Pain Management Perceptions of the Neonatal Nurses in NICUs and Neonatal Units in Ardebil, Iran

Document Type : Original Article


1 Ph.D Candidate, Department of Nursing, International Branch of Shahid Beheshti University of Medical Sciences, Tehran, Iran Pediatrician, Ayatolla Khatam Hospital, Yazd, Iran

2 Ph.D, Department of Nursing, School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran

3 M.D, Department of Neonatology, Tabriz University of Medical Sciences, Tabriz, Iran

4 M.D, Department of Anesthesiology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran

5 M.D, Department of Neonatology, Ardebil University of Medical Sciences, Ardebil, Iran


Background: This study aimed to determine neonatal nurses’ perceptions of knowledge and practice in pain management in NICUs & neonatal units.
Methods: A cross-sectional descriptive study design was used. A total of 120 neonatal nurses who working in NICUs & neonatal units in Ardebil province, Iran were selected using the convenience sampling technique. A questionnaire of Nurses’ Perceptions of Neonatal Pain (Cong, 2013), including 36 questions with Likert scale and 2 open ended questions, was used. Data collected were analyzed with descriptive statistics of frequencies and percentages.
Results: Nurses had Appropriate knowledge of neonatal pain management , but less than 50% felt that they received adequate training and continuing education on pain. Participants reported that they don’t use of pain assessment tools (65%). Less than half felt that the pain tool used in their unit was an accurate measure (44.2%). Fewer than half reported that pain was well managed (28.3%) , that their pain protocols were research evidence based (34.2%) and more than half reported that parents should be involve with the care and comfort of their infant during painful procedures (71.6%). Barriers to effective pain management emerged as high workload, shortage of personnel, lack of knowledge, absence of pain protocols, lack of time, and lack of trust in the pain assessment tools.
Conclusions: proper pain management was significantly correlated with adequate training, use of proper and accurate pain tools, and clear and research-based protocols and parental involvement. It can be improved by developing guidelines and support of nurses, develop of clinically feasible pain tools, adequate training and proper supervision.


  1. Im H, Kim E, Park E, Sung K, Oh W. Pain reduction of heel stick in neonates: Yakson compared to non-nutritive sucking. J Trop Pediatr. 2008; 54(1):31-5.
  2. Mirzarahimi M, Mehrnoush N, Shahizadeh S, Samadi N, Amani F. Effect of non-nutritive sucking and leg massage on physiological and behavioral indicators of pain following heel blood sampling in term neonates. Int J Adv Nurs Stud. 2013; 2(2):74.
  3. Jain S, Kumar P, McMillan DD. Prior leg massage decreases pain responses to heel stick in preterm babies. J Paediatr Child Health. 2006; 42(9):505-8.
  4. Eriksson M, Storm H, Fremming A, Schollin J. Skin conductance compared to a combined behavioral and physiological pain measure in newborn infants. Acta Paediatr. 2008; 97(1):27-30.
  5. Cong X, Delaney C, Vazquez V. Neonatal nurses' perceptions of pain assessment and management in NICUs: a national survey. Adv Neonatal Care. 2013; 13(5):353-60.
  6. Lago P, Guadagni A, Merazzi D, Ancora G, Bellieni CV, Cavazza A, et al. Pain management in the neonatal intensive care unit: a national survey in Italy. Pediatr Anesth. 2005; 15(11):925-31.
  7. Carbajal R, Rousset A, Danan C, Coquery S, Nolent P, Ducrocq S, et al. Epidemiology and treatment of painful procedures in neonates in intensive care units. Jama. 2008; 300(1):60-70.
  8. Lago P, Garetti E, Merazzi D, Pieragostini L, Ancora G, Pirelli A, et al. Guidelines for procedural pain in the newborn. ActaPaediatr. 2009; 98(6):932-9.
  9. Grunau RE, Holsti L, Peters JW. Long-term consequences of pain in human neonates. Semi Fetal Neonatal Med. 2006; 11(4): 268-75.

10. American Academy of Pediatrics Committee on Fetus and Newborn; American Academy of Pediatrics Section on Surgery; Canadian Paediatric Society Fetus and Newborn Committee, Batton DG, Barrington KJ, Wallman C. Prevention and management of pain in the neonate: an update. Pediatrics. 2006; 118(5):2231-41.

11. Cong X, McGrath JM, Delaney C, Chen H, Liang S, Vazquez V, et al. Neonatal nurses’ perceptions of pain management: survey of the United States and China. Pain Manag Nurs. 2014; 15(4):834-44.

12. Byrd PJ, Gonzales I, Parsons V. Exploring barriers to pain management in newborn intensive care units: a pilot survey of NICU nurses. Adv Neonatal Care. 2009; 9(6):299-306.

13. Harrison D, Loughnan P, Johnston L. Pain assessment and procedural pain management practices in neonatal units in Australia. J Paediatr Child Health. 2006; 42(1‐2):6-9.

14. Latimer MA, Johnston CC, Ritchie JA, Clarke SP, Gilin D. Factors affecting delivery of evidence‐based procedural pain care in hospitalized neonates. J Obstet Gynecol Neonatal Nurs. 2009; 38(2):182-94.

15. Akuma AO, Jordan S. Pain management in neonates: a survey of nurses and doctors. J Adv nurs. 2012; 68(6):1288-301.

16. Pölkki T, Korhonen A, Laukkala H, Saarela T, Vehviläinen‐Julkunen K, Pietilä AM. Nurses’ attitudes and perceptions of pain assessment in neonatal intensive care. Scand J Caring Sci. 2010; 24(1):49-55.

17. Schultz M, Loughran‐Fowlds A, Spence K. Neonatal pain: a comparison of the beliefs and practices of junior doctors and current best evidence. J Paediatr Child Health. 2010; 46(1‐2):23-8.

18. Ozawa M, Yokoo K. Pain management of neonatal intensive care units in Japan. ActaPaediatr. 2013; 102(4):366-72.

19. Pölkki T, Korhonen A, Axelin A, Saarela T, Laukkala H. Development and preliminary validation of the Neonatal Infant Acute Pain Assessment Scale (NIAPAS). Int J Nurs stud. 2014; 51(12):1585-94.

20. Franck LS, Bruce E. Putting pain assessment into practice: why is it so painful? Pain Res Manag. 2009; 14(1):13-20.

21. Obeidat H, Kahalaf I, Callister LC, Froelicher ES. Use of facilitated tucking for nonpharmacological pain management in preterm infants: a systematic review. J Perinat Neonatal Nurs. 2009; 23(4):372-7.

22. Cong X, Cusson RM, Walsh S, Hussain N, Ludington-Hoe SM, Zhang D. Effects of skin-to-skin contact on autonomic pain responses in preterm infants. J Pain. 2012; 13(7):636-45.

23. Cong X, Ludington-Hoe SM, McCain G, Fu P. Kangaroo Care modifies preterm infant heart rate variability in response to heel stick pain: pilot study. Early Hum Dev. 2009; 85(9):561-7.

24. Johnston CC, Filion F, Campbell-Yeo M, Goulet C, Bell L, McNaughton K, et al. Kangaroo mother care diminishes pain from heel lance in very preterm neonates: a crossover trial. BMC Pediatr. 2008; 8(1):13.

25. Cignacco E, Hamers JP, Stoffel L, Lingen RA, Gessler P, McDougall J, et al. The efficacy of non‐pharmacological interventions in the management of procedural pain in preterm and term neonates. A systematic literature review. Eur J Pain. 2007; 11(2):139-52.

26. Young J, Barton M, Richards-Dawson MA, Trotman H. Knowledge, perception and practices of healthcare professionals at tertiary level hospitals in Kingston, Jamaica, regarding neonatal pain management. West Indian Med J. 2008; 57(1):28-32.

27. Haydeh H, Marzieh H, Marjan F. An Exploration of the Viewpoints of Parents and Nurses on Care Provision in Neonatal Intensive Care Units. IJN. 2015; 6(4):30-6.

28.  Zahra AR, Mohsen HM, Yadolla ZP, Mosa A-K, Afroz K, Soraya K, et al. The Effects of Kangaroo Mother Care (KMC) on the Fuss and Crying Time of Colicky Infants. IJN. 2015; 6(1):23-7.