Pain Management in Children - Coursework Example

Pain Management in Children Name: Institution: Pain Management in Children Introduction Pain management is a very broad aspect and defined as the use of pharmacological techniques to manage a patients’ identified pain. The hurt management extends to beyond the mere pain relief covering vital aspects in the human life such as the patient’s quality life, ability to work productively and the capacity to enjoy recreation as well as participate in family or social activities and die with dignity. While pain is a repulsive, sensory afflicted associated with actual or potential tissue damage that can be emotional too. The factor that pain is always subjective and children are not able to express themselves well because it will depends with the developmental stage or previous pain experience. Medical research reveals that pediatric nurses in many instances hold on the misconception about legitimacy of the self-reported pain intensity measurement that include opioid pharmacokenetics and dynamics influencing the inadequate pain relief for hospitalized children, causing them to rely on the child’s behavior and physiological responses Goldin & Reinert, 2007). The paper looks at pain management in children and its influences the nursing practice, including relevant literature. For a long period, it is assumed that young children experience pain and suffering from procedures within the health facilities that have gone untreated or worse still under-recognized. In most cases, children do not help much as many of them are unable to explain how they feel. It is at this point that pain management plays a vital role as it aims at reducing the pain; anxiety and distress that nurses are instrumental in helping and supporting the child in the entire period of pain. A report done in 2006 reviles that appropriately, 2.3 million American children were hospitalized, 1.2 million experienced surgery and researchers further stated a large portion of children had moderate to severe pain (DeFrances et al,2008). In cases of increased pain not properly managed may lead in pain susceptibility and sensitivity in future that may interfere with the quality of the child’s life. Health personnel rely on the pain intensity that helps them to choose methods and treatment to management pain such as doses of morphine administered in relieving pain. Summary Children in pain are vulnerable and nurses have a great challenge in trying to ease their pain and anguish. It is true that treatment procedure expose children to pain and suffering while in the health care facilities. Pain relief is among basic human rights and nurses try out all measures to ensure pain is relieved especially in children. According to Reiman & Gordon (2007), infants are predisposed to pain that in some occasions where children experience long-term pain due to their undeveloped nerves system may lead to lifelong abnormal responses to noxious and non-noxious stimuli causing a lowered pain threshold and central sensitivity. In the effort to reverse the suffering that includes acute pains among children, analgesic is administered, which acts as a sedative drugs with other forms of pain management including a combination of pharmacological methods and voluntary coping strategies in order to reduce the pain. In children, behavioral change is the ultimate effect of change that occurs with influence from information and treatment options. The inability for children to communicate effectively hindered proper pain management as nurses only depend on observational as comfort measures are rarely used (Finloy et al 2005). The factor that children are not able to advocates for themselves renders them a vulnerable group depending on other people to recognize their pain then plan actions to manage. Pain Management in Children Younger children of four years and older, indicators used to depict pain and sting intensity relies on a child’s self-report. However, in many occasion observation is necessary to complement the self-report making it efficient or in cases where self-report is not applicable. On the other hand, physiological measures that encompasses vital sign usually essential in indicating stress reactions applicable during acute pain incidents that tenuously correlated with the self-report of pains. According to Goldin & Reinert (2007), children behavior especially very young children behavior does not correlate well with their self-report of pain intensity. For this reason, it is always recommended that both the child’s self-report and observation are considered and most importantly as a primary measure for their pain intensity. Alternatively, in cases where the child is in position to give out a proper self-report then the nurses can rely on it. Since time in memorial, research suggests that some pediatric nurses who rely on infant and young patients’ behavior continue to rely on behavior more than the child's self-report to judge pain intensities in children older than 4 years of age who can clearly report on their pain levels. Administering of analgesics is another way of managing pain in children. This method faces many problems, as nurses have been adamant to use it because they want to distinguish overt and objective verification. They wait until the child’s behavior and signs begin to change in order to administer a dose of morphine especially to a happy child with a smile yet reports severe pain on a standardized pain scale (Huth et al, 2005). Majority pediatric nurses fail to recognize the legitimacy of the intensity of pain even in the event of availability of measurement with a self-report reviling vast evident and the factor that self-report is a reliable measure for younger children with the capability to report on their suffering and pain. Analgesic use among children has been coupled with verse side effects ranging from respiratory depression, sedation, addition making many nurses avoid its use. Moreover, there exist many belief about opioid pharmacokinetics and dynamics and unless information is provide on the effects and usage, many children in hospital wards will continue to go without receiving the necessary pain relief. Studies indicate that because of the fear to inflicted the side effects on the children, they end up administering fewer amounts of analgesics than that recommended by the national standards (Ellis et al, 2007). Unfortunately, these have not relieved the pain among the suffering children. It is clear that effectiveness of any drug is in administering sufficient doses at the right time, frequent intervals for it to mitigate the twinge. Relevant literature Pain is a complex phenomenon especially in children as nurses find it difficult to establish the root and origin of the pain. It becomes even harder when the medical diagnosis of the child is clear with a couple of physical pain and the nurse in charge is able to establishes a pattern to follow to ease the sting but the youngster fails to respond to treatment despite all the efforts. According to Goode (2000), pediatric oncology patients are said to experience pain from treatment and procedures greater than from problem such as painful malignant diseases and other body alignments. A child’s pain can be plastic or complex as most of their pain perception influences are by emotional thoughts arising from pain signals and experiences that come with pain when the brain receives a nerve signal. Intervention such as the use of analgesic and sedative drugs are used to reduce the pain Pain management may be massive and youngster requires optimal plan to evade the pain, however nurses usually are hesitant to use some medication for fear of the side effect. Research done in a hospital in New York city identifying children admitted in the unit during the study tenure that involved obtaining all their medical records to aid in the collection of data responsible in the calculation of analgesics administered and children's pain levels for the 30-day pre- and 30-day post-intervention observation period (DeFrances et al 2008). The findings illustrated a large reduction in pain levels among the children and notable improvement in nurses’ willingness to administer analgesic. Analgesics are mainly prescribed and administered by pediatric nurses includes acetaminophen, ibuprofen, keterolac, and morphine whose usage depends on the pain intensity. Morphine is rarely used unless necessary because of its “neuro effects”. Adequate information on pain management and effects of analgesic administering is necessary for any nurse especially pediatric clinicians. Recommendations Knowledge on how to support a child in pain during a painful procedure makes it easy for both the parents, nurses enabling them to facilitate essential treatment. Nurses in charge of taking care of children should receive plenty evidence-based information that would change their beliefs about the legitimacy of self-report and usage of analgesic that subsequently influence their pain management strategies. Improvement of nurses’ perception and underlying beliefs on pain assessment and management is yet another strategy because nurses occasionally fail to access children’s pain accurately and only resort to assess the pain merely by observing a child’s behavior and change in physiology. Ellis et al., (2007) explains that improved knowledge is essential in increasing the frequency of pain assessment documentation leading in increased use of non-pharmacological interventions. Nurses’ attitude towards pain management influences their motive and self-image regarding different aspects of pain. Coping strategies such as distraction and imagery alongside pharmacological intervention may be effective in pain management in children besides the usual analgesic and sedative drugs. On the other hand, cognitive and behavioral distractions are also applicable as both techniques are able to draw attention from the pain experience to more enjoyable activities (Goldin & Reinert, 2007). In the recent, focus to include pain management in nursing education is increasing incorporating strategies essential to aid nurses in assessing thus relieving pain. Studies state that nurses have had difficulties in differentiating between pain, fear and anxiety by just observing a child’s behavior. This is because a child in pain is capable to escape a painful experience by withdrawing or going to sleep. Therefore, pain management entailing the inclusion of assessment scales is able to validated children’s different needs should be implemented and management actions taken in accordance with the measurement. Lastly, there is no better single technique that outshines the rest therefore in order to get an appropriate strategy it will depends on the individual infant who is the patient, procedure and the setting. Mostly, nurses are able to stimulate pain management practices that are capable to relief infants ensuring comfort. Conclusion Pain management in children is a huge challenge for nurses especially in the unpredictable situations. Appropriate intervention is essential in preventing or substantially reduces potential pain. Clinical practices are essential in evading pain during procedural that aims at providing comfort and relief to children. Good knowledge and a positive attitude among the nurse is necessary in the event of practical pain management. Unless the nurses understand the effects of pharmacokinetic and pharmacodynamic, it is unlikely that hospitalized children will receive optimal pain relief. Existence of misconception about certain beliefs and clinical practices interferes with nurses and their work in the event affecting nursing practices. Individuals prescribing and administering pharmacologic agents opt to be knowledgeable about the onset, duration, and mechanism of action for agents and be skilled in managing adverse effects and complications resulting in painful episode. Therefore, pain management in children is very impactful in nursing practices and thus the need to address it in order to evade the suffering is essential. References American Academy of Pediatrics, & American Pain society (2001). The assessment and management of acute pain in infants, children, and adolescents. pediatrics; Canada: TBT Publisher. DeFrances CJ, Lucas CA, Buie VC, Golosinskiy A. (2006 & 2008) National hospital discharge survey. National health statistics reports. New York. Retrieved from http://www.cdc.gov/nchs/data/nhsr/nhsr005.pdf. Ellis JA, McCleary L, Blouin R, Dube K, Rowley B, MacNeil M, Cooke C. (2007). Implementing best practice pain management in a pediatric hospital. Journal for Specialists in Pediatric Nursing. New Jersey: Routledge . Finley, A, Franck, S, Grunau,E. & Von Baeyer, L. (2005). Why children's pain matters. Pain Clinical Updates. Cambridge: Cambridge university press. Gebbie, Kristine M., Wakefield, Mary, and Kerfoot, Karlene (2000). “nursing and health policy.” journal of nursing scholarship. Third Edition. .Chichester, West: Blackwell. Goldin, I & Reinert, K. (2007). Globalization for development: trade, finance, aid, migration, and policy.trade and development series. World bank e-library. New York: World Bank Publications. Goode, Colleen J. (2000). “What Constitutes the “Evidence in Evidence-Based Practice?”. Applied Nursing Research. Canada: Wiley-Blackwell Publisher. Huth, M, Broome,E, Mussatto, A & Morgan, W. (2003). a study of the effectiveness of a pain management education booklet for parents of children having cardiac surgery. pain management nursing. Washington: Routledge press. Rieman,T & Gordon M. (2007). Pain management competency evidenced by a survey of pediatric nurses’ knowledge and attitudes. pediatric nursing. New York: Sage publication. Read More