DOI: 10.5205/reuol.9106-80230-1-SM1007201613
ISSN: 1981-8963
Costa LC, Souza MG de, Sena EMAB et al.
The use of non-pharmacological measures by...
ORIGINAL ARTICLE
THE USE OF NON-PHARMACOLOGICAL MEASURES BY THE NURSING TEAM
FOR NEONATAL PAIN RELIEF
UTILIZAÇÃO DE MEDIDAS NÃO FARMACOLÓGICAS PELA EQUIPE DE ENFERMAGEM PARA
ALÍVIO DA DOR NEONATAL
UTILIZACIÓN DE MEDIDAS NO FARMACOLÓGICAS POR EL EQUPO DE ENFERMERÍA PARA ALIVIO DEL
DOLOR NEONATAL
Luana Cavalcante Costa1, Mariana Gonzaga de Souza 2, Erika Maria Araújo Barbosa Sena3, Mércia Lisieux Vaz
da Costa Mascarenhas4, Rossana Teotônio de Farias Moreira5, Ingrid Martins Leite Lúcio6
ABSTRACT
Objective: to learn how the nursing staff uses nonpharmacological measures for relief of neonatal pain.
Method: descriptive study with qualitative approach carried out with 26 professionals of the nursing staff in a
teaching hospital of Maceió/AL, from August 2014 to July 2015. Semi-structured interviews were conducted
and then transcribed and analyzed through content analysis technique in the Categorical modality. Results:
the categories presented were << Nursing in the identification of neonatal pain >>, << Potentially painful
procedures and interventions of the nursing team >>,<< Use of Non-Pharmacological measures in the
management of neonatal pain >>. Conclusion: although professionals assess neonatal pain through
observation of behavioral and/or physiological changes, they do not use pain scales in the sector/service as an
auxiliary instrument in the systematization of care related to pain. Descriptors: Neonatal Intensive Care
Units; Neonatal Nursing; Newborn; Pain.
RESUMO
Objetivo: conhecer como a equipe de enfermagem utiliza as medidas não farmacológicas para alívio da dor
neonatal. Método: estudo descritivo, com abordagem qualitativa, realizado com 26 profissionais da equipe de
enfermagem, em hospital escola de Maceió/AL, entre agosto de 2014 e julho de 2015. Foram realizadas
entrevistas semiestruturadas; em seguida, transcritas e analisadas pela Técnica de Análise de Conteúdo, na
modalidade Categorial. Resultados: foram apresentadas categorias << A enfermagem na identificação da dor
neonatal >>, << Procedimentos potencialmente dolorosos e as intervenções da equipe de enfermagem >> e <<
A utilização de Medidas Não Farmacológicas no manejo da dor neonatal>>. Conclusão: apesar dos profissionais
avaliarem a dor neonatal por meio da observação de alterações comportamentais e/ou fisiológicas, não
utilizam escalas de dor no setor/serviço como instrumento auxiliar na sistematização dos cuidados
relacionados à dor. Descritores: Unidades de Terapia Intensiva Neonatal; Enfermagem Neonatal; RecémNascido; Dor.
RESUMEN
Objetivo: conocer cómo el equipo de enfermería utiliza las medidas no farmacológicas para alivio del dolor
neonatal. Método: estudio descriptivo, com enfoque cualitativo, realizado con 26 profesionales del equipo de
enfermería, en hospital escuela de Maceió/AL, entre agosto de 2014 y julio de 2015. Fueron realizadas
entrevistas semi-estructuradas; en seguida, transcritas y analizadas por la Técnica de Análisis de Contenido,
en la modalidad Categorial. Resultados: fueron presentadas categorías << La enfermería en la identificación
del dolor neonatal >>, << Procedimientos potencialmente dolorosos y las intervenciones del equipo de
enfermería >> y << La utilización de Medidas No Farmacológicas en el manejo del dolor neonatal>>.
Conclusión: a pesar de los profesionales evaluar el dolor neonatal por medio de la observación de alteracionrs
comportamentales y/o fisiológicas, no utilizan escalas de dolor en el sector/servicio como instrumento
auxiliar en la sistematización de los cuidados relacionados al dolor. Descriptores: Unidades de Terapia
Intensiva Neonatal; Enfermería Neonatal; Recién-Nacido; Dolor.
1
Undergraduate Student, Nursing School, Federal University of Alagoas/UFAL. PIBIC/CNPq fellow. Maceió (AL), Brazil. Email:
luanac.costa@live.com; 1Undergraduate Nursing student, Federal University of Alagoas/UFAL. Fellow PIBIB/UFAL. Maceió (AL), Brazil.
Email: marysouza_15@hotmail.com; 3Nurse, Neonatal Unit and Surgical Center, University Hospital Professor Alberto
Antunes/HUPAA/UFAL. Master student, Graduate Nursing Program, Federal University of Alagoas/UFAL/PPGENF. Maceió (AL), Brazil.
Email: erikasenaenf@gmail.com; 4Nurse, Neonatal Unit, University Hospital Professor Alberto Antunes (HUPAA/UFAL) Maternity School
Santa Mônica/MESM/UNCISAL. Master student, Graduate Nursing Program, Federal University of Alagoas/UFAL/PPGENF. Maceió (AL),
Brazil. Email: mercialisieux@hotmail.com; 5Nurse, Professor, Nursing and Pharmacy School, Federal University of Alagoas/UFAL. PhD
student in Environmental and Experimental Pathology, Graduate Program, University Paulista. Maceió (AL), Brazil. E-mail:
rossanateo@hotmail.com; 6Nurse, Associate Professor III, Nursing and Pharmacy School, Federal University of Alagoas/UFAL. Maceió (AL),
Brazil. Email: ingridmll@esenfar.ufal.br
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INTRODUCTION
Neonatal Intensive Care Unit (NICU) is one
of the specialized sectors in the care of
Newborns (NB) within health institutions.1 In
this space, the work process is involved by the
particularities related to assistance to
critically ill NB, with pronounced use of
diagnostic and therapeutic approaches that
are often invasive and aggressive, frequent
introduction of technological innovations,
narrow threshold between favorable responses
and possible adverse reactions to the therapy
implemented, and the organic immaturity of
NB, especially in premature babies, which
may limit their physiological responses.2
When admitted to the NICU, the NB
receives immediate care for recovery of their
clinical status and adaptation to extrauterine
life. The NB is often intubated, ventilated,
and repetitively punctured, characterizing a
process of excessive handling episodes, about
50-134 times every day, for both noninvasive
and
invasive
as
potentially
painful
procedures.3
The NB, especially when premature,
responds to painful stimuli in a generalized
and more intense manner than adults and
infants due to immaturity of the inhibitory
system, responsible for pain modulation. As a
result, the pain felt by the NB is much
stronger and more acute, resulting in physical
and psychological discomfort and suffering.4
Due to
the
impossibility
of any
verbalization, the main way that the NB has to
express pain is thorugh behavioral responses.
Thus, it is understood that its assessment is
based on these responses. However,
physiological changes can also be verified
observed before, during or after a potentially
painful stimuli.5
Tools for pain assessment have been
developed and used for decoding the pain
language of NB. Scales called contribute to a
more effective communication between the
NB and the team, allowing the recognition,
measurement and management of pain.6 The
most commonly used scales with NB are:
Neonatal Facial Coding System (NFCS),
Neonatal Infant Pain Scale (NIPS) and
Premature Infant Pain Profile (PIPP).7 The
frequency of assessment of pain varies with
the clinical context, but periodic and
systematic records are fundamental to
monitor the newborn's development and to
make measures for pain management
accessible to all NB.8
The approach of pain for its control and
prevention may be done through the use of
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DOI: 10.5205/reuol.9106-80230-1-SM1007201613
The use of non-pharmacological measures by...
pharmacological and non-pharmacological
measures. Since analgesia is not routinely
performed for control of pain in NB, it is
estimated that some specific analgesic or
anesthetic treatment is indicated in only 3% of
the potentially painful situations, and
techniques to minimize pain are used in 30%.9
In Brazil, the right of the NB be freed from
pain is guaranteed in the Rights of
Hospitalized Children and Adolescents,
expressed in Resolution 41/1995, and must be
contemplated in the assistance provided by
the multidisciplinary team.10
Thus, an extended care requires control of
two factors: the physical environment and
human resources. Professionals need to pay
attention to aspects of the environment and
control the levels of noise and light, the bond
and the interaction between mother and NB,
strategies for reducing the number of
manipulations, and pain control, in order to
promote the welfare of the NB. The
maintenance of a favorable environment for
the treatment of NB, free of noxious stimuli,
and minimizing the negative effects of the
disease and the separation from parents, are
differential factors in neonatal nursing
care.11,12.
Relief of neonatal pain is the responsibility
of a multidisciplinary team, but especially of
nursing professionals, because of the closer
contact with the patient in the carrying out of
their care activities. Nursing stands out in the
implementation of actions to reduce the
newborn's suffering such as the recognition of
pain through its assessment and the use of
non-pharmacological measures (NFM) to
relief, avoiding harmful consequences for the
growth and development of child.7,13
Non-pharmacological
measures
are
considered non-invasive techniques for pain
control and comprise a set of measures of
educational,
physical,
emotional
and
behavioral nature mostly of low cost, easy to
use and with minimal risk of complications.5 In
Brazil, the most commonly used involve: the
environment, music therapy, facilitated
restraint and covering, positioning, nonnutritive sucking and the use of glucose,
kangaroo method, and breastfeeding.14
Non-pharmacological measures
are as
important as the pharmacological measures
and they need to be discussed more
frequently among professionals of the nursing
staff and other health professionals because
they are methods of relief and prevention of
neonatal pain that help in the behavioral
organization of the baby and they are of low
cost. Therefore, the following question is set:
How are NFM employed to relieve neonatal
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pain by the professional of the nursing staff?
To answer this question, the following
objective was outlined:
● To learn how the nursing staff uses
nonpharmacological measures for relief of
neonatal pain.
METHOD
Descriptive
studywith
qualitative
15
approach, carried out from August 2014 to
July 2015 in the Neonatal Intensive Care Unit
(NICU) which consists of 10 beds, from the
University
Hospital
Professor
Alberto
Antunes/HUPAA of Maceió/AL.
Twenty-six professionals of the nursing
team of the NICU at the moment of
collection, regardless of the work shift,
willingly participated in the study by signing
the Informed Consent (IC).
The production of data occurred in a
private place, assuring confidentiality and
privacy, through the application of a semistructured interview conducted by the main
responsible for the study and with an average
duration of 1 hour containing questions for
professional characterization and questions
about nonpharmacological measures used by
the research subjects in the workplace.
In order to preserve anonymity, subject
were identified by the initial letter of their
professional category followed by sequential
number according to the order of interview,
as exemplified:
nurse (N01);
nursing
technician (NT02); nursing assistant (NAE03).
Interviews were recorded, after the
participant's consent, and transcribed to
facilitate the organization and presentation of
discussion in categories. After transcription,
data were submitted to thematic content
analysis.
Ethical principles were followed in all
phases of the study, in line with the
Resolution 466/12 that ensures the rights and
duties with respect to the research
participants, the scientific community and the
state. The study protocol was submitted to
the Ethics Committee of the UFAL - Federal
University of Alagoas through the Platform
Brazil
www.saude.gov.br/plataformabrasil
and approved by nº 663.409.
RESULTS AND DISCUSSION
Among the 26 nursing professionals studied,
seven were nurses (26.92%), nine were nursing
technicians (34.62%) and 10 were nursing
assistants. Regarding the characterization of
these professionals, only one respondent
(14.29%) was male, the others were females.
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DOI: 10.5205/reuol.9106-80230-1-SM1007201613
The use of non-pharmacological measures by...
Regarding the time of professional
experience, half of professionals (13) work in
the field of neonatology for over 9 years,
representing 50% of the total; five (19.23%)
work for 7 to 9 years; two (7.69%) work for 4
to 6 years; five (19.23%) work for 1 to 3 years
and only one (3.85%) has worked in the area
for less than 1 year. However, 65.38% of the
interviewed professionals have more than nine
years of professional experience, referent to
an absolute number of 17 professionals, four
(15.38%) have between 7 and 9 years, three
(11.54%) have between 4 and 6 years, one
(3.85%) has between 1 to 3 years and one
(3.85%) has less than 1 year.
Regarding the participation in courses
and/or scientific events on neonatal pain, the
results showed that investment in training and
development of human resources, either from
personal or institutional initiative, is still
small, as only 11 of respondents (42.3% ) had
frequency (three nurses, seven nursing
technicians and one nursing assistant).
The analysis of the collected material
allowed the delimitation of three categories:
nursing in the identification of neonatal pain,
potentially
painful
procedures
and
interventions of the nursing staff, and the use
of
Non-pharmacological
Measures
for
management of neonatal pain.
 Nursing in
neonatal pain
the
identification
of
The newborn's lack of ability to verbalize
and the similar reactions to different stimuli
may hinder the interpretation and evaluation
of responses to pain. A key point to the
therapeutic approach to pain in the neonatal
period is an appropriate assessment of its
presence. The beginning of this evaluation is
given by the awareness that the NB is able to
feel pain.5
It was the unanimous opinion of
professionals that the NB is able to feel pain,
even without expressing scientific knowledge
on neonatal pain. They were able to express
their understanding based on their knowledge,
values, beliefs and experience, being the
routine service within the NICU a source of
knowledge about the pain that for them is
strongly
associated
with
procedures
performed, according to the statements
below:
I think that is caused by stimuli, procedures or
pathologies of the newborn. (NA03)
Result of all invasive procedure and handling.
(NT17)
Very intense discomfort from which they
cannot defend themselves. (NA21)
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Due to the subjectivity of pain and the
inability to express in words their pain, NB
develop their own language in face of the
painful event.16 This is characterized by
behavioral and physiological changes and it is
through them that neonatal pain is identified.
Speeches
positively
mentioning
the
recognition of pain in NB were common among
respondents. The most referenced behavioral
trait was crying, and in the sequence, the
forehead frown, agitation, tremors, and
tongue out of the mouth in shell format.
Three
participants
still
mentioned
physiological changes, especially, increased
heartbeat and respiratory rate, decreased
oxygen saturation, as well as hormonal
changes, referred to in the statements below:
Yes, when I observe the newborn with any
of these signs: twisted face, crying,
saturation fall, hormone levels change, as
well as respiratory rate, heartbeat, and
blood clotting occurring more quickly. (N1)
I can recognize when a newborn is feeling
pain by facial expressions (frowning),
crying, restlessness and change in heart
rate. (N20)
You can tell by the increased movement,
intense crying, tongue in shell shape and
wrinkled forehead. (NA21)
Pain activates compensatory mechanisms of
the autonomic nervous system producing
responses that involve changes of heart and
respiratory rate, increased blood pressure,
decreased oxygen saturation, peripheral
vasoconstriction, sweating, dilated pupils and
increased release of catecholamine and
adrenocorticosteroid hormones.17
Another method to identify pain in
newborns is based on the observation of their
behavior (crying, facial expression, motor
activity). Crying is considered the main way of
communication of NB, but when assessed
isolated from other factors, it becomes
unspecific.5 "The crying in pain is strained and
strident with higher fundamental frequency
and variations, such as breaks, double tone
and harmonic breaks."18
The facial expression is a useful sign to
assess pain in premature and full-term NB.
Expressions most commonly observed for
recognition of pain are protruding forehead,
narrowed palpebral fissure, deep naso-labial
fold, parted lips, stretched mouth, trembling
chin and tense tongue.19
The analysis of the motor pattern has been
less sensitive and less specific than facial
expression in preterm and term NB, because
in premature neonates, motor responses may
be less evident than in term NB due to
hypotonic posture or associated systemic
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DOI: 10.5205/reuol.9106-80230-1-SM1007201613
The use of non-pharmacological measures by...
diseases.
Other elements are needed to
properly understand the pain.5
It is important to highlight the fact that
none of the professionals tudied was aware of
pain assessment scales for NB, taking into
account that there are several of them
available,
validated,
and
widely
recommended by national and international
literature. To assess pain, these professionals
most often cited the observation of behavioral
changes, especially the presence of facial
expression followed by body movement. The
use of specific scales was not observed, as a
tool for this population, as can be noticed in
the statements below.
[...] There is no scale in the sector, I
evaluate by the visual appearance. (NA06)
[...] We have no instrument to assess, no, I
do this by observing facial expressions.
(N20)
Here we do not use no scale ... we observe
the facial expressions, upper limbs
contracted, irritation. And by the behavior.
(NT25)
In fact, facial expression is widely used to
measure the pain of NB and its effectiveness
and reliability as an evaluation tool has been
widely demonstrated.20 This is considered the
most sensitive and specific indicator of pain in
NB, since in the very first 24 hours of life,
even preterm infants show facial expressions
seconds after a painful procedure.21 The
movement of members was also pointed out
by most professionals as pain assessment
parameter in NB. However, it is important to
remember that motor activity should be
evaluated along with other indicators in order
to endow more reliability to the assessment of
pain.
Physiological and behavioral changes, when
identified and evaluated simultaneously,
provide more information about the individual
responses to pain and possible interactions
with the environment.22 However, it is
recommended by the Ministry of Health that
the objective of the evaluation of pain in NB
must be carried out by means of scales that
cover various parameters and seek to
standardize the criteria for measuring
variables (BRASIL).23
Despite the identification of pain be
efficiently performed by respondents, a need
exists for a more specific evaluation of both
the presence and the intensity of pain. Thus,
the ideal situation would be the systematic
adoption, by the entire team, of already
validated instruments - scales - to measure
neonatal pain, this way ensuring quality and
more humanized care.
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 Potentially painful procedures and
nursing staff interventions
Nursing professionals should recognize
actions in their care that can trigger the
painful stimulus so that they may intervene in
order to alleviate and treat pain in NB. Among
the most frequent procedures in routine care
in a NICU are: endotracheal suction and of
upper airways, bladder and umbilical
catheterization, nasal CPAP, subcutaneous
and muscle injections, peripherally inserted
central catheter, insertion and removal of the
chest tube, endotracheal intubation and
removal of the endotracheal tube, lumbar
puncture, capillary and arterial or venous
blood collection, dressings, among others. All
of these cause discomfort and pain to the
NB.14
So when asked what could cause pain in
NB, respondents described invasive and noninvasive and painful situations. Among
invasive procedures, professionals cited
venipuncture, aspiration, capillary blood
glucose, probe passage and Nasal CPAP
(Continuous Positive Airway Pressure).
Regarding non-invasive painful procedures,
respondents mentioned: excessive handling,
sudden touch, uncomfortable position and
dressing, as identified in the sections of the
following interviews:
[...] aspiration, insertion of bladder probe
and dressing, we do these very frequently.
(N01)
[...] blood glucose that is performed daily
for all of them. (NA03)
[...] excessive handling causes more pain.
(N09)
[...] venipuncture, the use of prong when
will put on CPAP and pass orogastric is what
causes pain in the little babies. (NT26)
After analyzing the responses, it is clear
that invasive procedures were the most
frequently cited painful procedures. The same
occurred in a study of 25 nursing technicians
where 100% emphasized punctures, whether
venous, capillary, arterial, or lumbar.24 In the
NICU, while procedures are performed in the
NB, increasing survival chances, they can, in
turn, trigger stress and pain.6
The NICU is considered an environment
where stressful and/or painful factors such as
excessive light, loud noises, frequent
manipulations,
painful
stimuli,
are
concentrated. These may bring as a result
changes in dietary patterns and in the motherchild relationship, also causing irritability,
decreased attention and changes in sleep
patterns.5
We understand that the nursing staff has an
important role in maintaining the vitality
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conditions of vulnerable NB, and this must
base their actions on scientific knowledge.
Thus, we emphasize that pain management
begins by humanized actions and attitudes in
the NICU, such as reduction of noise and light,
minimization of intrusive protocols in the NB,
through a non-pharmacological approach to
pain and through drug therapy.19
When asked about pain management used
by the nursing staff, the use of anesthetic
prescription
was
mentioned
as
a
pharmacological strategy. However, the use of
non-pharmacological measures (NFM) was
mentioned more often. These were not used
by two respondents only, one for relating
glucose utilization to 25% as a pharmacologic
strategy and the other for showing not to
understand the distinction between the
pharmacological and NFM. Therefore, it is
imperative that health professionals should
make use of non-pharmacological and
pharmacological interventions appropriately
to prevent, reduce or eliminate the stress and
pain in NB.25
 The use of non-pharmacological
measures in the management of
neonatal pain
The MNF are strategies aimed at preventing
the increased intensity of the painful process,
behavioral disorganization of the NB, stress
and agitation, that is, to minimize pain
commitments. They are efficient with most
NB when used individually in mild pain, but
may need a complementary strategy for
analgesia in the face of moderate or severe
pain.7
When asked which MNF were used, it was
observed that respondents cited numerous
MNF for pain relief, including proper
positioning, massage, reducing environmental
stimuli (light and noise reduction) and others
such as non-nutritive sucking and the
administration of 25% glucose. Glucose
utilization and positioning of the NB were the
more frequently used strategies. Regarding
the position, respondents identified changing
position, fetal position and warmth through
the formation of "little packets" as outlined in
the following lines:
I leave the room with the the lights turned
off and as quiet as possible. (NT04)
[...] I wrap the NB with the sheet, leaving
the baby in the fetal position. (NA06)
[...] I do head and foot massage [...] (N19)
I put three drops of glucose or soak a gauze
with glucose and put in the NB's mouth
before the procedure, depending on the NB's
agitation, I leave it during and after the
procedure. (NT22)
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[...] Non-nutritive sucking and warmth is
what I do more often... I leave the NB well
positioned and supported in the incubator,
making rolls with the sheet itself. (N23)
universally to all NB, let alone confirm its
effectiveness.
The
wrapping
technique/facilitated
containment and positioning were the most
cited
NFM
through
the
interviewees'
statements and this converges with literature
as a measure several times used in neonatal
units as comfort strategy to promote body
organization of the NB. Since wrapping the NB
with flexion of the lower limbs, and alignment
in the midline of the bent upper limbs, placing
a hand near the mouth is effective in
controlling pain, it helps in the maturation of
brain functions by promoting physiological and
behavioral stability
in the NB, and this
reduces agitation and stress, preventing that
its energy reserves be directed to the crying
and to irritability, using them for their growth
and development instead.7,14
Before the procedure, I offer a finger glove
with glucose. (NA15)
The change of decubitus referred as
positioning technique is also effective in
relieving pain. Placing the NB in a new
position every two or three hours, and
preventing the accumulation of secretion and
deformities of the head, are measures that
relieve pressure on bone or air prominences,
accelerate circulation, relaxes muscle and
promote general comfort and better
sensorineural
and
psychomotor
17,26
development.
The use of sugary substances such as
glucose, sucrose, and breast milk is a very
often recommended measure for pain control
in NB. There is no doubt about the benefits of
in on pain relief before procedure in term and
pre -term NB.5 Such measures decrease the
duration of crying, attenuate the facial
muscles and increase in FC, in addition to
reducing pain scores in the application ofPIPP
scale in full-term and premature NB.27
Glucose and sucrose are the most adopted
measures and were highlighted because they
have better analgesic effect. The use of
glucose solution soaked in gauze is the main
measure used to calm the NB and reduce pain
during procedures known to be painful,
calming the baby before the procedures.4
However, the authors argue that the use of
sucrose to 24% is more effective in decreasing
pain signals that other sugary solutions. This is
justified by the fact that sucrose is a
disaccharide that has an equivalent of glucose
and an equivalent fructose.14,28
According to respondents, the use of sugary
substances was restricted, basically, to
utilization of glucose to 25%, however, it was
observed that the administration technique is
not uniform so that care cannot be provided
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[...] I soak the gauze with glucose 25% and
give to the NB to suck. (N01)
Minutes before the procedure I give 3 to 4
drops of glucose 25%, depending on the size
of the newborn, and during the procedure
also I give glucose, if the procedure is long.
(NA21)
The volume of glucose 25% solution to be
administered is from 01ml to 02ml, orally,
representing 20 to 40 drops of the solution
used from 1 to 2 minutes before the
potentially painful procedure.17 One can also
use a gauze soaked in glucose solution in the
baby's mouth during the procedure. However,
despite its proven efficacy on neonatal pain,
investigations are needed to determine the
concentrations and appropriate volumes, and
the effects of glucose after repeated use.12,
28,29
In time, the adoption of a NFM allows the
health professional may observe later in the
NB beneficial behavioral and physiological
changes after and even during the procedure,
which results in providing less stressful care,
minimizing damage to the clinical recovery of
this NB.
When asked about what was observed after
the use of a NFM, they unanimously
mentioned the "quietness" of the NB as well as
better conditions to perform the procedure by
reducing the exposure time to the painful
stimulus, as verified by the following lines:
The newborn does not cry, or kicks, but it is
quiet, and it's easier to do the procedure.
When the baby is agitated it is bad for him
and for us. (NT07)
They calm down, relax and sleep. (N12)
He gets better, more quiet, until his heart
rate returns to normal. (NT25)
The awareness of the professionals who
work with hospitalized NB, followed by
changes in welfare care can reduce the
intensity of stress in the neonate, since
exposure to multiple stressful or painful
events result in physiological and behavioral
disorganization and use of energy reserves
that would be directed to their growth and
development,
generating
future
biopsychosocial
complications
to
hospitalization.13
The results of this study are important, as
the scientific knowledge should be introduced
in the practice of all professionals working in
the field of neonatology, through access to
specific literature and team training,
contributing to the awareness of these
2400
ISSN: 1981-8963
Costa LC, Souza MG de, Sena EMAB et al.
professionals about the need to develop a
comprehensive and universal care in face of
painful events and so they may become
multipliers of knowledge promoting a
humanized and qualified care to NB in
situation of risk in the NICU.
FINAL CONSIDERATIONS
This study allowed us to know how the nursing
staff involved in direct care to newborns in
the NICU uses NFM to prevent and/or
minimize neonatal pain. The performance of
these professionals in face of the pain is
facilitated by individual experiences. The
systematization of the management of
neonatal pain was not observed though. They
use observation for identification and
evaluation of the painful event, mainly
behavioral changes such as crying, facial
expression and agitation, and even the
physiological changes in vital parameters.
Such
changes
are
identified
after
conducting a procedure in routine care.
Invasive procedures such as venipuncture
were reported as the more painful. The
intervention in the pain of NB, by these
professionals, occurs primarily through the use
of glucose 25% and positioning, as NFM,
adopting little standardized techniques.
In this context, the lack of use of scales for
evaluation of neonatal pain is considered a
prominent issues in this study, as well as the
use of NFM with non-standardized techniques,
which raises the need for caution on the
proper approach to pain by professionals. This
corroborates the literature that shows the
existing gap between the theoretical
development of the subject neonatal pain and
the daily practice of neonatal care. There is
therefore need for further discussion, training
and / or training for these professionals to
consider neonatal pain as the fifth vital sign,
making its systematic management and
treatment carried out using previously
established
protocols,
thus
reducing,
empiricism and undertreatment.
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Submission: 2015/07/07
Accepted: 2016/04/10
Publishing: 2016/07/01
Corresponding Address
Luana Cavalcante Costa
Universidade Federal de Alagoas
Escola de Enfermagem e Farmácia - ESENFAR
Av. Lourival Melo Mota, s/n
Cidade Universitária
CEP 57072-900  Maceió (AL), Brazil
English/Portuguese
J Nurs UFPE on line., Recife, 10(7):8395-403, July., 2016
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