Management of Pain in Pediatric Nursing Essay

Pain management is a complex issue that has become increasingly significant in the nursing profession; so much so that the assessment of pain has become known as the fifth vital sign. This issue becomes even more crucial when attempting to manage pain in pediatric patients.

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Hospitalized pediatric patients often undergo procedures which cause pain; therefore, nurses must have knowledge regarding various pain management methods. Recently, a study was conducted that explored the rationale for the poor management of pediatric pain by nurses. According to Twycross (2010), nurses today have a knowledge deficit concerning pediatric pain and continue to believe many fallacies regarding pain management in children. Nurses continue to disregard the subjective aspect of pain, and according to Kortesluoma et al., (2008), there have been limited studies that have addressed a child’s preferred pain management strategies and less is understood about the strategies performed by pediatric patients themselves. Little attention has been given to the pediatric patient’s perception of pain, nor to the interventions that the nurse can provide in order to effectively manage a child’s pain.

Most current studies have focused primarily on pain relief methods initiated by healthcare workers rather than the pediatric patient’s perception of pain or her preferred pain management strategies (Kortesluoma et al., 2008). The purpose of this paper will be to explore the importance of inquiring about the patient’s self-imposed pain relief methods, and the role of the nurse in assisting the child to minimize his pain. For this paper, the term self-imposed will be used to identify any strategy initiated by the pediatric patient himself to relieve pain.Management of Pain in Pediatric Nursing Essay

Review of the Literature:

Pain management in pediatric patients has been extensively examined by many researchers, although, less is known about the pediatric patient’s perception of pain relief and the self-imposed methods the patient uses to relieve pain. A study completed by Kortesluoma et al., in 2008 studied the pediatric patient’s self-help strategies for pain relief. The authors concluded that hospitalized children utilized a variety of self-help methods during episodes of pain. Nineteen self-imposed pain relief methods were identified including strategies such as: massaging the painful site, deep breathing, changing body position, exercise, positive self-talk, crying, applying ice and/or heat, and attention diversion.Management of Pain in Pediatric Nursing Essay

According to Kortesluoma et al., (2008), a child’s perception of pain and his self-help methods to reduce pain should be the most reliable source when developing a plan to manage care, as pain is an entirely subjective experience. In this same study, it was concluded that children also identified nurse-initiated pain relief methods to be very beneficial when attempting to achieve pain relief. The children stated the desire for nursing services to help manage pain, and they sought out the assistance of nurses on a regular basis. The findings support identifying self-imposed pain relief methods when attempting to develop a plan to manage pediatric patients’ pain. The authors identified that children rely on nurses to help relieve pain; therefore, it is important that nurses include the pediatric patient’s preferred self-help methods when assessing pain and developing a plan of care.Management of Pain in Pediatric Nursing Essay

Though children reported that nurses are important in managing their pain, nurses continue to perform suboptimal pain management. According to Twycross (2010), nurses lack knowledge regarding pharmacological and non-pharmacological pain management techniques, as well as the psychological factors that may play a role in managing pain. She also discovered that nurses consider pain management to have a low priority in nursing care, and that many nurses incorrectly assume that some pain is to be expected during a child’s hospitalized stay. Twycross (2010), observed that nurses tend to assess pain using only developmental and behavioral milestones, and continuously negate the child’s self-reported pain. The results of this study support the idea that further research is needed regarding the usefulness of including the pediatric patient’s self-imposed pain relief methods as part of the nursing pain assessment.Management of Pain in Pediatric Nursing Essay

Many of the self-imposed pain relief techniques identified by Kortesluoma et al., (2008) such as: massage, deep breathing, and hot/cold therapy can be considered forms of complementary therapy. Gerik (2005), studied the importance of mind-body complementary therapies in achieving pain relief for procedure-related pain. She concluded that cognitive-behavioral training, such as distraction and relaxation, effectively decreased fear and pain in pediatric patients. Many of the methods identified by Gerik (2005) as effective pain relief measures were similarly identified by Kortesluoma et al., (2008) as the self-help methods reported by pediatric patients for pain relief strategies. A strong connection can be made between the effectiveness of the self-reported methods and pain relief. This research supports the need to identify the preferred self-imposed pain relief methods in pediatric patients.Management of Pain in Pediatric Nursing Essay

Though the use of complementary therapies has been researched and shown to be effective at managing pain, the use of these therapies is rarely discussed by physicians. A study conducted by Roth, Lin, Kim, and Moody (2009) researched pediatric oncologists’ views of the use of complementary therapies in children with cancer. The pediatric oncologists believe that therapies such as prayer, guided imagery, and exercise have significant potential to relieve pain in their patients. Many of these complementary therapies are utilized as self-help pain relief methods for pediatric patients (Kortesluoma et al., 2008 & Gerik, 2005). The researchers concluded that 99% of pediatric oncologists believe it is important to know what complementary therapies are used by the patient. However, less than half of these physicians actually ask their patient about complementary therapies stating a lack of time as a rationale for the omission; therefore, the role of the nurse may be essential in providing information and advocating for their patients regarding complementary therapies.Management of Pain in Pediatric Nursing Essay

Nursing Implications

The identification of the pediatric patient’s preferred self-imposed pain management methods will significantly affect the delivery of nursing care for these patients. The ability to recognize the child’s preferred interventions will allow the nurse to better assess and care for the child’s pain. Interventions can be developed accordingly that will significantly decrease the child’s overall level of pain. Many nurses do not place significant emphasis on managing pain in pediatric patients. Performing a more thorough pain assessment is an issue of great importance for the nursing community. While performing this pain assessment, nurses will be able to incorporate information regarding complementary therapies to help alleviate the patient’s pain. Currently, nurses use a variety of pain scales to assess a child’s pain and pain relief measures are initiated based on this nursing assessment. Though pain assessments are routinely completed, nurses often fail to question the child regarding the self-imposed pain relief methods utilized to relieve pain. Listening to the patient regarding self-imposed pain management strategies and including complementary pain management options will help to augment pharmacological methods, which will help to greatly reduce the child’s pain.Management of Pain in Pediatric Nursing Essay

Children are under assessed and under treated for pain associated with medical
procedures, specifically during venipuncture. Recent studies show that procedural pain is
preventable and that pain management interventions are underutilized. Failure to provide
adequate pain relief can mentally and physically hurt children – in addition to inducing fear,
suffering and lack of trust, exposures to pain can alter the central nervous system and increase a
child’s sensitivity to pain. Pediatric nurses are responsible for assessing and managing pain
before, during and after a procedure. Therefore, this review of literature and pilot study examines
how registered nurses practicing in the acute care setting manage pain with pharmacological and
nonpharmacological interventions across the pediatric developmental spectrum during
venipuncture. This quantitative descriptive exploratory pilot study was guided by the Kolcaba
theory of comfort which focuses on holistic care and considers all dimensions of an individual
when addressing discomfort. Based on this theory, a quantitative survey was created to obtain
information regarding nurses’ perceptions and interventions related to pediatric venipuncture.
Seven nurses participated be completing the survey. The literature review and pilot study reveal
how nurses currently manage pain and how nursing care and pediatric procedural pain
management can be improved. Management of Pain in Pediatric Nursing Essay
PEDIATRIC IV PLACEMENT PAIN MANAGEMENT 5
Introduction
Pediatric patients undergoing procedures in the acute care setting are not always
effectively treated for pain. Pain can be controlled and sometimes avoided with correct
pharmacological and nonpharmacological interventions. However, not all children receive the
correct amount or type of pain relieving interventions. Past research has shown that the two age
groups that have historically received the least amount of pain management have been the very
old and the very young. For example, within an international perspective, at the Bwindi
Community Hospital in Uganda children underwent painful procedures such as wound
debridement without any pain relieving interventions – even though pharmacological and
nonpharmacological resources were available. Pediatric nurses hold great responsibility in
anticipating and recognizing pain in children and subsequently determining appropriate
assessment tools, interventions, continued management and re-evaluation of interventions used.
Problem Statement
Many children are not effectively treated for pain related to procedures in the acute care
setting. Despite available resources and research, children continue to be under assessed and
under treated for pain associated with medical procedures (Bice, 2014). A recent study by Bernie
(2014) surveyed over 100 children, ages 3 weeks to 18 years, and their families in four hospitals
in Canada and found that 94% of the children experienced pain within the past 24 hours of their
hospital stay. Of the 94%, only 66% were given pharmacological pain relief. The study also
found that the younger age correlated with less pain assessments and interventions for the child.
The study suggested that procedural pain is preventable and that pain management interventions
are underutilized (Birnie, 2014).Management of Pain in Pediatric Nursing Essay
PEDIATRIC IV PLACEMENT PAIN MANAGEMENT 6
The World Health Organization states that access to pain relief is a basic human right
(Lohman, 2010). Additionally, the American Society for Pain Management Nursing asserts that
every person has the right to optimal pain management before, during, and after a potentially
painful or stressful procedure (Czarnecki, 2011). Failure to provide adequate pain relief can
mentally and physically hurt children – in addition to inducing fear, suffering and lack of trust,
exposures to pain can alter the central nervous system and increase a child’s sensitivity to pain
(Marshall, 2018).
Nurses must manage a variety of patient symptoms, pain being one of the most
crucial. Pediatric nurses are directly responsible for anticipating, recognizing and evaluating
pain and subsequently implementing necessary interventions before, during and after procedures.
Pharmacological and nonpharmacological pain management resources are usually available,
however, not all nurses may use, be aware of, or have the knowledge to utilize these resources.
Therefore, the aim of this study is to investigate how nurses currently utilize pharmacological
and nonpharmacological interventions to manage pain before, during, and after procedures for
pediatric patients. The research question for this study is: Which pharmacological and
nonpharmacological interventions have been found to be most effective in the management of
procedural pain in the pediatric population?
Purpose Statement
Therefore, the aim of this study is to investigate how nurses currently utilize
pharmacological and nonpharmacological interventions to manage pain before, during, and after
procedures for pediatric patients.
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Research Question
The research question for this study is: Which pharmacological and non-pharmacological
interventions are the most effective and most commonly used to manage procedural pain in the
pediatric population?Management of Pain in Pediatric Nursing Essay

NOW

Literature Review
The following literature review addresses recent information regarding the types of
nursing practices surrounding pediatric pharmacological and nonpharmacological pain
management. The reviewed literature was retrieved from the following databases: CINAHL,
Iceberg and Google Scholar. Ten articles were reviewed under the following subheadings: Pain
experience and assessment, pharmacological interventions, nonpharmacological interventions,
pediatric considerations and implications for nursing practice.
Pain Experience and Assessment
The article, Pediatric Pain Measurement, Assessment, and Evaluation by Manworren
(2016) explores various definitions, characteristics, and assessments of pain specific to the
pediatric population. Manworren states that pain is a biopsychosocial phenomenon that depends
on sensation, emotions, behavior, development, spirituality, and culture. A pain sensation can
represent potential or actual tissue damage. Each pain experience should be viewed and treated
as a valid and real event.
Different types of pain require specific assessments and interventions. Pain can be acute,
chronic, or a combination. Acute pain is generally immediate and short-lived whereas chronic
pain is persistent and occurs for three or more months. Medical procedures such as venipuncture
and wound debridement usually cause acute pain. Pain sensation can be neuropathic or
nociceptive. Neuropathic pain is caused by nervous system damage. Whereas nociceptive pain
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occurs with actual or potential damage to non neural tissues. Nociceptive pain can be somatic,
involving external organs and the musculoskeletal system, or visceral, affecting internal organs Management of Pain in Pediatric Nursing Essay
(Manworren, 2016).
Similarly, Beecham’s (2013) study, Pharmacological interventions for pain for lifelimiting conditions in children and adolescents, describes four ways of characterizing pain:
Nociceptive versus neuropathic, intensity, temporality, and location. Nociceptive pain occurs
with direct tissue injury whereas neuropathic pain is caused by injury or malfunction of the
nervous system. Pain intensity refers to the objective and subjective spain level scoring. Intensity
can be determined by pain scales ranging from 0 to 10 or pain diagrams displaying pictures of
pain levels. Objective assessments such as vital signs can also provide information about
intensity. Temporality refers to the timing of pain such as acute versus chronic and episodic
versus recurrent pain. Location describes the exact area and radiation of the pain sensation.
Manworren asserts that a multidimensional pain assessment should include: Pain
intensity, location, duration, quality, perception, emotional response, and pain influencers. To
effectively assess pain in children, health care providers should: Take a pain history, assess the
child’s pain with an appropriate tool, and reassess the child after initiating interventions. Various
pain assessment tools are available to address different developmental ages, types of pain, and
pain associated symptoms. However, of the thirty self-reporting pain intensity assessments, only
six have evident reliability, validity, and feasibility (Manworren, 2016).Management of Pain in Pediatric Nursing Essay
Pharmacological Interventions
The article Pain management in the acute care setting: Update and debates by Palmer
(2016) focuses on the use of pharmacological pain management options commonly administered
pediatric patients in acute pain. Some of theses medications include: Non-steroidal anti
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inflammatory drugs, nonopioid analgesics, opioid analgesics, anesthetics and other medications
such as tramadol and benzodiazepines. Medications are administered to children based on the
child’s condition, suspected need, possible side effects, and present contraindications. Palmer
suggests that pediatric health care professionals need increased awareness and knowledge of
pharmacological management of pediatric pain (Palmer, 2016).
Beecham (2015) described four main categories of pediatric pharmacological pain
management: Non-opioid analgesics, opioid analgesics, local anesthetics, and adjuvant
analgesics. Non-steroidal anti-inflammatory medications, such as acetaminophen, are considered
non-opioid analgesics and are of the most common pain-relieving drugs administered to children.
Opioid analgesics, such as morphine, are not as commonly used. Interestingly, Beechman states
that children receiving an opioid may need higher and more frequent dosing compared to adults
because children can metabolize opioids quickly. For localized pain, local anesthetics such as
lidocaine patches may be effective. Finally, adjunct analgesics are medications not specifically
indicated for pain relief but may help with other symptoms contributing to the child’s pain.
Examples of adjunct analgesics include anticonvulsants, antidepressants, and muscle relaxants
(Beechman, 2015).
The randomized factorial study – Mitigating procedural pain during venipuncture in a
pediatric population by Bahorski (2015) studied the implications of child age, sex, and ethnicity
on acute pain perception and response to pain relieving measures. One of the pain reducing
measures tested was a topical Lidocaine cream. This noninvasive pharmacological intervention
was effective in relieving pain in most children but was no more effective than other
nonpharmacological techniques such as the Buzzy Bee ® vibration and cooling device. This
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suggests that other modes of pain relief should be considered before and during the
administration of pain-relieving medications (Bahorski, 2015).
Nonpharmacological Interventions
Palmer’s article described some modes of age-specific nonpharmacological pain
management interventions. For infants, Palmer mentions oral sucrose and non-nutritive sucking
as effective comforting measure. For infants through older children Palmer states that
thermotherapy, positioning, vibration, districation and hypnosis may helpful in alleviating pain
and associated sensations. (Palmer, 2016).Management of Pain in Pediatric Nursing Essay
Non-pharmacological interventions across the developmental spectrum are described by
Short (2013) in the article, Nonpharmacologic Techniques to Assist in Pediatric Pain
Management. Short groups non-pharmacological pain treatments into four categories:
Behavioral, cognitive, complementary and physical. These interventions can be applied to the
following four age groups: Infant, toddler and preschool, school-aged, and adolescent. The four
types of interventions can be applied to each age group; however, specific treatments will vary
depending on the developmental and actual age of the child. Examples of behavioral
interventions include parent presence and positive encouragement. Cognitive interventions range
from distraction to self-coping statements. Music, medical play, and therapeutic art are
complementary methods. And non-nutritive sucking, positioning, deep breathing, and heat-cold
therapy are physical interventions. These therapies combined with medical and pharmacological
interventions can help mitigate a child’s acute or chronic pain experience (Short, 2013).
Katende’s (2015) study, Comforting strategies and perceived barriers to pediatric pain
management during IV line insertion procedure in Uganda’s national referral hospital: A
descriptive study addressed how nurses in Uganda manage pain associated with intravenous line Management of Pain in Pediatric Nursing Essay
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insertion in children. Despite the limited resource environment, the study suggested that rural
areas such as Uganda have great capability to provide effective non-pharmacological pain relief.
The following pain relieving measures were examined: Greeting the family, having the child
suck their finger, maternal-child skin-to-skin contact, breastfeeding, swaddling, distraction,
positioning, verbal consent and explanation and play preparation. Parental presence and
involvement were found to be effective in reducing the stress and pain related to the procedure
(Katende, 2015).
A randomized controlled trial conducted by Bergomi (2018) that observed the Efficacy of
Non-pharmacological Methods of Pain Management in Children Undergoing Venipuncture in a
Pediatric Outpatient Clinic suggested a combination of multiple comforting measures provides
the best pain relief. The trial of 150 children aged five to twelve years found that watching
animated cartoons while having parental support provided the best form of nonpharmacological
acute pain relief during venipuncture. The study tested other distraction techniques such as the
Buzzy Bee ® tool and combined Buzzy Bee ® and animated cartoon viewing. Buzzy Bee ® is a
plastic device that wraps around the patient’s arm above the site of intended venipuncture. The
device vibrates and cools the skin with attached ice packs. Buzzy Bee ® showed to be effective
only for children ages five to nine. And the combination of Buzzy Bee ® with viewing animated
cartoons provided less pain relief than watching cartoons. The distraction methods chosen for
this study were based on the Gate Control Theory. The Gate Control Theory suggests that the
perception of pain can be altered or decreased by interrupting the nociceptive pathways with
other sensations (Bergoni, 2018). Management of Pain in Pediatric Nursing Essay
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Pediatric Considerations
In her article Palmer (2016) noted that the effectiveness of pain management techniques
greatly depends on the physical and developmental stage of the child. Palmer stresses the
importance of recognizing and assessing the developmental stage of the child before choosing
and implementing any pain management interventions (Palmer, 2016). Similarly, Bergomi
(2018) references that pediatric pain assessment is especially unique and challenging because a
child’s perception, understanding and ability to communicate pain largely depends on their
cognitive and overall development.
The article by Short (2013) organized non-pharmacological pain relieving techniques by
appropriate age group. Common interventions for infants include distraction with interactive
toys, music therapy, calming environment, nonnutritive sucking, and swaddling. Interventions
are generally more effective with parental involvement. Toddlers and preschoolers may respond
positively to desensitization and familiarization with medical equipment before procedures
through play therapy. Distraction, music therapy, therapeutic art, positioning, and deep breathing
may also benefit the toddler or preschool-aged child. Older children in grade school may also
benefit from distraction, medical play, and deep breathing. Additionally, school-aged children
can respond to guided imagery, thermal therapy, and vibration. Independence is a key value to
adolescents, so it is important to engage the adolescent child when selecting their preferred pain
relief methods. As with school-aged children, guided imagery, distraction, and music can be
effective methods for older children. However, informative procedure preparation and positive
self talk are effective pain relieving techniques unique to adolescents (Short, 2013).Management of Pain in Pediatric Nursing Essay
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Implications for Nursing Practice
In order to properly care for a patient’s pain, the nurse must properly assess and
understand the pain characteristics. Different types of pain require different treatments. A child
may experience an array of pain characteristics and require unique interventions – the nurse’s
knowledge and assessment of the pain is crucial to effective treatment (Beecham, 2015).
The article, Relationship between knowledge, attitudes, and self-efficacy for nurses in the
management of pediatric pain by Stanley (2013) described how nurses view and think about
pediatric pain management. Twenty five nurses were asked to complete a two questionnaires:
Pediatric Nurses’ Knowledge and Attitudes Survey Regarding Pain, known as PNKAS, and
Nurses’ Self-Efficacy in Managing Children’s Pain. It was found that higher scores on the
PNKAS correlated with increased years of nursing experience and membership a professional
healthcare organization. It was also discovered that nurses with associate degrees had high selfefficacy, but low knowledge as compared to bachelor degree nurses who had lower self-efficacy
but a higher level of knowledge. The study concluded that feeling overly confident in one’s
knowledge can lead to poor pain management. The research also determined that pediatric nurses
need more education regarding pain identification and management (Stanley, 2013).Management of Pain in Pediatric Nursing Essay
Katende’s (2015) study identified multiple limitations and barriers to nursing care
directed towards pain management. Nurses in Uganda stated that limited resources, lack of time,
emergent situations, poor child behavior, lack of knowledge and personal attitudes contributed to
ineffective procedural pain management. The study concluded that all healthcare professionals,
in addition to nurses, need more education surrounding pediatric procedural pain management
(Katende, 2015).
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The study, Exploration of nurse’s pediatric pain management experiences in rural
hospitals: A qualitative descriptive study by Marshal (2018) described challenges nurses may
face when managing pain in children. In order to effectively manage pain nurses must correctly
assess, collaborate with the care team, and implement interventions. Inadequacy in any of these
three nursing responsibilities can produce less than desirable patient outcomes. The main barriers
to pain management that this study identified were: institutional flaws, lack of resources, and
lack of staff education. Institutional flaws such as not prioritizing pain management, lack of
standard protocols, and poor communication and leadership contribute to the lack of appropriate
pain management. The lack of financial, material, staff, and educational resources also has an
impact. Lack of specific pain management education was found to especially contribute to poor
pediatric pain management (Marshall, 2018).
At Lucile Packard Children’s Hospital Stanford, Staveski (2017) led the study,Management of Pain in Pediatric Nursing Essay
Interprofessional team’s perception of care delivery after implementation of a pediatric pain and
sedation protocol. This study was conducted to address concerns of substandard and inconsistent
pain management in the pediatric cardiac intensive care unit. Staveski’s team implemented a
protocol developed by the American College of Critical Care Medicine to manage pain,
agitation, and delirium. All healthcare staff were encouraged to follow the protocol. After the
implementation of the protocol, four areas of improvement were noted: consistency in using the
pain, agitation, and delirium treatment guidelines, open interprofessional communication,
enhanced pain management knowledge and improved provider treatment and performance. The
use of a collaborative and standardized protocol improved the effectiveness of the health care
team and thus patient care (Staveski, 2017).
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Conclusion
This review demonstrated the knowledge currently available on pharmacological and
non-pharmacological pain management options and attitudes in the pediatric population. There
are many pain management interventions available. The literature reviewed suggests that the
most effective form of acute pediatric pain reduction requires a combination of pain relieving
factors. The most common and successful form of combined pain relief found in the literature
was parent involvement combined with some form of distraction such as watching television.
Local pharmacological pain relief, such as Lidocaine, was found to be effective but no more
effective than non pharmacological interventions. The nurse must consider pediatric factors such
as age, developmental stage and the patient’s condition to provide effective pain relief. Proper
assessment, timely interventions, reassessment, and multidisciplinary teamwork is crucial to
providing a child excellent comfort care.
Theoretical Framework
The theoretical framework guiding this research is Kolcaba’s Theory of Comfort.
Katharine Kolcaba developed the theory of comfort in 1994 to clarify and emphasize the nursing
role in preventing and treating patient discomfort. Kolcaba’s theory uses a holistic care approach
that consider all aspects of the patient when assessing the causes of their discomfort. Kolcaba
states that there are three forms of comfort: Relief, ease and transcendence. Relief of discomfort
occurs when the patient’s immediate needs are met. Ease follows patient contentment such as
decreased anxiety. And transcendence occurs when the patient conquers the challenge of
discomfort. Kolcaba suggests that comfort extends across the physical, psychospiritual,
environmental and sociocultural contexts of a patient. Considering these four contexts when
providing care allows the nurse to view the patient as a complex and holistic individual. Finally,
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Kolcaba suggests a model to guide nurses in effectively obtaining and maintaining patient
comfort. Similar to the traditional nursing process, Kolcaba’s model of comfort nursing care
includes: Objective and subjective patient assessment, plan development, care implementation,
and intervention evaluation. This model allows nurses to effectively identify and treat patients
experiencing the complexities of discomfort (Kolcaba, 1994).
Kolcaba’s theory of comfort is especially relevant to the acutely ill pediatric population.
Kolcaba’s emphasis on holistic care is exemplified in this study as the focus of this research is
the combination of pharmacological and nonpharmacological interventions to manage acute
pediatric pain. Nurse’s perceptions of a child’s perceived or actual pain determine how the nurse
responds to the child’s discomfort. Kolcaba’s model of nursing care is crucial to understanding
how nurses think and act when confronted with a child who could or is experiencing pain. Pain is
a complex, individual experience that may require multiple interventions. This idea is supported
by Kolcaba’s theory that comfort affects all aspects of the individual – physical, psychospiritual,
environmental and sociocultural. This study views pain as a complex issue requiring holistic and
comprehensive nursing care. Kolcaba’s theory of comfort sets the standard for the nursing care
required to prevent, treat and manage pain (Kolcaba, 1994).
Kolcaba’s theory of comfort provides a comprehensive view of the complexity of pain.
Nurses are responsible for identifying and implementing appropriate pain management
interventions. While Kolcaba’s theory supports the topic of nonpharmacological and
pharmacological nursing interventions in managing pediatric pain, more research is still needed
in this field of study and practice. Management of Pain in Pediatric Nursing Essay
PEDIATRIC IV PLACEMENT PAIN MANAGEMENT 17
Methods
Research Question
The literature review displayed some the of effective pharmacological and
nonpharmacological interventions for managing pediatric procedural pain. With the knowledge
of pain management accumulated from the literature review, a study is proposed to answer the
question: How do registered nurses working in the acute care setting manage pain across the
developmental spectrum, neonate to adolescent, during venipuncture in pediatric patients?
Specifically, what are the most commonly used interventions and how effective do nurses
perceive these interventions to be?
Study Design
This exploratory pilot study gathered preliminary information which can potentially be
applied to more extensive studies regarding pediatric procedural pain management. The
quantitative descriptive design of this study was achieved through the survey tool that uses
numerical Likert scales to record responses to subjective and objective questions.Management of Pain in Pediatric Nursing Essay
Population
The population of this study included all pediatric registered nurses who perform
intravenous line placement for children in acute hospital care settings. Non-nursing health care
providers and health care personnel who perform venipuncture on adult clients were not included
in the population. Due to the limits of a pilot study, this study does not accurately represent the
population.
Subjects
Subjects were included based on the following criteria: Holds a current unrestricted
registered nursing license and performs venipuncture on children in an acute care setting.
PEDIATRIC IV PLACEMENT PAIN MANAGEMENT 18
Subjects with an expired or revoked nursing license were excluded from the data collection.
Additionally, nurses who do not perform venipuncture or who do not care for pediatric clients
were excluded. Subject participation in the research and survey was completely voluntary. A
notice at the beginning of the survey stated that participation was voluntary, anonymous, and that
participation could be withdrawn at any time. Additionally, the contact information of the
researcher and the primary research advisor were given to all participants should any questions
or concerns arise during participation.
Sample Size
The goal for this pilot study was to receive fifteen to thirty completed surveys from
eligible subjects. However, only seven responses were collected. Nurses who completed the
survey but who do not meet the eligibility criteria will be excluded from the data collection.Management of Pain in Pediatric Nursing Essay
Sampling Procedures
Subjects were selected via non-probability convenience sampling. An email was sent to
all pediatric nurses who were current and expired members of the Rho Alpha chapter of the
honors society, Sigma Theta Tau International, to request participation in this research.
Additionally, emails were sent to specific pediatric nursing faculty members at Dominican
University. Snow ball sampling was encouraged; each email sent to potential participants stated
that the link to the survey could be copied and shared. The survey was sent in an email as link.
Operational Definitions
Pharmacological: Interventions having to do with medications and drugs to obtain specific
physiological effects
Non-pharmacological: Interventions without medications or drugs to obtain certain physiological
and psychological effects
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Pediatrics: healthcare specialty focused on the care of children
Child: individual ranging from the actual age of 0 – 18 years old, or as otherwise specified by the
healthcare institution.
Pain: Pain is whatever the patient says it is, happening when and wherever the patient says.
Procedure: Any invasive or non-invasive medical intervention involving direct patient contact.
Venipuncture: medical procedure where a vein is punctured with a needle in order to draw blood
out of the vein or administer a substance through the vein.
Buzzy Bee ® : An FDA approved device that can wrap around an extremity and vibrate. Ice
packs can be attached to the device thus providing vibration and cold therapy simultaneously.
Instrument
A survey designed by the researcher was used to collect data. The survey includes
demographic information and thirty-nine questions regarding nursing perceptions and
interventions related to pediatric venipuncture. The demographic questions included: Age,Management of Pain in Pediatric Nursing Essay
gender, nursing license, total years holding nursing license, highest degree awarded, current
workplace, hours worked per week, nursing specialty, nursing unit of work, and level of pain
management education. Subjects rated their answers to each question on a Likert scale from zero
to five. Zero being “never” and four being “always”. See Appendix A for the survey template.
The survey was developed using Google Forms within the researcher’s private, secured Google
account. The survey was anonymous and no identifying information of the participants was
collected or stored. The survey was approved by the Dominican University of California
Institutional Review Board. Management of Pain in Pediatric Nursing Essay

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