Pain Management in Children
Pediatric Pain Management during Intravenous Line Placement: Nursing Perceptions and Interventions
Introduction
Nurses handling pediatric patients undergoing procedures in the acute care setting do not usually focus on the effective treatment of pain. Correct pharmacological and nonpharmacological interventions are the best ways to control and avoid pain. Many children are not given the correct type and amount of pain-relieving interventions. A study shows that the old and the young are two age groups with a small amount of pain management intervention in society. For instance, from an international perspective, children in Uganda underwent painful wound debridement but were not given any pain-relieving intervention. This happened even though there were pharmacological and nonpharmacological resources. Pediatric nurses are responsible for assessing pain in children and designing proper interventions and management.
Review of Literature
Articles obtained from CINAHI and google scholar were reviewed under the following subtitles, pain assessment and experience, pharmacological interventions, and nonpharmacological interventions.
Pain Assessment and Experience
Manwomen (2016) explored various definitions, characteristics, and assessment regarding pain among children. He pinpointed that pain is a biopsychosocial occurrence determined by the emotions, culture, behavior, and spirituality of an individual. A feeling of pain can represent actual or potential damage to body tissue. An experience of pain should be seen as a valid event and appropriately treated. Any pain experience requires specific assessment and intervention so that an individual may be relieved of it. Pain presents itself as acute or chronic, depending on the level of the damage of the body tissue. Chronic pain is one that persists for an extended period, whereas acute one is immediate and short-lived. Acute pain is usually caused by medical procedures such as wound debridement.
Beecham’s (2013) characterized pain in four different ways in his article, Pharmacological interventions for pain for limiting conditions in children and adolescents. The four categories include location, intensity, temporality, and nociceptive versus neuropathic. Nociceptive pain occurs when body tissue is directly injured, whereas neuropathic pain occurs when the nervous system is damaged. The intensity of pain is determined by pain diagrams depicting pictures of the level of the pain. Another way of detecting the intensity of pain is by use of pain scales with a range of 0-10. Location, on the other hand, refers to the point in the body where an individual experiences pain sensation. Temporality represents pain trimming, for instance, episodic versus recurrent pain and acute versus chronic.
Pharmacological Interventions
Palmer (2016) focused on the options of pharmacological pain management in his article Pain management in the acute care setting: Update and debates. These options involve medications that are administered to the children suffering from acute pain, and they include anesthetics, opioid analgesics, and nonopioid analgesics, just to mention but a few. The pediatrics administer the medication in consideration of the patient’s condition, possible side effects, and the suspected requirements. Bahorski (2015) explored how children’s age, sex, and ethnicity impact his/her perception and response to acute pain and relieving interventions. In his study, he tested topical Lidocaine cream, one of the pain-reducing measures. He found that the measure was effective in controlling pain among many children that were involved in the study.
Nonpharmacological Interventions
Short (2013) study, Nonpharmacological Techniques to Assist in Pediatric Pain Management. Short focused on the no-pharmacological pain treatment, of which he categorized them into four types: physical, behavioral, cognitive, and complementary. He stated that these treatments could be given to infants, kids, pre-school, school-aged, and adolescent. However, the amount of treatment varies in different groups. He pinpointed the presence of a parent and his/her encouragement as one of the behavioral interventions. Distractions and self-copying utterances are examples of cognitive interventions. Complimentary interventions use therapeutic music art and medical play, whereas physical methods consist of sucking, deep breathing, and positioning. Short concluded that combining these therapies with medical and pharmacological interventions helps relieve the child of both acute and chronic pain.
Data Analysis
The researcher analyzed the collected data using a statistical package. The data however, were separated into different categories to identify how nurses manage pain among children. These categories include education on pediatric procedural pain management, the importance of pain management time for implementing pain-relieving measures the frequency of performing placement on infants. The results from the analysis were presented through bar graphs that are easy to read and interpret.
Methodology
This study is a quantitative research that used numerical Likert scales to obtain the responses of both objective and subjective questions. The information gathered from the exploratory study can be applied to various studies on pediatric procedural pain management. Subjects used in this study were chosen through non-probability convenience sampling. Current and expired nurses affiliated to both the Rhao Alpha chapter of the honors society were requested through email to participate in the study. Also, emails were sent to specific pediatric nurses at the Dominican University, faculty of nursing. The researchers encouraged snowball sampling, and survey questions were sent through an email link that could be shared among the chosen nurses.
Outcomes of the study and implications for future research
The evidence presented in each step of the study supports the overall outcome. The study reveals that nurses judge children who experience less pain, which is why pediatric nurses have poor management of pain. The study leads us to the suggestion that nurses need to understand that children of different age groups show varied responses when exposed to pain stimuli. Children continue to suffer from poor pain management despite ongoing researches on the topic. Future research should include a study of the specific age groups and assess the effective ways of interventions to manage pain among children properly. Moreover, research needs to be done to establish the root cause of the barriers to managing pediatric pain.
While it is essential to focus on the topic of the study, researchers should also focus on protecting human subjects and culture. In this particular study, researchers took into consideration the protection of the lives of those who participated in the research. As it involved interview pediatrics from various departments, those chosen were experienced, professionals. Therefore their responses came from the scientific point of view that they have acquired in their practice. The suggestions of the possible ways of controlling both acute and chronic pain among children, for instance, the use of opioid and nonopioid analgesics, are informed by the accumulate pediatric knowledge and, therefore, the holds no danger to human life if used. The nursing culture was considered in the research as the researchers involved pediatric from recognized institutions in the study.
Limitations and Strengths
Researchers reviewed the literature of the research done in the past. The reviewed literature is within five years since its publication. Therefore, the information obtained was a representation of the nursing field’s current situation and in the line of pediatric pain management. However, limitations were present in the study as the selected nurses represented a particular group. So the responses received were not representing the entire population. To avoid this, the researchers could have chosen various nurses all over the country to obtain information representing the whole country as a whole.
The reviewed literature revealed that current nurses perceive that children experience less pain when exposed to pain stimuli. This might be one of the reasons why pain management among them is lower than as expected. This study suggests that pediatrics need some training to know how to identify the intensity of pain a child is suffering from and address it effectively. Also, pediatrics need to evaluate personal judgments and thoughts to understand who to treat different age groups.
Nurses’ Competence in Pain Management in Children
Background
The procedural pain of children has been lowly recognized and treated in history. Pediatric patients have complained about pain during treatment and other procedures than the pain from the actual ailment. Children judge the intensity of pain based on the types of pain they have experienced in the past. Children understand pain according to the level of development and the nature of the pain they experienced in the past. Many of them lack the vocabulary to describe the pain or fear the consequences of expressing it. Children do not describe the pain as the adults do; therefore, we are led to understand that the understanding of pain relies on the individual’s age.
Literature review
According to Meretoja, Leino-Kilipi, & Karia (2014), the understanding of competence among nurses requires that we consider an integrative, holistic, and context-specific dimension. This perspective takes into account values ethics, skills, and context-specific knowledge. Competence is acquired through a combination of knowledge and skills, and attitude and values are juxtaposed with this knowledge and skills. A competent person possesses trust, adaptability, communication skills, and shows care. (Girot 2015) explored the topic Manifestation of Competence. In his study, he found that competence is manifested by the ability to build and sustain relationships, empower people, promote knowledge development, and take action on behalf of other individuals.
Data analysis
This study aimed to identify various factors that influence how nurses manage pain in children. Researchers identified statements related to situations where a child in pain was being attended to by a nurse. The outcome for the observation was either positive or negative. Content analysis was utilized in the study to analyze data. The method was suggested by Krippendorf (2004). Graneheim and Lundman’s (2014) working model were employed in the abstraction from the text to categories. Researchers identified each incident as a meaningful unit that was contracted and coded. Codes were then combined divided into categories and subcategories. Finally, the categories and subcategories were present in decreasing order.
Methodology
This study is a qualitative one, and it aims at establishing factors influencing the management of pain children. The researchers selected 21 nurses from the pediatric department to participate in the study. Nurses they were eligible for selection were those who had more than one year of work experience. The researches use interviews to collect data from the selected nurses.
This study aimed to give us an in-depth understanding of the importance of nurses’ competence in pain management in children. The outcomes of the research revealed that caring for children in pain requires competencies, which include professional knowledge, abilities, motives, and self-image and individual characteristics. Looking at evidence presentment in the methodology, data analysis, literature review, and background information clearly supports the outcome. For instance, Girot (2015) stated that competence among professionals manifest in how the deal create relationships between patients and colleagues. On the other hand, data analysis helped the research to organize data in a way that was easy to obtain vital information.
This research showed that nurses’ theoretical knowledge of compassion for taking care of patients in pain is paramount. A competent nurse is the one that can assess the intensity of the pain the patient is suffering from. After assessing it, he/she move to the next step of managing pain. Pain management is a broad concept as it involves combining several factors to realize the outcome, which is relieving the patient of the pain. This is the step that competence is the essential aspect of a nursing professional or a pediatric. While this study sought to identify nurses’ competence in dealing with pain, future research needs to include the aspect of strengthening nurses. Identifying competence shortcoming will still leave gaps in pain management in children, but identifying the possible ways of empowering nurses will close this gap.
The researchers addressed several factors in the study, including the protection of human subjects and cultural considerations. In every study, the protection of people is crucial. The research should keep this in mind from collecting data to the interpretation of the data. In this study, researchers interviewed nurses who have work experience of more than one year. This forms a group whose views on the current competencies of nurses in pain management, if implemented, won’t harm people.
Furthermore, they were more experienced and learned nurses in the sample that was used for the study. The study took into consideration the nursing culture as those selected for the study were nurses. So the conclusions of this study are concerning the permissive culture inward, which is crucial in helping pediatrics to optimize the work around the children.
Limitations and strengths
Any study has both strengths and limitations, with the former being the advantage side and the latter being the disadvantage of a study. The researchers interviewed nurses who had spent more than one year in the nursing field. This group has first-hand information on how the situation as far as the field is. This means that the information collected by the researchers is the actual representation of the nursing landscape regarding the competence of nurses in pain management. The limitation of this study is that nurses tend to conclude that certain professionals are based on years of experience in the field. The years of experience are not enough to point to the fact that one is competent, but exposure to various aspects of competence in pain management qualifies a nurse to be competent.
The evidence in the article informs the current nurse’s practice in several ways. First, it indicates that nurses need to be empowered to develop the desire to handle a child in pain with utmost care and professionalism. Also, nurses require to take a multidimensional approach to assess pain, including collaboration with other colleagues and parents to realize the overall goal of pain management. It also indicates that nurses’ communication skills are below the expected standard, and therefore it is crucial to be further developed. To enable nurses to build professional competence, strengthening nurse’s professional development and reflection is paramount.
Pain management in children is a topic that has attracted several scholars. Their studies have aimed to develop interventions or possible ways of reliving children of pain. The two articles have provided various evidence of pain management in children. The literature reviewed in these articles has further helped advance the work of the authors of these studies. The first study focused on the interventions that can be taken to relieve children of pain. The study pinpointed that children of different age groups have different perceptions of pain, and therefore the nurse needs to understand this fact to administer proper medication. The second study focused on the competence of nurses, where it reveals that competence is acquired through the combination of knowledge and skills with attitude and skills. All in all, the two studies served to advance pain management in children.
References
Beecham, E., Howard, R., Mcculloch, R., Candy, B., Laddie, J., Rees, H., . . . Jones, L. (2015). Pharmacological interventions for pain for life-limiting conditions in children and adolescents. Cochrane Database of Systematic Reviews,(3). DOI:10.1002/14651858.cd010750
Palmer, G. M. (2016). Pain management in the acute care setting: Update and debates. Journal of Paediatrics and Child Health,52(2), 213-220. DOI:10.1111/jpc.13134
Manworren, R. C., & Stinson, J. (2016). Pediatric Pain Measurement, Assessment, and Evaluation. Seminars in Pediatric Neurology,23, 189-200
Bahorski, J. S., Hauber, R. P., Hanks, C., Johnson, M., Mundy, K., Renner, D., . . . Gordon, G. (2015). Mitigating procedural pain during venipuncture in a pediatric population: A randomized factorial study. International Journal of Nursing Studies,52(10), 1553-1564. DOI:10.1016/j.ijnurstu.2015.05.014
Short, S., Pace, G., & Birnbaum, C. (2017). Nonpharmacologic Techniques to Assist in Pediatric Pain Management. Clinical Pediatric Emergency Medicine,18(4), 256-260. DOI:10.1016/j.cpem.2017.09.006
Meretoja,R.,LeinoKilpi,H.,&Kaira,A.M.(2014).Comparisonofnursecompetenceindifferenthospitalworkenvironments.JournalofNursingManagement,12(5),329—336.
Girot, E. A. (2015). Assessment of competence in clinical practice: a phenomenological approach. Journal of Advanced Nursing, 18(1), 115-119
Krippendorf, K. (2004). Content Analysis: An Introduction to its methodology (2. ed.). London: SAGE Publications.
Graneheim, U. H., & Lundman, B. (2014). Qualitative content analysis in nursing research: concepts, procedures, and measures to achieve trustworthiness. Nurse education today, 24(2), 105-112.