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Nursing assessment and management of pain in critically ill children
S Coffman1, Y Alvarez, M Pyngolil
1Broward General Medical Center, Ft. Lauderdale, FL 33316, USA.
Insights
Nurses use cardiovascular, respiratory, behavioral, and neuromuscular indicators to assess pain in critically ill children. Assessment must consider the child's limited communication abilities.
Area of Science:
- Pediatric critical care nursing
- Pain management in children
- Clinical assessment tools
Background:
- Effective pain assessment is crucial for critically ill children.
- Children in pediatric intensive care units (PICUs) have unique communication challenges.
- Standardized tools aid in consistent pain evaluation.
Purpose of the Study:
- To describe the methods nurses use to assess and manage pain in critically ill children.
- To identify the specific pain indicators utilized by nurses in a PICU setting.
Main Methods:
- A descriptive, comparative research design was employed.
- The Indicators of Pain in Critically Ill Children assessment tool was utilized.
- Data were collected from 24 PICU nurses assessing 25 critically ill children.
Main Results:
- Nurses most frequently selected cardiovascular and respiratory changes, followed by behavioral and neuromuscular indicators.
- An average of 5.3 pain indicators were noted per medication event.
- More indicators were used for trauma, surgical, and younger patients; fewer for ventilated patients.
Conclusions:
- Pain assessment in critically ill children involves unique indicators compared to less ill children.
- Nurses must account for a child's diminished capacity to communicate pain.
- The study highlights the importance of comprehensive pain assessment in PICU settings.
Objectives:
To describe how nurses assess and manage pain in critically ill children.
Design:
Descriptive, comparative research design, with use of the Indicators of Pain in Critically Ill Children assessment tool.
Setting:
Twelve-bed pediatric intensive care unit in a metropolitan general hospital with a level II pediatric trauma center.
Participants:
Twenty-four pediatric intensive care unit nurses who conducted 112 assessments of 25 critically ill children.
Results:
Pain indicators selected most frequently by nurses included cardiovascular and respiratory changes (increased heart rate, respiratory rate, and blood pressure), followed by behavioral indicators (irritable/fussy, verbalizing pain, crying), and neuromuscular responses (tenseness/rigidity, squirming, drawing up legs). The average number of pain indicators selected during each medication event was 5.3. More indicators were selected for trauma, surgery, and younger patients; fewer indicators were selected for patients receiving ventilation treatment.
Conclusion:
Pain assessment of critically ill children includes unique indicators, as compared to less sick children, and must take into account the child's decreased ability to communicate pain.