Acute Pain in Children - Essay Example

Acute pain in children In the last decade, the practice pediatric pain management has recorded changes following the inventions of pain management equipment specifically for pediatric patients. Prior to that, assessment and treatment of the pediatric patients faced many changes such as lack of clinical knowledge, fear of side effects, inadequate research, and addiction. The intervention made to health institution through the initiative international health bodies has led to the creation of the pediatric analgesic trails, which aim at providing evidence pain management in child across the ages. In practice, assessments methods for pain intensity are critical in treating children of different ages. Acute pain is one of the common ailments in childhood and one that requires emergency response. In this paper, we will discuss the RCN guidelines on response given to acute pain in children. Acute Pain Assessment Tools In the last decade, a number of assessment tools required for testing the pain for appropriate ages have enabled documentation and quantitative and qualitative assessment of pain. The assessment method for children across the ages have undergone various changes, where issues affecting the new born to those children that are talking can be addressed. Currently, assessment methods include behavioral measures of pain. In this measurement method, the pediatrician would use behavior checklists, which has a list of pain effects that a child would encounter (Twycross, Dowden, and Bruce, 2009:85-136). The list has scores, which the pediatrician would check before assigning a given pain. In the assessment checklist, issues such as time, response to pain among others influence the decision that the pediatrician would make against a given pain. Acute pain in children may herald medical or surgical emergency depending with the approach that the pediatrician takes in attending to the reported cases. In medical practice, timely diagnosis is critical in responding to children or patients problems (Finley, McGrath, and Chambers, 2006:1-32). However, the preexisting methods, tools, and materials had proved inadequate in responding to the situation. Presently, articles with clinical guideline on the same have created a comprehensive response to acute pain in children. The RCN guideline has nine key areas that health professionals should observe when assessing acute pain in children. The provision in the guideline indicates when pain should be accessed, indictors, what the health professionals should do, as well as the parents of the child. The RCN guideline sought to achieve three objectives; first, create awareness about symptoms, which helps in recognition of pain, second, recommend methods for pain assessment, lastly, promote use of method in pain assessment. While many nurses claim they know when children are in pain, the guideline for pain assessment intended to clarify how best the nurses should respond to children pain. In addition, it sets standards, which nurses should uphold while assessing pain. Since nurses did not have standards of assessment, it is arguable that cases of misinterpretation of pain existed. Prior to the creation of the RCN guideline on pain assessment, critics observed that nurses interpreted pain differently. It was argued that parent and nurse observation and interpretation of pain is different. Most of the available research on pain assessment indicates that observation was the most common method used in the assessment. Although the method proves to be worthy, the behavior observed might not be the degree of pain. Other consideration included emotional response to pain as observed by their parents. Thus, settling on an inclusive procedure acceptable by parents and nurses was critical at this stage. It is also notable that consideration of the preexisting literature and research on pain were adequately done before the recommendation of the guideline. Since the introduction of pain assessment scale, observation made on its application has indicated that the scale is useful because it helps in eliminating judgment imposed when nurses use observation method to assess pain. Moreover, the pain scale translates the pain into measure, which several parties can understand. RNC recognizes the pain scale used by most health facilities in assessing pain. RCN recognized the use Faces, Ladder, and Ruler in pain assessment (Royal College of Nursing, 2011:2-25). The qualitative analysis on the method enables the researcher to identify the responses of the patients at different moods. In addition, the nurses also reported the favored methods used in most cases in handling pain among children. Some of the discrepancies identified included the difference in difference in response provided by the nurses. Further, some of the information collected from patients were not subjected to the Faces, Ladder, and Ruler assessment guide. Largely, the recommendations settled on the most frequent observation. Critically, this approach was critical in developing universal recommendation. Pharmacological and non-drug methods Pediatricians use both pharmacological and non-pharmacological methods in managing acute pain among children. In non-pharmacological method, the patient receives therapies, which do not involve any medicine administration. Before deciding the pain management methods, nurses usually evaluate the influence of the approach they are yet to take. If the proposed method would increase pain or tissue damage, the nurses are likely to seek for an alternative method. On the other hand pharmacological pain management method entails medicinal administration in reducing the pain. In practice, the nurses usually assess the strength of the medicine that they would administer for a given pain. The pain management employed for parietal pain, for example would not be the same as the method applied for the referred pain. Some of the medicines which nurses use to manage pain include tramodal, morphine, paracetamol and non-steroidal anti- inflammatory medicine. The RCN recommendation on pharmacological approach in pain management evaluated the effects of the drugs, the knowledge of the nurses and existing literature on the same. According to the RCN guideline, grouping of medicine used pain management was critical. Ketamine, for example, applies when nurses intend to decrease surgical pain. It is also notable, that the accuracy of dosing these drugs has improved in the past decade. Intravenous paracetamol enables the nurses to give accurate dosage for pain. Nurses usually apply nonopioid analgesics for moderate or mild pain. The response mechanism created in the body of the patients tends to prevent sensitization of receptors that detect pain thereby preventing the release of the prostaglandin (Bowden and Greenberg, 2009: 836-845). The RCN guidelines recommend that pediatricians may settle on non-pharmacological pain management because of the following reasons; one if the non pharmacological therapies would help the child to feel relaxed or comfortable, second, if the non pharmacological method would help the child to avoid more complications, and may be applicable after surgery or painful experience (Bowden and Greenberg, 2009: 836-845). In some cases, nurses may ask the family or the caregiver of the child to accompany the child to hospital or learn the non-drug pain management. The non-drug method that a child may take includes physical, cognitive, and behavioral intervention. Literature reviewed on non-pharmacological approach to pain management includes reports collected from parents, patients, and various hospitals. Largely, the guideline settled on mechanism for implementation of the guidelines in medical facilities. In cognitive approach to non-drug pain management, for example, the RCN guideline indicated that the child learns special techniques of imagining and thinking. Largely, the activities taught to children tend to withdraw the mind of the child from the pain. It is arguable that distraction from pain enables the muscles causing pain to relax. Guided imagery is another method applied in non-pharmacological pain management. The method involves guiding to the child to think about favorite places or think about favorite things. Studying the feeling of the child with respect to smell, pain, feeling or taste is critical in designing the appropriate imagery guide for the child. Children should be aware of procedures that they are about to receive especially when they should take a surgery. Nurses usually advise that parents should play a centre role in explaining to the child the surgery procedures and the effects that they are likely to create on the child. Critics observe that the information provided to the child would enable the child to see the importance of the surgery or feel that the pain would not be bad (Reuters, 2012:1-3). The evaluation on preexisting methods tested the consistency of the methods. For example, psychological preparation to pain management influences child response to treatment (Bowden and Greenberg, 2009: 836-845). It is also arguable that the pain would decrease when that child develops the belief that the pain that he or she is yet to receive could be handled. Music and dance is also essential in influencing the pain management in children. Music can stimulate feeling of happiness or pain. The child should get the opportunity to choose music that stimulates feeling of happiness or joy. Since this method tends to control the information send to the brain, music that evoke sad feelings may lead to the release of natural opioids. It is also advisable to the child to dance in order to be part of what he or she is watching through the musical therapy. Themes drawn from the research and discussions were also critical in developing behavioral methods enables the child to learn techniques of exercising body sensations (World Health Organization, 2012:15-26). Some of the behavioral methods employed in managing pain include biofeedback. The techniques learnt in this method enable the child to stay calm and control pain. Nurses may use a biofeedback machine to measure the body pressure, heart rate, breathing, and temperature. Further, the machine enables the nurse to detect when the body is relaxing. With the use of biofeedback machine, the nurse or the caregiver may instruct the child to continue with a given practice. Positive reinforcement is behavioral intervention, which involves encouraging the child for his or her conduct during the surgery, or while healing from illness (Reuters, 2012:1-3). The parent may reward the child by buying a favorite item for the child. For instance, a favorite toy, stickers, games and other presentable items that would encourage the child are advisable. The intention of this method is to ensure that the child does not develop a feeling that would lead to regrets. While one is harboring a feeling of regret, it constrains the brain leading to the release of chemicals that aggravate the paining condition. The knowledge of techniques applied by the nurses and the parent of the patients are critical in managing the pain. In the RCN recommendation, the nurse or the caregiver would teach the child how to relax the body thereby decreasing body pain. It is observable in the technique that the child may develop deep and slow breath, while imagining that his or her muscle is relaxing. The breathing control would influence calming of the child. The nurses may use relaxing and breathing guide to practice this technique. The physical methods applied in pain management influence the surrounding. Calm environment is critical in creating child comfort. The surrounding should have colorful walls, games, toys out of rich for strange people. Children suffering from pain usually confide in the closest caregivers or parents (Walco and Goldschneider, 2008:55-62). Thus, strangers would make the child to develop emotional imbalance thereby increasing the pain. It is advisable that caregivers should observe tranquility without demonstrating nervousness because the condition will influence the attitude of the child into nervousness. When the caregiver or the parent shows a cheerful mood, the child will feel secure and less fearful. Documented materials on pain management indicate that some pains respond cold and heat packs. If this case applies to a given pain, then caregiver should respond by providing a pack that would reduce the pain. For example, warm birth may calm a pain while relaxing the muscles. On the other hand, a hot shower or a cool shower may give similar effects to pain management. It is important to identify the best pack that would lessen the pain of the child. Physical therapy and massage are other important methods of handling pain (Walco and Goldschneider, 2008:55-62). The caregiver or the nurse should caress, massage, or stroke the child’s back, legs, neck, and arms in order to create a relaxing atmosphere. In addition, methods taught by physical therapist are critical in ensuring that child receive the best physical pain management practice. Factors that hamper nurses pain management Available research on barriers to pain management indicates that both patients and healthcare givers act as barriers to pain management (Verghese and Hannallah, 2010:5-16). Healthcare professionals sometimes show disbelief what the patient tell them. This attribute hampers the right management for pain because it denies the patient the right to receive the right medication. In addition, the nurses do not have the right to deprive the choice for treatment for the patient. It is a misconception developed by the healthcare givers to believe that the patient is lying. Patients, on the other hand, may malinger from taking the prescribed medicine. Sometimes it might force the nurses to practically, administer the therapies when the above situation occurs. Ideally, skipping the prescribed treatment for pain does not ease strain, but increases it. Lack of knowledge on pharmacological principles hampers pain management. When the pediatrician lack the required knowledge for a given pain, parietal pain, for example, may hamper the process of pain management (Srouji, Ratnapalan, and Schneeweiss, 2010). Some patients react to some pharmacological treatment, this means that the healthcare giver should have adequate information about specific types of opioids. Some nurses fear to give the prescribed medication fearing that patients may develop addictive trends. The research, which sites this trend blame the nurses for the lack of pain management. Another laxity trend observed is lack of lack of pain management documentation (Chadha, 2008:5-14). Assessment done in hospitals sometimes relies on previous records about a given illness. On the contrary, when nurses fail to document information about a given patient, pain management becomes difficult. It is also observable that lack of this documentation attracts legal redress. Proper documentations of patient’s progress are critical in planning to change the preexisting drug or therapy. Some parents or caregivers may be resistive to prescribed medication for their children (Demir, 2011:2-5). This attribute makes the work of the nurses difficult because the patient will not receive the prescribed drug for the pain. It is advisable that parents or caregivers handling children patients should coordinate with the nurses in ensuring that the patients receive the right prescription for the illnesses. Lack of coordination between the patient caregiver and the nurses usually hamper the detection of pain because the nurse or the caregiver may fail to heed to information provided (PAT, 2012:5-15). In normal cases, parents or caregivers spend time with their children monitoring a given response, failure to acknowledge the efforts of the parent or the caregiver would lead to wrong attention of the pain. In addition, a coordinated effort between the caregiver and or the patient and the nurse leads to effective result in pain management. Care guidelines for future children pain management The pain assessment procedures should combine both modern techniques (tools and equipment) and information from the caregiver in assessing the information. Presently, the available, assessment methods and equipments are elaborate in providing information about pain in children. RCN guideline recommends upgrading of courses among the nurses to enable them to gain more information about pharmacological response to pain management (Srouji, Ratnapalan, and Schneeweiss, 2010:1-15). Critically, new methods of assessment do emerge following research work. However, validation of present research with the guideline is critical in creating harmony in the work conducted. Nurses and health caregivers should embrace pain management documentation in order to increase the efficiency in handling pain management (PAT, 2012:5-15). Since lack of knowledge on pharmacological principles hamper provision of right pain management, hospitals should conduct familiarization workshops. These workshops will enable the nurses and the healthcare givers to equip themselves with knowledge about the latest drugs. In conclusion, acute pain management in children has undergone tremendous changes in the last decade due to the invention of pain assessment equipment and drugs. The available information on pain management has not only improved response to acute pain challenges but also efficiency of the approach. The knowledge about the intensity of the pain is critical in prescribing the right treatment for the pain. The approach taken to pain management includes pharmacological and non-drug methods. However, nurses usually make adequate consideration, which may entail pain intensity, the effects of the drugs and effectiveness of the pain management method before applying it. While pain management has registered various positive changes, some practices perpetrated by the patients and nurses hamper the pain management. A consideration of the above literature would promote response to pain management. Bibliography Anderson, B.J. and Palmer, G.M. (2006) Recent developments in the pharmacological management of pain in children. Accessed 25 June 2012 . Bowden, R. V. and Greenberg, S. C. (2009) Children and Their Families: The Continuum of Care. Philadelphia: Lippincott Williams & Wilkins. Chadha, M. (2008) PHARMACOLOGICAL PAIN RELIEF IN PEDIATRIC PATIENTS. Accessed 25 June 2012 Demir, Y. (2011) Non-Pharmacological Therapies in Pain Management. Accessed 25 June 2012 Finley, A. G., McGrath, J. P. and Chambers, T. C. (2006) Bringing Pain Relief to Children: Treatment Approaches. London: Springer. Royal College of Nursing (2011) Health care service standards in caring for neonates, children, and young people. Accessed 25 June 2012 LaRuffa, A. A. (2008) Pain Evaluation for Acute Otitis Media in Children. New York: ProQuest. PAT (2012) Paediatric Acute Pain Policy. Accessed 25 June 2012 Reuters, T. (2012) Non-pharmacological Pain Management Therapies For Children. Accessed 25 June 2012 Srouji, R., Ratnapalan, S., and Schneeweiss, S. (2010) Pain in Children: Assessment and Nonpharmacological Management, International Journal of Pediatrics. Assessed 25 June 2012 Twycross, A., Dowden, S. and Bruce, E. (2009) Managing Pain in Children: A Clinical Guide. New Jersey: John Wiley & Sons. Verghese, T. S. and Hannallah, S. R. (2010) Acute pain management in children, Journal of Pain Research. Accessed 25 June 2012 Walco, A. G. and Goldschneider, R. K. (2008) Pain in Children: A Practical Guide for Primary Care. London: Springer World Health Organization (2012) WHO guidelines on the pharmacological treatment of persisting pain in children with medical illnesses. Accessed 25 June 2012 Read More