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INTENSIVE CARE OF THE NEWBORN IMPLEMENTATION OF A PAIN ASSESSMENT TOOL IN THE NEONATAL INTENSIVE CARE UNIT CASE STUDY Registration NO: 100252125 Module NO : SNM2137/3114 Unit Leader : Angela Thurlby Word Count : 2058 According to the international association for the study of pain, it is an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage (American Academy of paediatrics 2000). In addition, Boxwell (2010) identifies that if newborn pain is not recognised, treated or managed, it can have several short term and long term consequences. Slater et al (2008) suggests that because babies are unable to express the intensity of pain verbally, the assessment of their pain is a complex issue, as it is difficult to measure their pain accurately. As a result, this shortcoming is a major hindrance in providing effective analgesia for babies undergoing neonatal intensive care. It is recommended that nursing and medical staff need to acquire the observational skills necessary to assess the physiological and behavioural cues of the babies to enable them give effective neonatal pain management (Walden M,Gibbins S 2008). They also suggest that the implementation of a pain assessment using a recognised pain assessment tool is necessary. ...read more.


According to Stevenson et al (2007), the most important behaviour which babies use as a signal of emotional and painful distress is to cry. The baby in the case discussed had behavioural changes each time she was exposed to invasive procedures which was a very reliable indicator of pain. Therefore a tool such as CRIES (Crying, Requiring Oxygen, Increased Vital Signs, Expression, and Sleeplessness), Hogan et al. (1996) would be quite appropriate. However because the technique also involves recording the crying of the baby in order to give a score, this would be difficult to score because the baby in this case was intubated and receiving ventilation. Further, in a different situation, for example, where the baby was not able move, different variables would need to be measured. Therefore there is a need to observe the baby in order to determine which assessment tool would be more effective depending on variables that can be measured. Buttner and Finkew (2001) found that hormonal and metabolic alterations occur when pain is repetitive or persists for hours or days, which compensate the physiological parameters thus making the assessment of pain more difficult. Biochemical measurement of pain includes measuring blood levels of steroids, catecholamine, glucagon, growth hormone, insulin and rennin (Anand et al 2007). ...read more.


These variables were clearly observed and a tool that takes into consideration such variables could be implemented in practice to give accurate assessment of pain. Anand (2006) recommends that more research is needed in to the assessment of pain in the neonatal period. It has also been identified that there is an evidence-practice gap for the assessment and management of pain in neonates even though there is a vast amount of evidence (Gharavi et al 2007; Heaton et al 2007). Therefore in conclusion, training staff to use different tools that measure different variables along with using them more frequently in the NICU will mean that pain assessment tools are both successfully, and accurately implemented, leading to greater effectiveness in identification of pain; which, in the neonatal unit is the most crucial part in providing effective care. If such a tool and techniques had been used for the baby discussed, her pain could have been discovered earlier and managed more effectively. When choosing a pain assessment tool, the clinical value or viability relative to that particular setting should be taken into consideration. This would guarantee compliance among health workers and success in the implementation of a standard pain assessment tool. At the same time further research into more accurate and reliable tools must also be undertaken. ...read more.

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