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Procedural Pain And Brain Development

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Procedural Pain And Brain Development Question: Discuss about the Procedural Pain and Brain Development.     Answer: Introduction: Infants are affected very much by pain of different medical procedures in hospitals. This happens due to lack of knowledge of different therapies and massages that can be used while treatment of any infant. From different studies of sensorial saturation, massage has been proved to be an effective, non-pharmacological treatment for pain-relief (Bellieni et al., 2012). Venipuncture is process for access into vain for intravenous therapy or for drawing blood from vein. The journal, published in Honk Kong investigates thoroughly how massage can be an effective process in order to reduce the pain in infants during Venipuncture. Dr. Kai Chow Choi is a PhD in statistics an expert in epidemiological studies and biostatistics. Another author Dr. Wan-Yim Ip is an associate professor at Nethersole School of Nursing, Faculty of medicine. He is a specialist in obstetric care and general nursing. Dr. Yuen-Man Chik is another member of faculty of medicine and he is also a child specialist and expert in teenage medicine. A territorial hospital in Hong Kong is chosen as the organisation for the discussion. Massage has been proved as an effective pain reducing method from the previous studies. A study of sensorial saturation has showed that it elevates heart rates and pain scores remarkably (Brummelte et al., 2012). The result of a study relating nursing methodology among 135 infants has showed that infants with gestational age between 33-36 weeks have to endure 60 painful procedures, whereas infants with gestational age 28 weeks have to endure near about 700. The symptoms of pain include elevated respiratory rate, heart rate, blood pressure and oxygen saturation depletion (Slater et al., 2012). Infants’ responses like body motion, crying and facial indication depend on their gestational age and resistance power (Madlinger-Lewis et al., 2014). Their facial gestures include squeezing of eyes, nasolobial furrow, swelling of eye-brows and open lips. The importance of this study lies with professional help of the health expert to minimize the infant pain (Chik, Ip & Choi, 2017). Elimination or prevention of pain for infants during medical processes is not possible, but it can be minimized using effective non-pharmacological steps (Bergomi et al., 2014). Massage has been proved to be a technique that provides sensitive care. Effective weight gain, reduction of stress level and improvement of behavioural status in infants are some of the effects of massage (Abdallah, Badr & Hawwari, 2013).   The main objective of this study can be categorized into two sections. First one is examination of the response of infants in pain while Venipucture process and the second one is determination of effectiveness of upper limb massage in order to reduce the pain response of infants while undergoing Venipuncture (Savino et al., 2013). Neonatal Intensive Care Unit of a hospital deals with the problems of newborn infant (Maxwell, Malavolta & Fraga, 2013). With approval of local ethical committee various methods have been applied for the study. The methodology for this study is a crossover one that can be controlled randomly. Infants have been categorized into two parts for this study. These two groups are Massage 1st and Massage 2nd. The criteria included for this study are the gestational age of the infants, their proper size and required Venipuncture that can find out the defects (DiCenso, Guyatt & Ciliska, 2014). The infants who are involved with neuromuscular medication or sedation within 48 hours before application of pain reducing procedures or have gone through surgery previously or have anomalies in central nervous system have not been included in this study (Akuma & Jordan, 2012). This categorization helps this study by making it simple. The collected data can verified separately which will help to draw the conclusion of the study. Application Of Methodologies: The infants in Massage 1st group have undergone intervention of upper limb massage primarily and subsidiary cares afterwards. The Massage 2nd group infants have gone through a vice-versa process (Chen et al., 2012). After massaging by a well trained nurse, ten physicians have performed the Venipuncture process using same technique (Cullum et al., 2013). Appearance of a good number of physicians ensures the safety of infants (Hall & Anand, 2014). Upper limb massage is a modified massage therapy, derived from the concepts of Vimala McClure, founder of International Association of Infant Massage, developed for premature progressive stimulation for infants, which enhances blood circulation and co-ordination, improves muscle tone and sleep (Gandhi, 2017). In this technique, the upper limbs are subjected to gentle strokes, milking and rolling (Bergomi et al., 2014). The massage is applied 5 minutes before Venipuncture to the upper limbs and the infants are covered to secure their blinding (Savino et al., 2013). The massage has lasted for two minutes. After that, Venipuncture is performed by the physicians using 24 gauge, 0.75 inch angiocatheter. The size of this catheter is standard for drawing intravenous fluids from infant body. A second blood sample is taken to check the infection level after completion of 24 to 48 hours of first Venipunccture.   Video recording has been done for data collection. Heart rate is being measured using a data collecting system consists of three electrocardiogram leads, which gives accurate data and an infrared oximeter is used to review oxygen saturation (Slater et al., 2012). Phillips IntelliVue MP30, which is a lightweight, 6 cm. Screen machine, comes with a multi-measurement server and one battery, used to monitor the infants routinely. It has 5 hours battery back-up and touch screen option. There are two nurses, one for data collection and another for data review. Premature Infant Pain Profile (PIPP) is the tool used in this study for evaluation of infant behaviour (Akuma & Jordan, 2012). This tool focuses on gestational age, state of behaviour, saturation of oxygen and measures of heart rate. These are the areas on which preliminary data has been collected. The PIPP evaluation tools investigate the data in behavioural, circumstantial and psychological terms (Abdallah, Badr & Hawwari, 2013). The reliability coefficient has been marked 0.91 to 0.99 for pain events in infant. IBM SPSS statistics 22.0 has been used for data analysis. The fundamental characteristics for different groups are compared using Pearson chi-square tools. A generic evaluation system is used for examining the difference in pain scores between massage and other required care. Within 80 infants, 52.5% are male and 47.5% are female. The average gestational age is 37 weeks and average bodyweight has been considered to be 28 Kg. The PIPP results indicate that, for the 1st infant group mean pain scores are 6.0 and 12.0 with massage and without massage respectively and for the 2nd infant group the scores are 7.3 and 12.7 respectively (van Dijk et al., 2012). The carryover effects, the comparison between usefulness of massage as a pain reduction therapy and other necessary treatment are examined by using the generic evaluation equations (GEE) model (Hall & Anand, 2014). Two GEE models have been used in this case. The first one incorporates no adjustment for infant characteristics and the second one incorporates adjustments form gestational age, sex and bodyweight of the infants. The assessment of the model for both the cases indicates that the pain scores for the infants are essentially low who have received massage after potential time and carryover effects rather than who have received the necessary treatments.   Analysing the data it can be noticed that PIPP is effective method of study that can be used to deduce the effectiveness of upper limb massage for pain management in infants (Brummelte et al., 2012). The level of pain that can be caused by Venipucture ranges from moderate to severe. The ranges of pain score are set as below: Comparison table for pain scores Pain score Level of pain 0 No pain 6 and below Minimal pain 7 to 12 Moderate pain Beyond 12 Severe pain The previous table shows the relationship between pain score and level of pain for the infants who have undergone through massage before Venipuncture (van Dijk et al., 2012). For the infants, who have not been subjected to massage, the severity6 of pain does not follow the table, rather increases by a lot. For the Massage 1st and Massage 2nd group, however the difference in pain scores does not have much significance. However, the study does not clinically represent the relationship between upper limb massage and reduction of pain. Another lack of the study is that the massage technique cannot be applied equally to all clinical practices, it needs to be standardized. To determine various illnesses present at birth, infants have to go through Venipucture process and it is almost impossible to eliminate the resulting pain (Chik, Ip & Choi, 2017). Proper application of some non-pharmacological techniques can comfort infants during this process. However, very few nurses have completed these training. In modern day clinical practices, physiotherapists are the ones who perform this massage (DiCenso, Guyatt & Ciliska, 2014).   Conclusion: In modern day medical practices, the importance of Venipuncture is very high and it is irreplaceable till now in order to determine the child-birth diseases. But infants suffer a great deal because of this. In order to compensate the pain massage of upper limbs is one of the non-pharmacological therapies that can be applied. Limb massage is not a common intervention method that can be applied to an infant but several studies prove that infants, whose gestational age are in between 30 to 40 weeks, feel comfort with application of limb massage before the application of any medical procedure. The Neonatal Intensive Care Unit of any hospital, where the infants are being treated, should have a good number of trained nurses and physiotherapists, who can perform this procedure. Instruments, required for Venipuncture as well as for monitoring the infants should be accurate because wrong data can lead to severe damages. Differences between pain scores under different explains the usefulness of non-pharmacological practices like upper limb massage, the conditions of their application. Relevance: The study is related to the health of infants, which is itself a very delicate and valuable issue in nursing. An infant has very low resistance power, which becomes the main issue when they are subjected to any medical procedure. The study relates this resistive power of infants to Venipuncture which is a very critical procedure. The process causes lots of pain to an infant, which can cause severe damage (Chik, Ip & Choi, 2017). It is very important to understand their behaviours and gestures because infants cannot express their pains through words (Maxwell, Malavolta & Fraga, 2013). Through this study, a brief idea can be generated about the behaviours of infant while application of Venipuncture (Savino et al., 2013). The research shows the requirement of clinical expertise in this case which can be related to nursing. The nurses and the physiotherapists should be well-trained in their fields, because the non-pharmacological processes are performed by them (Madlinger-Lewis et al., 2014). The non-pharmacological processes are compulsory for various medical procedures as they help to reduce pain, maintain health status (Gandhi, 2017). In this research, limb massage has been proved to be the most effective pain reduction process for Venipuncture (DiCenso, Guyatt & Ciliska, 2014). Various data have been obtained and analysed which provide the circumstantial pain scores and measures of pain realisation. The data is obtained by dividing the infants into two categories and by applying vice-versa procedure. Another thing which has been noticed from the study is the use of proper instruments. The measurements of heart rate, oxygen saturation have been measured using accurate and safe instruments. In nursing practice, it is very important to know about the operation of instruments properly (Bergomi et al., 2014). Pain relief is one of the primary contexts of nursing practices. The main objective of this practice is to take care of the sick. From the report, a link can be established between this study and basic nursing practices based on evidence (Cullumet al., 2013).   References: Abdallah, B., Badr, L. K., & Hawwari, M. (2013). The efficacy of massage on short and long term outcomes in preterm infants. Infant Behavior and Development, 36(4), 662-669. Akuma, A. O., & Jordan, S. (2012). Pain management in neonates: a survey of nurses and doctors. Journal of Advanced Nursing, 68(6), 1288-1301. Bellieni, C. V., Tei, M., Coccina, F., & Buonocore, G. (2012). Sensorial saturation for infants’ pain. The Journal of Maternal-Fetal & Neonatal Medicine, 25(sup1), 79-81. Bergomi, P., Chieppi, M., Maini, A., Mugnos, T., Spotti, D., Tzialla, C., & Scudeller, L. (2014). Nonpharmacological techniques to reduce pain in preterm infants who receive heel-lance procedure: a randomized controlled trial. Research And Theory for Nursing Practice, 28(4), 335-348. Brummelte, S., Grunau, R. E., Chau, V., Poskitt, K. J., Brant, R., Vinall, J., … & Miller, S. P. (2012). Procedural pain and brain development in premature newborns. Annals of Neurology, 71(3), 385-396. Chen, M., Shi, X., Chen, Y., Cao, Z., Cheng, R., Xu, Y., … & Li, X. (2012). A prospective study of pain experience in a neonatal intensive care unit of China. The Clinical Journal of Pain, 28(8), 700-704. Chik, Y. M., Ip, W. Y., & Choi, K. C. (2017). The Effect of Upper Limb Massage on Infants’ Venipuncture Pain. Pain Management Nursing, 18(1), 50-57. Cullum, N., Ciliska, D., Haynes, B., & Marks, S. (Eds.). (2013). Evidence-based nursing: an introduction. John Wiley & Sons. DiCenso, A., Guyatt, G., & Ciliska, D. (2014). Evidence-Based Nursing-E-Book: A Guide to Clinical Practice. Elsevier Health Sciences. Gandhi, A. (2017). Non-pharmacological analgesia-effective but underused. Hall, R. W., & Anand, K. J. (2014). Pain management in newborns. Clinics in Perinatology, 41(4), 895. Madlinger-Lewis, L., Reynolds, L., Zarem, C., Crapnell, T., Inder, T., & Pineda, R. (2014). The effects of alternative positioning on preterm infants in the neonatal intensive care unit: A randomized clinical trial. Research in Developmental Disabilities, 35(2), 490-497. Maxwell, L. G., Malavolta, C. P., & Fraga, M. V. (2013). Assessment of pain in the neonate. Clinics in Perinatology, 40(3), 457-469. Savino, F., Vagliano, L., Ceratto, S., Viviani, F., Miniero, R., & Ricceri, F. (2013). Pain assessment in children undergoing venipuncture: the Wong–Baker faces scale versus skin conductance fluctuations. PeerJ, 1, e37. Slater, L., Asmerom, Y., Boskovic, D. S., Bahjri, K., Plank, M. S., Angeles, K. R., … & Fayard, E. (2012). Procedural pain and oxidative stress in premature neonates. The Journal of Pain, 13(6), 590-597. van Dijk, J. F., van Wijck, A. J., Kappen, T. H., Peelen, L. M., Kalkman, C. J., & Schuurmans, M. J. (2012). Postoperative pain assessment based on numeric ratings is not the same for patients and professionals: a cross-sectional study. International Journal of Nursing Studies, 49(1), 65-71.

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