Changing the way we think about childhood pain By Deanna Hiott RN SBSN 498, March 2010
Remember Our patient’s are Children...A characteristic of thenormal child is hedoesnt act that wayvery often. ~AuthorUnknown
Reasons for Pain AssessmentContinuity of care is important. Pain initiatives show forethought andplanning which indicates good nursing care!It’s a JACHO requirement.Ethically, it is the right thing to do! Child Life studies have consistentlyshown certain measures increase comfort and decrease fear.Lastly, happy children produce satisfied parents. Satisfied parents increaseour patient satisfaction rates which impacts our work environment.
JACHO Pain Standards“The Joint Commissions 2001 pain management standards state thatevery patient has a right to have his or her pain assessed and treated.”Consequently, each child must be assessed for pain and this must beentered on the chart.These charts are audited and available for JACHO inspection.
FLACC pain scale assessmentFlacc pain assessment includes five categories of pain behaviors:facial expressionleg movement O uch!activitycryconsolability
Number Assessment• On a scale of 1-10, with 10 being the worst pain you have ever felt, what is your pain level now?
Helping our Kids CopeResearchers have produced numerous studies to document ways to helpchildren cope with pain they include the use of:One VoiceDistractionExplanations and reassuranceLimited choicesComfort holdsFreezy spray and Sweet Ease
One Voice...O ne voice should be heard during the procedure.N eed for parental involvement.E ducate the patient before the procedure about what is going to happen.V alidate a child with your words.O ffer the patient the most comfortable, non-threatening position.I ndividualize your game planC hoose appropriate distraction to be used.E liminate unnecessary staff who are not actively involved with the procedure. (Conklin, Debbie; CLS, BS)
Distractions...Distracting a child during apainful procedure can helpminimize the discomfort anddecrease crying time.Distractions vary with a child’sage.Some common distractionsinclude bubbles and books.
Explain and ReassureExplain what we are going to do, “ I have to get a little blood in my tube sowe can help you feel better.”What it may feel like... “It may pinch a little, you may feel a little stick likea pin prick.”Everyone’s jobs, “Mom’s job is to hug and hold you, your job is to be stilllike a statue and my job is to do this quickly so you can go home and feelbetter.”
Limited ChoicesGiving a child limited choices helpsthem feel more in control.“Would you like to sit up or liedown?”“You must get this to help you stayhealthy, do you want it in your arm orleg?“Not getting the shot is not an option,would you like Freezy Spray?”“Let’s see you can be still in Mom’sarms or the nurse may have to gethelp to hold you.”
Why Comfort Holds?Fewer people are needed to complete a procedureChildren feel comforted and protected in their parents arms orlaps.Promotes close physical contact with a care giver.Provides caregiver with an active role in supporting child in apositive waySitting position promotes sense of control for the child.Don’t Forget:Prepare the parent; do not just expect them to instinctivelyknow how to hold their child. Show them the way. Explain theimportance of holding them still, to protect the child, themand you! These are some effective comfort holds.
What we know...Studies have shown that infants givenSweet Ease before a painful experiencesuch as circumcisions, heel sticks, andshots comfort easier and quicker.Designed for infants to six months old.Recommended to be administered twominutes prior to the procedure.Sweet Ease helps release the bodiesown pain killers called endomorphins.This only takes a moment and theresults are twofold: it comforts thechild and it makes the parents feel thatthey have received extra, special care.
Freezy SprayFreezy spray serves a three foldpurpose as well.1) It numbs the skin.2) It provides a distraction.3) Parents feel as though theirchild’s pain is being addressed.To use the stream (which is whatwe have) point it at one spot andspray for ten seconds. You mayalso employ the use of a cottonball or alcohol swab.
Happy parents= high satisfactionAny thing we do large or small to increase satisfaction rates impacts ouroverall rating. Let’s treat our clients as we would want our own families tobe treated.Introduce yourself, smile, and explain procedures to the adults and thechildren...When you can make the experience better with sweet ease, freezy spray,prizes and stickers, do it!Remember what it feels like to be afraid, nervous and vulnerable.Reassurance just takes a minute.
Remember to use One VoiceOne Voice to explain and reassureNurture parental involvementEducateValidateOffer comfort positions and choicesIndividualizeChoose distractionsEliminate unnecessary staffWhenever possible use Freezy Spray and Sweet EaseImpressions which can impact later medical care are being created now!
In the End...In the end a happier office visit for the family impacts their future ideas ofhealth care.A positive experience can impact a family and ripple through thecommunity.Go the extra mile with pain assessment and intervention to help create anenvironment of trust and caring!
References•• Conklin, Debbie; CLS. “One Voice” retrieved from http://www.childrensomaha.org/body.cfm?id=210.• Garner, Jamie. (2009, August) . Positioning for Comfort is Only the Beginning.• Code of Ethics, “Greenville Hospital System’s Mission, Vision and Values”, p.3. retrieved from http://www.ghs.org/Content.aspx?id=88472• Lacey, C.M., Finkelstein, M.,& Thygeson,M.V.(2008). The Impact of Positioning on Fear During Immunizations: Supine Versus Sitting Up. Journal of Pediatric Nursing, 23(3), 195-200.• Pain Standards of The Joint Commission retrieved from http://jointcommission.org/NewsRoom/health_care_issues.htm#9 http://www.jointcommission.org/NewsRoom/health_care_issues.htm#9• Positioning for Comfort retrieved from http://www.childrensomaha.org/body.cfm?id=211