Pediatric Pain Management : An Evidence Based Approach Conducted By Maria Ramira Essay

As I begin my fifth year of working as a nurse practitioner in a leading children’s hospital, I am certain the pediatric acute care setting is where I will continue my career of service to children and their families. Although I hold a masters degree in nursing and have been a primary care certified pediatric nurse practitioner for many years, I wish to expand my knowledge of pediatric nursing to encompass the unique and challenging aspects of pediatric acute care.

They must always maintain privacy and confidentiality in a nurse/child relationship. They should also differentiate between normal and abnormal physical findings and serve a child advocate. Nurses must also participate in activities to help manage the child’s pain and analyze any situations to anticipate pathophysiological problems and detect any changes in the status. Pediatric nurses may also administer medication while using an age- appropriate guidelines and determine the child’s needs related to pain management. One of the last general tasks is, that a nurse must evaluate a child for signs and symptoms of abuse and provide as much supportive care as possible to dying children.

When managing the childs pain during cancer treatment the nurse must work with an interdisciplinary team involving many different experts to come up with the best possible pain management plan for the child. The nurse would be the one to carry this plan out in the child’s care. Knowing what opioid’s, nonopioids, NSAIDS, acetaminophen with codeine, oxycodone, and morphine to give during different times is crucial. The nurse must also know the side effects of these medication and monitor the child closely.

Pain is a condition that is determined and described by the person reporting it. There are several components to pain including the emotional, psychological, and physical aspects. Many health professionals struggle to understand this phenomenon and thereby insert their own perspectives into the pain assessment of patient reporting pain. The Affordable Care Act (ACA) (2010), also titled the Patient Protection and Affordable Care Act H.R. 3590, was passed by Congress and signed into law on March 23, 2010 (U.S. Department of Health and Human Services (DHHS), 2013). Hospital value based purchasing programs (VBP) were developed to align patient quality care and outcomes to the support initiatives from the ACA. A component of the VBP includes patient satisfaction. Patient satisfaction is a self-reported response to questionnaire administered by a third party. Many hospitals utilize Press Ganey to administer the survey for the inpatient and outpatient patients. One component the survey includes patient’s self-reporting how well their pain was managed during their hospitalization. This measure of satisfaction can have an adverse effect on patient outcomes and increase opioid use in this setting. Patient satisfaction and pain management are both subjective however pain management while within scope of healthcare professionals should not be included in the patient satisfaction survey.

Nursing assessment is a substantial way of gathering physiological, psychological, spiritual, and emotional condition of the patient. It creates a whole picture of an individual and assist the health care providers to formulate a diagnosis. Assessing the comfort of the patient is equally important as taking the blood pressure or temperature. Pain is the fifth (5th) vital sign that is subjective in nature when performing an assessment of a patient. Various studies were conducted in finding the most appropriate evidence-based nursing practice in assessing and managing the pain of a cognitively impaired patient, whether it is acute or chronic or the underlying cause is cancer or post-operative incision. As emphasized by Song, Eaton, Gordon, Hoyle, and Doorenbos (2015), it is vital to ensure that “pain management is based on the best evidence” (p. 456). Perhaps knowing the causes of inability to assess and manage the pain in a cognitively impaired patient would give a clearer understanding of the practice.

There were 3 periods over 3 different years and it was split between pediatrics and adults and men and women. In the results, the amount of time that it took to administer the medication decreased over the years overall. Pediatric patients received pain medication more quickly than adults and adult men received their pain medication before adult women. Most of the time adult women had higher pain scores than the adult men, but they were still given analgesics last. Pain in women should be respected as pain in men is. Pediatric patients that came in for vaso-occlusive crisis decreased over the years, but adult patients fluctuated throughout. This research also considered some reasons that analgesics are taking so long to be administered. One reason that they noticed were that laboratory tests and image studies may delay the amount of time it takes to give the pain medications. Another reason was because these patients go to the emergency department and they are not considered to be a medical urgency if they are medically stable and therefore will not be seen first. This article in comparison to the one by Wilson and Nelson have some similarities and differences. Both articles are the same in that they both believe

The content for the educational strategy can vary depending on the group, individual and the learning needs of each. While the overall aim is to reduce rates of worsened pain through accurate documentation, some nurses may benefit from in-depth

However, a better understanding of the factors that affect such knowledge and attitudes and of the discrepancy between attitudes and practice can provide useful information to be included in education programs for nurses and to inform policy on the provision of pain management. On the other hands (Rushton, Eggett, and Sutherland, 2003) stated that nurses do not use evidence-based practice in pain management consistently. Until recently there was no standard of care by which to judge the adequacy of pain management. Study findings support the premise that many nurses have inadequate knowledge about pain theory, assessment, and management strategies, especially pharmacological and non-pharmacological strategies. Importantly, study findings suggested that nurses do not objectively assess pain or individualize care plans for patients with pain complaints. In particular, nurses expect patients to tolerate pain, do not differentiate well between acute and chronic pain, consistently overestimate the incidence of narcotic addiction and malingering (i.e., false pain complaint), and tend to rate patients ' pain and related needs lower than patients themselves. Pain assessment is the first step in effective pain management and is an independent nursing function. It has been estimated that a significant number of problems with pain management relate to inadequate assessment (Clark et al., 1996). The research evidence suggests that nurses ' attitudes and beliefs constitute significant

This study was little different from the previous studies as it was carried out by the student nurses. The students performed a research in collaboration with the faculty and unit to describe the root cause and provide recommendation on improving clinical documentation practices within the health care setting. This included describing the pain reassessment process or plan of care compliance. Six pilot units were selected within the healthcare system with a team or 4-5 students for each unit with a lead faculty for each team. Each faculty was responsible for the work of 3 student teams. 2 teams focused on the pain reassessment and one team on the plan of care documentation. Each student used about 8 hours of clinical hours for this project. The RCA teams met weekly to summarize the current status and develop data tools and recommendations on this project. The project process was completed in 3 phases: background overview, data collection and synthesis and project evaluation including recommendations. The total time to complete the project was approximately 7

Children are taken to the emergency department for various reasons, but pain is one of the most common. Habich and Letizia state, “Despite the high frequency of pain, pediatric patients are often not appropriately assessed for pain.” Nurses and other medical personnel failing to properly assess the pain in the emergency department is a problem that needs to be fixed. To resolve this problem, Habich and Letizia decided to conduct an evidence based protocol to review what ways the program needed to review.

The aim of this study was to examine different methods of pain management in children during invasive medical procedures. Studies by other researchers have found distractions especially useful in reducing child stress, as well as a new medication called EMLA (a combination of lidocaine and prilocaine). Since only one other study had been conducted to compare these two methods of pain management, the researchers in this study sought to “evaluate EMLA versus nurse coaching and movie distraction for managing the distress and pain associated with children's immunizations” (Cohen, Blount, Cohen, Schaen, & Zaff, 1999, 592). They hypothesized that nurse coaching and movie distraction would result in more nurse coaching and child coping and less child

There are many ways to manage pain in today’s society. Some prefer non-analgesic treatment, and others rather manage their pain by taking analgesics as soon as they 're aware of the severity of their pain. On the specific topic of neonates, it is often said that their pain is overlooked. Because it is so difficult to suspect whether or not the infant is in pain due to their developmental age group, nurses are reluctant to take pharmacological measures without proof. There are a considerable amount of pain scales accessible for neonates and neonatal nurses.

Statistics are showing that the pediatric population is at risk of insufficient pain management, with age-related issues that are having an effect on pain management that is in children. Children are regularly provided token or no analgesia for actions that would habitually be preserved hostilely in adults. With said, making sure that the pain management department is running effectively is very important. The importance of improving the care provided in America's pediatric division has encouraged the development and endorsement of an increasing portfolio performance measures especially in pain management (Bhargava, R., & Brown, L., 2011). It is important to understand that promoting a high performing health care system does require better measurement and the utilization of those measures to compensate proper care, improve health outcomes, and permit customers and purchaser to utilize the statistics to make suitable value-driven choices (Feinberg, 2002). Even though there has been quite a bit progress over the past decade in the parts of measure growth and commendation, there continues to be important breaches in both serious measurement areas - for instance competence and differences of care - and putting that info to use for performance-based imbursement, consumer support, and quality improvement. Saying all of this, this essay will analyze and critically discuss pain management in the pediatric department.

Pediatric pain management is measured subjectively because it is based off of what the patient says or how the nurse interprets the pain scale. Pain is rated using different scales, unfortunately these different scales could yield different results. Nurses are trained to use pediatric pain scales to analyze and treat pain but parents are not supplied with the tools to manage pain when the patient goes home. With 84% of all pediatric surgical procedures performed on an outpatient basis, the importance of teaching parents how to assess for and manage pain has become more important than ever (Rony, Fortier, Chorney, Perret, & Kain, 2010). According to Rony’s et al. (2010) study, it is apparent that pediatric pain is not being treated effectively. The study showed that 58.8% of children were receiving less than the daily recommended does prescribed by the pediatrician (p.1). Results of the study also showed that parents had false assessments on if their child was actually in pain. 36% of parents believed that if their child was in pain, they would cry out for the parent , 30% agreed that their child would always tell them if they are in pain, while 22% said that the child would report their pain immediately (Rony, Fortier, Chorney, Perret, & Kain, 2010, ). Children do not always verbalize when they are in pain. Sometimes the pain can be so intense that a child is unable to talk. If the child catches on to the parents negative perception of pain medications, the child may not

Policies and resources are important tools to use for guidance on developing a plan of care for pediatric pain management. Nurses must look at their hospital policies to determine the appropriate actions to take. The Doernbecher Children’s Hospital in Oregon developed a policy using a multi-modal approach for the staff to follow. A multi-modal approach is where pain management is provided before, during, and after all procedures that may cause pain and/or anxiety for the child (Oregon Health & Sciences University, 2012). Team huddles are used before procedures to discuss the appropriate pain management approach that will be used based on the child. The nurse’s report and assessment on the child’s past perceptions of pain, any current symptoms the child is facing, and cultural background are important for other members of the healthcare team to create a proper plan during huddle. If the child’s nurse feels that the child needs more pain interventions, the nurse may stop the procedure to provide the child with additional comfort measures (Oregon Health & Sciences University, 2012). The policy in place at Doernbecher Children’s Hospital is developed in order to provide the child with compassionate care while alleviating pain and anxiety that will decrease any physical or psychological effects caused by untreated pain. All hospitals must have a pain policy in place for guidance on how to provide quality care.