Pediatric Pain Assessment

Monique Sandoval Azusa Pacific University

Scientific Writing GNRS 507

Background

• The Joint Commission on Accreditation of Healthcare Organization (JCAHO) requires effective pain assessment & management within accredited healthcare institutions

• Pain is subjective

• Inappropriate assessment tool utilization

• FACES vs. FLACC scale

(Vael & Whitted, 2014)

PICOT Question

• In hospitalized pediatric patients younger than 36 months of age, does an educational intervention intended to educate staff nurses about the use of an appropriate pain assessment scale alter nursing practice by increasing pain assessment, and decreasing pain, in preverbal children over a period of two months, compared to no educational intervention?

Key Points

• Nurse education in-services demonstrate positive outcomes

• Developmentally & age appropriate pain assessment tools, such as the faces, legs, activity, cry, consolability (FLACC) scale

• Increased nurse awareness

• Increased pain management

• Decreased pain

(Treadwell, Franck, & Vichinsky, 2002; Vael & Whitted, 2014)

Grading Outcome

• Eight studies were included demonstrating reliable evidence upon critical evaluation

• Majority were graded as level 3

• One was graded as level 4 and another as level 6, according to Fineout-Overholt, Melnyk, Stillwell, and Williamson (2010) Hierarchy of Evidence for Intervention Studies criteria

(Fineout-Overholt, Melnyk, Stillwell & Williamson, 2010)

Clinical Implications

• Implementation of quarterly in-service pediatric nurse education per unit

• Discussion topic: developmentally & age appropriate pain assessment tools (FLACC) for the preverbal patient population

• FLACC scale: effective, convenient, safe and easily implemented intervention to appropriately assess pain in preverbal pediatric patients

(Vael & Whitted, 2014)

Potential Barriers

• Staff response to change

• Attitude & unwillingness

• Loss of independence

• Post intervention, pediatric nurses reported increased FLACC scale use, increased pain assessment, improved staff responsiveness to pain, as well as greater satisfaction with assessment tools

(Treadwell, Franck, & Vichinsky, 2002; Vael & Whitted, 2014)

Ethical Considerations

• To comply with patient rights & justice frameworks, assessment of pain in all patients is required by JCAHO

• Ethical concern for any patient if needs are not met during one’s hospital stay

• Pain is physical, emotional, and spiritual for many patients, and every patient has the right to have their pain assessed & managed to provide quality, personalized, patient-centered care (O’Brien, 2014)

Expected Outcomes

• Increased assessment, documentation & management of pain

• Decreased pain

• Increased nurse awareness

(Vael & Whitted, 2014)

Modes of Measurement

• Documentation of pain assessment

• Patient charts

• Decreased pain after assessment & treatment

• Scores in the documented categories of face, legs, activity, cry, and consolability, within patient charts, will be evaluated to measure pain assessment and management post-intervention (Vael & Whitted, 2014).

Conclusion

• Nurse education is cost-effective

• Easily implementable intervention

• Increases nurse awareness

(Vael & Whitted, 2014)

• Improves assessment & reduces pain in preverbal pediatric patients

Reference

Baulch, I. (2010). Assessment and management of pain in the paediatric patient. Nursing Standard, 25(10), 35-40. Retrieved from

http://eds.a.ebscohost.com/eds/pdfviewer/pdfviewer?sid=c3a62a2f-7392-4c20-9bfc-4b2e39f39c69%40sessionmgr4005&vid=1&hid=4102

Bear, L., & Ward-Smith, P. (2006). Interrater reliability of the COMFORT scale. Pediatric Nursing, 32(5), 427. Retrieved from http://eds.a.ebscohost.com/eds/detail/detail?sid=62f3324e-cee4-4492-bc68-e2d383a7c0a0%40sessionmgr4004&vid=0&hid=4202&bdata=JnNpdGU9ZWRzLWxpdmU%3d#db=rzh&AN=2009314878

Fineout-Overholt, E., Melnyk, B.M., Stillwell, S.B., Williamson, K.M. (2010). Critical appraisal of the evidence: Part I. AJN, 110(7). 47–52.

Johansson, M., & Kokinsky, E. (2009). The COMFORT behavioural scale and the modified FLACC scale in paediatric intensive care. Nursing In Critical Care, 14(3), 122-130. doi:10.1111/j.1478-5153.2009.00323.x

O'Brien, M. (2014). The nurse-patient relationship: A caring ministry. In Spirituality in nursing standing on holy ground (5th ed., pp. 87-113). Burlington, MA: Jones and Bartlett Pub.

Reference

Pain management for children. (2001, April 1). Retrieved March 20, 2015, from http://www.health-first.org/ health_info/your_health_first/kids/pain.cfm

Smyth, W., Toombes, J., & Usher, K. (2011). Children's postoperative pro re nata (PRN) analgesia: Nurses' administration practices. Contemporary Nurse: A Journal For The Australian

Nursing Profession, 37(2), 160-172. doi:10.5172/conu.2011.37.2.160

Stanley, M., & Pollard, D. (2013). Relationship between knowledge, attitudes, and self-efficacy of nurses in the management of pediatric pain. Pediatric Nursing, 39(4), 165-171. Retrieved from http://eds.a.ebscohost.com/eds/pdfviewer/pdfviewer?sid=13cb2ab0-ad03-4990-8897- d3f2a124db30%40sessionmgr4004&vid=1&hid=4102

Treadwell, M., Franck, L., & Vichinsky, E. (2002). Using quality improvement strategies to enhance pediatric pain assessment. International Journal for Quality in Health Care, 14(1), 39-47. doi: http://0- dx.doi.org.patris.apu.edu/10.1093/intqhc/14.1.39

Vael, A., & Whitted, K. (2014). An educational intervention to improve pain assessment in preverbal children. Pediatric Nursing, 40(6), 302-306. Retrieved from

http://eds.a.ebscohost.com/eds/pdfviewer/pdfviewer?sid=0b594679-3f29-4271-9c12-13dd08e4c63e%40sessionmgr4004&vid=1&hid=4102

Reference

Van Hulle Vincent, C., Wilkie, D., & Wang, E. (2011). Pediatric nurses' beliefs and pain management practices: an intervention pilot. Western Journal of Nursing

Research, 33(6), 825-845. doi: http://dx.doi.org/10.1177/0193945910391681