title: Pain management in neonates: a survey of nurses and doctors.
abstract: OBJECTIVE
  This paper is a report of a descriptive survey of nurses' and doctors' knowledge and reported practice regarding procedural pain assessment and management in neonatal intensive care units.
  
  
  BACKGROUND
  There are concerns that pain is often unrecognized and under-treated in neonates. Current guidelines advocate administration of analgesia and comfort measures, but may be vulnerable to inter-professional differences in guideline implementation.
  
  
  METHODS
  All nurses and doctors working in all seven neonatal intensive care units in one area of the United Kingdom were surveyed between January to August 2007. Lead clinicians distributed and collected anonymous questionnaires.
  
  
  RESULTS
  Response rate was 44% (62 doctors, 137 nurses). Internal consistency was high, overall Cronbach's alpha 0·976. Respondents were knowledgeable, mean score 82% (SD13·3%). They agreed that neonates feel pain and need analgesia. Chest drain insertion was perceived to be the most painful procedure, heel-prick the least. Respondents reported that analgesia and comfort measures were not usually administered for most procedures: nurses were more likely than doctors to report adhering to guidelines advocating administration of analgesia and comfort measures. Statistically significant differences between current and optimal practice were acknowledged. Few (21% and 37%) had received training on neonatal pain and fewer (2·5%) employed recognized pain assessment instruments. Pain management guidelines were available to 29(47%) doctors and 85(62%) nurses; 20(18%) reported that these had been audited.
  
  
  CONCLUSIONS
  Clinicians were knowledgeable about neonatal pain, but gaps between knowledge and practice remain. This hiatus could be bridged by providing research evidence for the efficacy of guidelines incorporating validated pain assessment instruments.
authors: Leicester Royal Infirmary, UK.
authors: Akuma O
authors: AO
authors: Akuma
authors: Sue
authors: S
authors: Jordan
mesh_terms: D000698:Analgesia / Q000379:methods / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D003955:Diagnostic Tests, Routine / Q000009:adverse effects; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007231:Infant, Newborn; D015931:Intensive Care, Neonatal / Q000379:methods* / Q000592:standards; D008505:Medical Staff, Hospital; D009741:Nursing Staff, Hospital; D010146:Pain / Q000188:drug therapy; D059408:Pain Management / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data; D010147:Pain Measurement / Q000706:statistics & numerical data; D058748:Pain Perception; D017410:Practice Guidelines as Topic; D006113:United Kingdom