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Issue: Untreated Infantile Pain during Heel Lancing and Immunizations

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Issue: Untreated Infantile Pain during Heel Lancing and Immunizations

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Infantile pain is an ongoing area of research since it is under identified and under-treated. It is thought that infants feel pain more intensely than adults (Bhurtel, et. al., 2020). Untreated, severe pain can have devastating and lasting effects on infants, such as central nervous system changes that can last into adulthood (Koukou, et. al., 2022).

This is a concerning issues since newborns undergo many invasive procedures such as immunizations and heel sticks/lancing during their first 48 hours of life, and throughout their check-ups and possible hospitalization (Koukou, et. al., 2022). Proper treatment and management of infantile pain during these invasive procedures is crucial to nursing in order to prevent devastating neurodevelopment changes of excruciating newborn pain.

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1. One study was done as a randomized controlled trial that studied having infants either swaddled; swaddled and held; and swaddled, held, and breastfed during a heel lancing procedure. The study found that the group of infants who were breastfed in addition to being swaddled and held had the shortest cry time and lowest pain scores with statistical significance of all the interventions (Yilmaz & Inal, 2020).

2. A second study compared breastfeeding, oral 25% dextrose, kangaroo mother care method, and EMLA cream in reducing pain of infants after a heel-prick of newborns. It was a double-blind controlled clinical trial and yielded that breastfeeding group of infants had the lowest pain scores and lowest scores in regards to crying (Soltani, et. al., 2019).

3. A third study was done to assess breastfeeding as pain relief in regards to immunizations. It was a randomized clinical trial with a control group who received no pain relief and a group who was breastfed. The pain scores of the breastfeeding group had lower pain scores than the control group and the breastfeeding group had significantly lower duration of cry than the control group (Bhurtel, et. al., 2020).

The literature supports breastfeeding in reducing pain scores and crying times of infants undergoing heel lancing procedures and immunizations.

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While pain management is a known priority in the nursing world, infants' pain tends to be under assessed and under treated (Koukou, et. al., 2022). As a nurse, you do pain assessments and promote non-pharmacological and pharmacological methods of pain relief.

A current study was done that showed that even though there is research in breastfeeding reducing infantile pain during immunizations and heel lancing, some nurses are still not utilizing this intervention (Rosa, et. al., 2022). This stemmed from either lack of knowledge of breastfeeding being on of the most effective pain management measures and nurses acting in a way to discourage mother's from breastfeeding. By not utilizing this intervention, nurses are exacerbating the issue by not promoting a researched and effective way to treat infantile pain during heel lancing and immunizations: breastfeeding.

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As previously stated, nurses are the ones doing the heel lancing or giving immunizations and play a direct role in pain assessment and management for infants. Currently, there is not enough implementation of breastfeeding as a pain reduction technique, although the research supports the use of breastfeeding in heel lancing and immunizations. Since nurses are administered and collecting these labs, they play a direct role in promoting this pain reduction technique.

If nurses begin to utilize breastfeeding during immunizations and heel lancing, they can help reduce infantile pain during these invasive procedures and begin adhering to best practices (Komaroff & Forest, 2020).

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Challenges or barriers for nurse involvement 

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Challenges or barriers for nurse involvement 

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Some barriers to implementing breastfeeding for pain management during heel lancing and immunizations has to do with a lack of knowledge of breastfeeding being the most effective infantile pain reliever during both (Rosa, et. al., 2022).

Another barrier to nurses promoting breastfeeding had to do with bias or restrictive beliefs that do not convey a safe space for mother's to breastfeed during these invasive procedures (Rosa, et. al., 2022).

Other barriers to implementing this has to do with nurses not providing an environment that makes mother's feel comfortable with breastfeeding or the physical environment during the procedure does not promote breastfeeding (Benoit, et. al., 2022).

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1. One way to promote nursing participation in promoting breastfeeding during heel lancing and immunizations is to implement a clinical protocol that guides nurses to better assess infantile pain and promote this intervention in reducing pain (Komaroff & Forest, 2020).

2. A second way is to promote an environment for parents to feel comfortable breastfeeding within their physical environment, and also having nursing staff create a comfortable and holistic environment that allows the mother's to breastfeed comfortably (Rosa, et. al., 2022).

3. A third way to help with management of infantile pain during heel lancing and immunizations is to educate parents the benefits of breastfeeding during this invasive procedure (Benoit, et. al., 2022).

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PSLO 5. Implement nursing practice that focuses on health promotion and maintenance from a holistic perspective.

PSLO 6. Apply research findings to promote evidence-based practice.

The issue of infantile pain and the utilization of breastfeeding in reducing this pain directly shows how this intervention comes from a holistic approach and helps with health promotion and maintenance. By implementing breastfeeding, this will help with having parents adhere to immunization recommendations by having their infants pain controlled. Throughout this whole assignment, research had to be done to yield proper evidence-based articles, which shows how both these goals were met. This has prepared me to take a leadership role by showing the importance of researching best practices to promote my future nursing care to be competent. It also shows the importance of taking an active leadership role with patients and advocating for them to receive the best care that is evidence-based.

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Benoit, B., Cassidy, C., van Wijlen, J., Correll, Q., Campbell-Yeo, M., Hendra, S., Martin-Misener, R., MacDougall, J., & Cameron, A. (2022). Codevelopment of implementation interventions to support parent-led care for pain in infants: Protocol for a qualitative descriptive study. JMIR Research Protocols, 11(8). https://doi.org/10.2196/33770

Bhurtel, R., Yadav, U., Chaudhary, R., Shah, S., Poudel, P., Pokhrel, R. P., & Sharma, S. (2020). Effect of breastfeeding on relieving pain during immunization in infant. Kathmandu University Medical Journal, 18(4), 376–380. https://doi.org/10.312 6/kumj.v18i4.49249

Komaroff, A., & Forest, S. (2020). Implementing a clinical protocol using breastfeeding to mitigate vaccination pain in infants. Journal of Pediatric Nursing, 54, 50–57. https://doi.org/10.1016/j.pedn.2020.05.017

Koukou, Z., Theodoridou, A., Taousani, E., Antonakou, A., Panteris, E., Papadopoulou, S.-S., Skordou, A., & Sifakis, S. (2022). Effectiveness of non-pharmacological methods, such as breastfeeding, to mitigate pain in Nicu Infants. Children, 9(10). https://doi.org/10.3390/children9101568

Napiórkowska-Orkisz, M., Gutysz-Wojnicka, A., Tanajewska, M., & Sadowska-Krawczenko, I. (2022). Evaluation of methods to minimize pain in newborns during capillary blood sampling for screening: A randomized clinical trial. International Journal of Environmental Research and Public Health, 19(2), 870. https://doi.org/10.3390/ijerph19020870

Rosa, I. T., Rossato, L. M., Guedes, D. M., Fogaça, V. D., Domingues, F., & Silva, L. (2022). Beliefs, knowledge, actions of nursing techniques in breastfeeding in pain management in immunization. Revista Brasileira de Enfermagem, 75(6). https://doi.org/10.1590/0034-7167-2021-0546

Soltani S, Zohoori D, Adineh M. Comparison the effectiveness of breastfeeding, oral 25% dextrose, kangaroo-mother care method, and EMLA cream on pain score level following heel prick sampling in newborns: a randomized clinical trial. Electron Physician. 2018 May 5;10(5):6741-6748. doi: 10.19082/6741. PMID: 29997756; PMCID: PMC6033133.

Yilmaz, D., & Inal, S. (2020). Effects of three different methods used during heel lance procedures on pain level in term neonates. Japan Journal of Nursing Science, 17(4). https://doi.org/10.11 11/jjns.12338