As Editor of the Perinatal Section, I want to take this opportunity to formally thank Dr Jackie Tillett for the 12 years she served as Contributing Editor for the Perinatal Section of the Journal of Perinatal and Neonatal Nursing (JPNN). Jackie has managed the Expert Opinion column (Perinatal) for the Journal. She has been a strong champion for JPNN over the years and has provided us with many thought-provoking clinical topics in the Expert Perinatal column. Jackie will be stepping down from this role at JPNN but will be remaining on the Perinatal Board. She has been a prolific column writer, and I want to acknowledge her clinical acumen and writing abilities. Thank you, Jackie, for 12 years of dedication at this level to JPNN.
The vacancy left by Dr Tillett will be filled by one of our existing perinatal board members, Dr Elisabeth D. Howard. Liz brings years of both perinatal and midwifery clinical experience to this new role as well as writing and editing experience. She will be able to address the clinical expert content for the perinatal clinician. We welcome Liz in her new role with the Journal.
We also take this opportunity to welcome Dr Kate Gregory, as the new Neonatal Editor for JPNN. As many already know, Kate has been a Contributing Editor for the Neonatal Expert column for the past 2 years. She has been transitioning to her new role as the Neonatal Editor during this past year. We look forward to her leadership of the Journal on the neonatal side for years to come. Welcome Kate!
Pain management is the topic for this 31:2 issue of the Journal. Pain easily transcends both perinatal and neonatal care content. On the perinatal side, management of pain during labor and the postpartum period is a critical element of interest to all perinatal care providers. Within this issue are 4 manuscripts that clearly address this topic.
Mary Ann Stark presents the effectiveness of therapeutic showering in labor as a holistic pain intervention. She compares the effectiveness of therapeutic showering with usual care during active phase of labor. A convenience sample of healthy low-risk women in active labor was recruited with a pretest/posttest control group, repeated-measures design.
Rebecca R. Safley and Jasmie Swietlikowski put forth a clinical review of pain management in the opioid-dependent pregnant woman. Opioid dependence is an epidemic in the United States and the percentage of pregnant women who are opioid-dependent has increased in the last decade. Pain management in this population presents its own set of challenges during the perinatal period.
Best practices in the management of postpartum pain are documented by Jenifer O. Fahey. Pain in the postpartum period is often overlooked and has been a neglected area of clinical interest and research. She reviews the more common causes of pain during postpartum, and recommendations are made for pain management on the basis of the available evidence to date.
Nitrous oxide, although not that new to the perinatal scene as a pain management modality, is now used more widely in the United States. Michelle Collins discusses in this clinical article the best evidence to date on the use of nitrous and presents its use to manage anxiety and pain in labor, its expanded uses in the perinatal period, appropriate patient counseling, and practice implications.
I encourage you to peruse the two Perinatal columns. The Expert Perinatal column this month focuses on an innovative algorithm for managing labor pain. The Legal Issues and Risk Management column discusses the differences among the concepts of education, competency, certification, and credentialing for electronic fetal monitoring. The Parting Thoughts column completes the issue with a focus on the use of a hospital healing garden for pregnant women and their partners.
We have asked Renee Manworren to be our guest editor for the neonatal side of this issue. She reminds us in this editorial, how far we have come in managing neonatal pain, and the challenges that still exist. Global health experts suggest that there is an urgent need for research supporting healthcare for childbearing women that is both respectful and evidence-based beyond "too little, too late and too much too soon."
Thirty years ago, my daughter had open heart surgery. A clinical nurse specialist preoperatively explained every step of the surgery, every critical event, and every tube and monitor we would see after surgery. When we were reunited with my daughter after surgery, my elation at her survival turned to horror as I realized she was on a paralytic but not receiving anything for pain!
My husband and I were then told by the physicians and nurses we had entrusted with her care that "babies don't feel pain" and pain treatments were "too dangerous for infants." I demanded my daughter be given the pain medications that I, as a student nurse, had been giving my adult patients for postoperative pain. Although someone wrote in my daughter's chart that I was a young demanding mother, I don't believe these intelligent and caring healthcare professionals just gave in to my demands. I don't think they actually believed these myths and excuses for not treating babies' pain. It has since been my calling and my professional responsibility to challenge pediatric healthcare providers to stop making excuses and relieve children's pain.
Twenty years later, a research report1 title caught my eye, "Do We Still Hurt Newborn Babies?" The answer was unfortunately "yes." So when asked to be a special editor for this edition devoted to neonatal pain, I put out a call to the leading pain researchers in the world. I wanted to share with you the cutting-edge research that would revolutionize neonatal pain assessment and promise a pain management paradigm shift that would allow us to promise parents pain prevention and complete pain relief techniques for their babies' pain.
In this edition of the Journal, you will learn from the Polkki et al study of neonatal nurses that the majority don't use validated pain assessment tools and evidence-based nonpharmacologic strategies in their neonatal intensive care units. On the basis of neonatal nurses' self-report, written instructions and unit guidelines are associated with evidence-based practices that were innovative last century.
There are 3 innovative studies in this edition. I believe the Buyuky[latin dotless i]lmaz et al randomized controlled trial is the first report of the use of this nonpharmacologic device to address needle pain within 15 minutes of birth. Dr Buyuky[latin dotless i]lmaz submitted this report with the word "innovative" in the title, but the first publications about this device are more than a decade old.
How can we accelerate knowledge translation to neonatal pain care? Harrison et al provide the analytics and share the challenges of using social media as an innovative approach to accelerate knowledge translation. Bueno et al mine social media and provide an introduction of how YouTube postings might be leverage as a research tool to determine the status of knowledge translation. Breast-feeding was not used as a nonphramacologic strategy in the Portuguese YouTube videos reviewed. In the Benoit et al updated systematic review, you will learn that breast-feeding is analgesic for neonates but breast milk is not.
Perhaps, the challenge to translation of knowledge into routine clinical care of neonates is the ineffectiveness of currently available and validated pain assessment tools and pain management strategies, and/or perhaps these tools and strategies are undervalued by neonatal nurses. I invited Young et al to concisely explain the neurobiological evidence and challenges to the pain assessment and nonpharmacologic treatment strategies reported in this edition, as well as the consequences of these early painful experiences. We must pool our resources to shift the current paradigm of neonatal pain care from excuses and antiquated research methods to novel approaches, precision medicine, and brain initiatives. We must leverage data science, big data analytics, computer learning, and artificial intelligence to solve problems and build networks. Mats Eriksson et al introduce such an effort by PEARL.
In 2017, "do we still hurt newborn babies?" Unfortunately, the answer is still "yes, we do." It is up to YOU, the practicing perinatal and neonatal nurse, and YOU, the nurse scientist, to challenge the excuses that leave your vulnerable patients to suffer pain! A nurse, Margo McCaffery, defined pain, and a pediatric nurse, Jo Eland, in her presidential address to the American Society for Pain Management Nurses stated, "Every nurse is a pain management nurse!" After reading this edition, watch for progress on PEARL's Web site, scan social media, and champion your own efforts to stop hurting neonates!
-Diane Angelini, EdD, CNM, NEA-BC, FACNM, FAAN
Perinatal Editor
-Renee C. B. Manworren, PhD, RN-BC, APRN, PCNS-BC,
AP-PMN, FAAN
Neonatal Guest Editor
Reference