Pain Assessment in the Patient Unable to Self-Report: Position Statement with Clinical Practice Recommendations

Herr, Keela; Coyne, Patrick; McCaffery, Margo; Manworren, Renee C.B.; Merkel, Sandra

doi:10.1016/j.pmn.2011.10.002

Cited by 436 publications

(407 citation statements)

References 141 publications

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“…Of the 18 guidelines, 7 focused on neonates or infants only, [21][22][23][24][25][26][27] and 11 included infants and children 0 to 18 years old. [28][29][30][31][32][33][34][35][36][37][38] …”

Section: Results Of Literature Searchesmentioning

confidence: 99%

“…16 The average domain score rating was 25.5% 6 33.7%. Fourteen guidelines [21][22][23][24][25]27,28,[30][31][32][33]35,36,38 (77%) scored below 50% for this domain. These guidelines did not indicate how the guideline recommendations could be translated into clinical practice.…”

Section: Applicabilitymentioning

confidence: 99%

“…16 The average domain score rating was 28.7% 6 33.8%. Eight guidelines 21,23,27,28,30,33,36,38 (44.4%) did not provide a statement about sources of funding or describe how the competing interests were recorded and addressed.…”

Section: Editorial Independencementioning

confidence: 99%

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Pediatric Clinical Practice Guidelines for Acute Procedural Pain: A Systematic Review

et al. 2014

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BACKGROUND: Procedural pain assessment and management have been extensively studied through multiple research studies over the past decade. Results of this research have been included in numerous pediatric pain practice guidelines. OBJECTIVE:To systematically review the quality of existing practice guidelines for acute procedural pain in children and provide recommendations for their use. METHODS:A systematic search was conducted on Medline, Embase, CINAHL, PsycINFO, and Scopus from 2000 to July 2013. A gray literature search was also conducted through the Translating Research Into Practice database, Guidelines International Network database, and National Guideline Clearinghouse. Four reviewers rated relevant guidelines using the Appraisal of Guidelines for Research and Evaluation (AGREE) II Instrument. Screening of guidelines, assessment of methodological quality, and data abstraction were conducted by 2 pairs of raters. Disagreements in overall assessments were resolved through consensus. RESULTS:Eighteen guidelines from 4930 retrieved abstracts were included in this study. Based on the AGREE II domains, the guidelines generally scored high in the scope and purpose and clarity of presentation areas. Information on the rigor of guideline development, applicability, and editorial independence were specified infrequently. Four of the 18 guidelines provided tools to help clinicians apply the recommendations in practice settings; 5 were recommended for use in clinical settings, and the remaining 13 were recommended for use with modification. CONCLUSIONS:Despite the increasing availability of clinical practice guidelines for procedural pain in children, the majority are of average quality. More transparency and comprehensive reporting are needed for the guideline development process. Pediatrics 2014;133:500-515

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Section: Results Of Literature Searchesmentioning

confidence: 99%

Section: Applicabilitymentioning

confidence: 99%

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Pediatric Clinical Practice Guidelines for Acute Procedural Pain: A Systematic Review

et al. 2014

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“…Position statements and clinical practice recommendations to guide healthcare providers specific to procedural pain, needle-related procedures, (Czarnecki et al, 2011;Emergency Nurses Association, 2010 and pain assessment of nonverbal patients (Herr et al, 2006;Herr et al, 2011) exits (Bhargava & Young, 2007;MacLean et al, 2007;Young 2005). Research findings support that the implementation of educational programs and procedural pain management protocols in the ED improved the quality of care (Augarten et al, 2006; were contingent on the treatment of procedural pain as a priority, and the development of multidisciplinary committees with administrative authority to mandate change (MeunierSham & Ryan, 2003;Schechter, 2008).…”

Section: Environmental Issues and Policies In The Edmentioning

confidence: 99%

An Ethnography of the Culture of Pain in a Non-Pediatric Emergency Department

Cummings¹

2013

Journal of Pediatric Health Care

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Rationale for the Study: Despite the exponential growth in pharmacological and nonpharmacological methods for the treatment of pediatric procedural pain there remains a gap between available interventions and actual practice in the emergency department clinical setting. Researchers have recommended the examination of unit culture since culture is proposed to be a major factor that affects the implementation of pain management practices. Method:Ethnography was employed to gain access to the beliefs and practices of healthcare participants in a Northeastern non-pediatric emergency department. Data were collected for 5 months with over 100 hours of observation. Six key informants were interviewed and 44 pediatric procedural interactions with 27 healthcare providers during the treatment of children two to eight years of age undergoing procedures were observed.Other information gathered included documents from the institution, and pain related information from the patient's medical record. All interviews were recorded and transcribed verbatim. Data were managed using the Ethnograph 6.0 and analyzed using the procedure developed by Leininger and McFarland (2006). Results:Seven major themes with categories were discovered that included assessment, ii procedural pain, treatment of pain, communication related to comfort, fragmentation of care in the emergency department, healthcare provider attitudes, and environmental issues and policies. Conclusion:The results of this study suggest that practice environment of the emergency department and organizational culture exerted a significant degree of influence over healthcare providers' pediatric pain management practices. Nurses' did not use pain measurement tools as they were intended to be used and instead improvised measurement by observing the child's behavior. The management of children during painful procedures consisted of an array of behaviors and practices. The use of physical restraint during painful procedures was a common practice. Participants continue to hold many assumptions and misconceptions about pediatric pain assessment and management. The findings of this study provide insight to the everyday practice of emergency department healthcare providers for pediatric pain in a non-pediatric setting.iii Acknowledgments and Dedication

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“…Парацетамол имеет умерен-ный кратковременный положительный эффект у пациен-тов с болью в суставах, а также свои риски и отличается по цене. Это более слабый анальгетик, чем НПВП, и при приеме в суточной дозе 4 г и более, особенно при пере-дозировке, может вызвать токсическое действие на печень со значительным повышение уровня аминотранс-фераз [3,4].…”

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