Pediatric Acute Pain Issue - Research Paper Example

Pediatric Acute Pain and PEDIATRIC ACUTE PAIN Introduction Records indicate that of all issues reported in healthcare centers every day, about 40% of these are pain related (Clark, 2013). Due to the fact that it is not just a sensory but also, to a great extent, an emotional experience, pain remains one of the main issues under discussion. Different people experience pain at different degrees which is caused by different factors. The pain can be acute or chronic. In America, over 120 million people suffer from acute pain (Waren, 2010). Research and statistics compiled in 2012 show that the acute and chronic pain results to a loss of about $650 million working days and leads to a further loss of about $65 billion (Upp, Kent and Tighe, 2013). This means that it is necessary to address the sources of pain. This particular work shall lay a focus on acute pain, and deal greatly with the issue of pediatric pain. Acute pain has been defined as a pain that begins abruptly and in terms of quality; it is highly sharp (Coutenay and Carey, 2008). Acute pain, according to medical care providers should be taken as a warning of an ailment that is slowly developing (or has already developed) and hence, it should be addressed immediately. The main difference between acute pain and chronic pain is that whereas chronic pain appears suddenly, lasts for between 3-6 months and gradually subsides with the gradual healing of the injury, chronic injury is usually a long term problem and it persists long after the injury (or ailment) has healed (Waren, 2010). Chronic pain might manifest itself through arthritis pain, severe headaches and even cancer pain (Nash, 2012). It is therefore important to study and gain immense knowledge on the concept of acute pain. This is not only helpful in raising general awareness to people but also in providing recommendations for future improvements. In addition, the study is important in teaching about the treatment options and therapies that are applied in addressing acute pain. Generally, these has been poor response and inadequacy regarding the treatment of pain, especially that which has lasted (or is expected to last) for a long time. This can be attributed to several factors. To begin with, some caregivers are afraid of prescribing opiods for the fear of having the patients become addicts (Price et al, 2011). Secondly, at times the nurses do not believe the reports of the patients and hence, they tend to assume that the patient is exaggerating on their conditions (Clark, 2013). The other reason is the fact that some of the healthcare providers do not have sufficient and adequate knowledge regarding the treatment options and hence, the patient’s pain persists for a longer time. The last factor, as evidenced by multiple researches, is the fact that even when opiods can be prescribed to a patient, some of the doctors are reluctant of prescribing it to them, especially if they have very limited knowledge about them (Sabine, Chalkiadis and Davidson, 2012). If the patient’s records do not reflect their treatment history, the doctors might be reluctant to provide opiods to them. There has been colossal research that has been carried out regarding the issue of pediatric pain. Pediatric pain has been defined as pain that children go through, or pain that is experienced by children below the age of 18 years (Nash, 2012). This means that pain felt by hour-old infants is also categorized under pediatric pain. The prime goal of treatment of acute pediatric pain is to ensure that the child is restored to their normal optimal functions, and to relieve them of the discomfort. However, past research shows that pediatric pain has been insufficiently and inadequately addressed. Pediatric nurses have been reluctant to address and treat children’s pain, especially for the infants. Why? Massive research has concluded that the situation is so due to a few common factors exist from the past. One of these factors is the myth that children, especially those in the infant category, do not experience as much pain as the adults do (Nash, 2012). This myth is not only held by the health care providers but also by the parents at home. Another myth states that even if the children feel any pain, there isn’t any apparent outcome (Melby, McBride and McAfee, 2011). Another factor that has been cited from the past literature is the appalling notion that treating a child, especially an infant consumes way too much time and effort as compared to treating an adult (Nash, 2012). The lack of knowledge on how to treat some types of pain, nurses’ lack of understanding on how to quantify individual experience and the apparent fear of the extreme effects of analgesics on children are among the many other factors (Price et al, 2011). Respiratory depression and early age addiction are some of the many effects of analgesic on children. Parents are also reluctant to have pediatric pain addressed due to the notion and early belief that pain is responsible for building a strong character and an unbreakable spirit in an individual. Records also show that today, pediatric pain is addressed at a more improved level as opposed to the past. Pediatric nurses have become keener to addressing the issue of pediatric pain. Today, the number of children suffering from post operative pain, procedural pain, pain resulting from terminal illness among others has gradually decreased (Upp, Kent and Tighe, 2013). This is because the information and knowledge acquired by nurses has largely been utilized. From the literature conducted recently, it is evident that a significant percentage of children who suffer from acute pediatric pain are infants who cannot express themselves. According to the developmental model, the child is able to express themselves better as they grow and hence, they have higher chances of having their pediatric pain aptly addresses (Nash, 2012). In addition, it can be seen that of all the three commonly applied pain assessment tools, self report remains the most effective. The three assessment tools are the self report, the behavioral assessment tool and the physiological measures (Melby, McBride and McAfee, 2011). The self report means that the patient expresses themselves in both verbal and non-verbal forms. As valid and effective that this tool is, it does not work for children who cannot communicate or express themselves. This means that it is more effective for children above the age of 6 years. On the other hand, behavioral assessment is usually applied for the children who do not know how to communicate (Nash, 2012). The assessment is based on crying, body shifts and movements and body postures. It therefore works best for infants. The last assessment tool, the physiological tool, identifies the problem and source of pain through an assessment of the blood pressure, the heart bet, and palmer sweating among others. Lastly, it can be seen from the recent literature that Loeser’s onion model has largely helped the nurses and the parents to understand the concept of chain (Craig, 2010). In addition, it has been helpful to children who are of an understanding and concept comprehension age on how pain occurs. The rings indicate the different levels of pain. The nociception ring shows stimuli that acts on pain receptors and as a result, creates activities in the nerve fibers (Craig, 2010). The pain ring shows how people perceive pain while the pain behavior basically shows how different people behave towards pain. The suffering ring shows the various and different effects of pain. The model is as represented below. \ Dealing with pediatric pain can take different forms. Since different people interact differently to treatment and medication, both pharmacologic and non-pharmacological therapies are used. Pharmacology refers to the scientific study of drugs (Waren, 2010). This study might include very many aspects such as the composition of different drugs, where a particular drug originated form, the toxicology of the drug among many other areas. Pharmacological therapies in pediatric acute treatment, therefore, refer to the situation where drugs are prescribed to address the issue of pain in children (Nash, 2010). On the other hand, non pharmacological treatment refers to the treatment of pediatric acute pain without the use of medications (Waren, 2010). The two therapies have proven effective in the address of pains in children and each works differently. Pharmacological treatment includes the use of drugs such as non-opioid drugs, opioid drugs and adjuvants. Eutectic mixtures of Local Anesthetics (EMLA) and the use of ethyl chloride spray to minimize pain is among the categories of pharmacological treatment of pediatric acute pain. Opioid drugs include the use of drugs such as tramadol, codeine and hydromorphine among others. Examples of non-opioid drugs include acetaminophen and aspirin among others. Lastly, adjuvants are the drugs usually administered to complement the many other analgesics used I treatment of pediatric acute treatment. Some of the adjuvants include anti-depressants, pain patches and anti-seizures (Nash, 2010; Waren, 2010). When the pain is too acute, the pediatric nurses usually recommend these treatments, albeit at small doses for fear of addicting the patients to analgesics. On the other hand, non-pharmacological treatment of pediatric acute pain takes a whole new angle. Since it does not involve the use of drugs, it advocates and eggs on aspects such as physical interventions, behavioral interventions and introduction of distractions. For children, the ability to withstand pain is very low as compared to the adults’ ability (Frank, Noble and Liossi, 2010). These strategies of addressing acute pain are usually applied when the pediatric nurses are still unsure of the causes of the pain, when they are reluctant to prescribe analgesics to children and when they are sure that the non-pharmacological measures will help in addressing the pain (Courtenay and Carey, 2008). Examples of non-pharmacological therapies include Trancutaneous Electrical Nerve Stimulation (TENS), physical therapy, distractions, complementary therapies, and adoption of acupuncture among others (Frank, Nobble and Liossi, 2010). All these have different levels of efficiency and they depend on the source and extent of the pain. For children, starting up engaging conversations, training them on how to take deep breaths, introducing active distraction such as video games among others are some of the most common ways forms of non-pharmacological therapies in dealing with children (Frank, Noble and Liossi, 2010). Massage therapy, the use of heat, rest, exercise and the use of ice are also forms that are frequently used. However, acupuncture and TENS have been termed as the least effective forms of non-pharmacological therapies (Nash, 2012). It is important to realize that theoretical frameworks are imperative in addressing the pediatric acute pain. It enlightens pediatric nurses on the conduct in their places of work and on the many roles and responsibilities that are bestowed to them. In addition, theoretical approaches give ideas on what should be implemented, what steps should be taken, how pain should be handled and the procedures to be followed (Coutenay and Carey, 2008). However, a close look on the functionality of pediatric nurses shows that there is a difference between theory and practice. There is much recommendations on the importance of giving children a choice in the pain treatment and management that they want (Sabine, Chalkiadis and Davidson, 2012). This is theoretical and very little of it has been applied in the practical bit. Today, pediatric nurses still take upon themselves (and the parents) the decisions of whatever pain treatment strategy should be used. There is much knowledge about pediatric acute pain that has been forwarded theoretically. However, nurses in practice still appear to have huge information and knowledge gaps with regards to management of pediatric acute pain 9Upp, Kent and Tighe, 2013). Theoretically, pediatric acute pain nurses are bestowed with the responsibilities of being child advocates, knowing what is good for them in terms of acute treatment. However, this is not usually the case in practical applications. There therefore exist huge differences between the practical pediatric practices and the theoretical frameworks on the same. Appropriate pain control should include informed knowledge on the side treatments of the prescribed drugs, information on the most effective pharmacological and non-pharmacological therapy to apply and even give consideration to the treatment preference of the patient (Craig, 2010). Clinical unit practices are affected and impacted on by many factors. To begin with, the past performance rules and guidelines of the healthcare organizations affect how clinical unit practices perform (Sabine, Chalkiadis and Davidson, 2012). The rules and guidelines that have been set up in an organization greatly determine how a particular unit practice is run and managed. For the pediatric acute pain unit, the pediatric nurses have to adhere to the guidelines already stipulated. Another factor that impacts on the clinical unit practices of the level of technology available, and that which is being adopted (Price et al, 2011). If a healthcare or clinical unit has high performance machines, the rate of services are high. This means that for the pediatric clinical unit, improved technology greatly determines the outcome of the clinical unit. In addition, the beliefs and expectations of the child and parent seeking medication also determines the output in the clinical unit. Some parents will be reluctant to accept some form of treatment and hence, the pediatric nurses will most likely give their preferences on what they want, even if it is not the best form of treatment. In the clinical area, there should be well written policy and procedures available. To begin with, the procedures for acquiring treatment services should be well stipulated. This shall be important in providing knowledge to new patients, especially parents who are new to the health care institution, and have children suffering from acute pain (Warren, 2010). On the same, costs associated with the different therapies and the estimated costs for each should be clearly be spelt out. The policies and procedures should also indicate the therapies available so that it can be easier for the parents and the children to select the one they need. Policies regarding the timeframe for any activity should also be clearly indicated in the clinical area. This will improve the efficiency of the pediatric nurses in the duties dispatched to them. As evidenced, there are many roles of pediatric managers in the assessment and management of acute pain. They are an indispensable part of the health care providers’ fraternity, and they play many different roles. Acting as a child advocate is one of their many roles 9Clark, 2013). Most of the children are unable to communicate and express themselves, especially if they are in a period of pain. When they cannot express themselves, it is upon the pediatric nurses to be their advocates and advise their parents on the best pain management strategies. In addition, pediatric nurses also talk to the young children, especially when they are in a state of fear 9Nash, 2012). This helps them to open up and dispel their fears, and this helps them to communicate even more. Pediatric nurses also have a responsibility of intervening in emergent situations, especially those that result to patients in painful circumstances (Frank, Noble and Liossi, 2010). The nurses are also bestowed with the responsibility of assessing the needs of the children, keeping in mind their social, cultural and medical situations. The pediatric nurses also have a responsibility of determining all the needs that pertain to the pain. This is important as plans are effectively made on all requirements towards the treatment of the pain. Lastly, before a child undergoes any treatment to relieve them from pain, it is upon the pediatric nurses to explain all the processes and procedures to the parents and /or guardians. The current practices of nursing practices are quite satisfactory. However, there is much that can be done to improve the current practices in pediatric nursing. Pain in children should be aptly addressed, especially when the patients are infants who cannot communicate or express themselves (Clark, 2013). A few recommendations, however, can be put forward. To begin with, pediatric nurses should be encouraged to put into practice the much knowledge that they acquire in their schools. The information gap that exists in some of the pediatric nurses should and can be addressed by encouraging the nurses to utilize and put into practice the information acquired theoretically. Another recommendation that can be made is to allow children have some degree of flexibility in choosing the type of acute relief therapy that they would prefer. At some age, especially the teenage bracket, the child now has grown and developed. As a result, they will be more comfortable and a greater level of cooperation can be achieved. Conclusion Currently, pain is one of the many reasons why people visit the hospitals. In the developed countries, the case of pain related issues has greatly increased. Pediatric acute pain is one of the many issues that doctors are currently trying to handle. Research, as presented in the above discussion, shows that there have been major improvements in this specific area. The models being used have proved effective and the application of theory to practice has further made things better. Postoperative pain, procedural pain and pain emanating from terminal illness in children has been adequately addressed by the pharmacological and non-pharmacological treatment therapies. The two therapies work differently for differently individuals, and the choice of one over the other is dependent on the source of the pain, the extent of the pain and at times, the choice of the parents. However, nurses should be encouraged to apply the theoretical information to their daily practice. I addition, more autonomy should be allowed who are of reasonable age to make their decisions on the kind of therapy they desire. References Clark, M. (2013). How best to prevent acute pain from becoming chronic? Journal of Family Practice, 1(1), 53-59. Courtenay, M., & Carey. (2008). The impact and effectiveness of nurse led care in the management of acute and chronic pain: A review of the literature. Journal of Clinical Nursing, 17(13), 2001-2003. Craig, K. (2010). The social communication model of pain. Canadian Psychology, 50(1), 22-32. Frank, L., Noble, G., &Liossi, C. (2010). Translating the tears: Parents use of behavioral cues to detect pain in developing young children with minor illnesses or injuries. Child Care, Health and Development, 36(6), 895-904. Melby, V., McBride, C., & McAfee,A. (2011). Acute pain relief in children: Use of rating scales and analgesics, Emergency Nurse, 9(6), 32-37. Nash, L. (2012). How to assess pain in children and young people. Emergency Nurse, 20(2), 19-22. Price, A., Ong, J., Isedale, G., Mackellar, C. &McDermind, F. (2011). Documenting and treating acute pain in children. Emergency Nurse, 19(3), 18-20. Sabine, K., Chalkiadis, G., & Davidson, A. (2012). Developing a pediatric pain service. 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