIM: The aim of the study was to investigate the efficacy of use of stress balls and music therapy to reduce pain and anxiety during lithotripsy. DESIGN: This was a single-center, parallel randomized controlled trial. SETTINGS: The study involved the lithotripsy unit in a training and research hospital in Turkey. PARTICIPANTS: The study included 120 patients who had kidney or ureter stones. METHODS: The patients were randomly divided into three groups. The control group (group 1) received no interference, whereas experimental groups received stress ball (group 2) and music (group 3) interventions during lithotripsy, respectively. Data were collected using the Patient Information Form, visual analog scale, and State-Trait Anxiety Inventory. RESULTS: There was no statistically significant difference among the three groups in regard to anxiety and pain mean scores (p > .05). No statistically significant difference was found between anxiety scores before and after lithotripsy in each group (p > .05), whereas there was a statistically significant difference between pain scores during and after lithotripsy (p < .05). CONCLUSION: Based on the present study, no statistically significant difference was found between the use of stress balls and music in reducing pain and anxiety during lithotripsy. Further studies are needed to evaluate the effectiveness of stress balls used during lithotripsy.

Cognitive Dissonance and Pediatric Procedural Pain Management: A Concept Clarification.

BACKGROUND: Pediatric nurses have often reported that pain management is a vital part of patient care. Evidence, however, suggests pediatric procedural pain treatments are often underused. Cognitive dissonance, the mental conflict leading to unpleasant thoughts and or feelings, may be related to this evidence-based gap found between what pediatric nurses claim about procedural pain management (that it is important) and what they actually do (underutilize pain treatments). OBJECTIVE: The purpose of this manuscript is to clarify and further develop the concept of cognitive dissonance in terms of its relationship to nurses' mental struggles with underutilization of pediatric procedural pain treatments. A more relevant and extended definition of cognitive dissonance is presented. DESIGN: The concept of cognitive dissonance was examined using Rodgers' evolutionary concept analysis approach/framework. Analysis Methods: Through a six-step process of concept identification, setting and sample identification, data collection, data analysis, and future implication discussion, a more accurate and representative definition of cognitive dissonance is described. Databases used included CINAHL, Google Scholar, PsycINFO, ERIC, and PubMed. Seminal, recent, and relevant works were included in the review to adequately develop and clarify the concept. CONCLUSIONS: Procedural pain management breech among pediatric nurses is proposed to occur before the mental conflict produced. The unpleasant mental conflict created after the breech is followed by the nurse's determination to reduce mental conflict through attitude change followed by cognition change, which more closely reflects his or her behavior.