Helen N. Turner

A randomized, double-blind comparison study of EMLA and ELA-Max for topical anesthesia in children undergoing intravenous insertion.

Background : Topical anesthetics may help reduce discomfort associated with procedures involving needle‐puncture, such as intravenous (i.v.) insertions, in children. EMLA® cream has become a common, noninvasive therapy for topical anesthesia in children. ELA‐Max® is a recently introduced topical anesthetic cream marketed as being as effective in producing topical anesthesia after a 30‐min application as EMLA® is after a 60‐min application. The purpose of this research was to compare ELA‐Max® at 30 min with EMLA® at 60 min for providing topical anesthesia for i.v. insertions in children.

Complex Pain Consultations in the Pediatric Intensive Care Unit

The assessment and management of pain in children is not always easy and it is clearly more difficult in the critical care setting. Pain management is further complicated in this vulnerable population by the nature of their critical condition, the complexity and multidimensionality of their illness or injuries, and the intensity of emotions in this environment. A variety of pain syndromes are encountered in the pediatric intensive care unit, and the staff there may not be familiar with or comfortable managing these cases. Pain assessment and treatment can be more appropriately managed when guided by the experts of a multidisciplinary pediatric pain service.

American Society for Pain Management nursing position statement: pain management in patients with substance use disorders.

The American Society for Pain Management Nursing (ASPMN) has updated its position statement on managing pain in patients with substance use disorders. This position statement is endorsed by the International Nurses Society on Addictions (IntNSA) and includes clinical practice recommendations based on current evidence. It is the position of ASPMN and IntNSA that every patient with pain, including those with substance use disorders, has the right to be treated with dignity, respect, and high-quality pain assessment and management. Failure to identify and treat the concurrent conditions of pain and substance use disorders will compromise the ability to treat either condition effectively. Barriers to caring for these patients include stigmatization, misconceptions, and limited access to providers skilled in these two categories of disorders. Topics addressed in this position statement include the scope of substance use and related disorders, conceptual models of addiction, ethical considerations, addiction risk stratification, and clinical recommendations.

Parental Preference or Child Well-being: An Ethical Dilemma

An ethical dilemma that is not uncommon to encounter when caring for children occurs when parental preference does not appear to be in the childs best interest. Challenges facing the health care team are further amplified when the familys cultural background does not match that of the team. A case study will be used to illustrate the challenges of a pediatric palliative care ethical dilemma further complicated by cultural diversity. Review of the childs medical condition, patient/parent preferences, quality of life, and contextual features will be followed by an analysis and recommendations for resolution of this challenging situation.

American society for pain management nursing (aspmn) position statement: Male infant circumcision pain management

The ASPMN strongly recommends that infants who are being circumcised must receive optimal pain management. ‘‘If a decision for circumcision is made, procedural analgesia should be provided’’ (AAP, 1999, p. 691). Therefore, it is the position of the ASPMN that optimal pain management must be provided throughout the circumcision process. Furthermore, parents must be prepared for the procedure and educated about infant pain assessment. They must also be informed of pharmacologic and integrative pain management therapies that are appropriate before, during, and after the procedure.

Delirium in the Critically Ill Child

Purpose/Objective: The purposes of this article are to describe the scientific literature on assessment, prevention, and management of delirium in critically ill children and to articulate the implications for clinical nurse specialists, in translating the evidence into practice. Description: A literature search was conducted in 4 databases—OvidMEDLINE, Cumulative Index to Nursing and Allied Health Literature, PsychINFO, and Web of Science—using the terms “delirium,” “child,” and “critically ill” for the period of 2006 to 2016. Outcome: The scientific literature included articles on diagnosis, prevalence, risk factors, adverse outcomes, screening tools, prevention, and management. The prevalence of delirium in critically ill children is up to 30%. Risk factors include age, developmental delay, severity of illness, and mechanical ventilation. Adverse outcomes include increased mortality, hospital length of stay, and cost for the critically ill child with delirium. Valid and reliable delirium screening tools are available for critically ill children. Prevention and management strategies include interventions to address environmental triggers, sleep disruption, integrated family care, and mobilization. Conclusion: Delirium is a common occurrence for the critically ill child. The clinical nurse specialist is accountable for leading the implementation of practice changes that are based on evidence to improve patient outcomes. Screening and early intervention for delirium are key to mitigating adverse outcomes for critically ill children.