Pain Management in Paediatric Critical Care: A Cross-Sectional Study

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.

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.

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.

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.

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.

Understanding current pain management practices better enables frontline nurses, educators and leaders to identify, implement and sustain evidence-based pain management improvements.