Development, evaluation and adaptation of a critical realism informed theory of procedural pain management in preterm infants: The PAIN-Neo theory.

AIM: To present the development, evaluation and adaptation of the PAIN-Neo theory. DESIGN: Theory development. DATA SOURCES: A review of literature was conduct from 1980 to 2021. RESULTS: Using a critical realism paradigm, this paper presents the PAIN-Neo theory, which was developed from an analysis of existing theoretical perspectives on paediatric procedural pain, empirical studies conducted with preterm infants, and the research team's pain management expertise. The theory was then empirically tested and fine-tuned. IMPLICATIONS FOR NURSING: The PAIN-Neo theory highlights that the neonatal nurse is part of a larger picture as she is influenced by factors related to her unit, hospital and country of practice. This theory emphasizes the importance of parental involvement in pain management, which is consistent with family-centred nursing practices. CONCLUSION: The PAIN-Neo theory reflects the complexity of pain management nursing. This theory is innovative and specific enough to guide practice, structure research projects and contribute to the body of knowledge in the discipline of nursing.

Family Resilience as an Emerging Concept in Neonatology: Evidence From a Metasummary Review.

BACKGROUND: Family resilience can be observed through specific resilience-promoting processes, namely, shared belief systems, communication, and organizational processes, but the concept remains mostly unstudied in neonatology. This metasummary aims to evaluate the frequency of family resilience processes in qualitative scientific literature to illustrate how family resilience is exhibited in the neonatal intensive care unit (NICU) setting. METHODS: A search among 4 databases yielded 7029 results, which were reviewed for inclusion. Following Sandelowski and Barroso's qualitative metasummary method, findings from each study were independently coded and frequency effect size was calculated. RESULTS: Forty-six primary qualitative studies published between 2016 and 2022 conducted with parents of preterm infants who discussed their NICU hospitalization experience were included in this metasummary. All 9 of Walsh's family resilience processes were identified in the literature, and their frequency effect size ranged from 4% to 91%. Four additional themes emerged pertaining to specific family resilience behaviors exhibited by NICU families. CONCLUSION: This analysis sheds new light on the most recent qualitative evidence of parents' experiences in the NICU by analyzing it through the lens of family resilience and posits family resilience as a promising concept in relation to the predominance of the family-centered care philosophy in neonatal units.

French Translation, Adaptation, and Initial Validation of the Nurses' Attitudes and Perceptions of Pain Assessment in Neonatal Intensive Care Questionnaire (NAPPAQ).

PURPOSE: The purpose of this study was to translate, adapt and conduct initial psychometric validation of the French version of the Nurses' Attitudes and Perceptions of Pain Assessment in neonatal intensive care Questionnaire (NAPPAQ) developed by Polkki in 2010. BACKGROUND: Assessing nurses' perceptions, attitudes and knowledge about pain management in preterm infants is important to improve neonatal practices. METHODS: A sample of French-speaking nurses (n = 147) from Quebec and France working in neonatal intensive care was selected to validate the 46-item questionnaire. A French translation of the NAPPAQ, which includes Part I and II, was undertaken prior to its administration. The FIPM questionnaire was added as a Part III. Internal consistency and instrument structure were examined using Cronbach's alphas, inter-item and inter-scale correlations and exploratory factor analysis. RESULTS: The NAPPAQ-FIPM is divided into three parts. Part I of the French version had a Cronbach's alpha of 0.64 and was composed of five factors. Part II had good total internal consistency (0.79) and adequate structure, established by inter-item correlations. Part III had good total internal consistency (0.76), and factor analysis findings suggested the presence of five factors. CONCLUSIONS: The NAPPAQ-FIPM can be used for research purposes. Parts II and III obtained adequate psychometrics results. However, further refinement of Part I could improve its content and internal structure.

Nurses' Perception of Preterm Infants' Pain and the Factors of Their Pain Assessment and Management.

In the neonatal intensive care unit, preterm infants undergo many painful procedures. Although these can impair their neurodevelopment if not properly managed, only half of the painful procedures are optimally handled. This cross-sectional study aimed to evaluate nurses' perceptions of preterm infants' pain, to evaluate nurses' pain assessment and management practices, as well as to identify the individual and contextual factors that influence nurses' assessments and interventions for pain management. Secondary analyses, including a mixed-model analysis, were performed with data from a larger study (n = 202 nurses). Nurses were found to have attitudes and perceptions in favor of preterm infants' pain management, although they reported using few standardized instruments to assess pain. Nurses stated that they widely used sucrose, non-nutritive sucking, and positioning as pain management interventions, while skin-to-skin contact was rarely practiced. Nurses' attitudes and perceptions influenced their pain assessment practices, which predicted their implementation of interventions. Several contextual (country, level of care, and work shift) and individual factors (age, level of education, had a preterm infant, perceptions of family-centered care, and skin-to-skin contact) also predicted nurses' pain assessment and management practices.

Comprehensive and Innovative Clinical Tools for Nurses and Parents to Help Promote Family and Sibling Adaptation in the NICU.

Family-centered care (FCC) in NICUs aims to support parents and children facing the distressing experience of a preterm infant's NICU hospitalization. Neonatal nurses must also have proper knowledge of the support interventions for parents' and siblings' adaptation during the NICU hospitalization. This paper describes comprehensive and innovative clinical tools which consist of a clinical reference guide for nurses, a website for parents, and a storybook for siblings to promote families' adaptation, and help parents support their older children during NICU hospitalization. Based on scientific evidence and the family systems nursing approach, these comprehensive and innovative clinical tools for nurses, parents, and siblings contribute, through their development and implementation, to enhancing FCC and the quality of nursing care to families.

Effectiveness of interventions on early neurodevelopment of preterm infants: a systematic review and meta-analysis.

BACKGROUND: As preterm infants' neurodevelopment is shaped by NICU-related factors during their hospitalization, it is essential to evaluate which interventions are more beneficial for their neurodevelopment at this specific time. The objective of this systematic review and meta-analysis was to evaluate the effectiveness of interventions initiated during NICU hospitalization on preterm infants' early neurodevelopment during their hospitalization and up to two weeks corrected age (CA). METHODS: This systematic review referred to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses [PRISMA] guidelines and was registered in PROSPERO (CRD42017047072). We searched CINAHL, MEDLINE, PubMed, EMBASE (OVID), Cochrane Systematic Reviews, CENTRAL, and Web of Science from 2002 to February 2020 and included randomized controlled/clinical trials conducted with preterm infants born between 24 and 366/7 weeks of gestation. All types of interventions instigated during NICU hospitalization were included. Two independent reviewers performed the study selection, data extraction, assessment of risks of bias and quality of evidence. RESULTS: Findings of 12 studies involving 901 preterm infants were synthesized. We combined three studies in a meta-analysis showing that compared to standard care, the NIDCAP intervention is effective in improving preterm infants' neurobehavioral and neurological development at two weeks CA. We also combined two other studies in a meta-analysis indicating that parental participation did not significantly improve preterm infants' neurobehavioral development during NICU hospitalization. For all other interventions (i.e., developmental care, sensory stimulation, music and physical therapy), the synthesis of results shows that compared to standard care or other types of comparators, the effectiveness was either controversial or partially effective. CONCLUSIONS: The overall quality of evidence was rated low to very low. Future studies are needed to identify interventions that are the most effective in promoting preterm infants' early neurodevelopment during NICU hospitalization or close to term age. Interventions should be appropriately designed to allow comparison with previous studies and a combination of different instruments could provide a more global assessment of preterm infants' neurodevelopment and thus allow for comparisons across studies. TRIAL REGISTRATION: Prospero CRD42017047072 .

Nurturing and quiet intervention (NeuroN-QI) on preterm infants' neurodevelopment and maternal stress and anxiety: A pilot randomized clinical trial protocol.

OBJECTIVES: Primary objective of this pilot study is to evaluate the feasibility and acceptability of the NeuroN-QI and the study procedures. Secondary objectives are to assess the feasibility and acceptability of the NeuroN-QI by the nurses, assess the nurses' training needs about the components of the NeuroN-QI, and estimate the preliminary effects of the NeuroN-QI on infants' neurodevelopment as well as maternal stress and anxiety at infants' 36 weeks of gestational age. DESIGN: A two-group pilot parallel randomized clinical trial stratified by center. METHODS: The pilot study will be conducted in two neonatal intensive care units (NICUs). A sample of 24 mother-infant dyads born between 26 and 316/7 gestational age will be randomized into an experimental or control group. Fifty nurses will be recruited. The NeuroN-QI consists of four 2-hour skin-to-skin contact sessions/week with a 15-minute auditory stimulation by mothers with controlled ambient levels of light and noise. A 1-hour quiet period will follow where infants will rest in their incubator/crib with their mother's milk for olfactory stimulation and where the light and noise control will be continued. In the control group, mother-infant dyads will do four skin-to-skin contacts per week and receive standard care. Acceptability and feasibility of the NeuroN-QI in addition to maternal stress and anxiety will be measured through questionnaires, while infants' neurodevelopment will be assessed with Assessment of Preterm Infant Behaviour and General Movement Assessment. CONCLUSIONS: This pilot trial will address knowledge gaps and generate evidence in neonatal care by evaluating the feasibility and acceptability of a multi-component developmental care intervention. IMPACT: This project is an innovative step towards optimizing the neurodevelopmental trajectory of infants in NICUs and consequently promoting their long-term health outcomes. TRIAL REGISTRATION: NCT04593095.

Promoting Family and Siblings' Adaptation Following a Preterm Birth: A Quality Improvement Project of a Family-Centered Care Nursing Educational Intervention.

BACKGROUND AND PROBLEM: A Family-Centered Care (FCC) quality improvement project was implemented with nurses to promote families' and siblings' adaptation during the NICU hospitalization of a preterm infant. The objective of this quality improvement project was to compare the nurses' knowledge and perceptions as well as their implementation of nursing practices to facilitate the families' and siblings' adaptation during NICU hospitalization before and after they received the FCC educational intervention. METHODS AND INTERVENTION: A pre- and post-intervention evaluation design was used in this quality improvement project. A convenience sample of 20 nurses was initially recruited and completed the pre-intervention, while 13 completed the post-intervention. The educational intervention included a reflective practice exercise and a face-to-face training session. Nurses completed a self-administered questionnaire with two subscales assessing their knowledge, perceptions, as well as their implementation of nursing practices related to family and sibling adaptation in the NICU. RESULTS: The paired samples t-test shows Paired-samples t-test showed that the nurses' knowledge, perceptions and implementation of nursing practices were more favorable following the FCC educational intervention. CONCLUSIONS: Findings of this quality improvement project reinforce the value of supporting NICU nurses with educational training programs to enhance their practice. This educational intervention represents an effort to foster the implementation of FCC in NICUs.

[Theoretical perspectives on pediatric pain: A critical review]. / Les perspectives théoriques en douleur pédiatrique : une revue critique.

Introduction : Theoretical perspectives are essential for guiding clinical practice and nursing research.Context : The understanding of pain has evolved considerably, leading to new theoretical models integrating the different components of pain (sensory-discriminative, affective-motivational, and cognitive).Objective : To conduct a critical review of the different theoretical perspectives on children's procedural pain.Method : To identify relevant theoretical literature, a literature search on pediatric pain was conducted on PubMed, CINAHL, Embase, and Google Scholar.Results : Six theoretical perspectives for procedural pediatric pain were identified. These theoretical perspectives are described, and their strengths and limitations are explained.Conclusion : This critical review will help nurses to choose a theory that will guide a research project and their clinical practice.

Les perspectives théoriques en douleur pédiatrique : une revue critique.

Introduction : Theoretical perspectives are essential for guiding clinical practice and nursing research.Context : The understanding of pain has evolved considerably, leading to new theoretical models integrating the different components of pain (sensory-discriminative, affective-motivational, and cognitive).Objective : To conduct a critical review of the different theoretical perspectives on children's procedural pain.Method : To identify relevant theoretical literature, a literature search on pediatric pain was conducted on PubMed, CINAHL, Embase, and Google Scholar.Results : Six theoretical perspectives for procedural pediatric pain were identified. These theoretical perspectives are described, and their strengths and limitations are explained.Conclusion : This critical review will help nurses to choose a theory that will guide a research project and their clinical practice.

Acceptability to nurses of reducing NICU light and noise levels during skin-to-skin care: A pilot study.

INTRODUCTION: Light and noise levels may influence preterm infants and their mothers when they are experiencing skin-to-skin contact [SSC] in the Neonatal Intensive Care Unit [NICU]. METHODS: A pilot randomized controlled trial [RCT] of an intervention aiming at reducing light and noise levels during SSC was conducted. Twenty-one neonatal nurses from a level III NICU completed questionnaires assessing their acceptability of NICU light and noise levels reduction during SSC, whether it interfered with their care delivery, in addition to acceptability of specific interventions reducing these levels. FINDINGS: The majority of nurses considered that the reduction of NICU light and noise levels during SSC was acceptable in general, did not interfere with their care delivery, and that the nine selected interventions were also acceptable. CONCLUSION AND RESEARCH IMPLICATIONS: Nurses found it acceptable to reduce NICU light and noise levels during SSC. These findings support the conduct of a full-scale RCT to evaluate the effect of such an intervention on preterm infants and mothers' well-being.

Nurses' practices regarding procedural pain management of preterm infants.

BACKGROUND: It is well known that preterm neonates can feel pain which can be expressed through specific behaviors and signs. Repeated and untreated pain has consequences for the preterm neonates such as hypersensitivity to pain, as well as important repercussions on their motor and intellectual development. The use of non-pharmacological interventions for pain management by nurses is imperative to prevent these consequences in the NICU. The aim of this study is to survey neonatal nurses' interventions for pain management of preterm neonates. METHODS: Twenty (20) nurses were recruited for this pilot observational survey study. Standard pain management interventions used by nurses during heel prick were evaluated by means of a questionnaire. In addition, 11 out of the 20 nurses were observed during heel prick to evaluate what and how interventions were done. RESULTS: All infants (n = 11) received at least one pain management intervention during heel prick. Heterogeneity in pain management practices used by nurses is considerable. For 95% (19/20) of nurses, sucrose is a standard intervention reported in the survey but observations showed that it not always applied (64%). Positioning is more used (64%) by nurses than reported in the survey (45%). Swaddling also was also reported as a standard intervention by 45% of nurses, but it does not appear to be adequately performed (36%). CONCLUSION: According to the results, it would be essential to review nurses' knowledge and skills regarding standard pain management interventions, during painful procedures, as the quality of these practices is questionable. Homogeneity of the standard of care is particularly important in research to allow an appropriate comparison between study groups and prevention study bias.

A Pilot Randomized Controlled Trial of an Intervention to Promote Psychological Well-Being in Critically Ill Children: Soothing Through Touch, Reading, and Music.

OBJECTIVES: To examine the feasibility and acceptability of a PICU Soothing intervention using touch, reading, and music. DESIGN: Nonblinded, pilot randomized controlled trial. SETTING: The PICU and medical-surgical wards of one Canadian pediatric hospital. PATIENTS: Twenty PICU patients age 2-14 years old and their parents, randomized to an intervention group (n = 10) or control group (n = 10). INTERVENTION: PICU Soothing consisted of: 1) parental comforting (touch and reading), followed by 2) a quiet period with music via soft headbands, administered once daily throughout hospitalization. MEASUREMENTS AND MAIN RESULTS: Acceptability and feasibility of the intervention and methods were assessed via participation rates, observation, measurement completion rates, semistructured interviews, and telephone calls. Psychological well-being was assessed using measures of distress, sleep, and child and parent anxiety in the PICU, on the wards and 3 months post discharge. Forty-four percent of parents agreed to participate. Seventy percent and 100% of intervention group parents responded positively to comforting and music, respectively. Most intervention group parents (70%) and all nurses felt children responded positively. All nurses found the intervention acceptable and feasible. Measurement completion rates ranged from 70% to 100%. Pilot data suggested lower intervention group child and parent anxiety after transfer to hospital wards. CONCLUSIONS: PICU Soothing is acceptable and feasible to conduct. Results support the implementation of a full-scale randomized controlled trial to evaluate intervention effectiveness.

Effects of Cycled Lighting Versus Continuous Near Darkness on Physiological Stability and Motor Activity Level in Preterm Infants.

BACKGROUND: Preterm infants generally spend weeks in the neonatal intensive care unit where light intensity can fluctuate as well as be high, leading to physiological instability and increased motor activity in these infants. To date, 2 lighting control methods have been studied: cycled lighting and continuous near darkness. The most appropriate method of lighting is still unknown due to ambivalent results from the studies that have assessed these 2 interventions. OBJECTIVE: To compare the effects of cycled lighting versus continuous near darkness on physiological stability and motor activity level in preterm infants born between 28 and 32 weeks of gestation. METHODS: A randomized clinical trial was conducted to compare physiological stability and motor activity level in preterm infants assigned to cycled lighting or continuous near darkness. Thirty-eight participants were recruited and randomly assigned to one of the lighting conditions for 24 hours. Physiological stability was measured using the Stability of the Cardiorespiratory System in Premature Infants (SCRIP) score, the means, and the coefficient of variation of each physiological parameter measured. The level of motor activity was measured with an accelerometer. RESULTS: There were no significant differences between the 2 groups with regard to physiological stability measured by the SCRIP score, means, and coefficient of variation as well as motor activity level. Participants in both groups were physiologically stable and their motor activity level was comparable. IMPLICATIONS FOR PRACTICE AND RESEARCH: Neither cycled lighting nor continuous near darkness negatively impacted infant's physiologic stability and motor activity level. Further research is required to identify the most appropriate lighting control method for preterm infants born between 28 and 32 weeks of gestation.

Review and Critical Analysis of Massage Studies for Term and Preterm Infants.

PURPOSE: To review and analyze studies evaluating the effects of massage on term and preterm infants. DESIGN: A systematic review of literature. RESULTS: Benefits of massage for term infants are: improved weight gain, growth, and sleep and decreased hyperbilirubinemia. Benefits for preterm infants are: improved weight gain, decreased response to pain, and increased interactions with parents. However, the few studies use different interventions related to timing and number of massages, and the outcomes vary among studies. There is not enough evidence to support the use of massage for term and preterm infants, but massage may be considered on a case-by-case basis.

Physiological stability: a concept analysis.

AIM: To present a concept analysis of physiological stability. BACKGROUND: Physiological stability is an ubiquitous concept in the literature. However, no operational definition of this concept seems to be clearly established even though a literature review demonstrates multiple uses of the concept. Thus, a concept analysis is required to clarify the concept of physiological stability and identify its theoretical bases. DESIGN: Walker and Avant's method of concept analysis. DATA SOURCES: The databases consulted to perform the literature review of concept of physiological stability were: CINAHL, Ovid Medline, PsycINFO, Eric and EMB Reviews. Articles were included when the keywords physiological and stability were present in the title or abstract in articles published between 2000-2012, available electronically or in paper at the libraries. REVIEW METHOD: This concept analysis was performed using the 8-step method proposed by Walker and Avant. RESULTS: Identification of the attributes, antecedents and consequences of physiological stability led to an operational definition of the concept of physiological stability as a dynamic state of a living organism characterized by the maintenance of one or more physiological parameters within value ranges that vary only slightly in the presence of disruptive elements. It is an adaptive response reflecting the physiological balance of the living organism. CONCLUSION: This analysis contributes to the advancement of knowledge of the concept of physiological stability by proposing an operational definition derived from theoretical foundations. This concept is important within nursing because it helps to define the effectiveness of nursing interventions and attests to clients' well-being.

Prolonged pain in premature neonates hospitalised in neonatal intensive care units: A scoping review.

BACKGROUND: Exposure to repetitive pain during the neonatal period has been shown to have important short and long-term effects on the neurodevelopment of the premature neonate and can contribute to experienced prolonged pain. A uniform taxonomy of neonatal prolonged pain is still lacking to this day which contributes to suboptimal prolonged pain management in neonatal intensive care units. Accordingly, a scoping review exploring the state of knowledge about prolonged pain in preterm neonates hospitalised in the neonatal intensive care unit will contribute to the developing field of neonatal prolonged pain and provide recommendations for clinical prolonged pain management. OBJECTIVE: To determine the scope, extent, and nature of the available literature on prolonged pain in premature neonates hospitalised in neonatal intensive care units. DESIGN: Scoping review. METHODS: An electronic search was conducted from inception to November 2023 in the databases of CINAHL, PubMed, Medline, Web of Science, GeryLit.org and Grey Source Index. Included studies discussed concepts related to neonatal prolonged pain such as definitions of prolonged pain, indicators of prolonged pain, contexts that result in prolonged pain, prolonged pain evaluation tools, consequences of prolonged pain and interventions for prolonged pain management. RESULTS: Key concepts of neonatal prolonged pain were identified in the 86 included articles of this scoping review such as definitions (n = 26), indicators (n = 39), contexts (n = 49), scales (n = 56), consequences of prolonged pain (n = 30) and possible interventions for prolonged pain management (n = 22). Whilst a consensus on a definition has yet to be achieved, no proximate event was shown to cause prolonged pain and a time criterion was identified by authors as being relevant in defining prolonged pain. Interestingly, the context of hospitalisation was identified as being the most indicative of prolonged pain in premature neonates and should guide its evaluation and management, whilst only limited pain management interventions and consequences were discussed. CONCLUSION: The findings of this scoping review contribute to the foundation of growing knowledge in neonatal prolonged pain and shed light on the ambiguity that currently exists on this topic in the scientific literature. This review summarises knowledge of key concepts necessary for a better understanding of prolonged pain and stresses the importance of considering contexts of hospitalisation for prolonged pain evaluation and management in neonatal intensive care units, with the objective of improving developmental outcomes of premature neonates. TWEETABLE ABSTRACT: A scoping review reveals that the contexts of prolonged pain in premature neonates hospitalised in the neonatal intensive care unit are essential in guiding its evaluation and management.

[Developmental care principle-based concept analysis]. / Analyse du concept "soins du développement " selon la méthode basée sur les principes.

INTRODUCTION: Developmental care is a combination of interventions that focused on the adaptation of the neonatal environment to support the development of preterm infants. BACKGROUND: Although the concept of developmental care emerges from psychology, its application is integrated into the nursing care of premature infants hospitalized in the neonatal unit. OBJECTIVES: Analysis of developmental care concept has been carried out in order to establish the theoretical foundations and propose a conceptualization according to a nursing perspective. METHOD: This article presents the results of the principle based analysis of the developmental care concept. RESULTS: A conceptualization of developmental care in a nursing perspective is suggested according to the results of the principles analysis of developmental care. DISCUSSION: The identification of the theoretical basis of the concept of developmental care is the first step towards the theoretical integration of this concept that emerge from psychology in the nursing discipline. CONCLUSION: The results of this concept analysis and the proposed conceptualization contribute to the development of nursing knowledge. They can guide the practice of nurses working in the neonatal unit and who provide daily care for premature infant. They can also guide teaching and research on developmental care in nursing.

Cross-cultural adaptations of the Family Resilience Assessment Scale: a systematic review protocol of measurement properties.

OBJECTIVE: This review aims to critically appraise the measurement properties and adaptation processes of all cross-cultural adaptations of the Family Resilience Assessment Scale. BACKGROUND: A number of family resilience instruments have been developed over the past decade; however, the Family Resilience Assessment Scale reports the best psychometric properties among populations with health issues. Since its publication in 2005, numerous translations and adaptations have been undertaken to use this scale with culturally diverse populations. A systematic review of the properties of the Family Resilience Assessment Scale's cross-cultural adaptations is needed to evaluate the adapted versions' quality (validity, reliability, and responsiveness). INCLUSION CRITERIA: This review will consider validation and cross-cultural adaptation studies of the Family Resilience Assessment Scale as well as research publications reporting psychometric properties of cross-cultural adaptations in specific populations. METHODS: Nine databases will be consulted: CINAHL, PubMed, Embase, PsycINFO, PubPsych, Health and Psychosocial Instruments database, ProQuest Dissertations and Theses, ScienceDirect, and Web of Science. The search will be limited to publications since 2005 without language restrictions. Articles will be screened by two independent reviewers and will undergo risk of bias assessment. The measurement properties of retrieved instruments will be assessed following COSMIN guidelines. Data extraction will be piloted and completed by two independent reviewers using an adapted extraction form. Psychometric properties will be reported in a narrative synthesis and supported by a summary table. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42020219938.