A Qualitative Analysis of Parent Assessment and Management of Pain in Infants at Risk for Neurological Impairment
Bonnie Stevens, RN, PhD1, Patrick McGrath, OC, PhD, FRSC2, Joseph Beyene, PhD3, Lynn Breau, PhD4, Carol Camfield, MD, FRCPC5, Allen Finley, MD, FRCPC6, Linda Franck, RN, PhD7, Sharyn Gibbins, RN, PhD8, Alexandra Howlett, MD, FRCPC9, C. Celeste Johnston, RN, DEd10, Patricia McKeever, RN, PhD11, Karel O'Brien, MB, BCh, BAO, FRCPC12, Arne Ohlsson, MD, FRCPC12, Janet Yamada, RN, MSc13, and Madelyn Law, MA11. (1) The Centre for Nursing Room 4734 Atrium Building, Sick Kids Hospital, Toronto, ON, Canada, (2) Psychology, IWK Health Centre, Halifax, NS, Canada, (3) Research Institute, Sick Kids Hospital, Toronto, ON, Canada, (4) Paediatric Pain Service, IWK Health Centre, Halifax, NS, Canada, (5) Neurology, IWK Health Centre, Halifax, NS, Canada, (6) Anesthesiology, IWK Health Centre, Halifax, NS, Canada, (7) Great Ormond Street Hospital for Children NHS Trust, Institute for Child Health, School of Nursing and Midwifery, King's College, London, England, (8) Newborn and Developmental Paediatrics, Sunnybrook & Women's College Health Sciences Centre, Toronto, ON, Canada, (9) Paediatrics, Dalhousie University, Halifax, NS, Canada, (10) School of Nursing, McGill University, Montreal, QC, Canada, (11) Faculty of Nursing, University of Toronto, Toronto, ON, Canada, (12) Paediatrics, Mount Sinai Hospital, Toronto, ON, Canada, (13) Nursing Administration, Sick Kids Hospital, Toronto, ON, Canada
Objectives: To determine how parents assess procedural pain in infants at varying levels of risk for neurological impairment (NI) in the NICU and at a 6-month immunization. Methods: Using a qualitative exploratory design, a purposive sample of 79 parents of 86 infants from 3 Canadian tertiary level NICUs were interviewed. Using predetermined criteria, infants were categorized as high (n= 26), moderate (n=28) and low (n=32) risk for NI. Semi-structured interviews were conducted with parents and analyzed using qualitative content methods. Utilizing inductive reasoning, data were organized into categories reflecting emerging themes. Results: Four categories emerged: a) appearance of pain b) parental strategies used to relieve pain c) pain relief indicators d) health professional interactions with parents and infants. Parents of high risk infants reported less body movement, facial expression and crying in the NICU compared to the low risk group. Unique to the high risk group were reports of grunting, moaning, twitching and biting behaviours. At the 6-month immunization, parents of low-risk infants reported more facial expressions compared to the high and moderate risk groups. Pain relief strategies used after a painful event included distraction techniques, vestibular movement and physical contact. Physical indicators and parent-child interaction were reported as signs that pain had been relieved. Parents reported that health professionals' management of pain generally did not include talking to parents about pain management. Conclusion: Parents used behavioural and physical indicators to assess and evaluate pain interventions in their infants. Absences of communication from health professionals and the lack of preparation for painful events highlight the importance of including parents as stakeholders in the assessment and management of their infants' pain.