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

Margot A. Latimer, Celeste C. Johnston, Judith A. Ritchie, Sean Clarke, Debra Gilin

Research output: Contribution to journalArticle

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 careunits 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.

Original languageEnglish (US)
Pages (from-to)182-194
Number of pages13
JournalJOGNN - Journal of Obstetric, Gynecologic, and Neonatal Nursing
Volume38
Issue number2
DOIs
StatePublished - Jan 1 2009

Fingerprint

Nurses
Newborn Infant
Pain
Infant Care
Odds Ratio
Confidence Intervals
Physicians
Heel
Pain Measurement
Tertiary Care Centers
Documentation
Canada
Research

Keywords

  • Evidenced-based
  • Knowledge transfer
  • Neonatal procedural pain
  • Nurse-physician collaboration
  • Nurses

ASJC Scopus subject areas

  • Pediatrics
  • Critical Care
  • Maternity and Midwifery

Cite this

Factors affecting delivery of evidence-based procedural pain care in hospitalized neonates. / Latimer, Margot A.; Johnston, Celeste C.; Ritchie, Judith A.; Clarke, Sean; Gilin, Debra.

In: JOGNN - Journal of Obstetric, Gynecologic, and Neonatal Nursing, Vol. 38, No. 2, 01.01.2009, p. 182-194.

Research output: Contribution to journalArticle

Latimer, Margot A. ; Johnston, Celeste C. ; Ritchie, Judith A. ; Clarke, Sean ; Gilin, Debra. / Factors affecting delivery of evidence-based procedural pain care in hospitalized neonates. In: JOGNN - Journal of Obstetric, Gynecologic, and Neonatal Nursing. 2009 ; Vol. 38, No. 2. pp. 182-194.
@article{aa3419059a294fa4a54a6ea02cdbb328,
title = "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 careunits 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.",
keywords = "Evidenced-based, Knowledge transfer, Neonatal procedural pain, Nurse-physician collaboration, Nurses",
author = "Latimer, {Margot A.} and Johnston, {Celeste C.} and Ritchie, {Judith A.} and Sean Clarke and Debra Gilin",
year = "2009",
month = "1",
day = "1",
doi = "10.1111/j.1552-6909.2009.01007.x",
language = "English (US)",
volume = "38",
pages = "182--194",
journal = "JOGNN - Journal of Obstetric, Gynecologic, and Neonatal Nursing",
issn = "0884-2175",
publisher = "Wiley-Blackwell",
number = "2",

}

TY - JOUR

T1 - Factors affecting delivery of evidence-based procedural pain care in hospitalized neonates

AU - Latimer, Margot A.

AU - Johnston, Celeste C.

AU - Ritchie, Judith A.

AU - Clarke, Sean

AU - Gilin, Debra

PY - 2009/1/1

Y1 - 2009/1/1

N2 - 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 careunits 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.

AB - 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 careunits 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.

KW - Evidenced-based

KW - Knowledge transfer

KW - Neonatal procedural pain

KW - Nurse-physician collaboration

KW - Nurses

UR - http://www.scopus.com/inward/record.url?scp=63149177191&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=63149177191&partnerID=8YFLogxK

U2 - 10.1111/j.1552-6909.2009.01007.x

DO - 10.1111/j.1552-6909.2009.01007.x

M3 - Article

C2 - 19323714

AN - SCOPUS:63149177191

VL - 38

SP - 182

EP - 194

JO - JOGNN - Journal of Obstetric, Gynecologic, and Neonatal Nursing

JF - JOGNN - Journal of Obstetric, Gynecologic, and Neonatal Nursing

SN - 0884-2175

IS - 2

ER -