Variations in neonatal pain management following web-based continuing education: An explanatory sequential mixed-methods study across 15 neonatal intensive care units
- 1Corresponding author at: Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima city, Hiroshima, 734-8553, Japan.
- 2Department of Fundamental Nursing, Division of Advanced Nursing Practice, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
Abstract
Background: Despite growing evidence supporting neonatal pain management, its implementation in neonatal intensive care units remains inconsistent. Though web-based continuing education can improve nurses’ knowledge of neonatal pain management, the organisational and collaborative processes through which acquired knowledge is translated into routine clinical practice remain poorly understood. Objective: To identify organizational and interprofessional factors associated with the successful implementation of neonatal pain management following a web-based continuing education programme in Japanese neonatal intensive care units and explain variations in implementation outcomes across facilities. Design: Explanatory sequential mixed-methods study . Setting(s): Fifteen neonatal intensive care units incorporated a web-based continuing education program on neonatal pain assessment and non-pharmacological pain management into their annual nursing education plans. Participants: Quantitative data were collected from all units. Qualitative data were obtained through semi-structured interviews with 25 participating nurses. Methods: In the quantitative phase, longitudinal facility-level data were analysed to evaluate changes in neonatal pain assessment and non-pharmacological pain management practices before and after the programme implementation. The facilities were subsequently classified according to implementation outcomes. In the qualitative phase, semi-structured interviews were conducted with participants to explore their experiences of neonatal pain management and interprofessional collaboration following the programme implementation. Quantitative and qualitative findings were integrated to explain variations in implementation outcomes across facilities. Results: Implementation outcomes varied substantially across the participating units. Integrated analysis demonstrated that facilities with higher implementation levels at 12 months were characterised by proactive physician-nurse communication before procedures, collaborative pain management during procedures, shared recognition of the importance of neonatal pain management, nurse-led practice, sharing pain assessment and records, and family participation in pain relief interventions. These factors were associated with the translation of educational knowledge into routine clinical practice. Conclusions: Educational interventions alone were insufficient to improve neonatal pain management. Successful implementation may be associated with collaborative organizational processes through which acquired knowledge is translated into routine practice. Physician-nurse communication before invasive procedures may be associated with the translation of educational knowledge into practice. Registration: Not registered. Social media abstract: Same e-learning, different results. Better implementation of neonatal pain management was linked to interprofessional communication.
Related
- Perceived factors influencing healthcare professionals’ adherence to the ABCDE approach: an exploratory explanatory sequential mixed-methods study
- Knowledge, perceptions, and associated factors of marburg virus disease in selected towns and districts of the South Ethiopia Region: an explanatory sequential mixed-methods study
- Understanding Black Women’s Lived Experiences of Medical Mistrust and Trust in the Reproductive Care Setting: a nested sequential explanatory mixed methods study
- Community Health Nurses’ Perceptions of Emerging Artificial Intelligence and its Impact on Nursing Practice: An Explanatory Sequential Mixed Methods Study
- Compassion fatigue impacted by traumatic birth and psychological resilience among midwives in mainland China: an explanatory sequential mixed-methods.
BibTeX
@article{kojima2026variations,
title = {{Variations in neonatal pain management following web-based continuing education: An explanatory sequential mixed-methods study across 15 neonatal intensive care units}},
author = {Mio Kojima and Sayo Fukushima},
journal = {International Journal of Nursing Studies Advances},
year = {2026},
month = nov,
doi = {10.1016/j.ijnsa.2026.100719},
url = {https://doi.org/10.1016/j.ijnsa.2026.100719},
note = {CC BY},
}
RIS
TY - JOUR
TI - Variations in neonatal pain management following web-based continuing education: An explanatory sequential mixed-methods study across 15 neonatal intensive care units
AU - Mio Kojima
AU - Sayo Fukushima
PY - 2026
DA - 2026/11/02
JO - International Journal of Nursing Studies Advances
DO - 10.1016/j.ijnsa.2026.100719
UR - https://doi.org/10.1016/j.ijnsa.2026.100719
AB - Background: Despite growing evidence supporting neonatal pain management, its implementation in neonatal intensive care units remains inconsistent. Though web-based continuing education can improve nurses’ knowledge of neonatal pain management, the organisational and collaborative processes through which acquired knowledge is translated into routine clinical practice remain poorly understood. Objective: To identify organizational and interprofessional factors associated with the successful implementation of neonatal pain management following a web-based continuing education programme in Japanese neonatal intensive care units and explain variations in implementation outcomes across facilities. Design: Explanatory sequential mixed-methods study . Setting(s): Fifteen neonatal intensive care units incorporated a web-based continuing education program on neonatal pain assessment and non-pharmacological pain management into their annual nursing education plans. Participants: Quantitative data were collected from all units. Qualitative data were obtained through semi-structured interviews with 25 participating nurses. Methods: In the quantitative phase, longitudinal facility-level data were analysed to evaluate changes in neonatal pain assessment and non-pharmacological pain management practices before and after the programme implementation. The facilities were subsequently classified according to implementation outcomes. In the qualitative phase, semi-structured interviews were conducted with participants to explore their experiences of neonatal pain management and interprofessional collaboration following the programme implementation. Quantitative and qualitative findings were integrated to explain variations in implementation outcomes across facilities. Results: Implementation outcomes varied substantially across the participating units. Integrated analysis demonstrated that facilities with higher implementation levels at 12 months were characterised by proactive physician-nurse communication before procedures, collaborative pain management during procedures, shared recognition of the importance of neonatal pain management, nurse-led practice, sharing pain assessment and records, and family participation in pain relief interventions. These factors were associated with the translation of educational knowledge into routine clinical practice. Conclusions: Educational interventions alone were insufficient to improve neonatal pain management. Successful implementation may be associated with collaborative organizational processes through which acquired knowledge is translated into routine practice. Physician-nurse communication before invasive procedures may be associated with the translation of educational knowledge into practice. Registration: Not registered. Social media abstract: Same e-learning, different results. Better implementation of neonatal pain management was linked to interprofessional communication.
SN - 2666-142X
ER -