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Role of Family in Neonatal Pain Management

The role of the family in neonatal pain management is central and integral to supporting the identification of pain in the neonate, implementating interventions, and promoting the best neurological outcomes of the neonate. The environment of a neonatal critical care unit, which is full of monitors, wires, tubing, beeps, clicks, alarms, interventions, and foreign terminology, is, by itself, more stress than a family anticipates experiencing when discovering a new life is on its way (Heidari, Hasapour, & Foolardi, 2013). Add to the stress of this ­overwhelming environment the inability to manage even the simplest care for one’s newborn—feeding, holding, and positioning—oftentimes a frighteningly small newborn at that. Considering the parental stress in this environment, the loss of control, and the loss of the idea of a perfect delivery and newborn, realizing this fragile new person is experiencing pain can be a trigger point for some families in expressing a lack of coping mechanisms (Obeidat, Bond, & Clark Callister, 2009). Recognizing this loss of control, the stress, and the maternal need to protect, the clinicians should engage the family soon after the admission on how to identify signs of pain, how to deliver nonpharmacological interventions to alleviate or mitigate pain, while working to promote a strong family unit and a satisfactory experience in an otherwise unpleasant situation.

PARENT UNDERSTANDING

Understanding the family’s interpretation of pain cues and infant responses to interventions is an important first step in promoting a positive experience for everyone. Families who are educated about the behavioral and physiological cues of ­neonatal pain will be more inclusive members of the health care team while enjoying a more satisfying experience in the neonatal intensive care unit (NICU). Teaching parents the physiological cues may be the first step in helping the mother and the father understand the equipment and monitors. Helping parents understand the normal parameters of heart rate, respiration, and oxygen saturation for the infant will help them identify when an abnormality exists. Teach the family how to assess what may be a contributing factor to a change in vital signs—opening the portholes and speaking too loudly to the infant may cause a change in oxygenation status—indicate the need for lowered voices, with talking reduced to a minimum. Instruct them that a light, tickling touch on the infant’s extremities causes bradycardia and desaturation and that firm, containment touch is supportive for the fragile infant. Ensure that the infant receives nonpharmacological and sucrose support prior to all interventions to prevent physiological instability. When the family gains this level of understanding of thir neonate, their level of empowerment for driving the infant’s care increases, providing a greater sense of parenting and satisfaction. The family at the bedside that recognizes the smallest alteration in stability promotes better outcomes for the infant as well.

PARENT EDUCATION

Strategies for helping parents understand and recognize the physiological changes include encouraging frequent visitation through open visiting hours, encouraging parents to participate in daily rounds, encouraging parents to participate in the change-of-shift report, and encouraging skin-to-skin contact, as well as education. Encouraging parents to be present at the bedside as often and for as long as possible helps the parent to know the infant. Infants who go home with their parents are cared for 24/7 by the mother and the father. The family becomes attuned to the cues and behaviors of the infant through this constant bonding contact. The mother becomes attuned to the differences in the infant’s cry and what each means. The parents of a NICU infant do not have that proximity to the infant to learn these cues and frequently the infant is so medically fragile he or she is not able to provide the same cues. However, this does not mean the mother and father cannot learn their infant in a different way. Knowing the infant can only occur through regular visits with meaningful time spent at the bedside.

Encouraging that meaningful time at the bedside means providing an environment that supports time spent at the bedside. Liberal visiting hours with limited restrictions on when and how long to visit promote an environment in which the family is welcomed to be present. Allowing parents to visit 24/7 and to spend unrestricted time at the bedside promotes a sense of knowing what is normal and not normal for the child. Transitioning to single-family rooms instead of open-unit concepts can promote the comfort of the family in sitting at the bedside, with less distraction from other patient’s monitors, alarms, and general medical activity. Single-family rooms promote privacy and limit environmental distractions.

PARENTS AND ROUNDING

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