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Improvement of nurses’ clinical practice in neonatal pain management: A Protocol of Evidence-Based Intervention
Razieh Talebi, Mahnaz Modanloo, Fatemeh Heydari , Neda Mehrdad, Abbasali Keshtkar, Homeira Khoddam,
Volume 19, Issue 1 (1-2022)
Abstract
Background: Despite the expansion of knowledge of neonatal pain assessment and management, there is still a considerable gap between nurses' clinical practices in Iran and available evidence. The aim of this study was to develop an evidence-based protocol for neonatal pain management and to evaluate its effectiveness on nurses' clinical practice.
Methods: The present study will be based on the Johns Hopkins nursing evidence-based practice (JHNEBP) model and the three stages of practice question and project planning, evidence, and translation (PET). In this way, after forming an interprofessional team, clinical practice questions will be defined, and the main stakeholders will be identified. Then, the types, levels, and quality of evidence will be assessed to summarize their final strength using the proposed tools of the model, and finally, recommendations will be developed. In the translation phase, the recommendations will be implemented during a stepped wedge cluster randomized trial, and its implications for nursing practices in the management of pain in hospitalized neonates will be evaluated.
Results: The results of this study will lead to the production of an operational and applicable protocol in the management of pain in hospitalized neonates. It can provide the basis for improving the clinical practice of nurses and subsequently improving the quality of neonatal care.
Conclusion: One of the strengths of this study is the use of an interprofessional team approach, considering the clients' priorities, and the improvement of organizational culture in order to endeavor for knowledge translation and change in clinical practice.
 

Effects of buzzy device and distraction cards on pain relief during intravenous cannulation in children: A Randomized Controlled Trial
Mohammed Attaallah Ahmed , Al-Musawi Khatam M ,
Volume 22, Issue 1 (3-2025)
Abstract
Background: Under ethical and legal professional obligations, nurses are required to utilize evidence-based methods to enhance the experience of children during intravenous cannulation. Non-pharmacological pain management techniques are increasingly employed in clinical settings, as they can be implemented without incurring additional costs or requiring extra time. The aim of this randomized controlled trial is to evaluate the effectiveness of a Buzzy device and distraction cards in reducing pain associated with peripheral intravenous catheter (PIVC) insertion among school-aged children.
Methods: A randomized controlled trial study was conducted on 221 school-age children patients who underwent PIVC in emergency departments. Three groups of patients were randomly assigned using a lottery method: the Buzzy device group (n=73), the distraction cards group (n=71), and the control group (n=77) receiving the standard procedure without any interventions. The children were asked to evaluate the pain level immediately following PIVC using the Wong-Baker Faces Pain Scale. Using SPSS (version 26), the independent t-test, Fisher's exact test, analysis of variance, and chi-square test were used to analyze the data.
Results: Children in the intervention groups experienced significantly less pain during the PIVC procedure compared to those in the control group, with a pain score of 5.45 ± 1.67 (p = 0.0001). There was no statistically significant difference in pain reduction between the two intervention methods: the distraction cards (2.54 ± 1.37) and the Buzzy device (2.43 ± 1.60), both showing effectiveness (p = 0.0001).
Conclusion: The results of this study indicate that both the Buzzy device and distraction cards effectively reduce pain levels during intravenous cannulation when compared to the control group. Furthermore, the two strategies demonstrated equivalent effectiveness in pain reduction, as their outcomes were nearly identical. Therefore, it is recommended that these therapeutic approaches be employed to manage and alleviate pain associated with PIVC.
 

Intensive care unit nurses’ perceived Barriers to Optimal Pain management: A cross-sectional study in Tanzania
Banafsheh Ghorbani , Joel Simbeye , Majed Dehghani , Fatemeh Bahramnezhad ,
Volume 22, Issue 2 (6-2025)
Abstract

Background: Inadequate pain management among critically ill nonverbal patients in ICUs is a significant public health issue that can lead to prolonged mechanical ventilation and poor quality of life. Critical care nurses play a vital role in mediating pain management, and identifying barriers they face is essential for developing effective pain relief policies. This study aimed to assess nurses' perceived barriers to pain management in ICUs.
Methods: The study employed a cross-sectional design, adhering to STROBE reporting guidelines, and was conducted from January to May 2022 across four national referral hospitals in Tanzania, including university-affiliated and public hospitals. It utilized the Eastern Cooperative Oncology Group (ECOG) barrier tool to assess critical care nurses' perceived barriers to pain management in the ICU, with data analyzed using the Kruskal-Wallis test. A total of 202 nurses were recruited through census sampling. Data collection involved demographic questionnaires alongside the ECOG barrier tool to evaluate the challenges faced by nurses in managing pain effectively.
Results: The findings revealed that there were perceived nurse barriers related to medical staff and patients with the overall mean 4.57± 1.25 and 3.90±1.17 respectively.  ICU nurses did not perceive barriers related to the healthcare system with an overall mean 2.33±0.78.
Conclusion: Critical care nurses perceive barriers related to medical staff and patients as significant obstacles to effective pain management in ICUs. Intensive training on diagnosis and assessment, along with the use of tools like the Behavioral Pain Scale (BPS) and Critical Care Pain Observation Tool (CPOT), is essential for improving outcomes. Additionally, integrating patients' cultural backgrounds into pain assessments is crucial for effective management.
 


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