Effectiveness of In-service Education to Enhance the Knowledge of Newborn Pain and Nonpharmacological Management in the Mother-Baby Unit

Nurses are the primary caregivers of newborns in the MBU, and therefore, understanding the assessment of pain and its nonpharmacological management is vital. According to Cong, Delaney, and Vazquez (2013), studies about healthcare providers’ knowledge and attitudes towards newborn pain assessment and management are limited. Effective pain prevention and control have been endorsed as a standard of care in the MBU. However, nonpharmacological pain interventions for procedures are not utilized or are underutilized on the MBU. Nurses are supposed to be advocates for their patients, especially those patients who are vulnerable, such as newborns who cannot verbally communicate. Therefore, healthcare providers must be competent in recognizing newborn pain response in the neonatal population by utilizing evidence-based newborn pain assessment tools and initiating nonpharmacological pain management. Working in the MBU for about ten years, and observing nurses perform heel sticks without any comfort measures prompted the DNP student to initiate this project. Secondly, the organization promotes family-centered care, where there should be no separation of newborns from their mothers unless the newborn is admitted to the Neonatal Intensive Care Unit. However, the nurses do not feel comfortable enough to perform a heel stick in the room with the mother holding the newborn. The nurse will instead take the newborn to the nursery to perform the heel stick, where the provision of comfort measure is limited. Problem Statement Most newborns in the Mother-Baby Unit (MBU) undergo heel stick procedures for mandatory newborn screening, blood glucose, and other laboratory tests, such as complete blood count and basic metabolic profile. Most of the nurses in the MBU who perform the heel sticks do not utilize the newborn pain assessment tool available in the Procedure Manual of the MBU to provide evidence-based comfort measures to the newborns. Some of the nurses on the MBU are EFFECTIVENESS OF IN-SERVICE EDUCATION 9 not aware of the existence of the newborn pain assessment tool, and others feel that documentation takes too much of their time; therefore, the newborn pain assessment is another time-wasting task. Educating the MBU nurses via continuing in-service education will help ease this insufficient knowledge on pain assessment and in providing comfort measures to the newborns. Studies indicate that underutilization of the newborn pain assessment and nonpharmacological pain management (comfort measures) is due to a lack of knowledge of the behavioral responses and the physiological consequences of pain in the newborn. According to Norushe, Van Rooyen, and Strumpher (2004) the importance of continuing in-service education programs can be worthwhile and lead to increasing nurses’ awareness, knowledge, competence, and potentially improve newborn outcomes. Project Purpose The purpose of the DNP Project is to determine the effectiveness of in-service education related to newborn pain assessment and the provision of nonpharmacological interventions (comfort measures) for newborns during a heel stick procedure. Nurses caring for newborns must be knowledgeable and competent about the harmful effects of unmanaged pain during heel stick procedures on newborns and the initiation of the different nonpharmacological interventions available to reduce the impact of procedural pain (Aydin, Sahiner, & Ciftci, 2017). The provision of continuous educational practices is critical in achieving positive and better learning outcomes (Bluestone et al., 2013