Alison Twycross

Nurses' views about the barriers and facilitators to effective management of pediatric pain

Children continue to experience moderate to severe pain during hospitalization. This paper presents data from two modified focus groups undertaken as part of a larger study exploring pediatric pain management practices in one hospital in the south of England. Thirty nurses took part in the focus groups and were asked questions about their views about the barriers and facilitators to effective pain management in the hospital. Participants identified a number of barriers which related to the staff, children and parents and the organization. Nurses indicated that they and the medical staff lacked knowledge about pain management. They also felt that staff shortages and a heavy workload detracted from the quality of the care they could provide. Several participants indicated that insufficient analgesic drugs were sometimes prescribed. Many of the barriers identified related to parents and children. It appears that nurses may not take as active a role as they could do in managing pediatric pain rather seeing it as the parents and childs responsibility to let them know when they are experiencing pain. Nurses also felt that parents exaggerate their childs pain and ask for analgesic drugs before their child needs them. There is a need to explore the interactions between nurses, children and parents in this context in more detail.

Children's and parents' perceptions of postoperative pain management: a mixed methods study

AIMS AND OBJECTIVESnTo explore childrens and parents perceptions about the quality of postoperative pain management.nnnBACKGROUNDnChildren continue to experience moderate to severe pain postoperatively. Unrelieved pain has short- and long-term undesirable consequences. Thus, it is important to ensure pain is managed effectively. Little research has explored childrens and parents perceptions of pain management.nnnDESIGNnExploratory study.nnnMETHODSnChildren (n = 8) were interviewed about their perceptions of pain care using the draw-and-write technique or a semi-structured format and asked to rate the worst pain experienced postoperatively on a numerical scale. Parents (n = 10) were asked to complete the Information About Pain questionnaire. Data were collected in 2011.nnnRESULTSnMost children experienced moderate to severe pain postoperatively. Children reported being asked about their pain, receiving pain medication and using nonpharmacological methods of pain relief. A lack of preoperative preparation was evident for some children. Most parents indicated they had received information on their childs pain management. Generally, participants were satisfied with care.nnnCONCLUSIONnParticipants appeared satisfied with the care provided despite experiencing moderate to severe pain. This may be attributable to beliefs that nurses would do everything they could to relieve pain and that some pain is to be expected postsurgery.nnnRELEVANCE TO CLINICAL PRACTICEnChildren are still experiencing moderate to severe pain postoperatively. Given the possible short- and long-term consequences of unrelieved pain, this is of concern. Knowledge translation models may support the use of evidence in practice, and setting a pain goal with parents and children may help improve care.

Managing pain in children: where to from here?

AIMS AND OBJECTIVESnThe aims of this study are to review research published in the past 15 years to provide insight into the factors impacting on the management of pain in children and identify strategies that can be used to improve pain management practices.nnnBACKGROUNDnThe evidence to guide nurses pain management practices is readily available, in the form of clinical guidelines. However, childrens nurses pain management practices continue to fall short of the ideal with children experiencing moderate to severe unrelieved pain. Several factors have been suggested as providing an explanation for this. There is a need to explore the impact each of these factors have on pain management practices further. With this in mind, a literature review was undertaken.nnnDESIGNnLiterature review.nnnMETHODSnA computerised literature search was carried out using CINAHL, Medline and the British Nursing Index. The search terms used were as follows: pain, pain assessment, pain management, education, quality and nurses. Articles published in the last 15 years were included in the review.nnnRESULTSnSeveral themes emerged from this review of the literature as possible explanations for why childrens pain is still not managed effectively. These include knowledge deficits; incorrect or outdated beliefs about pain and pain management; the decision-making strategies used and organisational culture.nnnCONCLUSIONSnImproving pain management requires a multifactorial approach encompassing: education, institutional support, attitude shifts and change leaders. Issues that need addressing include education, decision-making strategies and organisational practices. Further research needs to be carried out to determine other factors that impact on pain management practices.nnnRELEVANCE TO CLINICAL PRACTICEnDespite the evidence to guide practice being readily available children continue to experience unrelieved pain. The strategies identified in this article may help to ensure that pain is relieved effectively.

How well is acute pain in children managed? A snapshot in one English hospital

This study set out to obtain a picture of pediatric pain management practices in one English hospital. Data were collected on two wards. Nonparticipant observation combined with a chart audit was used to collect data about actual practices. Questionnaires were used to collect information from parents and young people. Observational data showed that practices conformed to current guidelines in some but not all areas. When prescribed, the dosage of analgesic drugs complied with the hospitals guidelines, and drugs were usually administered as prescribed. There was some involvement of parents in decision making but this was usually initiated by them rather than the nurses. Pain assessment tools were not always used nor was a pain history routinely taken. Documentation about pain management was limited and there was little evidence of nonpharmacologic methods of pain relief being used. Parents and young people felt that their pain management was of an acceptable level or very good. This was despite the fact that 58% of children experienced severe pain and 24% moderate pain. The results provide a snapshot of pain management in one English hospital. As in other studies, pain management practices do not adhere to current guidelines in all areas, and children appear to be experiencing moderate to severe pain. Despite this, parents and children indicated that they were happy with the quality of pain management. There is a need to explore this further and to identify strategies that support the implementation of guidelines in practice.

Pediatric nurses' postoperative pain management practices: an observational study

PURPOSEnThis study was an in-depth examination of pediatric postoperative pain care.nnnDESIGN AND METHODSnParticipant 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.nnnRESULTSnA 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.nnnPRACTICE IMPLICATIONSnThe use of pain scores to guide treatment choices needs further debate. Future research should explore the implications of divorcing treatment from pain scores on childrens pain experience.

Does the perceived importance of a pain management task affect the quality of children's nurses' post-operative pain management practices?

AIMnTo ascertain whether there is a relationship between the perceived importance of pain management tasks and the quality of an individual nurses practice.nnnBACKGROUNDnThe evidence to guide nurses pain management practices is readily available. However, childrens nurses pain management practices often fall short of the ideal. The (lack of) priority attributed to pain management has been suggested as one reason for this. However, this supposition has not previously been explored.nnnDESIGNnParticipant observation.nnnMETHODnData were collected about childrens nurses (n = 13) post-operative pain management practices on one childrens surgical ward in the English Midlands. Nurses (n = 12) also completed a questionnaire to provide a measure of the importance attributed to pain management tasks.nnnRESULTSnThe questionnaire responses of individual participants (n = 12) were compared to the observational data. The perceived importance of a pain management task did not affect the likelihood of it being undertaken.nnnCONCLUSIONnSeveral explanations for these results have been put forward. It is apparent that the hypothesis, put forward in other studies that increasing the priority attributed to pain management will improve pain management practices may be overly simplistic.nnnRELEVANCE TO CLINICAL PRACTICEnThe evidence to guide nurses pain management practices is readily available. However, childrens nurses pain management practices seem to fall short of the ideal. Possible reasons for this need to be explored so that practice can be improved.

Review of Pain Content in Three-Year Preregistration Pediatric Nursing Courses in the United Kingdom

The results of several studies suggest that gaps remain in nurses knowledge about pain in children, and particularly regarding pain assessment, analgesic drugs, and nondrug methods, suggesting a need to explore the pain content of preregistration nursing curricula. Over the past decade, the way nurse education is delivered has changed with the advent of the internet and the use of virtual learning environments. This study, therefore, explored the depth and breadth of pain content in 3-year preregistration pediatric nursing courses across the U.K. as well as ascertaining how this content is delivered. The leads for pediatric nursing at all 56 U.K. higher education institutions running the 3-year preregistration pediatric nursing course were e-mailed a questionnaire. Participants were asked to indicate whether topics are covered in the program, and if so how it was delivered. Results suggest that preregistration pediatric nursing courses in the U.K. do not always equip students to manage pain effectively in clinical practice. There appears to be limited content on pain in nursing curricula, with several institutions not covering key topics. Most teaching is delivered face to face with limited workbooks and virtual learning activities. Further research is needed in this area to ascertain the impact of this on the quality of care provided.

Establishing the Validity and Reliability of a Pediatric Pain Knowledge and Attitudes Questionnaire

Children continue to experience unrelieved pain during hospitalization, despite the evidence to guide nurses pain management practices being readily available. Nurses knowledge and attitudes have been identified as a possible reason for suboptimal pain management. This study examines the validity and reliability of an existing questionnaire to validate it for use in the population of interest. Initial testing demonstrated low reliability and validity. Modifications to the questionnaire were made on the basis of these results and the feedback provided by experts in pediatric pain management. Subsequent testing demonstrated good validity and reliability, suggesting that the questionnaire is appropriate for measuring nurses knowledge and attitudes in relation to pediatric pain management.

Managing pain in children

Managing pain in children : , Managing pain in children : , کتابخانه دیجیتال جندی شاپور اهواز

Nurses' aims when managing pediatric postoperative pain: is what they say the same as what they do?

PURPOSEnThe purpose of this study was to explore nurses aims when managing postoperative pain and whether reported aims reflect actual practices.nnnDESIGN AND METHODSnParticipant 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?nnnRESULTSnAround 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).nnnPRACTICE IMPLICATIONSnThere is evidence of individual variation in practices. This may impact on the care provided.