TY - JOUR
T1 - Factors affecting delivery of evidence-based procedural pain care in hospitalized neonates
AU - Latimer, Margot A.
AU - Johnston, Celeste C.
AU - Ritchie, Judith A.
AU - Clarke, Sean P.
AU - Gilin, Debra
N1 - Funding Information:
Funded by Canadian Health Services Research Foundation/Canadian Institutes of Health Research, Formation et expertise en recherche en administration des services infirmiers (FERASI) Center; Canadian Institutes of Health Research, Pain in Child Health Program; Nova Scotia Health Research Foundation; Canadian Nurses Foundation; Nursing Research Fund, Dalhousie University; and Izaak Walton Killam Health Centre. The authors thank Marlene Furlong, RN.
PY - 2009
Y1 - 2009
N2 - Objective: To examine the effects of nurse, infant, and organizational factors on delivery of collaborative and evidence-based pain care by nurses. Design: Cross sectional. Setting: Two Level III neonatal intensive careunits in 2 large tertiary care centers in Canada. Participants: A convenience sample of 93 nurses completed survey data on procedures they performed on ill neonates. The 93 nurses performed a total of 170 pain producing procedures on 2 different shifts. Main Outcome: Nurse use of evidence-based protocols to manage procedure related pain using a scorecard of nurses' assessment, management, and documentation. Results: Procedural pain care was more likely to meet evidence-based criteria when nurse participants rated nurse-physician collaboration higher (odds ratio, 1.44; 95% confidence intervals 1.05-1.98), cared for higher care intensity infants (odds ratio, 1.21; 95% confidence intervals, 1.06-1.39), and experienced unexpected increases in work assignments (odds ratio, 1.55; 95% confidence intervals, 1.04-2.30). Nurses' knowledge about the protocols, educational preparation and experience were not significant predictors of evidence-based care for the most common procedures: heel lance and intravenous initiation. Conclusion: Nurse-physician collaboration and nurses' work assignments were more predictive of evidence-based care than infant and nurse factors. Nurses' knowledge regarding evidence-based care was not a predictor of implementation of protocols. In the final statistical modeling, collaboration with physicians, a variable amenable to intervention and further study, emerged as a strong predictor. The results highlight the complex issue of translating knowledge to practice, however, specific findings related to pain assessment and collaboration provide some direction for future practice and research initiatives.
AB - Objective: To examine the effects of nurse, infant, and organizational factors on delivery of collaborative and evidence-based pain care by nurses. Design: Cross sectional. Setting: Two Level III neonatal intensive careunits in 2 large tertiary care centers in Canada. Participants: A convenience sample of 93 nurses completed survey data on procedures they performed on ill neonates. The 93 nurses performed a total of 170 pain producing procedures on 2 different shifts. Main Outcome: Nurse use of evidence-based protocols to manage procedure related pain using a scorecard of nurses' assessment, management, and documentation. Results: Procedural pain care was more likely to meet evidence-based criteria when nurse participants rated nurse-physician collaboration higher (odds ratio, 1.44; 95% confidence intervals 1.05-1.98), cared for higher care intensity infants (odds ratio, 1.21; 95% confidence intervals, 1.06-1.39), and experienced unexpected increases in work assignments (odds ratio, 1.55; 95% confidence intervals, 1.04-2.30). Nurses' knowledge about the protocols, educational preparation and experience were not significant predictors of evidence-based care for the most common procedures: heel lance and intravenous initiation. Conclusion: Nurse-physician collaboration and nurses' work assignments were more predictive of evidence-based care than infant and nurse factors. Nurses' knowledge regarding evidence-based care was not a predictor of implementation of protocols. In the final statistical modeling, collaboration with physicians, a variable amenable to intervention and further study, emerged as a strong predictor. The results highlight the complex issue of translating knowledge to practice, however, specific findings related to pain assessment and collaboration provide some direction for future practice and research initiatives.
KW - Evidenced-based
KW - Knowledge transfer
KW - Neonatal procedural pain
KW - Nurse-physician collaboration
KW - Nurses
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U2 - 10.1111/j.1552-6909.2009.01007.x
DO - 10.1111/j.1552-6909.2009.01007.x
M3 - Article
C2 - 19323714
AN - SCOPUS:63149177191
SN - 0884-2175
VL - 38
SP - 182
EP - 194
JO - JOGNN - Journal of Obstetric, Gynecologic, and Neonatal Nursing
JF - JOGNN - Journal of Obstetric, Gynecologic, and Neonatal Nursing
IS - 2
ER -