Pediatric procedural pain

Young, Kelly D.

doi:10.1016/j.annemergmed.2004.09.019

Cited by 273 publications

(271 citation statements)

References 150 publications

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“…11,15 Untreated pain in children can lead to negative physical and psychological consequences, including poor health outcomes and maladaptive behaviours. [18][19][20] The medical literature has long demonstrated many effective pharmacologic and nonpharmacologic interventions (NPIs) for pediatric pain. 15,[21][22][23][24][25] The frequency and success of application of these interventions by Canadian pediatric emergency physicians has not been reported.…”

Section: Ré Sumémentioning

confidence: 99%

Reported practice variation in pediatric pain management: a survey of Canadian pediatric emergency physicians

Ali

Chambers

Johnson

et al. 2014

CJEM

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Objectives: To describe pediatric emergency medicine (PEM) physicians' reported pain management practices across Canada and explore factors that facilitate or hinder pain management. Methods: This study was a prospective survey of Canadian pediatric emergency physicians. The Pediatric Emergency Research Canada physician database was used to identify participants, and a modified Dillman's Total Design Survey Method was used for recruitment.Results: The survey response rate was 68% (139 of 206). Most physicians were 31 to 50 years old (82%) with PEM training (56%) and had been in practice for less than 10 years (55%). Almost all pain screening in emergency departments (EDs) occurred at triage (97%). Twenty-four percent of physicians noted institutionally mandated pain score documentation. Ibuprofen and acetaminophen were commonly prescribed in the ED for mild to moderate pain (88% and 83%, respectively). Over half of urinary catheterizations (60%) and intravenous (53%) starts were performed without any analgesia. The most common nonpharmacologic interventions used for infants and children were pacifiers and distraction, respectively. Training background and gender of physicians affected the likelihood of using nonpharmacologic interventions. Physicians noted time restraints to be the greatest barrier to optimal pain management (55%) and desired improved access to pain medications (32%), better policies and procedures (30%), and further education (25%). Conclusions: When analgesia was reported as provided, ibuprofen and acetaminophen were most commonly used. Both procedural and presenting pain remained suboptimally managed. There is a substantial evidence practice gap in children's ED pain management, highlighting the need for further knowledge translation strategies and policies to support optimal treatment. RÉ SUMÉObjectifs: L'é tude visait à dé crire les pratiques, dé claré es par les inté ressé s, en matiè re de prise en charge de la douleur en mé decine d'urgence pé diatrique (MUP), au Canada, et à examiner les facteurs qui facilitent ou, au contraire, entravent le traitement de la douleur. Mé thodes: Il s'agit d'une enquê te prospective, mené e parmi des urgentologues pé diatres au Canada. La base de donné es du Groupe de Recherche en Urgence Pé diatrique du Canada pour les mé decins a servi à repé rer les sujets é ventuels, et une version modifié e de la Dillman's Total Design Survey Method a é té utilisé e aux fins de participation. Ré sultats: Le taux de ré ponse à l'enquê te a atteint 68% (139 participants sur 206). La plupart des mé decins é taient â gé s de 31 à 50 ans (82%) avaient reç u une formation en MUP (56%) et pratiquaient depuis moins de 10 ans (55%). Le dé pistage de la douleur au service des urgences (SU) se faisait presque toujours au moment du triage (97%). Vingtquatre pour cent des mé decins ont fait é tat d'une documentation obligatoire sur l'é valuation de la douleur dans leur é tablissement. L'ibuprofè ne et l'acé taminophè ne (88% et 83%, respectivement) é taient souvent prescr...

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Section: Ré Sumémentioning

confidence: 99%

Reported practice variation in pediatric pain management: a survey of Canadian pediatric emergency physicians

Ali

Chambers

Johnson

et al. 2014

CJEM

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“…If untreated, pain can result in negative, long-term repercussions (Taddio, 1999;Young, 2005). The most common painful events during infancy are immunizations, which typically are conducted without pain management (Porter et al, 1997;Felt et al, 2000).…”

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confidence: 99%

Randomized clinical trial of distraction for infant immunization pain

Cohen

MacLaren

Fortson

et al. 2006

Pain

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Distraction has been shown to be an effective technique for managing pain in children; however, few investigations have examined the utility of this technique with infants. The goal of the current study was to investigate the effectiveness of movie distraction in reducing infants' immunization distress. Participants were 136 infants (range = 1 to 21 months; M = 7.6 months, SD = 5.0 months) and their parents, all of whom were recruited when presenting for routine vaccinations. The parent-child dyads were randomly assigned to either a Distraction or Typical Care control condition. Infant and adult behaviors were assessed using a visual analog scale and a behavioral observation rating scale. Results indicated parents in the Distraction group engaged in higher rates of distraction than those in the Typical Care group, whereas there was no difference in the behavior of nurses in the Distraction and Typical Care groups. In addition, infants in the Distraction group displayed fewer distress behaviors than infants in the Typical Care group both prior to and during recovery from the injection. Findings suggest that a simple and practical distraction intervention can provide some distress relief to infants during routine injections.Keywords: Acute pain; Distraction; Infants; Behavioral approaches; Immunizations Randomized Clinical Trial of Distraction for Infant Immunization Pain A surge of research has revealed that infants experience pain similarly, if not more intensely, than adults (Porter et al., 1999). If untreated, pain can result in negative, long-term repercussions (Taddio, 1999;Young, 2005). The most common painful events during infancy are immunizations, which typically are conducted without pain management (Porter et al., 1997;Felt et al., 2000). Nonpharmacologic pediatric pain management (i.e., cognitive-behavioral intervention) has few to no side-effects, is inexpensive and easy to use, and has been deemed "empirically supported" (Powers, 1999). These interventions typically include breathing retraining, relaxation, imagery, coping skills training, rehearsal, and reinforcement (Blount et al., 2003). They are not appropriate for infants as they require a degree of cognitive capacity not yet developed in infants.A promising intervention that does not require advanced cognitive skills is distraction.Distraction is a potent anxiety and pain management tool for children's pain (for reviews, see Kleiber and Harper, 1999;Piira et al., 2002;DeMore and Cohen, 2005) but has received little evaluation in infants.Two treatment studies have examined distraction pain management for infants. Cohen (2002) evaluated movie distraction for 2-month-olds to 3-year-olds receiving immunizations.Distraction was found to lower children's distress during the post-injection recovery phase but not during the anticipatory or procedural phases. In addition, results were demonstrated only on observational measures-treatment effects were not found on parent-or nurse-reports. More recently, Cramer-Berness and Friedman (2005) compare...

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“…Multiple researchers have documented both the short-term and long-term effects from inadequately treated pediatric pain, especially in younger children (Blount et al, 2003;Schechter, Berde, & Yaster, 2003). Short-term consequences to the patient include suffering during the procedure, increased distress, hypoxemia, and altered metabolic stress response (Pokela, 1994;Young, 2005). Consequences for the healthcare provider include prolongation of the procedure (Cohen, Bernard, Greco, & McClellan, 2002), the assistance of more staff during the procedure, and the potential for more than one attempt due to initial failure.…”

Section: Concern To Be Addressedmentioning

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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Pediatric procedural pain

Cited by 273 publications

References 150 publications

Reported practice variation in pediatric pain management: a survey of Canadian pediatric emergency physicians

Reported practice variation in pediatric pain management: a survey of Canadian pediatric emergency physicians

Randomized clinical trial of distraction for infant immunization pain

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

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