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Predicting Who Receives Nonpharmacologic Pain Interventions in the Pediatric Intensive Care Unit
Nicole L Bohr1, Elizabeth Ely2, Kirsten S Hanrahan3
1Department of Nursing Research and Evidence-Based Practice, University of Chicago Medicine, Chicago, Illinois; Section of Vascular Surgery and Endovascular Therapy, University of Chicago Biological Sciences Division, Chicago, Illinois.
Insights
Nonpharmacologic pain interventions are inconsistently used and documented in pediatric intensive care units (PICUs). Children with moderate to severe pain were more likely to receive these interventions, but overall application remains unclear.
Area of Science:
- Pediatric intensive care
- Pain management
- Nonpharmacologic interventions
Background:
- Pain is prevalent in pediatric intensive care units (PICUs).
- Nonpharmacologic interventions are recommended for pediatric pain management.
- Limited data exists on the use and patterns of nonpharmacologic interventions in PICUs.
Purpose of the Study:
- To analyze recorded nonpharmacologic pain interventions in PICU patients' electronic health records.
- To identify patterns in the use of these interventions based on patient demographics.
Main Methods:
- Secondary data analysis of electronic health records from 15 PICUs across 12 children's hospitals.
- Fisher's exact test and a generalized linear mixed effects model were used to examine intervention use and predictors.
Main Results:
- 44% of 220 enrolled patients had nonpharmacologic interventions recorded.
- Most common interventions: repositioning (65%), decreasing stimuli (55%), caregiver presence (37%), distraction (23%), music therapy (20%).
- Patients with moderate to severe pain were more likely to receive interventions.
Conclusions:
- Nonpharmacologic pain management in PICUs appears inconsistent, potentially underdocumented or underutilized.
- Further research is needed on nurse's rationale, application across patient groups, and intervention effectiveness.
Aims:
The majority of patients in the pediatric intensive care unit (PICU) experience pain daily, while nonpharmacologic interventions are indicated for pain management in children, there is limited information on which nonpharmacologic interventions are provided in the PICU and which patients receive those interventions. The aim of this descriptive correlational secondary data analysis was to determine what nonpharmacologic interventions were recorded in the electronic health record of PICU patients and patterns in use by patient demographics.
Setting/Subjects:
All patients hospitalized in 15 participating PICUs are located within 12 unique children's hospitals across the United States were eligible for participation.
Methods:
Nonpharmacologic interventions used in the PICU were identified and differences between patients who did and did not receive those interventions were examined using Fisher's exact test. A generalized linear mixed effects model was constructed to determine patient characteristics that predict nonpharmacologic pain intervention application.
Results:
Of 220 enrolled patients, 97 (44%) had nonpharmacologic pain interventions recorded in their electronic health record. The most frequently recorded interventions included repositioning (65%), decreasing environmental stimuli (55%), caregiver presence (37%), distraction (23%), and music therapy (20%). Children who had moderate to severe pain were most likely to receive nonpharmacologic pain interventions.
Conclusions:
Nonpharmacologic pain management is applied inconsistently across PICUs and may be underdocumented or underutilized. Additional research is needed to determine when nurses use nonpharmacologic pain interventions, their rationale for applying these interventions across differing groups, and the effectiveness of these interventions in managing pain in critically ill children.
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