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Pain Assessment Practices in the Pediatric Intensive Care Unit
Elyse Laures1, Cynthia LaFond2, Kirsten Hanrahan3
1University of Iowa, College of Nursing, Iowa City, IA United States of America.
Insights
Pain assessment in pediatric intensive care units (PICUs) is complex. This study found a wide variety of pain scales are used, highlighting the need for appropriate tool selection for critically-ill children.
Area of Science:
- Pediatric critical care medicine
- Pain management
- Clinical nursing research
Background:
- Effective pain assessment is crucial for managing pain in critically-ill children.
- Assessing pain in the Pediatric Intensive Care Unit (PICU) presents unique challenges.
- This study examines current pain assessment practices in PICUs.
Purpose of the Study:
- To describe the prevalence of pain, pain assessment methods, and interventions in critically-ill children.
- To analyze the communicative ability, pain scales used, and pain characteristics in this population.
- To report on current pain assessment practices within PICU settings.
Main Methods:
- A cross-sectional, multi-site, descriptive study design was employed.
- Data were collected over a 24-hour period from medical records and bedside nurses.
- Information was gathered from 220 children across 15 PICUs.
Main Results:
- An average of 11.5 pain assessments were performed per child.
- Seven behavioral and five self-report pain scales were utilized.
- Instances of no scale use, 'assume pain present' documentation, or sedation scale use were noted.
Conclusions:
- A diverse range of pain assessment tools, including behavioral scales for non-verbal children, are currently in use.
- Selecting the appropriate pain assessment method for each child is paramount for effective pain management.
- Further investigation is needed into 'assume pain present' practices, pain scale standardization, and clinical support tools.
Purpose:
Pain assessment is the first step in managing pain; however, this can be challenging, particularly in settings such as the Pediatric Intensive Care Unit (PICU). This paper reports the current pain assessment practices from a study that was conducted describing the prevalence of pain, pain assessment, painful procedures, interventions, and characteristics of critically-ill children. Specifically, this paper addresses the child's communicative ability, pain scales, and characteristics of pain.
Design And Methods:
The primary study was a cross-sectional, multi-site, descriptive design. Data from a 24-hour time period were collected from medical records and bedside nurses.
Results:
Data were collected from the records of 220 children across 15 PICUs. The average number of pain assessments per child was 11.5 (SD 5.8, range 1-28). Seven behavioral scales and five self-report scales were used. There were times when no scale was used, "assume pain present" was recorded, or a sedation scale was documented. Twelve pain scales, including the target population, scoring, psychometric properties, and clinical utility are described.
Conclusions:
Results of this study indicate that a wide range of pain assessment tools are used, including behavioral scales for children unable to self-report.
Implications:
Foremost, the appropriate assessment method needs to be chosen for each child to manage pain. Knowledge of the criteria for the use of each pain assessment scale will help the clinician select the appropriate scale to use for each child. The practice of "assume pain present," as well as standardization of pain scales, and clinical support tools needs further investigation.
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