Professor Denise Harrison is a registered nurse, midwife, and professor in the Department of Nursing at the University of Melbourne. Harrison has worked both in Australia and Canada and was the inaugural Research Chair in Nursing Care of Children, Youth and Families at the University of Ottawa and Children’s Hospital of Eastern Ontario in Canada. She leads the interdisciplinary Be Sweet to Babies research team which, together with parents and clinicians, aims to improve pain management in neonates, infants, and young children. Harrison is a national keynote speaker and will deliver the Bonica Lecture at the upcoming 43rd Annual Scientific Meeting (ASM) of the Australian Pain Society, which will be held in Canberra from April 2-5, 2023. In the lead-up to the ASM, Harrison spoke with Lincoln Tracy, a researcher and writer from Melbourne, Australia, about her path to becoming a paediatric intensive care nurse, the similarities and differences between Canada and Australia, and her love of running. Below is an edited transcript of their conversation.
Denise, you were a neonatal intensive care nurse when you first jumped into the world of pain research. What first drew you to nursing, and then how did you progress to working in the NICU?
I used to love looking after little babies, even when I was a little kid. When I was six or seven, my parents had friends with a couple of children around my age, but they also had a young baby. I absolutely loved the baby and spent a lot of time looking after her – back then people were obviously more comfortable leaving little kids alone with babies. I remember I would spend a whole hour sticking a dummy in the little pot of sweet glycerine that the mother had provided ‘for emergencies’ putting it the baby’s mouth, back in the pot, back in the mouth, as a way to calm her. It’s kind of ironic that my whole research career would end up revolving around sweet solutions for pain management in babies. I cared for a range of different families, and from 13, I was basically a full-time nanny in the school holidays.
So, when I was at school and I was trying to decide what I wanted to do as a career, I originally considered mothercraft nursing – similar to what you would call an enrolled nurse today. The careers counsellor told me those roles were being phased out, and she was exactly right. I pursued nursing instead and figured that would lead me to working with babies somehow. I loved almost every rotation I did – except for being a recovery nurse, I hated that with every bone in my body – but I still really enjoyed being on the paediatric ward.
Eventually, I saw the Royal Children’s Hospital in Melbourne were advertising for non-experienced neonatal nurses. That was my in. I had no idea what working with really sick babies would be like, but I absolutely loved it there, working in several different roles, including studying paediatric intensive care, midwifery, then completing graduate research studies. Even when I left the neonatal unit for my studies, I always returned back to the neonatal unit.
You’ve worked both in Australia and in Canada – are there a lot of similarities or differences between the two countries?
Australia and Canada – or wherever I went in Westernised countries – were pretty similar from a clinical perspective when you think about the neonatal intensive care unit. I felt like I could walk in, take my jewellery off, roll up my sleeves, and it would be no different. But at the time, I was offered the great opportunity to undertake postdoctoral studies with Professor Bonnie Stevens, a neonatal pain research guru. During my postdoctoral fellowship in Toronto and then my time at the Children’s Hospital of Eastern Ontario, there were excellent grant opportunities for knowledge synthesis or translation, so I was able to expand my program of funded research.
There were also more opportunities to support undergraduate nursing students to do research, which I felt really privileged to be involved in. I got to mentor around 30 undergraduate nurses in research. However, times have changed too. I moved back to Australia just prior to the COVID-19 pandemic, so it’s possible I was there when more opportunities were available; before much research pivoted and changed because of the pandemic.
Otherwise, the biggest difference is that The University of Ottawa is officially a bilingual university, so I had to learn French. I was lucky that I didn’t have to teach in French – my contract was to teach in English – but I did have to be able to understand and read the language. So, that was a big change [laughs].
What are you and the Be Sweet to Babies team working on most intensely now?
We’re currently surveying nurses, midwives, and phlebotomists who work in Australia about how they use pain management during routine painful procedures in both babies in neonatal intensive care all the way through to healthy, full-term babies. We have about 500 responses to date, and the survey will be open for another month. We’re doing this because the last lot of data collection about pain management in newborns in Australia was done well over a decade ago. Getting an up-to-date baseline understanding is important because it’s challenging to propose an intervention to improve pain management if you don’t have a solid understanding of what is already happening. We have previously surveyed parents on their perspectives of how things can improve; this second survey will be an important and complimentary piece of work.
We are interested in learning about whether nurses and midwives are encouraging and supporting mothers to breastfeed, or all parents and carers to hold the baby skin-to-skin during the heel prick test every baby gets in the first day or two after being born. And we’re actively trying to help clinical staff to support parents – we’ve made an ergonomics video with a multidisciplinary team to show nurses and phlebotomists how to best position themselves so they can successfully do the heel prick test while a baby is being breastfed or having skin-to-skin contact.
We want to focus on supporting parents on how to help calm their baby during the rest of their development, such as when they receive all their vaccinations during childhood. Because developing a fear of needles is a real thing, and helping parents implement effective strategies from the really early stages could have significant benefits for years to come.
You were recently part of a study exploring elevated sound levels in the NICU – why is this an important area of research?
Neonatal intensive care units are incredibly busy. There are so many sick babies and alarms – it’s really non-stop. Because of this, a lot of units would try to have a period of quiet time where there were no painful procedures performed or rounds undertaken for an hour or two just to give everybody – the babies, the staff, and the parents – a chance to get some quiet. But over time, one particular unit in Ottawa where I was working stopped having quiet time. And there’s a number of reasons for that, such as it being an older style unit with between four and eight babies in very large rooms. It makes it hard to minimise the noise.
Eventually, Kelli Mayhew, one of the clinical staff who would go on to become my master’s student, became aware of how loud the unit was and realised somehow the quiet time had just disappeared.
So, we bought Kelli a sound meter and after collecting thousands upon thousands of data points, she showed that the sound levels were consistently above the noise levels recommended by the American Academy of Pediatrics – in a lot of cases it was almost double the recommended level. But a lot of the noise was nurses and doctors talking, with more of noise attributed to the nurses because we’re there all the time. Then the question becomes, ‘short of building a whole new hospital, what can we change about the culture to reduce the sound?’ And we can look at strategies such as modifying our own voices or resetting the alarms so they’re loud enough for us to hear, but not so loud that they set everyone off.
What do you think the next ‘hot topic’ in your area of research will be?
In all the work I’ve done over the years, we still haven’t managed to truly partner parents and staff together to care for their baby and put all the known and evidence-based pain management strategies into place. This has been a slow process, as traditionally it has been seen that doctors and nurses look after the babies, while parents are just visitors. For example, I was looking at one study where parents were really supported to be engaged in their baby’s care, but they were still asked to leave the room when the baby needed a blood test. So, there’s this huge gap.
And although pain management is just one aspect of a baby’s care, it brings the broader idea of developmentally supportive care into play – how can we best support that baby throughout their whole hospital stay, but how can we also empower parents? They can often find themselves in a very stressful, anxiety-ridden place. Many paediatric and maternity hospitals are working towards this as the next step: bringing both parties together to look after the baby as one team. And a key part of this is having both parents and nurses on our research teams – working together to determine what research questions we have, how we’re going to measure it, and how we’re going to change practice.
I can see from your social media that you’re quite the avid runner; how did this interest come about?
I was never a runner until a decade ago when I was in Canada. I had recently been through a period of illness. One day I was walking down some stairs and had to stop, because I felt I wouldn’t be able to get back up the stairs. That moment really hit me in terms of how much conditioning and fitness I’d lost because of the illness. A friend of mine suggested I join the Running Room, which is a great business in Canada where they sell all the cool running gear, but they also do run clubs, where you can just show up and run.
Although I’d always been fit before my illness, I’d never been a runner. I was reluctant to join initially, but the idea just stuck in my head. I went along eventually and started with one of the ‘learn to run’ clinics they offered, before progressing to a five-kilometre run, a ten-kilometre run, and then a half-marathon. It was such a supportive group environment and a useful set of clinics – Ottawa is -30° in the winter and 35° plus in the summer – so you really needed to learn to run safely in these extreme temperatures.
Then when I moved back to Melbourne I was looking for something similar, and another friend told me about parkrun. I now run and volunteer at Parkville parkrun, my local. It’s only five kilometres, which is nice, short, and isn’t too hot by the 8am start time in summer. It’s great to volunteer and get to know people, which you don’t necessarily get when you are just running.
Finally, if you could have dinner with anyone in the world, dead or alive, who would it be?
As a nurse with a love of portraying and visualising data in a way that changes peoples minds and informs them, it has to be Florence Nightingale. She was a nurse who empowered teams around her to bring about change, but she was also a statistician who showed data in a clearly understandable way that bought about change. She clearly showed that most soldiers didn’t die from their wounds. Rather, they died from infection and communicable diseases, which resulted in significant changes in terms of sanitation and overcrowding.
People think of her as this romantic vision – the lady with the lamp – but she was so much more than that. She was educated, and rebelled against her family’s wishes by becoming a nurse, which wasn’t seen as a suitable profession for a lady at the time. She had incredible impact on military hospitals initially, but then medicine more broadly beyond that. I’d love to learn more about how she used data to tell stories, which is what we are trying to do now with our research translation efforts. She did this way before we all thought it was a useful thing!
Lincoln Tracy is a postdoctoral research fellow at Monash University and freelance writer from Melbourne, Australia. He is a member of the Australian Pain Society and enthusiastic conference attendee. You can follow him on Twitter (@lincolntracy) or check out some of his other writing on his website.