Recognition of Pain in the Neonate to Increase Effective Neonate to Nurse Communication

Abstract

Until the late 1980s, the healthcare standard assumption was that neonates did not experience pain. Currently, the neonatal mortality rate exceeds six/1,000 live births each year in the United States, in part, due to our inability to rapidly and accurately detect unexpected changes in their condition. Moreover, pain detection of the neonate is complicated with less than 50% of neonates’ able to communicate pain through crying. Miscommunication accounts for the loss of nearly 100,000 lives each year. The current electronic health record (EHR) is a contributor to this statistic as an ineffective communication tool. Of particular concern, is the communication of clinical events (CEs) or subtle changes in patient condition that risk unexpected patient death. CEs are defined as events that reflect a change in patient status and present as pain, fever, bleeding, changes in respiratory status, changes in output, and changes in level of consciousness. Effective neonate and nurse communication of pain is of particular interest in this research as a contributor of neonatal mortality. Additionally, ineffective neonate-nurse communication is a contributor to neonatal mortality. The purpose is to learn nurses’ perceptions of pain in the neonate and current methods of neonate-nurse communication of pain. Underpinned by Carrington’s work, in particular, Carrington’s Effective Nurse to Nurse Communication Framework, Synactive Theory of Behavioral Organization and Development, and Learning Theories, specifically, Predictive Brains as Hierarchical Learning Machines and Statistical Learning. The sample consisted of 30 participants who worked at a local hospital located in southwest Arizona, in a 42-bed level III neonatal intensive care unit (NICU). The participants, who met inclusion criteria, participated in audio-recorded interviews. The interviews were transcribed verbatim and analyzed using content analysis and the Goodwin statistic (Goodwin & Goodwin, 1985). The emerging categories are Perceptions of Pain in the Neonate, Nurse Communication, Neonate Communication, and Technology. Additionally, the strengths, limitations, and recommendations for future research are also presented. New discoveries were made from this research, revealing insights to neonate to nurse communication: 1) Nurses perceive pain in the neonate individually, and 2) The importance of monitors as a communication tool to pain in the neonate.