Knowledge and Attitude towards Management of Pain in Neonates among Health Care Providers working in NICU

 

Mone A¹, Kharde S²

¹PG student, Department of Obstetrics and Gynecological Nursing, KLEU’s Institute of Nursing Sciences, Belagavi, Karnataka.

²Professor and HOD, Department of Obstetrics and Gynecological Nursing   Institute of Nursing Sciences, KLEU’s Institute of Nursing Sciences,  Belagavi, Karnataka.

 

ABSTRACT:

Many of the comprehensive care components carried out on Neonates admitted to neonatal intensive care units (NICU) causes painful stimuli which is found to have potential damage and causes long term changes in pain pathways.  It becomes difficult in neonates to manage pain as they are unable to verbalize it but it can be very well reduced if health care providers have adequate knowledge and positive attitude towards assessment and management. This scenario suggests the need to assess the knowledge and attitude of health care providers towards management of pain in neonates. The objectives of the study were to assess the knowledge and attitude of health care providers towards management of pain in neonates and to find out the association between knowledge and attitude of health care providers towards management of pain in neonates with baseline data. Study was conducted by using descriptive research approach and descriptive design on a target population of 30 health care providers working in NICU selected by using convenient sampling technique. Tools used for data collection were structured knowledge questionnaire and 5 point likert scale to assess the attitude of health care providers towards management of pain in neonates. Data collected was analyzed and interpreted using descriptive and inferential statistics. Findings related to level of knowledge scores of health care providers towards management of pain in neonates revealed that 6(20%) had good knowledge, average knowledge was among 20(66.7%) and 4(13.3%) had poor knowledge with mean score of 19. Findings related to attitude of health care providers towards management of pain in neonates revealed that 3(10%) had positive attitude, neutral attitude was among 23(76.7%) and 4(13.3%) had poor attitude with mean score of 107. Chi square value for all associations of knowledge and attitude scores with baseline data was not significant at p<0.05 level. This revealed that there is no significant association between knowledge and attitude scores of health care providers towards management of pain in neonates with baseline data. It was conclusive from the results that health care providers had average knowledge regarding pain management in neonates and most of them showed neutral attitude towards the same.

 

 

 

INTRODUCTION:

Newborn babies who need intensive medical attention are often admitted into a special area of the hospital called Neonatal Intensive Care Unit (NICU), which combines advanced technology and trained health care professionals to provide specialized care to the tiniest babies.¹ These care components causes several painful stimuli. Repeated exposure of newborn to high number painful stimuli during the development of nervous system found to have potential damage and causes long term changes in pain pathways.² There will be alteration in cognition, motor function, sleep wake cycle. It may also permanently decrease an individual’s pain tolerance, and can lead to development of chronic pain.³ Effective pain management in neonates is difficult as they are unable to communicate or provide the subjective responses to pain. Hence the management of pain depends on the health care providers or family members understanding regarding neonates level of experiencing pain or discomfort.⁴ Even though these painful procedures are significant and are to improve the chances of survival of newborns, health care providers may not recognize and manage the pain. There are various misconception regarding neonatal pain such as newborns do not perceive pain, they have incomplete pain pathway, they do not remember pain, it is dangerous to administer anesthesia and analgesia to newborns. Other common barriers identified are neonates unable to verbalize pain, lack of time, absence or not adhering to pain management protocols, cultural differences, health care provider’s inadequate knowledge and negative attitude towards pain management.⁵ To effectively manage pain it is vital for the health care providers to have adequate knowledge regarding pain assessment and a positive attitude towards its management interventions.  This sound knowledge and attitude will improve pain control, prevent and reduce prolonged exposure of neonates to pain. It reduces immediate and long term effects including altered pain sensitivity and reactivity, decrease morbidity and lower mortality rate in neonates.⁶ Due to multiple evidences of potentially harmful consequences of untreated pain in neonates it should not be underestimated ethically and morally since pain management in neonates is not an option but a necessity.⁷ The concept of pain management in neonates is poor among health care providers, interventions are not taken to reduce pain and there are no standard protocols in NICU. Thus this study will assess the knowledge and attitude of health care providers towards pain management among neonates.

 

METHODOLOGY:

A descriptive research approach was considered to carry out the study with descriptive design. The target population comprises of Health care providers working in NICU of selected tertiary care hospital. Sample size considered for the study was 30 health care providers selected by using convenient sampling technique. The tools used for gathering data were structured knowledge questionnaire and a 5 point likert scale on attitude towards management of pain in neonates among health care providers. Data was analyzed and interpreted using descriptive and inferential statistics.

RESULTS:

Findings on distribution of sample characteristics according to baseline data of health care providers.

Revealed that out of 30 health care providers 21(66.7%) belonged to the age group of 22-28years, while 10(33.3%) belonged to the age group of 29-35 years. Gender distribution showed that higher numbers of health care providers were female 27(90%) and male health care providers were 3(10%). Educational qualification was of Post Graduation (pediatrics) was among 4(13.3%), B.Sc. Nursing was 12(40%), GNM Nursing was among 11(36.7%), Health Assistants were 3(10%) and none of them were M.Sc. Nursing. Duration of exposure in NICU was 19(63.3%) had 0-2years whereas 7(13.3%) had 3-5 years and 4(13.3%) had 6-8 years of clinical exposure in NICU.

 

Findings on distribution of knowledge and attitude of health care providers towards management of pain in neonates.

Table 1 Frequency and percentage distribution of knowledge scores of health care providers towards management of pain in neonates.                                                                                       n= 30

Level of knowledge	Score range	Frequency	Percentage (%)
Good	24 to 32	6	20
Average	14 to 23	20	66.7
Poor	0 to 13	4	13.3

 

Table no 1 revealed that 6(20%) had good knowledge, average knowledge was among 20(66.7%) and 4(13.3%) had poor knowledge.

 

Table no 2: Frequency and percentage distribution of attitude scores of health care providers towards management of pain in neonates.                                                                        n=30

Level of attitude	Score range	Frequency	Percentage (%)
Positive	119 to 170	3	10
Neutral	97 to 118	23	76.7
Negative	0 to 96	4	13.3

 

Table no 2 revealed that 3(10%) had positive attitude, neutral attitude was among 23(76.7%) and 4(13.3%) had negative attitude.

 

Findings on association between knowledge and attitude scores of health care providers towards management of pain in neonates with baseline data

Findings revealed that calculated chi square value for all associations of knowledge and attitude scores and baseline data was not significant at p<0.05 level. This revealed that there is no significant association between knowledge and attitude scores and baseline data. Hence hypothesis H1 was rejected.

 

DISCUSSION:

Findings on Distribution of knowledge of health care providers towards management of pain in neonates.

Data analysis for level of knowledge revealed that out of 30 highest number of health care providers had average knowledge 20(66.7%), good knowledge was among 6(20%) and 4(13.3%) had poor knowledge contrast to our study findings Sundaresan S, Samson R, Sujata S in their study showed that out of 60 highest number of health care providers had poor knowledge 32(53.33%), average knowledge was among 28(46.67%) and none of the participants had good knowledge score.⁸

 

Findings on distribution of attitude of health care providers towards management of pain in neonates

Data analysis for level of attitude revealed that among the total subjects (n=30), highest level of health care providers 23(76.7%) had neutral attitude whereas 3(10%) had positive attitude, 4(13.3%) had poor attitude. findings contrast to our study was found in study by Malarvizhi G, Vatsa M where out of 42 health care professionals 29(69%) had an negative attitude and 13(31%) had positive attitude towards neonatal pain management.⁹

 

Findings on association between knowledge and attitude scores of health care providers towards management of pain in neonates with baseline data.

Statistical analysis for all associations of knowledge and attitude scores with baseline data showed that calculated chi square value is not significant at p<0.05 level. This revealed that there is no association between knowledge and attitude scores and baseline data of Age, gender, educational qualification and duration of exposure in NICU. Contradictory findings were shown by Porter FL, Wolf CM, Gold J, Lotsoff D, Miller JP. Findings showed a significant association between selected demographic variable of age, year of experience and area of work and knowledge of health care providers towards management of pain in neonates.¹⁰

 

CONCLUSION:

Based on the findings of the study, the following inferences were drawn. Health care providers had average knowledge regarding pain management in neonates and most of them showed neutral attitude towards the same. There was no significant association between knowledge and attitude score of health care providers towards management of pain in neonates with baseline data.

 

REFERENCE:

1.        The Neonatal Intensive Care Unit (NICU) [Internet]. Stanford children’s health.2016. Available from: http://tinyurl.com/znfy3kj

2.        Carbajal R, Rousset A, Danan C, et al. Epidemiology and treatment of painful procedures in neonates in Intensive Care Units. JAMA. 2008; 300(1):60-70.

3.        Grunau RE. Neonatal pain in very preterm infants: long-term effects on brain, neurodevelopment and pain reactivity. Rambam Maimonides Med J. 2013 October; 4 (4):1-13.

4.        Clinical Best Practice Guidelines: Assessment and Management of Pain. [Internet]. Registered Nurses’ Association of Ontario. 2013 December. Available from: http://tinyurl.com/ju48v9u

5.        Neonatal Pain Policy.[Internet]. 2004 [cited2016April18]. Available from: http://tinyurl.com/zjv8hmg 

6.        Management of Pain and Developmental Supportive Care in Neonatal Intensive Care Unit. [Internet]. 2006. [Cited2016April12]. Available from: http://tinyurl.com/zhkpvso 

7.        Zelenovic J, Rae, A. Procedural pain relief for neonates: Non-pharmacological methods.[Internet]. [cited2016April18]. Available from: http://tinyurl.com/gsgmh7p

8.        Sujatha S, Samson R, Sundaresan S. Nurses knowledge and neonatal pain management. Int J Adv Res. 2015; 3(8):732 – 737.

9.        Malarvizhi G. Vatsa M. Knowledge, attitude and management of neonatal pain among Health Care Professional in Neonatal units. Int J Nurs Educ. 2012 December; 4(2):167-71.

10.     Porter FL, Wolf CM, Gold J, Lotsoff D, Miller JP. Pain and Pain Management in Newborn Infants: A Survey of Physicians and Nurses. PEDIATRICS. 2013 December; 100(4):627-32.

 

 

 

 

Received on 21.08.2016          Modified on 25.08.2016

Accepted on 28.10.2016         © A&V Publications all right reserved