Factors affecting delivery of evidence-based procedural pain care in hospitalized neonates

Abstract

Objective: To examine the effects of nurse, infant, and organizational factors on delivery of collaborative and evidence-based pain care by nurses.

Design: Cross sectional.

Setting: Two Level III neonatal intensive care units in 2 large tertiary care centers in Canada.

Participants: A convenience sample of 93 nurses completed survey data on procedures they performed on ill neonates. The 93 nurses performed a total of 170 pain producing procedures on 2 different shifts.

Main outcome: Nurse use of evidence-based protocols to manage procedure related pain using a scorecard of nurses' assessment, management, and documentation.

Results: Procedural pain care was more likely to meet evidence-based criteria when nurse participants rated nurse-physician collaboration higher (odds ratio, 1.44; 95% confidence intervals 1.05-1.98), cared for higher care intensity infants (odds ratio, 1.21; 95% confidence intervals, 1.06-1.39), and experienced unexpected increases in work assignments (odds ratio, 1.55; 95% confidence intervals, 1.04-2.30). Nurses' knowledge about the protocols, educational preparation and experience were not significant predictors of evidence-based care for the most common procedures: heel lance and intravenous initiation.

Conclusion: Nurse-physician collaboration and nurses' work assignments were more predictive of evidence-based care than infant and nurse factors. Nurses' knowledge regarding evidence-based care was not a predictor of implementation of protocols. In the final statistical modeling, collaboration with physicians, a variable amenable to intervention and further study, emerged as a strong predictor. The results highlight the complex issue of translating knowledge to practice, however, specific findings related to pain assessment and collaboration provide some direction for future practice and research initiatives.

Figure 1

Neonate, nurse and organizational factors influencing knowledge use for optimal pain care.