Using Evidence That Sticks To Ease Infant Pain

Implement and evaluate a practice change on a mother–baby unit to systematically provide evidence-based comfort measures to well newborns (NBs) during painful routine procedures like heel sticks or needlesticks. Research shows that NBs have lower pain thresholds and can experience long-term brain changes and adverse outcomes from repeated exposure to painful procedures. NBs who receive simple, nonpharmacologic pain relief (i.e., comfort measures) demonstrate less pain and fewer negative outcomes. NBs receive a minimum of three needle-/heel sticks and can have a dozen or more for routine procedures before being discharged from the hospital. Repeated sticks without pain management may affect immature pain circuits, causing long-term hypersensitivity to stimuli. Despite the existence of widely published research, NB pain for routine procedures is largely untreated. After collecting baseline data, staff were educated on and expected to provide comfort measures (swaddling, skin-to-skin contact, facilitated tucking, oral sucrose, breastfeeding and nonnutritive sucking) during procedures. After collecting baseline data, nurses were educated on and expected to provide comfort measures during procedures. To assess project success, outcomes were remeasured after implementation of the change. The Neonatal Infant Pain Scale (NIPS) measured pain before and during routine needle- and heel sticks for 102 NBs in Group 1 (baseline, before project) and 122 NBs in Group 2 (provided comfort measures). Group 2 NBs had significantly lower mean pain scores than Group 1 (NIPS of 4.0 vs. 2.6) during procedures, t(222) = –4.361, p < .0001, d = .80. As more comfort measures were used, pain levels declined (r = –.41, p < .001). When there was a greater number of procedures, pain scores were higher (r = .31, p < .001). Group 2 had lower mean pain scores than Group 1, regardless of procedure quantity. The provision of comfort measures during routine procedures can have long-lasting beneficial effects. Nurses felt these measures were simple, effective, and easy to implement. Presenters will share strategies, tips, and more detailed information for this successful practice change. Mother–baby nurses are uniquely positioned to improve care, ease suffering, and reduce potential for long-term problems.