Pain responses in preterm infants and parental stress over repeated painful procedures: a randomized pilot trial.

OBJECTIVES: In this pilot study, the aims were to determine the feasibility of whether pain behavior in extremely and very preterm infants and perceived parental stress change when parents are involved in pain reducing measures, either actively, performing facilitated tucking or passively, observing the intervention, in comparison to the involvement of nurses only. In addition, the infant's pain reactivity and parental stress over three time points of measurement was of interest. METHODS: Extremely and very preterm infants in need of subcutaneous erythropoietin were randomly assigned to the two intervention groups. The intervention encompassed that one parent of each infant was involved during the painful procedure: Either parents executed facilitated tucking themselves or stood by, observing the procedure. Usual care involved that nurse executed facilitated tucking. All infants received 0.5 ml of 30% oral glucose solution via cotton swab before the painful procedure. Infant pain was observed with the Bernese Pain Scale for Neonates (BPSN) and measured with the MedStorm skin conductance algesimeter (SCA) before, during, and after the procedure. Parents' stress levels were measured before and after the painful procedure on the infant, using the Current Strain Short Questionnaire (CSSQ). Feasibility of a subsequent trial was determined by assessing recruitment, measurement and active parental involvement. Quantitative data collection methods (i.e. questionnaires, algesimeter) were employed to determine the number of participants for a larger trial and measurement adequacy. Qualitative data (interviews) was employed to determine parents' perspectives of their involvement. RESULTS: A total of 13 infants (98% participation rate) were included along with their mothers. Median gestational age was 27 weeks (IQR 26-28 weeks), 62% were female. Two infants (12.5%) dropped out of the study as they were transferred to another hospital. Facilitated tucking turned out to be a good method to actively involve parents in pain reducing measures. No significant differences between the two intervention and control groups were found concerning parental stress and infant pain (p = .927). Power analysis indicated that at least N = 741 infants (power of 81%, α = .05) would be needed to obtain statistically significant results in a larger trial, as effect sizes were smaller than expected. Two of the three measurement tools - i.e. the BPSN and CSSQ) - proved easy to implement and were well accepted. owever, the SCA was challenging in this context. Measurements were also found to be time-consuming and resource-intense (i.e. health professionals as assistants). CONCLUSIONS: Although the intervention was feasible and was readily accepted by parents, the study design was found to be challenging along with the SCA. In preparation of the larger trial, the study design needs to be revisited and adjusted. Thus, issues of time and resources may be resolved. In addition, national and international collaboration with similar neonatal intensive care units (NICU) needs to be considered. Thus, it will be possible to conduct an appropriately powered larger trial, which will yield important results to improve pain management in extremely and preterm infants in NICU.

Systematic Review of the Effectiveness of Involving Parents During Painful Interventions for Their Preterm Infants.

OBJECTIVE: To systematically review the literature related to the effectiveness of parents' active involvement during painful interventions for their preterm infants. DATA SOURCES: We performed a systematic search of PubMed, EMBASE/Ovid, CINAHL, Livivio, and PsycInfo using the keywords "preterm infants," "pain," and "parents." STUDY SELECTION: Articles were eligible for inclusion if they were published between 2000 and 2021 and reported randomized controlled trials (RCTs) in which preterm infants underwent painful interventions, and parents were present and actively involved in pain-reducing measures. DATA EXTRACTION: We used the Consolidated Standards of Reporting Trials (CONSORT) checklist for RCTs for data extraction. We assessed methodologic quality using critical appraisal for RCTs according to the Joanna Briggs Institute. DATA SYNTHESIS: In total, 22 articles met the inclusion criteria. These articles reported 19 studies focused on kangaroo/skin-to-skin care, one focused on breastfeeding, and two focused on facilitated tucking. The methods used to evaluate pain in the infant varied substantially. Overall, kangaroo/skin-to-skin care and facilitated tucking resulted in clinically and statistically significant decreases in pain. For breastfeeding, effectiveness was linked to a more mature sucking pattern of the preterm infant. CONCLUSION: The current evidence suggests that involving parents in pain-reducing measures during painful interventions for their preterm infants is beneficial. However, more research is needed for the different methods of involving parents in pain-reducing measures.

[Measurement of attitudes toward interprofessional collaboration in an operating theatre - a cross-sectional study]. / Messung der Haltung zur interprofessionellen Zusammenarbeit in einer Operationsabteilung ­ eine Querschnittsstudie.

Measurement of attitudes toward interprofessional collaboration in an operating theatre - a cross-sectional study Abstract.Background: Interprofessional cooperation (IC) between healthcare professionals is essential for good treatment outcomes. Surgical departments place special demands on interprofessional cooperation (situational team formation, alterning work environment, coordinative overcrowding of work) within a health organisation. In order to achieve common goals in a team, it is important that those involved have a comparable understanding of and attitude towards interprofessional cooperation, regardless of their profession. Research Question: What is the internal consistency of the German version of the Jefferson Scale of Attitudes Toward Interprofessional Collaboration (JeffSATIC) when applied to personnel in an operating theatre? What is the attitude towards interprofessional cooperation between the various occupational groups in a surgical department of an acute care hospital functioning as a centre and a training establishment? Are there differences between the individual occupational groups and the sexes? Method: The validated JeffSATIC questionnaire was translated back into German and sent to 283 people in a surgical department with eleven operating theatres. The internal consistency of the questionnaire and differences in attitude towards interprofessional cooperation were examined. Findings: The German version of the JeffSATIC questionnaire is a reliable instrument for measuring the attitude of individuals towards interprofessional cooperation. It was used for the first time in the context of a surgical department. In the institution examined, there are no statistically significant differences between the different occupational groups and sexes in relation to the attitude to IC in the dimensions 'work relationship' and 'responsibility' determined by the questionnaire. The medical service anaesthesia shows the greatest divergence in attitude towards interprofessional cooperation within a professional group. Conclusions: In the institution examined, the prerequisites for successful interprofessional cooperation exist. In general, it should be further examined which factors influence the divergence in attitude per occupational group and whether these divergences in attitude are also associated with the quality of the actual cooperation.