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  • 1.
    Andersen, Randi Dovland
    et al.
    Department of Child and Adolescent Health Services, Telemark Hospital, Skien, Norway; Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Munsters, Josanne M. A.
    Department of Women’s and Children’s Health, University Children’s Hospital Uppsala, Uppsala, Sweden.
    Vederhus, Bente Johanne
    Department of Pediatrics, Haukeland University Hospital, Bergen, Norway and.
    Gradin, Maria
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Paediatrics, Örebro University Hospital, Örebro, Sweden.
    Pain assessment practices in Swedish and Norwegian neonatal care units2018In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 32, no 3, p. 1074-1082Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The use of measurement scales to assess pain in neonates is considered a prerequisite for effective management of pain, but these scales are still underutilised in clinical practice.

    AIM: The aim of this study was to describe and compare pain assessment practices including the use of pain measurement scales in Norwegian and Swedish neonatal care units.

    METHODS: A unit survey investigating practices regarding pain assessment and the use of pain measurement scales was sent to all neonatal units in Sweden and Norway (n = 55). All Norwegian and 92% of Swedish units responded.

    RESULTS: A majority of the participating units (86.5%) assessed pain. Swedish units assessed and documented pain and used pain measurement scales more frequently than Norwegian units. The most frequently used scales were different versions of Astrid Lindgren's Pain Scale (ALPS) in Sweden and Echelle Douleur Inconfort Noveau-Ne (EDIN), ALPS and Premature Infant Pain Profile (PIPP) in Norway. Norwegian head nurses had more confidence in their pain assessment method and found the use of pain measurement scales more important than their Swedish colleagues.

    CONCLUSION: The persisting difference between Swedish and Norwegian units in pain assessment and the use of pain measurement scales are not easily explained. However, the reported increased availability and reported use of pain measurement scales in neonatal care units in both countries may be seen as a contribution towards better awareness and recognition of pain, better pain management and potentially less suffering for vulnerable neonates.

  • 2. Axelin, Anna
    et al.
    Eriksson, Mats
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Gradin, Maria
    Smärta2013In: Familjecentrerad neonatalvård / [ed] Karin Jackson, Helena Wigert, Lund: Studentlitteratur AB, 2013, 1, p. 111-124Chapter in book (Other academic)
  • 3.
    Baylis, Rebecca
    et al.
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Ewald, Uwe
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Gradin, Maria
    Örebro University Hospital.
    Nyqvist, Kerstin Hedberg
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Rubertsson, Christine
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Blomqvist, Ylva Thernstrom
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    First-time events between parents and preterm infants are affected by the designs and routines of neonatal intensive care units2014In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 103, no 10, p. 1045-1052Article in journal (Refereed)
    Abstract [en]

    Aim: Early parental bonding with preterm babies is particularly important, and the aim of our study was to explore when parents experienced what they regarded as important events for the first time while their infant was in the neonatal intensive care unit (NICU).

    Methods: The study was part of a longitudinal project on Kangaroo Mother Care at two Swedish university hospitals. The parents of 81 infants completed questionnaires during their infants' hospital stay.

    Results: Most parents saw and touched their infants immediately after birth, but only a few could hold them skin to skin or swaddle them. Other important events identified by parents included the first time they performed care giving activities and did so independently, interaction and closeness with the infant, signs of the infant's recovery and integration into the family. The timing of the events depended on the physical design of the NICU, whether parents' could stay with their infant round-the-clock and when they were allowed to provide care under supervision and on their own.

    Conclusion: The design and routines of the NICU dictated when parents first interacted with their infants. Clinical guidelines that facilitate early contact with preterm babies can help parents to make the transition to their parental role.

  • 4.
    Blomqvist, Ylva Thernstrom
    et al.
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden .
    Ewald, Uwe
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden .
    Gradin, Maria
    Örebro University Hospital.
    Nyqvist, Kerstin Hedberg
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden .
    Rubertsson, Christine
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden .
    Initiation and extent of skin-to-skin care at two Swedish neonatal intensive care units2013In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 102, no 1, p. 22-28Article in journal (Refereed)
    Abstract [en]

    Aim To describe initiation and extent of parents application of skin-to-skin care (SSC) with their preterm infants at two Swedish neonatal intensive care units.

    Methods The duration of SSC was recorded in 104 infants medical charts during their hospital stay, and the parents answered a questionnaire.

    Results Both parents were involved in the practice of SSC. Three infants experienced SSC directly after birth, 34 within 1 h, 85 within 24 h and the remaining 19 at 2478 h postbirth. SSC commenced earlier (median age of 50 min) in infants whose first SSC was with their father instead of with their mother (median age of 649 min: p < 0.001). The earlier the SSC was initiated, the longer the infant was cared for skin-to-skin per day during his/her hospital stay (p < 0.001). The median daily duration of SSC was 403 min.

    Conclusion Early initiation of SSC had positive impact on the extent of parents application of SSC. Even though the infants in this study were cared for skin-to-skin to a high extent, there is a potential for extended use of SSC in this type of hospital setting for reducing separation between infants and parents.

  • 5.
    Blomqvist, Ylva Thernström
    et al.
    University Hospital, Neonatal Intensive Care Unit, Uppsala, Sweden; Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Gradin, Maria
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Pediatrics.
    Olsson, Emma
    Örebro University, School of Health Sciences. Department of Pediatrics.
    Pain Assessment and Management in Swedish Neonatal Intensive Care Units2019In: Pain Management Nursing, ISSN 1524-9042, E-ISSN 1532-8635, article id S1524-9042(19)30250-4Article in journal (Refereed)
    Abstract [en]

    AIMS: To investigate registered nurses' (RNs') and physicians' knowledge, attitudes, and experiences regarding assessing and managing pain in infants at seven level III neonatal intensive care units (NICUs) in Sweden.

    DESIGN: Descriptive and explorative study using an online questionnaire.

    METHODS: A researcher-developed online questionnaire with 34 items about knowledge, attitudes, and experiences regarding pain assessment and management was emailed to 306 RNs and 79 physicians working at seven neonatal intensive care units (NICUs) in Sweden.

    RESULTS: Most NICUs had pain assessment guidelines, but there was a discrepancy regarding interprofessional discussions of pain assessments. A total of seven different pain assessment instruments were reported from the included NICUs and RNs were reportedly those who usually performed the pain assessments. Most respondents expressed a positive attitude toward pain assessment but recognized a lack of intervention after the assessment. Forty-six percent (n = 11) of the physicians said they had sufficient knowledge of assessing pain using pain assessment instruments, versus 75% (n = 110) of the RNs. Difficulties assessing pain in certain populations of infants, such as the most premature infants and infants receiving sedative medicines, were recognized.

    CONCLUSIONS: RNs in this study reported that their pain assessments did not lead to appropriate pain management interventions. They were thus discouraged from further pain assessments or advocating for ethical pain management. An interprofessional team effort is needed to effectively assess and manage pain in neonates.

  • 6.
    Eriksson, Mats
    et al.
    Örebro University, School of Health and Medical Sciences.
    Gradin, Maria
    Örebro University, School of Health and Medical Sciences.
    Pain management in Swedish neonatal units: a national survey2008In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 97, no 7, p. 870-874Article in journal (Refereed)
    Abstract [en]

    AIM: The aim of this study was to investigate the degree to which Swedish neonatal units have adopted the national guidelines for prevention and treatment of pain in newborn infants. METHOD: A survey was sent to all units in Sweden that provide neonatal care. For a list of potentially painful procedures, compiled from the national neonatal pain guidelines, the units were asked if they would use pharmacological and/or behavioural interventions, and in each case to specify the treatment. RESULTS: The response rate was 80.4%. Eighty-eight percent of the units had written guidelines for pain management, and 59% of these had been updated within the last 2 years. For almost every presented case, all units reported that they used either pharmacological or behavioural treatment or both. The survey showed a wide variation in morphine and paracetamol dosing and the absence of a paracetamol loading dose in a fourth of the units. CONCLUSIONS: This study suggests that a majority of Swedish neonatal units have adopted pain management guidelines in concordance with the Swedish national guidelines, and kept them up-to-date. For most painful situations a variety of behavioural and pharmacological interventions are used, often in combination.

  • 7.
    Eriksson, Mats
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Gradin, Maria
    Söta lösningar och specifikt neonatalt omhändertagande2014In: Information från Läkemedelsverket, ISSN 1101-7104, Vol. 25, no 3, p. 45-47Article, review/survey (Other academic)
    Abstract [sv]

    Barn utsätts för ett antal smärtsamma procedurer i ny- föddhetsperioden, som obehandlade kan medföra nega- tiva konsekvenser på kort och lång sikt. Ofta är så kallad beteendestödjande behandling, oral tillförsel av söt lös- ning samt en optimering av vårdmiljön tillräcklig, men det ska vid behov kompletteras med farmakologisk be- handling.

    De beteendestödjande åtgärder som har visat effekt vid procedursmärta är icke-nutritivt sugande, hud-mot- hudvård, stödjande sammanhållning samt amning/ matning. Med en optimerad vårdmiljö menas dels en dämpning av stressande sinnesintryck och dels att barnet ska vara mätt, torrt och varmt.

    En liten mängd söt lösning, i Sverige oftast 30 % glukos, som ges i munnen före det smärtsamma ingrepp- et, dämpar smärtreaktionen vid flertalet procedurer.

    Enheter som vårdar och behandlar nyfödda barn bör arbeta efter lokala smärtbehandlingsriktlinjer som base- ras på de svenska eller internationella riktlinjerna 

  • 8.
    Eriksson, Mats
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Gradin, Maria
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Expertgrupp, _
    Behandling av barn i samband med smärtsamma procedurer i hälso- och sjukvård: kunskapsdokument2014Report (Other academic)
  • 9.
    Gradin, Maria
    et al.
    Örebro University Hospital, Örebro, Sweden.
    Eriksson, Mats
    Örebro University Hospital, Örebro, Sweden.
    Neonatal pain assessment in Sweden: a fifteen-year follow up2011In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 100, no 2, p. 204-208Article in journal (Refereed)
    Abstract [en]

    Background: It has been proposed that a systematic pain assessment increases the awareness of the need to treat and prevent pain, and most international and national neonatal pain guidelines state that pain assessment should be performed in a systematic way. National surveys show a wide variation in compliance to these guidelines.

    Methods: A survey to all Swedish neonatal units was performed in 1993, 1998, 2003 and 2008, concerning the use of, and need for, pain assessment tools.

    Results: The number of units that tried to assess pain increased from 64% in 1993 to 83% in 2008. Forty-four per cent of these used a structured method in 2003, compared to three per cent in 1998. The most common pain indicator was facial actions.

    Conclusion: The proportion of neonatal units that reported the use of a structured pain assessment tool has increased significantly from 1993 to 2008. There is a need for better evidence for the relation between the implementation of pain guidelines and the actual performance of pain assessment.

  • 10.
    Gradin, Maria
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Munsters, Josanne
    Dovland, Andersen, Randi
    Vederhaus, Bente
    Pain assessment practices in Swedish and Norwegian Neonatal care units2017Conference paper (Refereed)
  • 11.
    Olsson, Emma
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Baños, Josep-Eladi
    Universitat Pompeu Fabra, Barcelona, Spanien.
    Guardiola, Elena
    Universitat Pompeu Fabra, Barcelona, Spanien.
    Gradin, Maria
    Eriksson, Mats
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Skin-to-skin contact for pain relief: a bibliometric analysis2013Conference paper (Refereed)
    Abstract [en]

    Introduction & Aims

    Skin-to-skin contact originated as a life-saving alternative to conventional neonatal care in low-resource settings. Later research has focused on its advantages for e.g. breastfeeding, mother-infant attachment and also for pain-relief. This study is a part of a larger bibliometric project, analyzing neonatal pain research from 2000 to 2012, as a follow up of a previous investigation (1).

    Methods

    PubMed, PsychInfo, Cochrane, and EBSCO databases were searched using terms relating to pain, neonatal care, infancy, skin-to-skin contact and kangaroo mother care. In addition literature was searched from personal knowledge, reference lists in retrieved articles and from the International Network of Kangaroo Care Bibliography (2). The articles in the final inclusion were analyzed according to publication data and type of  research and also type of pain.

    Results

    A final number of 87 articles were included in the analysis. Publication rate increased from an average of 2.5 articles per year the first 5-year period; 2000-2004, to 8.2 2005-2009 and 12.0 2010-2012. Eighty-eight per-cents were published in English language and the main publishing countries were USA with 34 % and Canada with 24 % of the articles. Randomized controlled trials constituted 33 % of the included articles, followed by 14 % other original research. Twenty per-cents were systematic reviews and 34 % guidelines, position papers or commentaries. The most common topic for the studies were procedural pain (61 %) followed by general pain issues (32 %). Of the first authors,  62 % were nurses and 28 % physicians.

    Discussion & Conclusions

    Research about skin-to-skin contact as pain relieving measure shows an increasing trend over the last decade, both randomized trials and other original research, which is also seen in the increasing number of reviews and guidelines built on the results of this scientific work. The large proportion of nurses performing skin-to-skin contact research shows that skin-to-skin contact is a multi-professional team-based intervention. A next step would be to study compliance with the guidelines and the implementation process of skin-to-skin contact for pain-relief.

    References

    1. Baños, J. E., Ruiz, G., & Guardiola, E. (2001). An analysis of articles on neonatal pain published from 1965 to 1999. Pain Res Manag, 6(1), 45-50.

    2. Ludington-Hoe, S. Kangaroo Care Bibliography. Available at http://www.kangaroocareusa.org/uploads/KCBIB2012_May.pdf

    The authors have no conflict of interest to declare.

  • 12.
    Oras, Paola
    et al.
    Uppsala University, Uppsala, Sweden.
    Thernström Blomqvist, Ylva
    Uppsala University, Uppsala, Sweden.
    Hedberg Nyqvist, Kerstin
    Uppsala University, Uppsala, Sweden.
    Gradin, Maria
    Örebro University, School of Medical Sciences. Dept Paediat.
    Rubertsson, Christine
    Uppsala University, Uppsala, Sweden.
    Hellström-Westas, Lena
    Uppsala University, Uppsala, Sweden.
    Funkquist, Eva-Lotta
    Uppsala University, Uppsala, Sweden.
    Breastfeeding Patterns in Preterm Infants Born at 28-33 Gestational Weeks2015In: Journal of Human Lactation, ISSN 0890-3344, E-ISSN 1552-5732, Vol. 31, no 3, p. 377-385Article in journal (Refereed)
    Abstract [en]

    Background: Studies of breastfeeding patterns during preterm infants' first year of life are scarce but are important for providing breastfeeding mothers of preterm infants with optimal support.

    Objective: This study aimed to describe breastfeeding patterns in preterm infants up to 1 year of corrected age.

    Methods: As part of a larger study on kangaroo mother care in Sweden, a 24-hour breastfeeding diary was sent home after discharge from hospital, and at 2, 6, and 12 months of the infant's corrected age. Eighty-three mothers responded to the follow-up questionnaires, and the number of respondents to the breastfeeding diary was 48 at discharge, 43 at 2 months, 22 at 6 months, and 8 at 12 months. Infants were born at a median (range) gestational age of 32 (28-33) weeks. Breastfeeding patterns were analyzed according to durations, frequencies per 24 hours, and intervals between sessions.

    Results: In exclusively breastfed infants, the median (range) breastfeeding session frequency was 14 (8-26) times per 24 hours including 4 (1-9) times per night after discharge (n = 24) and 10 (6-25) times per 24 hours including 2 (0-5) times per night at 2 months (n = 23). In partially breastfed infants, the median (range) frequency was 5 (1-14) times per 24 hours including 2 (0-4) times per night at 6 months (n = 20) and 5.5 (1-12) times per 24 hours including 2 (0-3) times per night at 12 months (n = 8).

    Conclusion: Mothers reported large variations in breastfeeding patterns, with higher median breastfeeding session frequencies than previously described in term infants in affluent settings.

  • 13.
    Oras, Paola
    et al.
    Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.
    Thernström Blomqvist, Ylva
    Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.
    Hedberg Nyqvist, Kerstin
    Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.
    Gradin, Maria
    Department of Paediatrics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Rubertsson, Christine
    Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.
    Hellström-Westas, Lena
    Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.
    Funkquist, Eva-Lotta
    Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.
    Skin-to-skin contact is associated with earlier breastfeeding attainment in preterm infants2016In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 105, no 7, p. 783-789Article in journal (Refereed)
    Abstract [en]

    Aim: This study investigated the effects of skin-to-skin contact on breastfeeding attainment, duration and infant growth in preterm infants, as this has not been sufficiently explored.

    Methods: A prospective longitudinal study on Kangaroo mother care was carried out, comprising 104 infants with a gestational age of 28+0 to 33+6 and followed up to one year of corrected age. Parents and staff recorded the duration of skin-to skin contact during the stay in the neonatal intensive care unit (NICU). Medical data were collected through patient records and follow-up questionnaires were filled in by parents.

    Results: The 53 infants who attained full breastfeeding in the NICU did so at a median (range) of 35+0 (32+1 to 37+5) weeks of postmenstrual age and skin-to-skin contact was the only factor that influenced earlier attainment in the regression analysis (R(2) 0.215 p<0.001). The daily duration of skin-to-skin contact during the stay in the NICU did not affect the duration of breastfeeding or infant growth after discharge. Furthermore, infant growth was not affected by the feeding strategy of exclusive, partial breastfeeding or no breastfeeding.

    Conclusion: A longer daily duration of skin-to-skin contact in the NICU was associated with earlier attainment of exclusive breastfeeding.

  • 14.
    Scherman, Elna
    et al.
    Dept. of Nursing, Umeå University, Umeå, Sweden.
    Johansson, Linda
    Dept. of Nursing, Umeå University, Umeå, Sweden.
    Gradin, Maria
    Örebro University Hospital. Dept. of Paediatrics, Örebro University Hospital, Örebro, Sweden.
    van den Berg, Johannes
    Dept. of Clinical Science, Paediatrics, Umeå University, Umeå, Sweden.
    Eriksson, Mats
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Dept. of Paediatrics, Örebro University Hospital, Örebro, Sweden; Centre for Health Care Sciences, Örebro University Hospital, Örebro, Sweden.
    Procedural pain in neonates: Do nurses follow national guidelines? A survey to Swedish neonatal units2014In: Journal of Neonatal Nursing, ISSN 1355-1841, E-ISSN 1878-089X, Vol. 10, no 1, p. 31-36Article in journal (Refereed)
    Abstract [en]

    Purpose: to investigate if nurses at neonatal units in Sweden have adopted national guidelines when neonates are exposed to intravenous catheter, capillary heel prick, venepuncture and injections, to identify the frequency of documentation of pharmacological and behavioural treatments and to compare the answers from the nurses with results from an earlier national survey completed by the chief neonatologists at the same units.

    Design and sample: Four nurses at a total of 44 neonatal units in Sweden, received questionnaires. A total number of 116 surveys were analysed (response rate 66 %).

    Main outcome and results: All units had written guidelines for prevention and treatment of pain. Behavioural treatments were used in every painful procedure in the study, but only1/5 used EMLA® often or always. There was a higher tendency to document the use of drugs than behavioural treatments. The chief neonatologist reported higher use of glucose than did nurses.

    Conclusions: Swedish national guidelines are not used consistently in some neonatal units. There is a considerably larger cohort of nurses who use behavioral treatments, rather than  using drugs when painful procedures are performed. It was also evident that it was more common to document the use of drugs than behavioral treatments. 

  • 15.
    Strand, H.
    et al.
    Sch Hlth Nurse, Katedralskolan, Uppsala, Sweden.
    Blomqvist, Y. T.
    Neonatal Intens Care Unit, Univ Hosp, Uppsala, Sweden.
    Gradin, Maria
    Örebro University Hospital. Neonatal Intens Care Unit, Örebro University Hospital, Örebro, Sweden.
    Nyqvist, K. H.
    Dept Womens & Childrens Hlth, Uppsala Univ, Uppsala, Sweden.
    Kangaroo mother care in the neonatal intensive care unit: staff attitudes and beliefs and opportunities for parents2014In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 103, no 4, p. 373-378Article in journal (Refereed)
    Abstract [en]

    Aim: To compare attitudes towards Kangaroo mother care (KMC) among staff in two high-tech neonatal intensive care units, which provided parents with different opportunities to get involved in their infants' care.

    Method: Questionnaires were completed by healthcare staff in Unit A, which provided parents with unrestricted access so that they could provide continuous KMC, and Unit B, where parents could only practice KMC intermittently.

    Results: Unit A staff were more positive about the benefits and use of KMC, including its use in unstable infants, and rated their knowledge and practical skills more highly than staff in the other unit. Unit B staff also appreciated the method, but expressed more hesitation in using it with unstable infants. In particular, they stressed the need to adapt the physical environment of the NICU to enable parents to stay with their infants and practice the method.

    Conclusion: Staff working in the NICU that gave parents unrestricted access were more positive about KMC than staff in the NICU that offered limited opportunities for parents to stay with their children. This finding suggests that it is important to eliminate unjustifiable obstacles to the presence of parents in the NICU, so that they can provide KMC.

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