Bonnie Stevens’ program of research focuses on generating new knowledge on pain assessment and management for hospitalized infants and developing knowledge translation (KT) strategies to improve pain outcomes in health care settings that care for infants and children.
CIHR Team in Children's Pain
The CIHR Team in Children’s Pain was a multidisciplinary research team from nursing, medicine, psychology, and pharmacy with clinical and research expertise in pediatric pain, research utilization, evidence-based practice, quality assurance, and multiple research methods. The team conducted a novel, integrative, theoretically-based program. They carried out three studies:
- Study 1 – Creation of the Pediatric Pain Research Network – Establishing Baseline Pediatric Pain Practices
- Study 2 – Determining the Impact of Context on Pediatric Pain Process and Clinical Outcomes
- Study 3 – Determining the effectiveness of the Evidence-Based Practice for Improving Quality (EPIQ) intervention in improving pediatric pain process and clinical outcomes
Toolkit for Minimizing Pain (Ghana)
This toolkit includes two flip charts:
Healthcare Professional Flip Charts these flip charts help guide the process of pain practice change in neonatal intensive care units with evidence on age appropriate pain management and assessment practices and knowledge translation tools.
Parent Flip Charts these flip charts provide guidance on how parents can be involved in managing their infant’s pain.
Pain in Infants at Risk for Neurological Impairment (PINI)
PINI Phases 1 and 2 were the beginnings of a comprehensive research program on Pain in Infants at Risk for Neurological Impairment, with the goals of determining (1) the prevalence, frequency and nature of painful procedures in this population; (2) the most valid and reliable indicators for pain assessment; and (3) the most effective interventions for painful procedures in neonates at high, moderate and low risk for neurological impairment.
Phase 1 of the study identified pain responses in neonates at high, moderate and low risk for neurological impairment (NI) and the most reliable and valid indicators for pain assessment. Results revealed that neonates at the highest risk for NI had more procedures and fewer interventions to manage pain in the first days of life. In addition, neonates at the highest risk for NI had responses to painful procedures that were the most diminished and difficult to interpret compared to more mature neonates. Phase 2 established the feasibility of selected interventions in more mature preterm neonates.
PINI Phase 3: Analysis in progress
Phase 3 of the PINI study includes four studies focused on pain in Extremely Low Gestational Age (ELGA) neonates.
- Study 1 and 2
The objective of studies 1 and 2 in Phase 3 of the PINI study were to explore the perceptions of health professionals and parents on pain in Extremely Low Gestational Age (ELGA) neonates. These perceptions influence the ways in which their pain is managed. Health-care professional’s perceptions of pain influence their pain assessment and pain management strategies. Parent perceptions towards their child’s pain provide a more in depth understanding of neonatal cues of pain. Analysis for these studies is ongoing.
- Study 3
The objective of study 3 were to determine the pain responses of ELGA neonates, factors that affect these responses and how they change over time. Through a combination of physiological indicators, facial and body indicators and crying, we set out to determine how infant contextual variables influence pain responses in ELGA infants over time. By understanding how ELGA infants respond to pain, we can work towards better pain management strategies thereby improving their quality of life. Data analysis for this study is currently underway.
- Study 4
The objective of study 4 was to determine the feasibility of non-pharmacological pain interventions in ELGA neonates. Pacifier, sucrose and facilitated tucking were used to manage procedural pain in ELGA neonates. Babies were be observed to see how well they tolerate each type of intervention and how they influence pain indicators. This research will establish if non-pharmacological pain interventions are feasible for ELGA neonates, and help us learn if combinations of comfort measures are safe and easy to use in order to manage pain in ELGA infants. Data analysis for this study is currently underway.
- B. Stevens, S. Riahi, R. Cardoso, M. Ballantyne, J. Yamada + PINI Research Team. (2011). The influence of context on pain practices in the NICU: perceptions of health care professionals.. Qualitative Health Research, 21(6), 757-770.
- S. Gibbins, B. Stevens, K. Dionne, J. Yamada, R. Pillai Riddell, P. McGrath, E. Asztalos, B. Kyololo, J. Beyene, P. McNamara, C. Johnston. Perceptions of health professionals on pain in extremely low gestational age infants. Qualitative Health Research. 25(6), 763-774.