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Storch-De-Gracia P, Salido D, Molina A, Notario J, Tubal Perez-Perez J. Impact of a Strategy for Improving Early Management of Acute Pain in the Pediatric Emergency Department. Pediatr Emerg Care 2024; 40:521-526. [PMID: 38713834 DOI: 10.1097/pec.0000000000003199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/09/2024]
Abstract
OBJECTIVES The objective of this study was to measure the impact of an intervention on pain treatment in a pediatric emergency department (ED). The application of interventions to improve pain management in DE has demonstrated diverse effects so far, most of them successful. METHODS This is a quasi-experimental before-and-after, longitudinal, prospective study.Patients were collected between January 2020 and December 2021. Principal outcome was the number of patients with moderate or severe pain who received analgesia before 30 minutes to the ED arrival. The intervention consisted of several training sessions for nursing staff, pediatricians, and trauma physicians. RESULTS A total of 515 patients were enrolled, 230 during preintervention period and 285 during postintervention period. The percentage of patients receiving analgesia before 30 minutes increased from 24% to 29% and before 60 minutes increased from 31% to 42%. Time to analgesia administration decreased from 43 to 39 minutes.Only 254 patients (49%) received analgesia at some point during their stay in the ED, 137 (26.6%) before 30 minutes and 193 (37.5%) before 60 minutes. The probability of receiving analgesia was greater in patients seen by a pediatrician rather than an orthopedist (59%-37%). Metamizole was the most commonly used drug (48%), followed by ibuprofen and acetaminophen. CONCLUSIONS The application strategies to enhance early pain treatment in the ED can improve analgesia administration. Training strategies aimed at healthcare personnel working in the ED can change the way they work and achieve clear benefits for the patient. The treatment of pain in the ED should begin as soon as possible, and in this objective, the involvement of the nursing staff is a priority, because they are the professional who has the best opportunity for the detection and treatment of pain from the moment of triage.
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Affiliation(s)
| | | | - Alberto Molina
- From the Emergency Department, Hospital Infantil Universitario Niño Jesús
| | - Javier Notario
- Oncology Department, Hospital Universitario La Fe, Comunidad Valenciana, Spain
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Considine J, Shaban RZ, Fry M, Curtis K. Education interventions and emergency nurses' clinical practice behaviours: A scoping review. Australas Emerg Care 2024; 27:119-135. [PMID: 37980249 DOI: 10.1016/j.auec.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/19/2023] [Accepted: 10/29/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND Many education interventions in emergency nursing are aimed at changing nurse behaviours. This scoping review describes and synthesises the published research education interventions and emergency nurses' clinical practice behaviours. METHODS Arksey and O'Malley's methodological framework guided this review, which is reported according to Preferred Reporting Items for Systematic reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). CINAHL, MEDLINE complete, ERIC, and Psycinfo were searched on 3 August 2023. Two pairs of researchers independently conducted all screening. Synthesis was guided by the Behaviour Change Wheel and Bloom's Taxonomy of Educational Objectives. RESULTS Twenty-five studies were included. Educational interventions had largely positive effects on emergency nurses' clinical practice behaviours. Ten different interventions were identified, the most common was education sessions (n = 24). Seven studies reported underpinning theoretical frameworks. Of the essential elements of behaviour change, seven interventions addressed capability, four addressed motivation and one addressed opportunity. Mapping against Bloom's taxonomy, thirteen studies addressed analysis, eleven studies addressed synthesis and two studies addressed evaluation. CONCLUSION Few studies addressed elements of behaviour change theory or targeted cognitive domains. Future studies should focus on controlled designs, and more rigorous reporting of the education intervention(s) tested, and theoretical underpinning for intervention(s) selected.
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Affiliation(s)
- Julie Considine
- School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia; Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia; Centre for Quality and Patient Safety Research - Eastern Health Partnership, Box Hill, Victoria, Australia.
| | - Ramon Z Shaban
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Camperdown, New South Wales, Australia; Sydney Institute for Infectious Diseases and Biosecurity, Faculty of Medicine and Health, The University of Sydney, Camperdown, New South Wales, Australia; Centre for Population Health and New South Wales Biocontainment Centre, Western Sydney Local Health District, Westmead, New South Wales, Australia
| | - Margaret Fry
- Faculty of Health, University of Technology Sydney, New South Wales, Australia; Northern Sydney Local Health District, St Leonards, New South Wales, Australia
| | - Kate Curtis
- Susan Wakil School of Nursing and Midwifery, The University of Sydney, Camperdown, New South Wales, Australia; Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
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Çetintaş İ, Semerci R, Kostak MA, Akın N. The effect of evidence-based pain assessment protocol in pediatric emergency department on nurses' knowledge, attitudes, and practices towards pain. Int Emerg Nurs 2023; 68:101291. [PMID: 37084527 DOI: 10.1016/j.ienj.2023.101291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 03/07/2023] [Accepted: 03/18/2023] [Indexed: 04/23/2023]
Abstract
PURPOSE This study aimed to determine the effect of the "Evidence-Based Pain Assessment Protocol in Pediatric Emergency Department" on nurses' knowledge, attitudes, and practices towards pain. METHOD A pretest-posttest quasi-experimental study was conducted with 11 nurses. Before the protocol was applied, 337 nurses' records were assessed for one month. Subsequently, the nurses were educated in the Evidence-Based Pain Assessment Protocol in the Pediatric Emergency Department. After the education, the researchers assessed 315 nurses' records for one month to evaluate the protocol's effect on the nurses' clinical practice. RESULTS The study found no significant difference in the mean scores of nurses' Pediatric Pain Knowledge and Attitude Scale between the pre-and post-education periods (p > 0.05). However, there was a significant difference in the types of pain assessment tools used between these two periods (p < 0.001). In the post-education period, the frequency of both pharmacological and non-pharmacological interventions implemented increased significantly compared to the pre-education period (p < 0.001). Additionally, the study found that the frequency of nurses describing pain and reassessing pain increased significantly in the post-education period compared to the pre-education period (p < 0.001). CONCLUSIONS The study found that there was no significant change in the nurses' Pediatric Pain Knowledge and Attitude Scale scores before and after the training. However, it was observed that the frequency of nurses reassessing pain, using non-pharmacological interventions, and describing pain increased after the protocol was applied in the emergency department. In particular, therapeutic communication and the walking method were used more frequently in the post-training period among the non-pharmacological interventions applied by the nurses for pain.
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Affiliation(s)
- İsmail Çetintaş
- Trakya University, Faculty of Health Sciences, Department of Nursing, Turkey.
| | | | | | - Nefise Akın
- Trakya University, Health Research and Application Center, Pediatric Emergency Service, Turkey
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Holbert MD, Kimble RM, Chatfield M, Griffin BR. Effectiveness of a hydrogel dressing as an analgesic adjunct to first aid for the treatment of acute paediatric burn injuries: a prospective randomised controlled trial. BMJ Open 2021; 11:e039981. [PMID: 33402404 PMCID: PMC7786810 DOI: 10.1136/bmjopen-2020-039981] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To compare the effectiveness of two acute burn dressings, Burnaid hydrogel dressing and plasticised polyvinylchloride film, on reducing acute pain scores in paediatric burn patients following appropriate first aid. DESIGN Single-centre, superiority, two-arm, parallel-group, prospective randomised controlled trial. PARTICIPANTS AND SETTING Paediatric patients (aged ≤16) presenting to the Emergency Department at the Queensland Children's Hospital, Brisbane, Australia, with an acute thermal burn were approached for participation in the trial from September 2017-September 2018. INTERVENTIONS Patients were randomised to receive either (1) Burnaid hydrogel dressing (intervention) or (2) plasticised polyvinylchloride film (Control) as an acute burn dressing. PRIMARY AND SECONDARY OUTCOMES Observational pain scores from nursing staff assessed 5 min post application of the randomised dressing, measured using the Face Legs Activity Cry and Consolability Scale was the primary outcome. Repeated measures of pain, stress and re-epithelialisation were also collected at follow-up dressing changes until 95% wound re-epithelialisation occurred. RESULTS Seventy-two children were recruited and randomised (n=37 intervention; n=35 control). No significant between-group differences in nursing (mean difference: -0.1, 95% CI -0.7 to 0.5, p=0.72) or caregiver (MD: 1, 95% CI -8 to 11, p=0.78) observational pain scores were identified. Moreover, no significant differences in child self-report pain (MD: 0.3, 95% CI -1.7 to 2.2, p=0.78), heart rate (MD: -3, 95% CI -11 to 5, p=0.41), temperature (MD: 0.6, 95% CI -0.13 to 0.24, p=0.53), stress (geometric mean ratio: 1.53, 95% CI 0.93 to 2.53, p=0.10), or re-epithelialisation rates (MD: -1, 95% CI -3 to 1, p=0.26) were identified between the two groups. CONCLUSIONS A clear benefit of Burnaid hydrogel dressing as an analgesic adjunct to first aid for the treatment of acute paediatric burns was not identified in this investigation. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry (ACTRN12617001274369).
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Affiliation(s)
- Maleea Denise Holbert
- Centre for Children's Burns and Trauma Research, Centre for Children's Health Research, South Brisbane, Queensland, Australia
- Pegg Leditschke Paediatric Burns Centre, The Queensland Children's Hospital, Herston, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Roy M Kimble
- Centre for Children's Burns and Trauma Research, Centre for Children's Health Research, South Brisbane, Queensland, Australia
- Pegg Leditschke Paediatric Burns Centre, The Queensland Children's Hospital, Herston, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Faculty of Health, School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Mark Chatfield
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Bronwyn R Griffin
- Centre for Children's Burns and Trauma Research, Centre for Children's Health Research, South Brisbane, Queensland, Australia
- Pegg Leditschke Paediatric Burns Centre, The Queensland Children's Hospital, Herston, Queensland, Australia
- Faculty of Health, School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
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The Effect of Educational Strategies Targeted for Nurses on Pain Assessment and Management in Children: An Integrative Review. Pain Manag Nurs 2019; 20:604-613. [DOI: 10.1016/j.pmn.2019.03.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 01/22/2019] [Accepted: 03/31/2019] [Indexed: 12/19/2022]
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Effects of the Introduction of Intranasal Fentanyl on Reduction of Pain Severity Score in Children: An Interrupted Time-Series Analysis. Pediatr Emerg Care 2019; 35:749-754. [PMID: 29200141 DOI: 10.1097/pec.0000000000001376] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Children are at risk of inadequate analgesia due to paramedics' inexperience in assessing children and challenges in administering analgesics when the patient is distressed and uncooperative. This study reports on the outcome of a change to practice guidelines that added intranasal fentanyl and intramuscular morphine within a large statewide ambulance service. METHODS This retrospective study included patients younger than 15 years treated by paramedics between January 2008 and December 2011. The primary outcome of interest was the proportion of patients having a 2/10 or greater reduction in pain severity score using an 11-point Verbal Numeric Rating Scale before and after the intervention. Segmented regression analysis was used to estimate the effect of the intervention over time. A multiple regression model calculated odds ratios with 95% confidence intervals. RESULTS A total of 92,378 children were transported by paramedics during the study period, with 9833 cases included in the analysis. The median age was 11 years; 61.6% were male. Before the intervention, 88.1% (n = 3114) of children receiving analgesia had a reduction of pain severity of 2 or more points, with 94.2% (n = 5933) achieving this benchmark after intervention (P < 0.0001). The odds of a reduction in pain of 2 or more points increased by 1.01 per month immediately before the intervention and 2.33 after intervention (<0.0001). CONCLUSIONS This large study of a system-wide clinical practice guideline change has demonstrated a significant improvement in the outcome of interest. However, a proportion of children with moderate to severe pain did not receive analgesia.
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Williams S, Keogh S, Douglas C. Improving paediatric pain management in the emergency department: An integrative literature review. Int J Nurs Stud 2019; 94:9-20. [PMID: 30928719 DOI: 10.1016/j.ijnurstu.2019.02.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 02/26/2019] [Accepted: 02/26/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Children presenting to the emergency department continue to experience suboptimal pain management. While evidence-based pain management interventions are available to clinicians, effective and sustainable practice change is yet to be achieved. This practice gap requires a collaborative approach to knowledge translation targeting systems of care. OBJECTIVES The purpose of this review was to explore systems level change in the emergency department for improved paediatric pain management. DESIGN Integrative review. DATA SOURCES CINAHL, Embase, PubMed/Medline, Dynamed, Cochrane, Scopus, Prospero and Joanna Briggs Institute were systematically searched, and clinical guidelines and reference lists scanned. REVIEW METHODS Studies were screened and selected according to the inclusion criteria, and independently appraised for risk of bias. Integrative review methodology informed data extraction and synthesis, focused on organisational context and engagement, facilitation and implementation of practice change, key components of the pain management interventions, and evaluation. RESULTS Twenty studies met the inclusion criteria: 18 uncontrolled pretest-posttest and two pseudo-randomised design. Study populations ranged from children with a specific presentation, to all presenting children. All studies adopted a multifaceted approach to organisational change, bundling various interventions including pain assessment tools and management protocols, clinician education, nurse-initiated analgesia, feedback and family engagement. Four studies used local systems analysis to inform interventions and two studies applied an implementation framework. Time to analgesia was the most commonly improved primary outcome. Parent and child sensitive outcomes were assessed in five studies. Interventions that hold the most promise for optimised pain management if embedded in the workplace include nurse-initiated analgesia and family involvement at each stage of pain management in the emergency department. CONCLUSION The way forward is to respectfully engage all stakeholders-children, parents and clinicians-to collaboratively develop evidence-based, sustainable solutions aligned with the emergency department context. Guided by an implementation framework, future research designed to creatively translate evidence into practice and facilitate change at a systems level is a priority. Key to this solution is the integration of family involvement in pain management, considering child and family sensitive outcome measures. Effectiveness of new interventions should be evaluated in the short and long term to embed sustainable practice change. Frontline nurses are well placed to lead this transformation in paediatric pain management in the emergency department.
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Affiliation(s)
- Suzanne Williams
- Queensland University of Technology (QUT), School of Nursing, Kelvin Grove, QLD, Australia; Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology, Kelvin Grove, QLD, Australia; Children's Health Queensland Hospital and Health Service, Queensland Health, QLD, Australia.
| | - Samantha Keogh
- Queensland University of Technology (QUT), School of Nursing, Kelvin Grove, QLD, Australia; Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology, Kelvin Grove, QLD, Australia; Alliance for Vascular Access Teaching and Research Group (AVATAR), Menzies Health Institute Queensland, Griffith University, QLD, Australia
| | - Clint Douglas
- Queensland University of Technology (QUT), School of Nursing, Kelvin Grove, QLD, Australia; Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology, Kelvin Grove, QLD, Australia; Conjoint Associate Professor, Metro North Hospital and Health Service, Brisbane, QLD, Australia
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Treadgold R, Boon D, Squires P, Courtman S, Endacott R. Implementation of paediatric pain care-bundle across South-West England clinical network of Emergency Departments and Minor Injury Units: A before and after study. Int Emerg Nurs 2018; 43:56-60. [PMID: 30381143 DOI: 10.1016/j.ienj.2018.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 08/15/2018] [Accepted: 10/07/2018] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Pain management in children is often poorly executed in Emergency Departments and Minor Injury Units. The aim of this study was to assess the impact of a care bundle comprising targeted education on pain score documentation and provision of appropriately dosed analgesia for the paediatric population attending Emergency Departments (EDs) and Minor Injury Units (MIUs). METHODS A total of 29 centres - 5 EDs and 24 MIUs - participated in an intervention study initiated by Emergency Nurse Practitioners to improve paediatric pain management. In Phase 1, up to 50 consecutive records of children under 18 presenting at each MIU and ED were examined (n = 1201 records); Pain Score (PS), age, whether the child was weighed, and provision of analgesia was recorded. A care bundle consisting of an education programme, paediatric dosage chart and flyers, was then introduced across the 29 centres. Nine months following introduction of the care bundle, the same data set was collected from units (Phase 2, n = 1090 records). RESULTS The likelihood of children having a pain score documented increased significantly in Phase 2 (OR 6.90, 95% CI 5.72-8.32), The likelihood of children receiving analgesia also increased (OR1.82, 95% CI 1.51-2.19), although there was no increase in the proportion of children with moderate or severe pain receiving analgesia. More children were weighed following the care bundle (OR 2.58 95% CI 1.86-3.57). Infants and children who were not weighed were more likely to receive an incorrect analgesia dose (p < 0.01). CONCLUSIONS Rates of PS documentation improved and there was greater provision of analgesia overall following introduction of the care bundle. Although weighing of children did improve, the levels remain disappointingly low. EDs generally performed better than MIUs. The results show there were some improvements with this care bundle, but future work is needed to determine why pain management continues to fall below expected standards and how to further improve and sustain the impact of the care bundle.
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Affiliation(s)
- Ruth Treadgold
- Anaesthetic Department, Plymouth Hospitals NHS Trust, Plymouth PL6 8DH, UK.
| | - Daranee Boon
- Emergency Department, Derriford Hospital, Plymouth PL6 8DH, UK.
| | - Phillipa Squires
- Anaesthetic Department, Torbay and South Devon NHS Foundation Trust, Torquay TQ2 7AA, UK.
| | - Simon Courtman
- Anaesthetic Department, Derriford Hospital, Plymouth PL6 8DH, UK.
| | - Ruth Endacott
- Plymouth University/Royal Devon and Exeter Hospital Clinical School, Faculty of Health and Human Sciences, Plymouth University, Plymouth PL4 8AA, UK; School of Nursing and Midwifery, Monash University, Melbourne, VIC 3199, Australia.
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Pope N, Tallon M, Leslie G, Wilson S. Ask me: Children's experiences of pain explored using the draw, write, and tell method. J SPEC PEDIATR NURS 2018; 23:e12218. [PMID: 29790268 DOI: 10.1111/jspn.12218] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 04/03/2018] [Accepted: 04/25/2018] [Indexed: 12/15/2022]
Abstract
PURPOSE Pain management within emergency departments (ED) remains challenging. Given that unrelieved pain in children is linked to a number of negative physiological and psychological consequences, optimal management of children's pain is paramount. Many studies exploring children's pain have adopted quantitative methods or sought the perspectives of adults. Compared to adults, studies examining children's views on pain and pain management are limited. This study aimed to explore children's pain experiences, their perception of pain management and expectations of the role of the nurse. DESIGN This was a qualitative descriptive study using an inductive approach. METHODS Fifteen children, aged 4-8 years who presented to the ED of an Australian tertiary pediatric hospital in acute pain participated. Data were collected using draw, write, and tell (DWT) technique and analyzed using thematic analysis. RESULTS Three themes emerged (1) "Security," (2) "My pain" with subthemes: "The pain feelings" and "My sad/happy feelings," (3) "Comfort and relief" with subthemes: "Taking my mind off it," "Resting" and "Hospital things." When in pain children needed to feel secure. Parents and nurses were important in fostering a secure environment for children. Children were capable of describing their pain and identified nonpharmacological strategies to help their pain. PRACTICE IMPLICATIONS Children as young as 4 years old can provide detailed accounts of their pain, which extends beyond physical dimensions to include visual, auditory, and sensory features. Nurses need to listen, be honest, and develop trust with children to be helpful. Nonpharmacological pain-relieving strategies can be implemented by parents and nurses in collaboration with the child. Fostering a secure environment is essential.
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Affiliation(s)
- Nicole Pope
- Child and Adolescent Health Service, Princess Margaret Hospital for Children, Perth, Australia.,West Australian Centre of Evidence Informed Healthcare Practice: a Joanna Briggs Institute Centre of Excellence, Curtin University, Perth, Australia.,School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Australia
| | - Mary Tallon
- West Australian Centre of Evidence Informed Healthcare Practice: a Joanna Briggs Institute Centre of Excellence, Curtin University, Perth, Australia.,School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Australia
| | - Gavin Leslie
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Australia
| | - Sally Wilson
- Child and Adolescent Health Service, Princess Margaret Hospital for Children, Perth, Australia.,West Australian Centre of Evidence Informed Healthcare Practice: a Joanna Briggs Institute Centre of Excellence, Curtin University, Perth, Australia.,School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Australia
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Pope N, Tallon M, McConigley R, Wilson S. The experiences of acute non-surgical pain of children who present to a healthcare facility for treatment: a systematic review protocol. ACTA ACUST UNITED AC 2018; 13:12-20. [PMID: 26571278 DOI: 10.11124/jbisrir-2015-2466] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
REVIEW QUESTION/OBJECTIVE The qualitative objective of this systematic review is to identify and synthesize the best available evidence on experiences of acute non-surgical pain, including pain management, of children (between four to 18 years) when they present to a healthcare facility for treatment.The specific objectives are to identify: BACKGROUND The International Association for the Study of Pain defines pain as "an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage". The pain experience is multifaceted and complex, extending beyond the physiological interpretation of a noxious stimulus, encompassing other dimensions, including; psychological, cognitive, sociocultural, affective and emotional factors. Pain can be described as chronic (persisting for three months or more) or acute (a time limited response to a noxious stimuli). Over the past 50 years clinical research has made revolutionary contributions to better understanding pediatric pain. The once pervasive erroneous notion that infants do not experience pain the same way as adults has been firmly dispelled. We now know that nervous system structures associated with the physiological interpretation of pain are functional as early as fetal development. Despite this critical knowledge and the growing global commitment to improving pediatric pain management in clinical practice, evidence repeatedly suggests that pain management remains suboptimal and inconsistent, a phenomenon commonly referred to as oligoanalgesia. Research evidence has linked poorly managed pain in the pediatric population to negative behavioral and physiological consequences later in life. Effective pain management is therefore a priority area for health care professionals. Improved understanding of children's experiences of acute non-surgical pain may lead to improved pain management and a reduction in oligoanalgesia.In the 1970s and 1980s, studies began exploring the subjective experiences of pediatric pain and discovered children's abilities to articulate their pain experiences, and to link causes and consequences of their pain. Developmental trends or age related patterns with regards to children's expressions and experiences of pain were identified. Recent studies have also recognized apparent trends in children's understanding and expressions of pain; these follow an age and cognitive development trajectory in line with Piaget's theories of development.For many children psychosocial aspects of pain, including emotions like fear, stress and anxiety, are often more unpleasant than the painful experience itself. Emotional responses such as distress and anxiety are commonly associated with the anticipation of pain, can exacerbate and intensify the pain experience, and can significantly lower a child's pain threshold. One study utilized an observational pain assessment tool to explore children's pain experiences. The findings indicated that children who underwent "non-painful" procedures (such as restraint) had equal, and in some cases higher, pain scores than those who underwent painful procedures (such as intravenous cannulation).Several studies exploring pediatric pain within health care settings (including, but not limited to, general practitioners, hospitals, emergency departments and outpatient clinics) have adopted quantitative methods, some examined parents' perspectives, and others explored nurses' perceptions. While results of such studies have added to the existing body of knowledge that supports the need to focus on improving pediatric pain management, it has been suggested that failing to ask children directly risks not capturing subjective experiences of pain from the children's perspectives in their entirety. Seeking the children's perspectives could provide a more reliable and adequate means of gaining insight into their needs and expectations when they are in pain.A single centered study in Singapore used semi-structured face-to-face interviews (n=15) to explore children's experiences of pain management postoperatively. While the children, aged between six and 12 years, identified the role of analgesia in managing their pain, they also placed significant emphasis on the role of parents and health care professionals in implementing non-pharmacological interventions in pain management. These results are relevant as they provide insights into how children experience and express pain, and their expectations of health care professionals in managing their pain. These findings draw attention to effective pain management approaches when caring for children. Similarly, a UK study adopted a cross sectional descriptive design using the draw and write technique aimed at investigating children's views on what helped when they were in pain. The children (n=71) were aged between four and 16 years. Findings revealed that children viewed themselves as active agents in pain management, while also placing significant emphasis on the importance of parents and nurses in managing their pain. In both studies, children valued nurses for social interactions, such as kindness and humor, rather than the provision of clinical care, including analgesia administration. Adjunct therapies such as distraction, visualization and music have also been shown to be effective in managing the pain experience in children.Not only do these findings demonstrate the complexity of the pain experience for the child, they also support the notion that improved pain management may come from research that is designed to better understand the entire pain experience from the child's perspective. While there are systematic reviews on interventions for managing children's pain, and one explored children's experiences in the postoperative context, none have considered children's experiences of acute non-surgical pain when they present for treatment. This qualitative systematic review aims to identify and synthesize results of studies exploring children's experiences of pain and pain management.
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Affiliation(s)
- Nicole Pope
- 1Princess Margaret Hospital for Children, Child and Adolescent Health Service, Perth, Australia2West Australian Centre of Evidence Informed Healthcare Practice: a Collaborating Center of Joanna Briggs Institute, Curtin University, Perth, Australia3School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Australia
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Azize PM, Cattani A, Endacott R. Perceived language proficiency and pain assessment by registered and student nurses in native English-speaking and EAL children aged 4-7 years. J Clin Nurs 2018; 27:1081-1093. [PMID: 29076588 DOI: 10.1111/jocn.14134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2017] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To identify the factors that influence decisions made by health professionals when assessing the pain of native English speaking and children whose English is an additional language. BACKGROUND Pain assessment in children is often poorly executed following acute injury. Whilst a range of pain assessment tools have been developed, little guidance is provided for assessing pain in children with English as an additional language. DESIGN Factorial survey design. METHODS Twenty minor injuries unit nurses and 20 children's nursing students participated in an electronic survey to make judgements on 12 scenarios describing a child attending a minor injuries unit following an incident, accompanied by a parent. Respondents had to decide the most important form of pain assessment, and whether they would ask a parent or an interpreter to assess the pain of the child. An open-ended question asked about the difficulties found in making a judgement. RESULTS Observation of the child's behaviour was the most common pain assessment reported. The visual analogue scale was significantly associated with children with proficient English. Respondents were significantly more likely to involve parents in the assessment if they could speak English well compared to parents with poor English skills. Moreover, nursing students were significantly more likely than registered nurses to call for support from an interpreter. Thematic analysis identified three themes related to difficulties with pain assessment: contrasting approaches, differing perceptions of pain and overcoming challenges. CONCLUSIONS The reduced ability to communicate between child, parent and healthcare professional highlights the need to identify forms of assessment based on individual cases. RELEVANCE TO CLINICAL PRACTICE The number of children with English as an additional language has seen a marked rise over the last decade. In situations where communication ability is reduced, assessment of pain should be tailored to meet the needs of the child. This may require timely access to interpreter services.
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Affiliation(s)
- Pary M Azize
- School of Nursing and Midwifery, Plymouth University, Plymouth, UK.,Department of Nursing, Sulaimani Polytechnic University, Sulaimani, Iraq
| | | | - Ruth Endacott
- School of Nursing and Midwifery, Plymouth University, Plymouth, UK.,Royal Devon and Exeter Clinical School, Royal Devon and Exeter Hospital, Exeter, UK.,School of Nursing and Midwifery, Monash University, Melbourne, Vic., Australia
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Are We Adequately Treating Pain in Children Who Present to US Emergency Departments?: Factors That Contribute to Pain Treatment in Pediatric Patients. Pediatr Emerg Care 2018; 34:42-46. [PMID: 27253657 DOI: 10.1097/pec.0000000000000750] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES There are no recent national data on analgesic use for pain treatment in children. Our objective was to determine if there is adequate pain treatment for children in US emergency departments (EDs) and determine predictors of nonopioid and opioid analgesic administration. METHODS Children younger than 18 years with the diagnosis of extremity fracture, appendicitis, or urinary tract stones were obtained from the National Health Ambulatory Medical Care Survey (NHAMCS) (2006-2010) and analyzed using logistic regression for complex samples. There were 2 analyses: (1) those who received analgesics versus those who did not; and (2) of those who received analgesics, opioid versus nonopioid analgesic use. RESULTS There were 1341 records analyzed representing 4.5 million ED visits. Those who received analgesics were more likely to be older than age of 3 years (P = 0.05), be discharged from the hospital (odds ratio [OR], 1.72; 95% confidence interval [CI], 1.04-2.94), arrive between noon and midnight (OR, 0.1.85; CI, 1.12-3.03), and have a higher pain rating (P < 0.01). Children who received opioid analgesics were more likely to live outside the Northeast (P = 0.04), require admission (OR, 2.95; CI, 1.09-7.98), have a higher acuity triage level (OR, 1.79; CI, 1.04-3.06), have higher pain scores (P < 0.01), and have private insurance (OR, 1.75; CI, 1.06-2.94). CONCLUSIONS There is still a lot of room for improvement of pediatric pain control in US EDs. We aim to apply this information toward direct physician and nursing education interventions, including the recognition of age appropriate pain cues, and parental information and guidance to improve pediatric pain treatment in US EDs.
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Pope N, Tallon M, McConigley R, Leslie G, Wilson S. Experiences of acute pain in children who present to a healthcare facility for treatment: a systematic review of qualitative evidence. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2017; 15:1612-1644. [PMID: 28628521 DOI: 10.11124/jbisrir-2016-003029] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
BACKGROUND Pain is a universal and complex phenomenon that is personal, subjective and specific. Despite growing knowledge in pediatric pain, management of children's pain remains sub-optimal and is linked to negative behavioral and physiological consequences later in life. As there is no synthesis of these studies, it was timely to undertake a systematic review. OBJECTIVES To identify, evaluate and synthesize the existing qualitative evidence on children's experiences of acute pain, including pain management, within a healthcare facility. INCLUSION CRITERIA TYPES OF PARTICIPANTS Children aged four to 18 years (inclusive) attending a healthcare facility who experienced acute pain associated with any injury, medical condition or treatment. PHENOMENA OF INTEREST Children's experiences and perceptions of their acute pain, pain management and expectations of others in managing their pain. Studies on children's experiences of pain in the postoperative context were excluded as a systematic review exploring this phenomenon had previously been published. Studies reporting on children's experiences of chronic pain were also excluded. CONTEXT Any healthcare facility including general practitioners' surgeries, hospitals, emergency departments and outpatient clinics. TYPES OF STUDIES Qualitative studies including phenomenology, grounded theory, ethnography, action research and feminist research designs. SEARCH STRATEGY Using a three-step search strategy, databases were searched in December 2015 to identify both published and unpublished articles from 2000 to 2015. Studies published in languages other than English were excluded. METHODOLOGICAL QUALITY All studies that met the inclusion criteria were assessed by at least two independent reviewers for methodological quality using a standardized critical appraisal tool from the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI). DATA EXTRACTION Data were extracted from the papers included in the review using standardized data extraction tool from JBI-QARI. DATA SYNTHESIS Findings were pooled using JBI-QARI. Findings were rated according to their level of credibility and categorized based on similarity in meaning and then were subjected to a meta-synthesis. RESULTS Four studies were included in this review. Two meta-syntheses were generated from five categories based on 21 findings: first, children can express their pain experiences in terms of cause, location, meaning and quality. Children's pain experiences include both physical and psychological dimensions. Children's pain experiences are influenced by their previous pain experiences, pain expectations and sociocultural factors. Second, children use a range of cognitive/behavioral and sensory/physical self-soothing strategies not only to help manage their pain, but also rely on the actions and presence of others as helpers when they are in pain. CONCLUSION Children's pain is a multi-dimensional complex phenomenon relying upon a multi-modal approach to management. Children as young as four years are capable of articulating their pain in terms of location, intensity and depth. The way children perceive, express and respond to pain is shaped by sociocultural factors, previous pain experiences and their expectations of pain. Children, parents and healthcare professionals play an important role in managing children's pain experiences.
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Affiliation(s)
- Nicole Pope
- 1Princess Margaret Hospital for Children, Child and Adolescent Health Service, Perth, Australia 2The Western Australian Group for Evidence Informed Healthcare Practice: a Joanna Briggs Institute Centre of Excellence, Curtin University, Perth, Australia 3School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Australia 4School of Public Health, Curtin University, Perth, Australia
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Abstract
PURPOSE OF REVIEW This article provides a summary of recommendations for the multimodal and multidisciplinary approach to acute pediatric pain management and highlights recent research on this topic. RECENT FINDINGS Recent literature has focused on updating recommendations for the use of various analgesics in the pediatric population. While codeine is no longer recommended due to increasing evidence of adverse effects, the more liberal use of intranasal fentanyl is now encouraged because of the ease of administration and rapid delivery. The evidence base for the use of ultrasound-guided regional nerve blocks by qualified providers in the acute pediatric pain setting continues to grow. SUMMARY The pediatric emergency medicine provider should be able to assess pain and develop individualized pain plans by utilizing a range of nonpharmacologic and pharmacologic strategies. Knowledge of the most recent literature and changes in recommendations for various pain medications is essential.
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Brenner M, Hilliard C, Regan G, Coughlan B, Hayden S, Drennan J, Kelleher D. Research priorities for children's nursing in Ireland: a Delphi study. J Pediatr Nurs 2014; 29:301-8. [PMID: 24486031 DOI: 10.1016/j.pedn.2014.01.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 01/07/2014] [Accepted: 01/07/2014] [Indexed: 11/29/2022]
Abstract
This paper is a report of a study which identified research priorities for children's nursing in an acute care setting in Ireland. A limited number of studies have examined research priorities for children's nursing. This study was undertaken against the backdrop of significant proposed changes to the delivery of children's healthcare. A three round Delphi survey design was used to identify and rate the importance of research priorities for children's nursing. In round I participants were asked to identify five of the most important research priorities for children's nursing. Participants in round II were asked to rate the importance of each research priority on a 7-point Likert scale. In round III participants were presented with the mean score of each research priority from the second questionnaire, and again asked to consider the importance of each topic on a 7-point Likert scale. The aim was to reach consensus on the priorities. The top three priorities identified were recognition and care of the deteriorating child, safe transfer of the critically ill child between acute health care facilities, and the child and family's perceptions of care at end-of life. The wide variation of priorities reflects the scope of care delivery of children's nurses and mirrors many global care concerns in caring for children.
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Affiliation(s)
- Maria Brenner
- School of Nursing, Midwifery & Health Systems, Health Sciences Building, University College Dublin, Belfield, Dublin 4, Ireland.
| | - Carol Hilliard
- Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland
| | | | - Barbara Coughlan
- School of Nursing, Midwifery & Health Systems, Health Sciences Building, University College Dublin, Belfield, Dublin 4, Ireland
| | - Sharon Hayden
- Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland
| | - Jonathan Drennan
- Centre for Innovation and Leadership in Health Sciences, Faculty of Health Sciences, University of Southampton, Highfield, Southampton SO171BJ
| | - Deirdre Kelleher
- School of Nursing, Midwifery & Health Systems, Health Sciences Building, University College Dublin, Belfield, Dublin 4, Ireland
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Right care, every time -- reliability in the ED. Int Emerg Nurs 2013; 21:155-6. [PMID: 23742875 DOI: 10.1016/j.ienj.2013.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2013] [Indexed: 11/21/2022]
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