Physicians' and Nurses' Approach Regarding Pain Management of Newbornsin a Neonatal Clinic In Turkey
Öz
Purpose: This research was conducted as a descriptive study for the purpose of determining the status of pediatricians and nurses who work in neonatal clinics in some provinces in Turkey. The clinics staff were observed in regard to identifying pain indicators and approach to pain relief in neonates. Methods: The study sample included 145 nurses and physicians employees in the NICU of the Ege University, DokuzEylul University, Ankara University, Çukurova University, 19 Mayıs University, Mersin University, Kahramanmaraş Sutcu Imam University, Selcuk University, Firat University, Akdeniz University and Dicle University Research Hospitals. Results: The data was collected using a question survey and Pain Sensitivity Survey form. 40.7% physicians and 59.3% nurses were surveyed. Nurses and physicians who participated in the survey admitted to evaluate newborn pain symptoms through 48.2% physiologically, 47.5% note / anxiety / worry expressions, 45.5% behavioral concerns, 44.3% facial expressions and 49.6% change in voice tone. Nurses and physicians who participated in the survey stated that in pain management they prefer 57.2% pharmacological relief methods, 27.6% non-pharmacologic and 15.2% of also stated that they prefer both pharmacological and non-pharmacological methods. 48.8% of the nurses and 42.3% of the physicians reported that fentanyl pharmacological method is the most effective method of pain relief. Besides 37.2% of the nurses and 16.9% of the physicians reported that kangaroo care and mothers embrace are respectively the most effective non-pharmacological methods of pain relief. In second place, 19.7% of the nurses put a newborn massage and 16.9% of the physicians put giving the newborn a pacifier. Conclusion: It was determined that nurses used non-pharmacologic methods during invasive procedures in newborns more often than physicians.
Anahtar Kelimeler
Kaynakça
- Faye PM, De Jonckheere J, Loogie R, et al. Newborn infant pain assessment using heart frate variability analysis. Clin J Pain, 2010; 26: 777-82.
- Grunau RE, Holsti L, Peters JW. Long-term consequences of pain in human neonates. Semin Fetal Neonatal Med, 2006; 11: 268-75.
- Lima J De, Carmo KB. Practical pain management in the neonate. Best Practice & Research Clinical Anaesthesiology, 2010; 24: 291-307.
- Anand KJS. Analgesia for skin-breaking procedures in newborns and children:What Works best?. CMAJ, 2008; 179: 11-2.
- Asadi-Noghabi F, Tavassoli-Farahi M, Yousefi H, et al. Neonate pain management: what do nurses really know?. Glob J Health Sci, 2014; 14, 6: 284-93.
- Huang C, Tung W, Kuo L, et al. Comparision of pain responses of premature infants to the heelstick between containment and swaddling. Journal of Nursing Research, 2004; 12: 31-9.
- Simons SHP, Tibboel D. Pain perception development and maturation. Seminars in Fetal & Neonatal Medicine, 2006; 11: 227-31.
- Melo GM, Lélis AL, de Moura AF, et al. Pain assessment scales in newborns: integrative review. Rev Paul Pediatr, 2014; 32: 395-402.
- Çelebioğlu A, Polat S. Yenidoğanda ağrı değerlendirmesi. Sendrom Tıp Dergisi, 2004; 16: 99-101.
- Reyes S. Nursing assessment of infant pain. Journal of Perinatal & Neonatal Nursing: Academic Research Library, 2003; 17: 291-303.
- Srouji R, Ratnapalan S, Schneeweiss S. Pain in children: assessment and non-pharmacological management. Int J Pediatr, 2010; 1-11.
- Yaster M. Pain relief. Pediatrics, 1995; 95: 427-8.
- Schehcter NL. The undertreatment of pain in children: an overview. Pediatr Clin North Am 1989; 36: 781-94.
- Beyer JE, DeGood DE, Ashley LC, et al. Patterns of postoperative analgesic use with adults and children following cardiac surgery. Pain, 1983; 17: 71-81.
- Mather L, Mackie J. The incidence of postoperative pain in children. Pain, 1983; 15: 271-82.
- Howard VA, Thurber WF. The İnterpretation of infant pain. Physiological and behavioral indicators used by NICU nurses. JOGNN, 1998; 13: 164-74.
- Bozkurt H Yenidoğan yoğun bakım hemşirelerinin yenidoğanda ağrı yönetimi. Yüksek Lisans Tezi, İstanbul, Marmara Üniversitesi, 2003.
- Herrington CJ, Chiodo LM. Human touch effectively and safely reduces pain in the newborn intensive care unit. Pain Manag Nurs. 2014; 15: 107-15.
- Hall RW, Anand KJ. Pain management in newborns. Clin Perinatol, 2014; 41: 895924.
- Cignacco EL, Sellam G, Stoffel L, et al. Oral sucrose and “facilitated tucking” for repeated pain relief in preterms: a randomized controlled trial. Pediatrics. 2012; 129: 299-308.
- Jeong IS, Park SM, Lee JM, et al. Perceptions on pain management among Korean nurses in neonatal intensive care units. Asian Nurs Res (Korean Soc Nurs Sci). 2014; 8: 261-6.
- Al Qadire M, Al Khalaileh M. Jordanian nurses knowledge and attitude regarding pain management. Pain Manag Nurs, 2014; 15: 220-8.
- Yücel A, Özyalçın NS: Çocukluk Çağında Ağrı. Nobel Tıp Kitabevi, 2002, İstanbul.
- Cignacco E, Hamers JP, Stoffel L, et al. The efficacy of non- pharmacological interventions in the management of procedural pain in preterm and term neonates. A systematic literature review. European Journal of Pain, 2007; 11: 139-52.
- Akcan E, Yiğit R, Atici A. The effect of kangaroo care on pain in premature infants during invasive procedures. Turk J Pediatr, 2009; 51: 14-8.
- Efe E, Altun E, Çetin H, ve ark. Türkiye’de bazı illerde çocuk servislerinde çalışan çocuk hekimi ve hemşirelerin yenidoğanlarda ağrı konusundaki bilgi ve uygulamaları, Ağrı 2007; 19: 16-25.
- Efe E, Dikmen S, Altaş N, et al. Turkish pediatric surgical nurses’ knowledge and attitudes regarding pain assessment and nonpharmacological and environmental methods in newborns’ pain relief. Pain Manag Nurs, 2013; 14: 343-50.
- Halimaa SL, Julkunen KV, Heinonen K. Knowledge, assessment and management of pain related to nursing procedures used with premature babies: Questionnaire study for caregivers. International Journal of Nursing Practice, 2001; 7: 422-30
- Kılıç M, Öztunç G. Ağrı Konrolünde Kullanılan Yöntemler ve Hemşirenin Rolü. Fırat Sağlık Bilimleri Dergisi, 2012; 7: 1-17.
- Anand KJS, Hall RW, Desai N, et al. NEOPAIN Trial Investigators Group. Effects of morphine analgesia ventilated preterm neonates: Primary outcomes from the neopain randomised trial. Lancet, 2003; 363: 1673-83.
- Çağlayan N, Balcı S. Preterm Yenidoğanlarda ağrının azaltılmasında etkili bir yöntem: cenin pozisyonu. F.N. Hem. Derg, 2014; 22: 63-8.
- Cong X, Delaney C, Vazquez V. Neonatal nurses’ perceptions of pain assessment and management in NICUs: a national survey. Adv Neonatal Care. 2013; 13: 353-60.
- Abdallah B, Badr LK, Hawwari M. The efficacy of massage on short and long term outcomes in preterm infants. Infant Behav Dev, 2013; 36: 662-9.
- Bueno M, Yamada J, Harrison D, et al. A systematic review and meta- analyses of nonsucrose sweet solutions for pain relief in neonates. Pain Res Manag 2013; 18: 153-61.
- Pillai Riddell RR, Racine NM, Gennis HG, et al. Non-pharmacological management of infant and young child procedural pain. Cochrane Database Syst Rev 2015; 2: 12.
- Akcan E, Polat S. Yenidoğanlarda invaziv girişimler sırasında oluşan ağrıya anne sütü, amniyotik sıvı ve lavanta kokusunun etkisi. 2. Uluslararası 5. Ulusal Akdeniz Pediatri Hemşireliği Kongresi, 15-18 Kasım 2015, Ankara (sözel bildiri)
- Olsson E, Ahlsén G, Eriksson M. Skin-to-skin contact reduces near- infrared spectroscopy pain responses in premature infants during blood sampling. Acta Paediatr. 2015 Sep 5
Türkiye’de Yenidoğan Kliniklerinde Çalışan Hemşire ve Hekimlerin Yenidoğanda Ağrı Yönetimi ile İlgili Yaklaşımları
Öz
Amaç: Araştırma, Türkiye’nin değişik illerinde Yenidoğan Yoğun Bakım Üniteleri’nde YYBÜ çalışan hekim ve hemşirelerin yenidoğanda gözlemledikleri ağrı göstergelerini belirlemek ve ağrının giderilmesine yönelik yaklaşımlarını saptamak amacıyla tanımlayıcı olarak yapılmıştır. Yöntem: Araştırmanın örneklemini Ege Üniversitesi, Dokuz Eylül Üniversitesi, Ankara Üniversitesi, Çukurova Üniversitesi, On Dokuz Mayıs Üniversitesi, Mersin Üniversitesi, Kahramanmaraş Sütçü İmam Üniversitesi, Selçuk Üniversitesi, Fırat Üniversitesi, Akdeniz Üniversitesi ve Dicle Üniversitesi Araştırma ve Uygulama Hastanelerinin YYBÜ’da çalışan toplam 145 hekim ve hemşire oluşturmuştur. Bulgular: Veriler, anket formu ve Ağrı Duyarlılık Anketi aracılığıyla toplanmıştır. Araştırmaya katılanların %40.7’si hekim, %59.3’ü hemşiredir. Araştırmaya katılan hemşire ve hekimlerin %48.2’si fizyolojik, %47.5’i dikkat/anksiyete/kaygı açısından %45.5’i davranışsal; %44.3’ü yüz ifadelerini ve %49.6’sı ses ile ilgili ağrı belirtilerini değerlendirdiklerini ifade etmişlerdir. Araştırmaya katılan hemşire ve hekimlerin %57.2’si ağrıyı gidermede öncelikli olarak farmakolojik, %27.6’sı nonfarmakolojik ve %15.2’si de hem farmakolojik hem de nonfarmakolojik yöntemleri tercih ettiklerini ifade etmişlerdir. Farmakolojik yöntemler arasında ağrı gidermede en etkili yöntemin hemşirelerin %48.8’i ve hekimlerin %42.3’ü fentanyl olduğunu belirtmişlerdir. Nonfarmakolojik yöntemler arasında en etkili yöntemin hemşirelerin %37.2’si ve hekimlerin %16.9’u kanguru bakımı ve anne kucağı olduğunu, ikinci olarak hemşirelerin %19.7’si masaj, hekimlerin %16.9’u emzik yönteminin etkili olduğunu belirtmişlerdir. Sonuç: Hemşirelerin yenidoğanlarda invazif işlemler sırasında nonfarmakolojik yöntemleri hekimlere göre daha fazla kullandığı belirlenmiştir.
Anahtar Kelimeler
Kaynakça
- Faye PM, De Jonckheere J, Loogie R, et al. Newborn infant pain assessment using heart frate variability analysis. Clin J Pain, 2010; 26: 777-82.
- Grunau RE, Holsti L, Peters JW. Long-term consequences of pain in human neonates. Semin Fetal Neonatal Med, 2006; 11: 268-75.
- Lima J De, Carmo KB. Practical pain management in the neonate. Best Practice & Research Clinical Anaesthesiology, 2010; 24: 291-307.
- Anand KJS. Analgesia for skin-breaking procedures in newborns and children:What Works best?. CMAJ, 2008; 179: 11-2.
- Asadi-Noghabi F, Tavassoli-Farahi M, Yousefi H, et al. Neonate pain management: what do nurses really know?. Glob J Health Sci, 2014; 14, 6: 284-93.
- Huang C, Tung W, Kuo L, et al. Comparision of pain responses of premature infants to the heelstick between containment and swaddling. Journal of Nursing Research, 2004; 12: 31-9.
- Simons SHP, Tibboel D. Pain perception development and maturation. Seminars in Fetal & Neonatal Medicine, 2006; 11: 227-31.
- Melo GM, Lélis AL, de Moura AF, et al. Pain assessment scales in newborns: integrative review. Rev Paul Pediatr, 2014; 32: 395-402.
- Çelebioğlu A, Polat S. Yenidoğanda ağrı değerlendirmesi. Sendrom Tıp Dergisi, 2004; 16: 99-101.
- Reyes S. Nursing assessment of infant pain. Journal of Perinatal & Neonatal Nursing: Academic Research Library, 2003; 17: 291-303.
- Srouji R, Ratnapalan S, Schneeweiss S. Pain in children: assessment and non-pharmacological management. Int J Pediatr, 2010; 1-11.
- Yaster M. Pain relief. Pediatrics, 1995; 95: 427-8.
- Schehcter NL. The undertreatment of pain in children: an overview. Pediatr Clin North Am 1989; 36: 781-94.
- Beyer JE, DeGood DE, Ashley LC, et al. Patterns of postoperative analgesic use with adults and children following cardiac surgery. Pain, 1983; 17: 71-81.
- Mather L, Mackie J. The incidence of postoperative pain in children. Pain, 1983; 15: 271-82.
- Howard VA, Thurber WF. The İnterpretation of infant pain. Physiological and behavioral indicators used by NICU nurses. JOGNN, 1998; 13: 164-74.
- Bozkurt H Yenidoğan yoğun bakım hemşirelerinin yenidoğanda ağrı yönetimi. Yüksek Lisans Tezi, İstanbul, Marmara Üniversitesi, 2003.
- Herrington CJ, Chiodo LM. Human touch effectively and safely reduces pain in the newborn intensive care unit. Pain Manag Nurs. 2014; 15: 107-15.
- Hall RW, Anand KJ. Pain management in newborns. Clin Perinatol, 2014; 41: 895924.
- Cignacco EL, Sellam G, Stoffel L, et al. Oral sucrose and “facilitated tucking” for repeated pain relief in preterms: a randomized controlled trial. Pediatrics. 2012; 129: 299-308.
- Jeong IS, Park SM, Lee JM, et al. Perceptions on pain management among Korean nurses in neonatal intensive care units. Asian Nurs Res (Korean Soc Nurs Sci). 2014; 8: 261-6.
- Al Qadire M, Al Khalaileh M. Jordanian nurses knowledge and attitude regarding pain management. Pain Manag Nurs, 2014; 15: 220-8.
- Yücel A, Özyalçın NS: Çocukluk Çağında Ağrı. Nobel Tıp Kitabevi, 2002, İstanbul.
- Cignacco E, Hamers JP, Stoffel L, et al. The efficacy of non- pharmacological interventions in the management of procedural pain in preterm and term neonates. A systematic literature review. European Journal of Pain, 2007; 11: 139-52.
- Akcan E, Yiğit R, Atici A. The effect of kangaroo care on pain in premature infants during invasive procedures. Turk J Pediatr, 2009; 51: 14-8.
- Efe E, Altun E, Çetin H, ve ark. Türkiye’de bazı illerde çocuk servislerinde çalışan çocuk hekimi ve hemşirelerin yenidoğanlarda ağrı konusundaki bilgi ve uygulamaları, Ağrı 2007; 19: 16-25.
- Efe E, Dikmen S, Altaş N, et al. Turkish pediatric surgical nurses’ knowledge and attitudes regarding pain assessment and nonpharmacological and environmental methods in newborns’ pain relief. Pain Manag Nurs, 2013; 14: 343-50.
- Halimaa SL, Julkunen KV, Heinonen K. Knowledge, assessment and management of pain related to nursing procedures used with premature babies: Questionnaire study for caregivers. International Journal of Nursing Practice, 2001; 7: 422-30
- Kılıç M, Öztunç G. Ağrı Konrolünde Kullanılan Yöntemler ve Hemşirenin Rolü. Fırat Sağlık Bilimleri Dergisi, 2012; 7: 1-17.
- Anand KJS, Hall RW, Desai N, et al. NEOPAIN Trial Investigators Group. Effects of morphine analgesia ventilated preterm neonates: Primary outcomes from the neopain randomised trial. Lancet, 2003; 363: 1673-83.
- Çağlayan N, Balcı S. Preterm Yenidoğanlarda ağrının azaltılmasında etkili bir yöntem: cenin pozisyonu. F.N. Hem. Derg, 2014; 22: 63-8.
- Cong X, Delaney C, Vazquez V. Neonatal nurses’ perceptions of pain assessment and management in NICUs: a national survey. Adv Neonatal Care. 2013; 13: 353-60.
- Abdallah B, Badr LK, Hawwari M. The efficacy of massage on short and long term outcomes in preterm infants. Infant Behav Dev, 2013; 36: 662-9.
- Bueno M, Yamada J, Harrison D, et al. A systematic review and meta- analyses of nonsucrose sweet solutions for pain relief in neonates. Pain Res Manag 2013; 18: 153-61.
- Pillai Riddell RR, Racine NM, Gennis HG, et al. Non-pharmacological management of infant and young child procedural pain. Cochrane Database Syst Rev 2015; 2: 12.
- Akcan E, Polat S. Yenidoğanlarda invaziv girişimler sırasında oluşan ağrıya anne sütü, amniyotik sıvı ve lavanta kokusunun etkisi. 2. Uluslararası 5. Ulusal Akdeniz Pediatri Hemşireliği Kongresi, 15-18 Kasım 2015, Ankara (sözel bildiri)
- Olsson E, Ahlsén G, Eriksson M. Skin-to-skin contact reduces near- infrared spectroscopy pain responses in premature infants during blood sampling. Acta Paediatr. 2015 Sep 5
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Bölüm | Research Article |
| Yazarlar | |
| Yayımlanma Tarihi | 1 Eylül 2016 |
| Yayımlandığı Sayı | Yıl 2016Sayı: 3 |