Healthcare professionals' perceptions of pain in infants at risk for neurological impairment

Lynn M Breau¹ , Patrick J McGrath²^,3 , Bonnie Stevens⁴^,5 , Joseph Beyene⁶^,7 , Carol S Camfield²^,3^,8 , G Allen Finley¹^,2^,9 , Linda Franck¹⁰ , Alexandra Howlett³ , Karel O'Brien⁷ and Arne Ohlsson⁷

¹Pediatric Pain Service, IWK Health Centre, 5850 University Ave., P.O. Box 9700, Halifax, Nova Scotia, B3K 6R8, Canada

²Department of Psychology, Dalhousie University, Life Sciences Centre, Halifax, Nova Scotia, B3H 4J1, Canada

³Department of Pediatrics, Dalhousie University, 5850 University Ave., P.O. Box 9700, Halifax, Nova Scotia, B3K 6R8, Canada

⁴Faculty of Nursing, University of Toronto, 50 St. George St., Toronto, Ontario, M5S 3H4, Canada

⁵The Hospital for Sick Children Centre for Nursing, Room 4734B Atrium Building, 555 University Avenue Toronto, Ontario, M5G 1X8, Canada

⁶Population Health Sciences, The Hospital for Sick Children, 123 Edward Street, Room 407, Toronto, Ontario, Canada

⁷Department of Pediatrics, Department of Paediatrics, Mt. Sinai Hospital, 600 University Avenue, Toronto, Ontario, M5G 1X5, Canada

⁸Division of Neurology, IWK Health Centre, 5850 University Ave., P.O. Box 9700, Halifax, Nova Scotia, B3K 6R8, Canada

⁹Department of Anesthesiology, Dalhousie University, 5850 University Ave., P.O. Box 9700, Halifax, Nova Scotia, B3K 6R8, Canada

¹⁰Centre for Nursing and Allied Health Professionals Research, Great Ormond Street Hospital for Children NHS Trust, Great Ormond Street, London WC1N 3JH, UK

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BMC Pediatrics 2004, 4:23doi:10.1186/1471-2431-4-23


Published:	12 November 2004

Abstract

Background

To determine whether healthcare professionals perceive the pain of infants differently due to their understanding of that infant's level of risk for neurological impairment.

Method

Neonatal Intensive Care Units (NICU's) at two tertiary pediatric centers. Ninety-five healthcare professionals who practice in the NICU (50 nurses, 19 physicians, 17 respiratory therapists, 9 other) participated. They rated the pain (0–10 scale and 0–6 Faces Pain Scale), distress (0–10), effectiveness of cuddling to relieve pain (0–10) and time to calm without intervention (seconds) for nine video clips of neonates receiving a heel stick. Prior to each rating, they were provided with descriptions that suggested the infant had mild, moderate or severe risk for neurological impairment. Ratings were examined as a function of the level of risk described.

Results

Professionals' ratings of pain, distress, and time to calm did not vary significantly with level of risk, but ratings of the effectiveness of cuddling were significantly lower as risk increased [F (2,93) = 4.4, p = .02]. No differences in ratings were found due to participants' age, gender or site of study. Physicians' ratings were significantly lower than nurses' across ratings.

Conclusion

Professionals provided with visual information regarding an infants' pain during a procedure did not display the belief that infants' level of risk for neurological impairment affected their pain experience. Professionals' estimates of the effectiveness of a nonpharmacological intervention did differ due to level of risk.