Nurses’ Perceived Barriers and Strategies to Promote Parental Involvement in Newborn Pain Management

PURPOSE: To explore neonatal intensive care unit (NICU) nurses' perspectives on strategies and barriers to parental involvement in newborns' pain management (PM). BACKGROUND: Newborns undergo several painful procedures in the NICU that affect their neurodevelopment. When properly prepared and guided, parents can play an active role in their newborn's PM. Nurses play a crucial role in facilitating parental involvement. DESIGN: An exploratory, qualitative, and descriptive design was used. METHODS: Online focus group interviews were conducted with 24 nurses from three Portuguese NICUs. Inductive content analysis was performed, and reporting followed the Consolidated Criteria for Reporting Qualitative Research. RESULTS: Nurses described strategies to involve parents in PM, including parental education and training, progressive parental involvement, nonpharmacological methods, and communication. Facilitators for parental involvement in newborn PM included nurses' clinical expertise, the quality of the nurse-parent relationship, multidisciplinary teamwork, and an environment that provides physical comfort. Excessive workload, inadequate nurse-to-baby ratios, and limited physical space were identified as barriers. Parental reactions, such as emotional shock, stress, and avoidant attitudes, also posed challenges. CONCLUSIONS: Although parental involvement and nonpharmacological approaches support family-centered PM, ongoing organizational barriers and parental emotional distress limit their consistent application. CLINICAL IMPLICATIONS: Supporting parental involvement in neonatal PM requires systemic and relational strategies. Recommendations include acknowledging parents' willingness to engage, reviewing nurses' workload, and developing organizational policies that encourage collaboration and create an environment conducive to parental presence.