Effectiveness of e-Learning on Neonatal Nurses' Pain Knowledge and Pain Measurement Skills: A Pilot Study.

BACKGROUND: Reported benefits of virtual programs include user satisfaction and feasibility to train nurses to utilize pain scales. However, the effectiveness of the virtual neonatal pain management program on nurses' knowledge and scoring skill acquisition has not been examined. PURPOSE: This study developed a comprehensive virtual program on neonatal pain management and examined its effectiveness on nurses' knowledge and skill acquisition of selected pain scales. METHODS: Evidence-based content was designed as a virtual program and pre-and posttests to examine skill and knowledge acquisition were developed and validated. Analysis of covariance was used to assess the differences from pre- to posttest based on the intensity of participants' involvement while examining the overall effectiveness of the program. RESULTS: A total of 115 nurses representing 7 hospitals completed the virtual neonatal pain management program, and 52 nurses completed the posttest. The Student paired t test showed an increase in posttest scores from pretest scores among participants. Participants' final degrees and years of experience were not related to posttest scores. The analysis of covariance showed that the high study group had a significantly higher amount of change in total scores and pain measurement skill scores than the low study group on the posttest. IMPLICATIONS FOR PRACTICE: The virtually delivered neonatal pain management program can be useful for nurses' attainment of knowledge and skills for managing neonatal pain, including an appropriate use of selected scoring tools. IMPLICATIONS FOR RESEARCH: It is necessary to examine how organizational unit attendance rate for e-learning and posttest results are related to patient outcomes. VIDEO ABSTRACT AVAILABLE AT: https://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx?autoPlay=false&videoId=46.

A Quality Improvement Collaborative Program for Neonatal Pain Management in Japan.

BACKGROUND: Neonatal pain management guidelines have been released; however, there is insufficient systematic institutional support for the adoption of evidence-based pain management in Japan. PURPOSE: To evaluate the impact of a collaborative quality improvement program on the implementation of pain management improvements in Japanese neonatal intensive care units (NICUs). METHODS: Seven Japanese level III NICUs participated in a neonatal pain management quality improvement program based on an Institute for Healthcare Improvement collaborative model. The NICUs developed evidence-based practice points for pain management and implemented these over a 12-month period. Changes were introduced through a series of Plan-Do-Study-Act cycles, and throughout the process, pain management quality indicators were tracked as performance measures. Jonckheere's trend test and the Cochran-Armitage test for trend were used to examine the changes in quality indicator implementations over time (baseline, 3 months, 6 months, and 12 months). FINDINGS: Baseline pain management data from the 7 sites revealed substantial opportunities for improvement of pain management, and testing changes in the NICU setting resulted in measurable improvements in pain management. During the intervention phase, all participating sites introduced new pain assessment tools, and all sites developed electronic medical record forms to capture pain score, interventions, and infant responses to interventions. IMPLICATIONS FOR PRACTICE: The use of collaborative quality improvement techniques played a key role in improving pain management in the NICUs. IMPLICATIONS FOR RESEARCH: Collaborative improvement programs provide an attractive strategy for solving evidence-practice gaps in the NICU setting.

Development of a Neonatal End-of-Life Care Education Program for NICU Nurses in Japan.

We developed the first end-of-life care education program for neonatal intensive care unit (NICU) nurses in Japan. It focused on ethical decision making, care of dying neonates, bereavement, and cultural communication. The program improved nurses' knowledge, F(2.16, 62.5) = 260.6, p < .001, and understanding, F(2.05, 59.4) = 29.1, p < .001, and significantly reduced weaknesses in neonatal end-of-life care. It was considered well designed and may provide further mentoring support for NICU nurses.

Subsequent pregnancy after having a baby who was hospitalized in the NICU.

PURPOSE: To understand experiences of mothers who had a baby hospitalized in the NICU and then decided to have another pregnancy. STUDY DESIGN AND METHODS: We used a descriptive phenomenological approach to study 12 mothers in Japan who had a child hospitalized in the NICU and had a subsequent child. Data were collected by semistructured interviews that occurred two to four times per participant. Data were analyzed using Colaizzi's method. RESULTS: Although all of the mothers had a child who was making steady progress, they experienced difficulty when deciding on having another pregnancy. Our analysis identified five theme clusters: delaying pregnancy; unwavering view about having subsequent children; changing values regarding pregnancy and childbirth; relief of anxiety and fear about repeated hospitalization in the NICU; and preparedness to accept the outcome of pregnancy. CLINICAL IMPLICATIONS: Our study suggests that mothers require support during babies' hospitalization in the NICU and for the process of decision-making about a subsequent pregnancy. Family-centered care as the basis for nursing practice in the NICU is ideal to provide this type of support.

Pain management of neonatal intensive care units in Japan.

AIM: To describe current neonatal pain management and individual and organizational factors that can improve neonatal pain practice from the viewpoints of both head nurses and head neonatologists in Japan. METHODS: An anonymous questionnaire was sent to general perinatal maternal and child medical centres that had level 3 units across Japan. RESULTS: A total of 61 of 89 head nurses and 54 of 89 head neonatologists replied. The responses of head nurses and head neonatologists were almost the same. More than 60% of units (head nurses, 65%; head neonatologists, 61%) did not use pain scales, and about 63% units (both head nurses and head neonatologists) had no rules for health care professionals on the best methods for implementing pain relief for painful diagnostic and therapeutic procedures. Only 17% of head nurses and 24% of head neonatologists considered that nurses and physicians in their units collaborated in pain management, and <20% of units (both head nurses and head neonatologists) had written guidelines for their unit on neonatal pain management. CONCLUSION: This study suggested that Japanese neonatal intensive care units need national guidelines for pain management, and these might improve collaboration between nurses and physicians in minimizing neonatal pain.