A cultural approach to the treatment of neonatal pain

This week’s blog was written by Dr. Siti Yuyun Rahayu Fitri, Associate Professor of Pediatric Nursing on the Faculty of Nursing, Padjadjaran University, Indonesia

The survival rate of newborns, especially those treated in neonatal intensive care units (NICUs), has improved significantly. This is in keeping with WHO data showing that infant deaths have decreased by 44% since 2000 ¹. The decline in mortality rates is essentially attributed to advances in health care services and technology. However, the standard of lifetime of these survivors stays a challenge as they often struggle with various problems as a consequence of long-term treatment and an environment that will not be conducive to the optimal development of newborns. Newborns treated in hospitals often undergo invasive procedures that cause pain. Studies show that newborns within the NICU undergo a median of seven.5 to 17.3 painful procedures per day. ². Unfortunately, the power of healthcare professionals to treat pain stays limited, with only 21-34% of cases receiving appropriate treatment ³.

Effective pain management is hampered by several barriers, including insufficient staff knowledge of pain management and lack of obligatory equipment. It is obligatory to take a serious and comprehensive approach to the treatment of pain in newborns. Untreated pain in newborns can result in a wide range of short-term complications, akin to decreased oxygen saturation and increased heart rate, in addition to long-term consequences, including poorer cognitive, motor, and behavioral development in infants and kids born very prematurely. ⁴.

Various analgesic techniques and their variations have been studied in various contexts to scale back pain in neonates. Recently, cultural approaches have grow to be increasingly essential in neonatal health care and have gotten more widely accepted in communities ⁵. Culture has been recognized as a central element of nursing (called cultural nursing), contributing to safer and more humane health care services ^6.7. The nurse’s understanding of cultural and traditional practices is due to this fact crucial. However, to make sure the security of traditional health interventions, formal research is required to gather data and evaluate current traditional practices in the neighborhood. Patients on the clinical level urgently need reliable details about complementary and alternative medicine from healthcare professionals.

Cultural aspects have significantly influenced the event of a wide range of pain treatments in numerous communities ⁸. Research has shown that culture shapes the perception and response to pain, including in children. However, most studies of cultural practices in pediatric pain management have ignored neonates.

The review highlights the potential advantages of cultural practices within the management of procedural pain in neonates, although these studies often face limitations related to check design, procedure standardization, and final result measures. The advantages of cultural practices in neonatal pain management transcend measurable outcomes and include the processes and beliefs underlying these practices. A balanced research approach is required to look at each the target pain relief advantages of culture-based approaches and the subjective importance of those approaches in neonatal pain management.

Traditional pain relief methods have been studied in several countries and have shown relative effectiveness in reducing neonatal pain ⁹. It is important to contemplate traditional knowledge and practices when developing intervention strategies for newborn health ¹⁰ as a consequence of the strong connection between cultural beliefs and newborn care ¹¹. According to the World Health Organization ¹²traditional medicine (TM) – including traditional analgesia – encompasses knowledge, skills and practices rooted within the theories, beliefs and experiences of varied cultures. TM is used not only to take care of health, but in addition to stop, diagnose, improve or treat physical and mental diseases.

As a pediatric nurse, I imagine it is necessary to contemplate and develop cultural or traditional approaches to neonatal pain management. Nurses can play a key role in examining, validating, and ensuring that pain management practices commonly utilized in society are truly protected. On the opposite hand, it’s equally essential to discover and address cultural practices in neonatal pain management that could be harmful or inconsistent with established health science principles.

By incorporating cultural approaches to pain management, our goal is to realize a harmonious integration of conventional and cultural treatments. The goal of this approach will not be to contradict modern medical practices, but fairly to create a synergy that leverages the strengths of each methods, ultimately finding the very best combination.

Achieving this harmony would require more in-depth research to assemble solid evidence to support the combination of traditional and modern medicine. This balanced approach can improve the standard and effectiveness of neonatal pain management while respecting cultural values ​​and practices.

Reference

1. World Health Organization. Infant mortality [Internet]. 2024 [cited 2024 Mar 14]. Available at: https://www.who.int/news-room/fact-sheets/detail/newborn-mortality
2. Cruz MD, Fernandes AM, Oliveira CR. Epidemiology of painful procedures in newborns: a scientific review of observational studies. Eur J Pain (UK). 2016;20(4).
3. Courtois E, Droutman S, Magny JF, Merchaoui Z, Durrmeyer X, Roussel C, et al. Epidemiology and management of neonatal heel pain in intensive care units: EPIPPAIN 2, a prospective observational study. Int J Nurs Stud. 2016;59:79–88.
4. Vinall J., Grunau RE. The impact of repetitive procedural pain stress in very preterm infants. Pediatric Res [Internet]. 2014;75(5):584–7. Available at: http://www.ncbi.nlm.nih.gov/pubmed/24500615
5. Bangari A, Thapliyal SK, Ruchi R, Aggarwal B, Sharma U. Traditional beliefs and practices in newborn care amongst moms in a tertiary care center in Dehradun, Uttarakhand, India. Int J Community Med Public Treatment. 2019;6(6):2600.
6. Leininger MMM. Transcultural nursing as a humanizer, diversifier and unifier of world care. Hoitot (Journal Nurs Sci. 1997;9(5):219–25.
7. Molloy L, Walker K, Lakeman R, Skinner I. Ethnonursing and the ethnographic approach to nursing. Nurse Res. 2015;23(2):17–21.
8. Narayan MC. The influence of culture on the assessment and treatment of pain. I’m J Nurs. 2010;110(4):38–47.
9. Fitri SYR, Wardhani V, Rakhmawati W, Pahria T, Hendrawati S. Culture-based practice in neonatal procedural pain management: a mini review. Front pediatrician. 2020;8(September):1–6.
10. Upadhyay RP, Singh B, Rai SK, Anand K. The role of cultural beliefs in influencing chosen neonatal care practices in rural Haryana. J Trop Pediatrician. 2012;58(5):406–8.
11. Reshma, R. Sujatha. Cultural practices and beliefs regarding newborn care amongst moms in a specific hospital in Mangalore Taluk. Nitte Univ J Heal Sci [Internet]. 2014;4(2):2249–7110. Available at: http://nitte.edu.in/journal/June2014/21-26.pdf
12. WHO. WHO Global Report on Traditional and Complementary Medicine 2019 [Internet]. World Health Organization. 2019. 1–228 pp. Available at: https://apps.who.int/iris/bitstream/handle/10665/312342/9789241515436-eng.pdf?ua=1

(Visited 2 times, 2 visits today)