EXPLORING BARRIERS TO PAIN MANAGEMENT IN NEWBORN INTENSIVE CARE UNITS
Boyd PJ, Gonzales I, Parsons V. Adv Neonatal Care. 2009;9(6):299-306.
This is a descriptive survey study to assist in identifying barriers that nurses experience when attempting to manage newborn pain. The survey consisted of 37 questions pertaining to newborn pain management and barriers neonatal intensive care units nurses may face when managing newborn pain.
A sample of 90 responses from members of the National Association of Neonatal Nurses residing in California was collected. Less than half of the nurses felt that newborn pain was well managed in the neonatal intensive care units where they were employed. Barriers identified included physician pain management practices, lack of evidence-based pain management protocols, nurses' and physicians' resistance to change practice, infant pain assessment tools, and inadequate staff training regarding pain assessment and management.
The authors conclude that a gap remains between knowledge and practice for management of newborn pain and those strategies to address resistance to change must be addressed as well as the need to increase caregiver education.
EXPERIENCE WITH ELECTROLYTE LEVELS AFTER CRANIOTOMY FOR PEDIATRIC BRAIN TUMORS
Madden JR, Dobyns E, Handler M, Foreman NK. J Pediatr Oncol Nurs. 2010;27(1):21-23.
Children with brain tumors undergo craniotomies for tumor resection, in which postoperatively, these children may develop inappropriate vasopressin secretion, cerebral salt wasting syndrome, or a combination of both. Both high and low sodium levels are associated with serious complications.
Sodium levels were prospectively observed for 72 hours perioperatively. Thirty-six patients had 201 serum sodium levels measured over the course of 1 year. Postoperatively, 79 of the sodium levels were less than 135 or greater than 145 mEq/L; of these abnormal sodium levels, 3 were less than 125 and 2 were greater than 165 mEq/L. All of the abnormal sodium levels occurred in patients with suprasellar or hypothalamic lesions.
This study suggests that children with resections of suprasellar or hypothalamic tumors need specialist attention in postoperative management of fluid and electrolytes and would benefit in a neurological intensive care unit.