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Djordjevic CM. Finding a meaning for pain: Definitions, sense-making, and philosophical health. J Eval Clin Pract 2023; 29:1196-1202. [PMID: 37309094 DOI: 10.1111/jep.13873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/15/2023] [Accepted: 05/16/2023] [Indexed: 06/14/2023]
Abstract
Pain has proven to be a refractory problem in US healthcare. This paper argues that starting to address this requires viewing pain-assessment as a form of sense-making that occurs between patients and providers. Section I argues that two standard definitions of 'pain' that are thought to subtend pain assessment are not viable. Section II proffers a very different way to think about the meaning of 'pain'. Section III develops this novel account by pairing Rorty's account of hermeneutics with recent developments in the pain-assessment literature. Finally, section four moves beyond Rorty by linking sense-making to philosophical health. Should this prove persuasive, I will have shown an area in biomedicine where philosophy is not an 'optional add on', but a vitally important part of what should be clinical practice.
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Affiliation(s)
- Charles M Djordjevic
- Lorain County Community College, Elyria, Ohio, USA
- Cleveland Clinic Foundation, Cleveland, Ohio, USA
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2
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Zontag D, Kuperman P, Honigman L, Treister R. Agreement between children's, nurses’ and parents’ pain intensity reports is stronger before than after analgesic consumption: results from a post-operative study. Int J Nurs Stud 2022; 130:104176. [DOI: 10.1016/j.ijnurstu.2022.104176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 12/14/2021] [Accepted: 01/08/2022] [Indexed: 01/11/2023]
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3
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Drendel AL, Brousseau DC, Casper TC, Bajaj L, Alessandrini EA, Grundmeier RW, Chamberlain JM, Goyal MK, Olsen CS, Alpern ER. Opioid Prescription Patterns at Emergency Department Discharge for Children with Fractures. PAIN MEDICINE 2021; 21:1947-1954. [PMID: 32022894 DOI: 10.1093/pm/pnz348] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To measure the variability in discharge opioid prescription practices for children discharged from the emergency department (ED) with a long-bone fracture. DESIGN A retrospective cohort study of pediatric ED visits in 2015. SETTING Four pediatric EDs. SUBJECTS Children aged four to 18 years with a long-bone fracture discharged from the ED. METHODS A multisite registry of electronic health record data (PECARN Registry) was analyzed to determine the proportion of children receiving an opioid prescription on ED discharge. Multivariable logistic regression was performed to determine characteristics associated with receipt of an opioid prescription. RESULTS There were 5,916 visits with long-bone fractures; 79% involved the upper extremity, and 27% required reduction. Overall, 15% of children were prescribed an opioid at discharge, with variation between the four EDs: A = 8.2% (95% confidence interval [CI] = 6.9-9.7%), B = 12.1% (95% CI = 10.5-14.0%), C = 16.9% (95% CI = 15.2-18.8%), D = 23.8% (95% CI = 21.7-26.1%). Oxycodone was the most frequently prescribed opioid. In the regression analysis, in addition to variation by ED site of care, age 12-18 years, white non-Hispanic, private insurance status, reduced fracture, and severe pain documented during the ED visit were associated with increased opioid prescribing. CONCLUSIONS For children with a long-bone fracture, discharge opioid prescription varied widely by ED site of care. In addition, black patients, Hispanic patients, and patients with government insurance were less likely to be prescribed opioids. This variability in opioid prescribing was not accounted for by patient- or injury-related factors that are associated with increased pain. Therefore, opioid prescribing may be modifiable, but evidence to support improved outcomes with specific treatment regimens is lacking.
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Affiliation(s)
| | | | | | - Lalit Bajaj
- University of Colorado, Children's Hospital Colorado, Colorado
| | | | - Robert W Grundmeier
- University of Pennsylvania, Children's Hospital of Philadelphia, Pennsylvania
| | - James M Chamberlain
- Children's National Medical Center, The George Washington University, Washington, DC
| | - Monika K Goyal
- Children's National Medical Center, The George Washington University, Washington, DC
| | | | - Elizabeth R Alpern
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago for The Pediatric Emergency Care Applied Research Network (PECARN), Chicago, Illinois, USA
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Andersen RD, Olsson E, Eriksson M. The evidence supporting the association between the use of pain scales and outcomes in hospitalized children: A systematic review. Int J Nurs Stud 2020; 115:103840. [PMID: 33360247 DOI: 10.1016/j.ijnurstu.2020.103840] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 11/15/2020] [Accepted: 11/16/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Systematic use of pain intensity scales is considered a prerequisite for treatment of pain in hospitalized children, but already a decade ago, attention was called to the lack of robust evidence supporting the presumed positive association between their use and desired outcomes. OBJECTIVES To re-evaluate the evidence supporting the association between the use of pain scales and patient and process outcomes in hospitalized children. DESIGN Systematic literature review. DATA SOURCES The online databases PubMed and Cumulative Index of Nursing and Allied Health Literature (CINAHL) were searched from inception to April 15, 2020. REVIEW METHODS We performed single screening of all records followed by duplicate screening of full texts of interest with a disagreement procedure in place. Studies where the authors evaluated outcomes from the use of self-report or behavioral-based pain scales in children 0-18 years in a hospital setting were included. Emergency care settings were excluded. RESULTS In a majority of the 32 included studies, complex interventions that included one or more pain scales were evaluated. Process outcomes (e.g., documentation) were most frequently studied. Interventions were commonly associated with improved documentation of pain assessment, while the effect on pain management documentation was inconsistent. However, improvements in process outcomes did not necessarily result in better patient outcomes. In regard to patient outcomes (e.g., pain intensity, side effects, or satisfaction with treatment), some authors reported reduced pain intensity on group level, but the effect on other functional outcomes, child and parent satisfaction, and aspects of safety were inconsistent. Methodological issues, e.g., weak study designs and small samples, biased the results, and it was not possible to determine how pain scales contributed to the overall effects since they were studied as part of complex interventions. CONCLUSIONS Although both a theoretically founded understanding of pain and clinical experience suggest that the use of pain scales will make a difference for hospitalized children with pain, there is still limited evidence to support this notion. As pain scales have been almost exclusively studied as an aspect of complex interventions, research that determines the active ingredient(s) in a complex intervention and their joint and individual effects on outcomes that are meaningful for the child (for example reduced pain intensity or improved function) are urgently needed. Tweetable abstract: Limited #research supports association between use of pediatric #pain scales and patient outcomes @_randida @PainPearl.
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Affiliation(s)
- Randi Dovland Andersen
- Department of Child and Adolescent Health Services and Department of Research, Telemark Hospital Trust, P.O. Box 2900 Kjørbekk, Skien 3710, Norway; Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro 701 82, Sweden.
| | - Emma Olsson
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro 701 82, Sweden; Department of Pediatrics, Faculty of Medicine and Health, Örebro University, Örebro 701 82, Sweden
| | - Mats Eriksson
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro 701 82, Sweden; Department of Pediatrics, Faculty of Medicine and Health, Örebro University, Örebro 701 82, Sweden
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Andersen RD, Nakstad B, Jylli L, Campbell-Yeo M, Anderzen-Carlsson A. The Complexities of Nurses' Pain Assessment in Hospitalized Preverbal Children. Pain Manag Nurs 2019; 20:337-344. [PMID: 31103508 DOI: 10.1016/j.pmn.2018.11.060] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 09/03/2018] [Accepted: 11/28/2018] [Indexed: 10/26/2022]
Abstract
BACKGROUND Preverbal children are at increased risk for underassessment of pain. Pain is a social transaction involving the child in pain and the nurse assessor. However, our understanding of the nurse's part in this transaction is limited. AIMS The aim of this study was to explore nurses' assessment of pain in hospitalized preverbal children based on self-selected clinical examples. DESIGN Qualitative, descriptive design. SETTINGS Five different hospital units in Canada and Norway. All units had an observational pain scale for preverbal children available for use. PARTICIPANTS/SUBJECTS Nurses (N = 22) with ≥1 year experience caring for preverbal children. METHODS Individual, semistructured interviews. Data were analyzed using inductive thematic analysis. RESULTS Nurses' assessment of pain in hospitalized preverbal children emerged as a nonlinear complex process incorporating different actions and reflections in response to the child's situation and expression of distress. Information from parents was routinely included in the assessment, although further parental involvement varied considerably. Although each assessment was personalized to the individual child, the nurse used previous experiences to interpret observations of and information from the child and the parents. Few nurses described using structured pain scales, but when used, these scales were included as only one aspect of their overall assessment. CONCLUSIONS Nurses preferred pain assessment based on clinical judgment and tailored to the individual child. Implementation strategies that aim to integrate structured pain scales with clinical judgment to assess pain may be more likely to succed. Further examination of this approach is warranted.
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Affiliation(s)
- Randi Dovland Andersen
- Department of Child and Adolescent Health Services, Telemark Hospital, Skien, Norway; Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden.
| | - Britt Nakstad
- Department of Pediatric and Adolescent Medicine, Akershus University Hospital, Lørenskog, Norway; Institute of Clinical Medicine, Campus Ahus, University of Oslo, Lørenskog, Norway
| | - Leena Jylli
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden; Department of Anesthesia and Intensive Care, Pain Clinic, Karolinska University Hospital Huddinge, Sweden
| | - Marsha Campbell-Yeo
- School of Nursing, Faculty of Health Professions and Departments of Pediatrics, Psychology & Neuroscience, Dalhousie University, Halifax, Canada; Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Canada
| | - Agneta Anderzen-Carlsson
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Faculty of Health, Science, and Technology, Department of Health Sciences, Nursing, Karlstad University, Karlstad, Sweden
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6
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Peirce D, Corkish V, Lane M, Wilson S. Nurses' Knowledge and Attitudes Regarding Pediatric Pain Management in Western Australia. Pain Manag Nurs 2019; 19:707-717. [PMID: 29773353 DOI: 10.1016/j.pmn.2018.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 01/09/2018] [Accepted: 03/06/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND AIM Despite clinical guidelines, suboptimal pediatric pain management persists. A local audit found poor guideline compliance. Inadequate knowledge is a recognized barrier to the delivery of evidence-based care. The aim of the study was to investigate nurses' knowledge and attitudes regarding pain management at an Australian tertiary pediatric hospital. Design, Setting, Participants and Method: A cross-sectional, descriptive study using the Pediatric Pain Knowledge and Attitudes Questionnaire (Revised) was distributed to 590 nurses in an Australian pediatric hospital. RESULTS The mean knowledge score (n = 201) was 77.56 out of 100 (range 49.82-94.16, standard deviation [SD] 8.55); mean attitude score (n = 229) was 72.46 out of 100 (range 33.33-93.33, SD 11.76). Significant differences in mean knowledge scores were found between nurses' designations (p = .018), with the greatest mean difference (MD) between clinical nurses and enrolled nurses (10.5; p = .002). Nurses with experience in critical care had significantly higher mean knowledge scores (MD 3.1; p = .012). Senior registered nurses had the most positive mean attitude score (82.4, SD 6.2), which was significantly higher than clinical nurses (73.77, SD 10.0), registered nurses (71.64, SD 12.6), and enrolled nurses (68.89, SD 8.8) (p < .05). Nurses with specialist pediatric qualifications had significantly more positive attitude scores (mean 75.65, SD 11.6) than those without (mean 70.86, SD 11.7; p = .005). However, 51% of respondents believed that children tolerate pain better than adults do. CONCLUSION Although nurses' overall knowledge and attitude toward pediatric pain were among the highest reported, areas for targeted education using in-service education and workshops were identified alongside a need for exploration of the impediments to providing best care.
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Affiliation(s)
- Deborah Peirce
- Princess Margaret Hospital for Children, Child and Adolescent Health Service, Perth, Western Australia; School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, Perth, Western Australia.
| | - Victoria Corkish
- Princess Margaret Hospital for Children, Child and Adolescent Health Service, Perth, Western Australia
| | - Margie Lane
- Princess Margaret Hospital for Children, Child and Adolescent Health Service, Perth, Western Australia
| | - Sally Wilson
- Princess Margaret Hospital for Children, Child and Adolescent Health Service, Perth, Western Australia; School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, Perth, Western Australia
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Drendel AL, Ali S. Ten Practical Ways to Make Your ED Practice Less Painful and More Child-Friendly. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2017. [DOI: 10.1016/j.cpem.2017.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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8
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Abstract
PURPOSE OF REVIEW This review highlights challenges and current trends in tools used to assess acute pain across the lifespan. RECENT FINDINGS A plethora of similar assessment tools exist for acute pain, most focused on self-report of pain intensity. Attempts to improve the frequency and visibility of pain assessment by prompting pain as 'the fifth vital sign' resulted in unintended consequences, creating a pressing need for a conceptual shift to multidimensional assessment of acute pain. SUMMARY Valid and pragmatic assessment of pain is essential for effective pain management. Unidimensional scales that capture self-reported pain intensity ratings undervalue to the complexity of the pain experience. Pain is a biopsychosocial experience and assessment is a complex social transaction and an exchange of the meaning of pain that demands a more comprehensive approach.
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Affiliation(s)
- Debra B Gordon
- Integrated Pain Care Program, Department of Anesthesiology and Pain Medicine Harborview, Seattle, Washington, USA
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Welsh JT. Assessing Pain in the ED Including the Use of Pain Scales (Such as OSBD, FLACC, VRS, NRS, CRS, and Oucher). CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2016. [DOI: 10.1007/s40138-016-0091-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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10
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Twycross AM, Williams AM, Finley GA. Surgeons' aims and pain assessment strategies when managing paediatric post-operative pain: A qualitative study. J Child Health Care 2015; 19:513-23. [PMID: 24728398 DOI: 10.1177/1367493514527022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Children experience moderate to severe pain post-operatively. Nurses have been found to have a variety of aims in this context. Surgeons' aims when managing post-operative pain have not been explored. This qualitative study set out to explore paediatric surgeons' aims when managing post-operative pain in one paediatric hospital in Canada. Consultant surgeons (n = 8) across various specialities took part in semi-structured interviews. Surgeons' overarching aim was to keep the child comfortable. Various definitions of comfortable were given, relating to the child's experience of pain itself and their ability to undertake activities of daily living. Children's behavioural pain cues seem to be a primary consideration when making treatment decisions. Parents' views regarding their child's pain were also seen as important, suggesting children may not be seen as competent to make decisions on their own behalf. The need to maintain a realistic approach was emphasised and pain management described as a balancing act. Surgeons may draw on both tacit and explicit knowledge when assessing children's pain. There appears to be an expectation among surgeons that some pain is to be expected post-operatively and that the diagnostic value of pain may, in some cases, supersede concerns for the child's pain experience.
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Twycross AM, Williams AM, Bolland RE, Sunderland R. Parental attitudes to children's pain and analgesic drugs in the United Kingdom. J Child Health Care 2015; 19:402-11. [PMID: 24459102 DOI: 10.1177/1367493513517305] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Many children experience treatable moderate to severe pain following surgery. Increasingly, children undergo surgery as day cases, and, as such, parents are more likely to be responsible for managing pain post-operatively. Research in the United States and Finland has found parents fear the side effects of analgesics; think they are addictive; and that children should receive as little analgesia as possible. Little is known about parental attitudes in this context in the United Kingdom. This study set out to explore parental attitudes towards children's pain and analgesic drugs to contribute to existing knowledge about parental attitudes elsewhere so that the information provided to parents can be tailored effectively. A convenience sample of parents (n = 108) at one hospital in South West London completed the Parental Pain Expression Perceptions and the Medication Attitudes Questionnaires. Although many parents have a good understanding of the ways in which children express pain, a substantial proportion of parents hold misconceptions regarding how children express pain and concerns in relation to analgesic drugs. This may impact on the quality of the pain management provided to children post-operatively and needs taking into account when preparing parents in this context.
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Affiliation(s)
| | | | - Rachael E Bolland
- London South Bank University, UKGreat Ormond Street Hospital, UKSt George's Healthcare Trust, UK
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12
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A Debate on the Proposition that Self-report is the Gold Standard in Assessment of Pediatric Pain Intensity. Clin J Pain 2015; 31:707-12. [DOI: 10.1097/ajp.0000000000000165] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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PICU Nurses' Pain Assessments and Intervention Choices for Virtual Human and Written Vignettes. J Pediatr Nurs 2015; 30:580-90. [PMID: 25682019 PMCID: PMC4470724 DOI: 10.1016/j.pedn.2015.01.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 01/11/2015] [Accepted: 01/14/2015] [Indexed: 11/23/2022]
Abstract
The purpose of this concurrent mixed-methods study was to 1) examine the factors pediatric intensive care unit nurses consider when assessing and intervening for children who report severe pain and to 2) determine the effect of child behavior and diagnosis on the nurses' pain ratings and intervention choices for written and virtual human vignettes. Quantitative and qualitative results substantiated that despite recommendations to use self-report, many PICU nurses use behavior as the primary indicator to assess and treat pain, even when a child is old enough to articulate pain intensity and there is sufficient cause for pain to be present.
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Zisk-Rony RY, Lev J, Haviv H. Nurses' report of in-hospital pediatric pain assessment: examining challenges and perspectives. Pain Manag Nurs 2014; 16:112-20. [PMID: 25282384 DOI: 10.1016/j.pmn.2014.05.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 05/02/2014] [Accepted: 05/14/2014] [Indexed: 10/24/2022]
Abstract
Pain is a symptom pediatric nurses commonly encounter in the hospital setting. Untreated pain can lead to adverse physiologic and psychological effects. This study examines in-hospital pain assessment methods nurses report using and assesses challenges, difficulties, and barriers nurses report to assessing pain in hospitalized children. Cross-sectional study of 82 pediatric nurses from all pediatric departments of a tertiary hospital in Israel. A self-report questionnaire was developed to examine how nurses assess children's in-hospital pain and barriers to in-hospital pain assessment. Nearly all nurses (90%) reported having enough knowledge to assess children's pain in the hospital, relying on child's self-report (86%) and being familiar with commonly used validated pain scales (90%). However, a majority (75%) reported not using pain scales recently and only half (58%) reported using an alternative method involving the child. Most nurses (86%) reported relying on their own overall impression of the child's pain and only a third (34%) reported involving the parents in their pain assessments. Nurses included comments stressing the importance of pain assessments and their frustration with the current validated measures available. This study adds to a growing body of literature demonstrating a gap between recommended pediatric pain assessment guidelines and reported practice, with nurses showing a resistance to relying on single-item or unidimensional measures to assess and evaluate the rich and complex pain experience. A multidimensional approach involving child self-report, parent report, and nurses' own overall impression based on clinical assessment skills of pain is discussed.
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Affiliation(s)
- Rachel Yaffa Zisk-Rony
- Hadassah Hebrew University Medical Center, Ein Kerem; Henrieta Szold Hadassah-Hebrew University School of Nursing in the Faculty of Medicine, Jerusalem, Israel.
| | - Jodi Lev
- Hadassah Hebrew University Medical Center, Ein Kerem
| | - Hagit Haviv
- Hadassah Hebrew University Medical Center, Ein Kerem
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Voepel-Lewis T. How reliable are 'valid and reliable' pain scores in the pediatric clinical setting? Pain Manag 2014; 3:343-50. [PMID: 24654867 DOI: 10.2217/pmt.13.38] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY Over the past decade, growing clinician skepticism and inconsistent use of self-report pain scales have raised important questions regarding the clinical meaning and interpretation of pain scores. The appropriate use of pain scores at the bedside requires an understanding of what they may mean to the child who is providing them. This article summarizes the evidence regarding pain score meaning, showing that despite the established psychometric properties of pain scales, pain score numbers mean different things to different children, complicating the clinical interpretation. The evidence suggests that it is inappropriate to use standardized pain score thresholds for treatment or evaluation, and suggests an individualized approach to the interpretation and use of pain scores is needed.
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Affiliation(s)
- Terri Voepel-Lewis
- Department of Anesthesiology, Section of Pediatrics, Room 4917 CS Mott Children's Hospital, University of Michigan, Box 4245, 1540 E Hospital Drive, Ann Arbor, MI 48109 4245, USA.
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Bai J. Letter to the Editor. Pain 2014; 155:833-834. [DOI: 10.1016/j.pain.2013.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Revised: 08/03/2013] [Accepted: 08/09/2013] [Indexed: 12/01/2022]
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17
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Twycross A, Finley GA. Nurses' aims when managing pediatric postoperative pain: is what they say the same as what they do? J SPEC PEDIATR NURS 2014; 19:17-27. [PMID: 24393225 DOI: 10.1111/jspn.12029] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Revised: 01/15/2013] [Accepted: 02/17/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study was to explore nurses' aims when managing postoperative pain and whether reported aims reflect actual practices. DESIGN AND METHODS Participant observation was used to collect data regarding nurses' (n = 17) pain management practices. Nurses (n = 19) were asked: When managing postoperative pain, what is your overall aim? RESULTS Around half the participants (n = 10) aimed for patients to be comfortable while others aimed for a pain score of 2-3 (n = 7), or below 5 (n = 2). Observed practices matched aims for just more than half the participants (n = 9). PRACTICE IMPLICATIONS There is evidence of individual variation in practices. This may impact on the care provided.
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Affiliation(s)
- Alison Twycross
- Faculty of Health Social Care and Education, Kingston University and St. George's University of London, London, UK
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18
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Myrvik MP, Brandow AM, Drendel AL, Yan K, Hoffmann RG, Panepinto JA. Clinically meaningful measurement of pain in children with sickle cell disease. Pediatr Blood Cancer 2013; 60:1689-95. [PMID: 23776145 PMCID: PMC3993972 DOI: 10.1002/pbc.24624] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 05/07/2013] [Indexed: 11/06/2022]
Abstract
BACKGROUND Limited understanding of the interpretability of patient-reported pain scores may impact pain management. The current study assessed the minimal clinically significant improvement in pain and pain scores signifying patient-reported need for medication and treatment satisfaction in patients with sickle cell disease (SCD). PROCEDURE Patients, 8-18-years-old, with SCD were recruited while receiving treatment for pain. Patients completed initial pain severity ratings using the Visual Analog Scale (VAS) and the Numeric Rating Scale (NRS). Serial assessments of pain severity, pain relief, perceived need for medication, and treatment satisfaction were completed in the emergency department and the hospitalization. Data were used to calculate the minimal clinically significant improvement in pain and pain scores associated with perceived need for pain medication and treatment satisfaction. RESULTS Twenty-eight patients completed 305 assessments during 37 total visits. A decrease in pain severity score of 0.97 cm for the VAS and 0.9 for the NRS was found to be the minimum clinically significant improvement in pain. Pain scores >7.45 cm on the VAS or 7.5 on the NRS were suggestive of patient-reported need for pain medication. Pain scores <7.35 cm on the VAS or 8.5 on the NRS were suggestive of patient-reported treatment satisfaction discrimination. CONCLUSIONS The minimal clinical significant improvement was defined for the VAS and NRS and both scales were able to discriminate between important clinical findings including pain relief, need for pain medication, and treatment satisfaction. Collectively, this study provides data to improve our understanding of pain ratings of pediatric patients with SCD.
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Affiliation(s)
- Matthew P Myrvik
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - Amanda M Brandow
- Medical College of Wisconsin,Division of Pediatric Hematology/Oncology/Transplant
| | - Amy L Drendel
- Medical College of Wisconsin,Division of Pediatric Emergency Medicine
| | - Ke Yan
- Medical College of Wisconsin,Quantitative Health Sciences
| | | | - Julie A Panepinto
- Medical College of Wisconsin,Division of Pediatric Hematology/Oncology/Transplant
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Schiavenato M, Alvarez O. Pain assessment during a vaso-occlusive crisis in the pediatric and adolescent patient: rethinking practice. J Pediatr Oncol Nurs 2013; 30:242-8. [PMID: 23850944 DOI: 10.1177/1043454213494014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Pain assessment of the child and adolescent with sickle cell disease is complex and challenging. We present a paradigm of pain assessment during a vaso-occlusive crisis in children and adolescents based on the Pain Assessment as a Social Transaction model. Using this model, the assessment of pain severity in sickle cell disease is uniquely highlighted as comprising at least 4 key factors: the limitations of current pain assessment tools, the existence of acute pain of various origins and the emergence and coexistence of chronic pain, the prevalence of cognitive deficits, and the sociocultural dynamics in America. Improved tools for pain assessment and targeted practitioner education are warranted.
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Affiliation(s)
- Martin Schiavenato
- 1University of Miami School of Nursing and Health Studies, Coral Gables, FL, USA
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20
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Twycross A, Finley GA, Latimer M. Pediatric nurses' postoperative pain management practices: an observational study. J SPEC PEDIATR NURS 2013; 18:189-201. [PMID: 23822843 DOI: 10.1111/jspn.12026] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Revised: 01/24/2013] [Accepted: 01/28/2013] [Indexed: 01/17/2023]
Abstract
PURPOSE This study was an in-depth examination of pediatric postoperative pain care. DESIGN AND METHODS Participant observational data were collected on the care of 10 children. Particular attention was paid to actions when pain scores were ≥5 and to the relationship between pain scores and medications administered. RESULTS A pattern of care emerged of giving pain medications regularly even if they were prescribed pro re nata. Actions when pain scores were ≥5 varied. Recorded pain scores rarely guided treatment choices. PRACTICE IMPLICATIONS The use of pain scores to guide treatment choices needs further debate. Future research should explore the implications of divorcing treatment from pain scores on children's pain experience.
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Affiliation(s)
- Alison Twycross
- Faculty of Health, Social Care and Education, St George's University of London, London, United Kingdom.
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Twycross A, Finley GA. Children's and parents’ perceptions of postoperative pain management: a mixed methods study. J Clin Nurs 2013; 22:3095-108. [DOI: 10.1111/jocn.12152] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2012] [Indexed: 12/26/2022]
Affiliation(s)
- Alison Twycross
- Faculty of Health, Social Care and Education; Kingston University and St George's University of London; London UK
| | - G Allen Finley
- Anesthesia & Psychology; Dalhousie University; Halifax NS Canada
- Dr Stewart Wenning Chair in Pediatric Pain Management; IWK Health Centre; Halifax NS Canada
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