| 1. |
- Andreasson, Matilda, et al.
(författare)
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State of the art in parent-delivered pain-relieving interventions in neonatal care
- 2021
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Konferensbidrag (refereegranskat)abstract
- Objectives: Parent’s active involvement during painful procedures is considered a critical first step in improving neonatal pain practices. Of the non-pharmacological approaches in use, the biopsychosocial perspective supports parent-delivered interventions, in which parents themselves mediate pain relief, consistent with modern family-integrated care. Methods: A scoping review was performed to achieve a broad understanding of the current level of evidence and uptake of parent-driven pain- and stress-relieving interventions in neonatal care. Specific objectives of the scoping review were to:1. Explore the breadth and extent of the literature, identify the types of available evidence, map and summarize the evidence, and inform future research on parent-delivered pain- and stress-relieving interventions in neonatal care. 2. Describe parents’ experiences of delivering pain and pain-related stress relief to their newborn infant. 3. Map and summarize recommendations as well as define knowledge gaps in national and international guidelines and in professional organizations or networks.
Results: There is strong evidence for the efficacy of skin-to-skin contact and breastfeeding,
preferably in combination. These parent-delivered interventions are safe, valid, and ready for
prompt introduction in infants’ pain care globally. Research into parents’ motivations for, and
experiences of, alleviating infant pain is scarce. More research on parent-delivered
pain alleviation, including relationship-based interventions such as the parent’s musical
presence, is needed to advance infant pain care. Guidelines need to be updated to include infant pain management, parent-delivered interventions, and the synergistic effects of
combining these interventions and to address parent involvement in low-income and low-tech
settings.
Conclusions: A knowledge-to-practice gap currently remains in parent-delivered pain
management for infants’ procedure-related pain. This scoping review highlights the many advantages of involving parents in pain management for the benefit not only of the infant and
parent, but also of health care.
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| 2. |
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| 3. |
- Carlsen Misic, Martina, 1986-, et al.
(författare)
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Balancing power by including parents as co-researchers : Live parental singing, breastfeeding, skin-to-skin-contact as procedural support in Swedish neonatal pain care
- 2022
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Konferensbidrag (refereegranskat)abstract
- Frequent and inadequately treated pain combined with separation from the parent cause adverse interruptions to the parent-infant attachment process. The pain might harm the infant physically and psychologically including increasing the risk for abnormally heightened sensitivity to pain. Effective pain management strategies are needed and parent-delivered interventions such as infant-directed lullaby singing, breastfeeding and skin-to-skin contact where parents themselves mediate pain relief, is consistent with a modern understanding of pain and of family-integrated care. Important for translating research into practice is to involve healthcare professionals and parents as co-researchers. Neonatal pain research is an interdisciplinary field where music therapy has just started to publish results. The Nordic neonatal music therapy pain management strategy provides a theoretical and practical resource-oriented music therapy model of how parent-delivered infant-directed singing can be comprehensively used in interdisciplinary neonatal pain research. Parents as pain management in Swedish neonatal care (SWEpap), is a new cutting-edge interdisciplinary multi-centre clinical study with mixed methods. The collaborative participatory action research design for the qualitative part of the SWEpap study aims to democratise the research process involving both parents and health professionals in the knowledge-making. The second part of SWEpap is a randomised controlled trial informed by music therapy expertise and research using the Nordic neonatal music therapy pain management strategy as a theoretical framework for its design. The RCT will investigate the efficacy of combined pain management with live parental lullaby singing, breastfeeding and skin-to-skin contact compared with standard pain care during routine metabolic screening of newborn infants.
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| 4. |
- Carlsen Misic, Martina, 1986-, et al.
(författare)
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“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
- 2023
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Konferensbidrag (refereegranskat)abstract
- 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.
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| 5. |
- Carlsen Misic, Martina, 1986-, et al.
(författare)
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Parent-delivered pain-relieving interventions in Swedish neonatal care, a mixed methods study
- 2022
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Konferensbidrag (refereegranskat)abstract
- Background: For improving the management of infant pain and translating research into practice, parents’ active involvement during painful procedures is considered a critical first step. Research into parents’ motivations for and experiences of alleviating infant pain, is scarce. More research on combined parent-delivered pain alleviation including relationship-based interventions such as the parent’s musical presence is needed to advance infant pain care.Aim: Parents as pain management in Swedish neonatal care (SWEpap), is a new cutting-edge interdisciplinary multi-center clinical study. Using a mixed methods approach, SWEpap investigates parent-delivered interventions such as infant-directed lullaby singing, breastfeeding and skin-to-skin contact where parents themselves mediate pain relief. This approach is consistent with a modern understanding of pain and of family-integrated care.Material and method: The qualitative part of the SWEpap study applies collaborative participatory action research design, video observations and interviews to investigate health care professionals’ and parents’ motivational factors in and experiences of parent- delivered pain alleviation. The second part is a randomized controlled trial. The RCT will investigate the efficacy of combined pain management with live parental lullaby singing, breastfeeding and skin-to-skin contact compared with standard pain care during routine blood sampling of newborn infants. The enrollment has started and is expected to be completed during 2023.Results: Preliminary results acknowledge the need for parents to be educated and prepared about the effectiveness of the parent-delivered methods and how to apply them prior to the procedure. In addition, when preparing for the actual procedure, both parents and health care professionals emphasize the importance of allowing the parents sufficient time to cope with the situation and the dyad to relax before the skin puncture.Conclusion: Video observations and interviews with parents and health care professionals indicate that parent- delivered interventions such as infant-directed lullaby singing, breastfeeding and skin-to-skin contact are feasible pain treatment methods during painful procedures.
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| 6. |
- Carlsen Misic, Martina, 1986-, et al.
(författare)
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Parents as pain management in Swedish neonatal care – SWEpap
- 2024
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Konferensbidrag (refereegranskat)abstract
- Parents as pain management in Swedish neonatal care (SWEpap), is a new cutting-edge interdisciplinary multi-center clinical study. Using a mixed methods approach, SWEpap investigates combined parent-delivered interventions such as infant-directed lullaby singing, breastfeeding and skin-to-skin contact where parents themselves mediate pain alleviation. This approach is consistent with a modern understanding of pain and of family-integrated care. Today non-pharmacological strategies are considered the first choice in neonatal pain management, and parent-delivered interventions are valuable but often overlooked resources in the procedural pain management in newborn infants. Research shows that parents desire to be actively involved. More research on parents’ experiences of being active in pain alleviation is needed, as well as research on the effectiveness of combined parent-delivered pain management including relationship-based interventions as the parent’s musical presence. The qualitative part of the project is investigating the experiences and attitudes of parents and nurses towards combined parent-delivered pain management. The study applies a collaborative participatory action research (PAR) design with ethnographic inspired data collection in form of focus groups, video-observations, and video-stimulated recall interviews for data collection. ResultsPreparation was considered the key for combined parent-delivered pain management. Both parents and nurses emphasized the importance of allowing time for the parent-infant dyad to calm down together before the painful procedure to cope with the situation. The combined parent-delivered pain management was considered feasible by both parents and nurses. Parents expressed that the singing helped them focus on their infant instead of the procedure. The parental lullaby singing created a calm and trusting atmosphere, affecting not only the parent-infant dyad but also the nurses. After the procedure both parents and nurses felt that they have successfully supported the infant through a painful procedure. The second part of the ongoing SWEpap project is a randomized controlled trial investigating the efficacy of combined parent-delivered pain management with live parental lullaby singing, skin-to-skin contact, and breastfeeding compared with standard pain care during routine blood sampling of healthy newborn infants.
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| 7. |
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| 8. |
- Carlsen Misic, Martina, 1986-, et al.
(författare)
-
Parents to new-born infants rated parent-delivered pain management as significantly meaningful during venepuncture
- 2023
-
Ingår i: Örebro University's Nobel Day Festivities. - 9789187789922
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Konferensbidrag (refereegranskat)abstract
- Background/Objective: Parents express great readiness to actively deliver comfort for their infant during painful procedures. Previous research shows evidence for the efficacy of skin-to-skin contact and breastfeeding, preferably in combination. Live parental lullaby singing combined with skin-to-skin contact and breastfeeding has not previously been investigated during painful procedures. Parents as pain management in Swedish neonatal care (SWEpap), is a cutting-edge interdisciplinary multi-center study with mixed methods. The randomized controlled trial investigates the efficacy of combined parent-delivered pain management compared with standard care during routine blood sampling of healthy newborn infants.Method: The aim of this analysis was to investigate how meaningful the parents experienced providing procedural pain management to their newborn infant in the three treatment groups; standard care with glucose, skin-to-skin contact, or a combination of skin-to-skin contact, breastfeeding (if applicable) and live parental lullaby singing. The parents rated the meaningfulness of the various conditions on a 100 mm visual analogue scale (VAS) 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 comment on how they experienced providing pain management.Result: A total number of 151 newborn infants with at least one parent, participated in this analysis. The mean VAS-ratings for meaningfulness were 82.1 for standard care with glucose, 89.5 for skin-to-skin contact, and 88.9 for combined interventions with live parental lullaby singing, breastfeeding and skin-to-skin contact. The ratings for parent-delivered pain-alleviation were significantly higher than for standard care (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.Conclusion: Parents found it meaningful to provide parent-delivered pain-alleviating interventions with skin-to-skin contact, breastfeeding and live parental lullaby singing during painful procedures in postnatal care. The parents stated that they will continue using these methods in future painful situations.
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| 9. |
- McMurtry, C. Meghan, et al.
(författare)
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Speak Up! The Parent’s Voice and Musical Presence During Painful Procedures in Neonatal and Paediatric Care
- 2022
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Konferensbidrag (refereegranskat)abstract
- Although pain is best understood from a biopsychosocial perspective, the social context of pain is often overlooked. For infantsand children undergoing painful medical procedures, parents are a key social factor who can influence pain outcomes. Parents’feeling of being helpful to their child can contribute to a sense of control over a challenging situation and affirm their parental role.Integrating parents in procedural support and pain management is consistent with family integrated care and helps equip parentswith nurturing skills they can use beyond the acute period. Yet major gaps exist in our knowledge about parent-child interactionsduring their children’s pain which would inform best practices including a focus on how parents speak to their children (i.e.,beyond what they say), the role of fathers, and singing as serving an important communicative function. In an interdisciplinaryworkshop, three talks will explore the voice of parents in infant, child and youth procedural pain. The first talk will provide datafrom a cutting edge scoping review of parental vocal cues in the context of their children’s pain and relations to child outcome.The second talk will focus on fathers including their experience with the neonatal intensive care unit (NICU) and father-ledinterventions for infant pain. In the third talk, we argue that music therapy via singing provides a means through which parentscan access and learn to use their nurturing resources to promote neonatal procedural support. Results from new research whereparents and health professionals are included as co-researchers to identify facilitators for parent-delivered pain management willbe presented. This workshop will include critical reflections of the available research evidence including key areas for futureresearch and translating what is known into effective practice.
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| 10. |
- Olsson, Emma, 1980-, et al.
(författare)
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Study protocol : parents as pain management in Swedish neonatal care - SWEpap, a multi-center randomized controlled trial.
- 2020
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Ingår i: BMC Pediatrics. - : Springer Science and Business Media LLC. - 1471-2431. ; 20:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: During the first period of life, critically ill as well as healthy newborn infants experience recurrent painful procedures. Parents are a valuable but often overlooked resource in procedural pain management in newborns. Interventions to improve parents' knowledge and involvement in infants' pain management are essential to implement in the care of the newborn infant. Neonatal pain research has studied a range of non-pharmacological pain alleviating strategies during painful procedures, yet, regarding combined multisensorial parent-driven non-pharmacological pain management, research is still lacking.METHODS/DESIGN: A multi-center randomized controlled trial (RCT) with three parallel groups with the allocation ratio 1:1:1 is planned. The RCT "Parents as pain management in Swedish neonatal care - SWEpap", will investigate 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, during routine metabolic screening of newborn infants (PKU-test).DISCUSSION: Parental involvement in neonatal pain management enables a range of comforting parental interventions such as skin-to-skin contact, breastfeeding, rocking and soothing vocalizations. To date, few studies have been published examining the efficacy of combined multisensorial parent-driven interventions. So far, research shows that the use of combined parent-driven pain management such as skin-to-skin contact and breastfeeding, is more effective in reducing behavioral responses to pain in infants, than using the pain-relieving interventions alone. Combined parental soothing behaviors that provide rhythmic (holding/rocking/vocalizing) or orogustatory/orotactile (feeding/pacifying) stimulation that keep the parent close to the infant, are more effective in a painful context. In the SWEpap study we also include parental live lullaby singing, which is an unexplored but promising biopsychosocial, multimodal and multisensory pain alleviating adjuvant, especially in combination with skin-to-skin contact and breastfeeding.TRIAL REGISTRATION: ClinicalTrials.gov ( NCT04341194 ) 10 April 2020.
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