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Pain Management in Paediatric Critical Care: A Cross-Sectional Study
Elyse Laures1, Cynthia LaFond2, Ann Marie McCarthy3
1University of Iowa Health Care, Iowa City, Iowa, USA.
Insights
Pediatric intensive care unit (PICU) nurses often struggle with pain management. This study highlights the need for better tools and strategies to improve pain assessment and analgesic practices for children in the PICU.
Area of Science:
- Pediatric intensive care nursing
- Pain management in children
- Clinical practice research
Background:
- Moderate to severe pain affects up to 24% of children in the pediatric intensive care unit (PICU).
- Nurses face challenges in managing pediatric pain due to patient variability and complex equipment.
- Limited research exists on pain management practices, barriers, and facilitators specifically within the PICU setting.
Purpose of the Study:
- To describe current pain assessment and analgesic premedication practices among PICU nurses.
- To identify facilitators and barriers influencing pain management in the PICU.
Main Methods:
- Secondary analysis of a cross-sectional survey study involving PICU nurses.
- Survey assessed pain assessment methods, premedication practices, pain indicators, and perceived barriers/facilitators.
Main Results:
- Nurses more frequently used behavioral scales than self-report for pain assessment, especially for ventilated patients.
- Premedication decisions for painful procedures were inconsistent among nurses.
- Nurses identified only four key behaviors indicative of pain.
- Facilitators, such as standardized tools and charting systems, were perceived more often than barriers.
Conclusions:
- There is a need to implement evidence-based pain management by leveraging existing facilitators and minimizing barriers.
- Future research should focus on developing clinician support tools grounded in implementation science principles.
- Improved understanding of current practices can guide sustainable, evidence-based pain management improvements for PICU nurses.
Background:
Up to 24% of children admitted to the paediatric intensive care unit (PICU) experience moderate to severe pain. Nurses have the ethical responsibility to manage pain, which is often challenging due to a wide range of age, developmental ability, medical diseases and complex medical equipment. Limited research has been done, specifically in the PICU, related to pain management practices and barriers and facilitators.
Aim:
The purpose of this study is to describe PICU nurses' current pain assessment and analgesic premedication practices, in addition to facilitators and barriers to pain management.
Study Design:
This study is a secondary analysis of a previous cross-sectional study. PICU nurses were asked to complete a survey regarding their pain assessment practices, premedication practices, perceptions of patient behaviours indicative of pain and barriers and facilitators.
Results:
A total of 106 nurses responded. It was found that nurses more routinely use behavioural assessment scales compared to self-report and do not regularly attempt to obtain a self-report for those who are mechanically ventilated. The decision to premedicate prior to a painful procedure was variable. Nurses found only four patient behaviours as most commonly indicating pain. Lastly, facilitators were perceived more commonly present than barriers, with nurses valuing having a designated charting system and standardised assessment tools.
Conclusion:
Overall, there is a need to leverage facilitators and minimise barriers to successfully implement evidence-based pain management practices. Future research in the creation of clinician support tools, following the principles of implementation science, is needed.
Relevance To Clinical Practice:
Understanding current pain management practices better enables frontline nurses, educators and leaders to identify, implement and sustain evidence-based pain management improvements.
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