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Observation of Emergency Room Nurses Managing Pediatric Pain: Care to Be Given… Care Given…
Soulaima Abouzida1, Patricia Bourgault1, Sylvie Lafrenaye2
1Université de Sherbrooke, Faculté de médecine et des sciences de la santé, Sherbrooke, Quebec, Canada.
Insights
Pediatric pain management in the emergency room (ER) needs improvement. Increased parent involvement in pain management can enhance care for children.
Area of Science:
- Pediatric Emergency Medicine
- Nursing Best Practices
- Pain Management
Background:
- Pain management in pediatric emergency rooms (ERs) is often suboptimal.
- Negative consequences of pain underscore the need for improved interventions.
- Current best-practice guidelines for pediatric pain management exist but adherence varies.
Purpose of the Study:
- To investigate adherence to pediatric pain management guidelines in the ER.
- To examine interactions between children, parents, and nurses during pain management.
- To identify areas for optimizing pediatric pain care in emergency settings.
Main Methods:
- Observational study using qualitative and quantitative methods.
- An adapted nursing observation tool assessed pain management for children aged 0-14 years.
- Child-parent-nurse interactions were evaluated alongside pain management practices.
Main Results:
- Pain screening occurred in 55% of cases; pain scales were used in only 10%.
- Analgesic treatment was given in 75% of painful episodes, with limited follow-up (19%).
- Nonpharmacologic methods were rarely used, and parent collaboration was minimal.
Conclusions:
- Pediatric pain management in the ER is suboptimal and requires optimization.
- Enhancing parental involvement in pain management can significantly improve outcomes.
- Current practices show limited adherence to best-practice guidelines, particularly regarding parent engagement.
Background:
Although pain undeniably has negative consequences, pain management often remains suboptimal, particularly in the pediatric population in the emergency room (ER).
Aim:
In this observational study using qualitative and quantitative methods, we investigated everyday adherence to current nursing best-practice pediatric guidelines in the ER paying particular attention to the interaction between children, parents, and nurses.
Methods:
An adapted version of the nursing observation tool for pain management was used to describe pediatric pain management provided by nurses caring for children (0-14 years old) admitted to the ER. We also assessed child-parent-nurse interactions. (The aim of the study was presented to the nurses as part of the survey on interactions without specifying the focus on pain management.) RESULTS: Forty-seven children were included (91 painful episodes) during the observation period (112 hours). There was a screening for pain in 55% of cases, and pain scales were used in 10% of cases. Analgesic treatments were administered in 75% of cases (procedural or disease-related pain). Follow-up evaluations were performed in 19% of cases. Nonpharmacologic approaches were scarcely used. The use of both helpful and nonhelpful languages were noted during interactions with children and parents. Parents' collaboration was rarely requested to help relieve their child's pain.
Conclusions:
Our results show that pediatric pain management in the ER could be optimized. Parents are still not considerably involved in their child's pain management. Parents' involvement could contribute to improving pediatric pain management.
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