“Having my boy on my chest, humming to him, made us both very calm.” : Parents to new-born infants rated parent-delivered pain management as significantly meaningful during venepuncture

• Background:Parents are a valuable but underutilized resource in procedural pain management in newborn infants. Parents want to take an active role in their infants’ pain management.  Yet, there is a lack of knowledge concerning the parents’ experiences of providing pain management.  Newborn infants experience several painful procedures related to postnatal care and immunizations. Not all infants receive adequate pain management during these procedures causing unnecessary suffering and leaves the infant at risk of complications. Parent-delivered pain management such as skin to skin contact and breastfeeding alleviate the infant’s pain during painful procedures. Live parental infant-directed lullaby singing has not been previously investigated during painful procedures. Infant-directed singing can be an apt medium for parents and infants to communicate in affective mutual relationship during painful procedures. Parents have a unique expertise about their infants and by including them in the pain management they could become valuable partners for the health professionals. The aim of the study was to investigate how meaningful the parents experienced providing procedural pain management to their newborn infant. Method: This study was part of a multi-center randomized controlled trial (RCT) with three parallel groups of healthy newborn infants and their parents. The SWEpap study (Parents as pain management in Swedish neonatal care), investigates the efficacy of combined pain management with skin-to-skin contact, breastfeeding and live parental lullaby singing compared with standard pain care initiated by health care professionals, and compared with just holding skin-to-skin during routine metabolic screening of newborn infants. The infant-parent dyads were randomly assigned to one of three treatment groups. For the parents’ ratings of meaningfulness, a visual analogue scale (VAS) with a 100mm line anchored at the ends is used; from “not meaningful” on the left end point, up to “most possible meaningful” on the right end point of the scale. The parents were also asked to give their verbal comment on how they experienced the blood sampling situation and providing pain management.  Results: A total number of 151 newborn infants with at least one parent, participated in the study. Mean gestational age was 39.6 w., mean birth weight was 3547 g., and 49,7 % were girls.  The mean VAS-ratings for meaningfulness were 82.1 in the standard care group, 89.5 in the skin-to-skin group and 88.9 in the combined intervention group. The ratings in the two groups with parent-delivered pain-alleviation were significantly higher than in the standard care group (p=0.036).  Parents in all groups expressed that it was meaningful to provide pain-relief and participate in the pain management of their newborn infant.  “Very meaningful. It felt much safer to have her close to me during the skin puncture. Usually, she is on the examination table which gives an unsecure feeling because when she is in pain you can’t do anything as a parent.” (Mother, skin-to-skin group) “It felt very good to make a positive impact. Singing went very well. I usually sing all the time at home.” (Father, combined group) “I could control the syringe with glucose which made me less helpless as a parent because I could contribute.” (Parent, standard care group) Some parents commented that providing pain management helped themselves to overcome their own fears. “I am scared of needles myself and has been worrying about needles and blood but this went really well. She was so calm, gave not a sound. I could also relax when she was calm.” (Mother, skin-to-skin group) Parents also compared with previous blood sampling situations. “My previous child was totally hysteric during blood sampling on the examination table. Today, the baby was absolutely calm.” (Parent, combined group)  Finally, many parents expressed that they wanted to continue providing parent-delivered pain management in the future. “I can absolutely think to use this pain relief combination in the future. He does recognize the singing and my voice from before.” (Mother, combined group)  Conclusions: The findings of this study shows that parents find it meaningful to provide parent-delivered pain-alleviating interventions during painful procedures in postnatal care. The parents in the skin-to-skin group and the group that combined skin-to-skin, breastfeeding, and live parental lullaby singing expressed that they wanted to keep using these methods in future painful situations as well. Even parents with fear of needles felt it was meaningful to participate in parent-delivered pain-alleviating pain management since their participation blunted their own fear.  Relevance for patient care: All newborn infants are subjected to painful procedures during the first months of life and pain-relieving methods are insufficiently used. Modern neonatal care strives to be family oriented with a high degree of parental participation. This must also be the case with pain management and parents must be given tools and opportunities to be an active agent in their infant’s pain management. 

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Hälsovetenskap -- Omvårdnad (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Health Sciences -- Nursing (hsv//eng)

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