By Deanna Hiott RN

SBSN 498, March 2010

Changing the way we think about childhood pain

Remember Our patient’s are Children...

A characteristic of the normal child is he doesn't act that way very often.  ~Author Unknown

Reasons for Pain Assessment

Continuity of care is important. Pain initiatives show forethought and planning which indicates good nursing care!

It’s a JACHO requirement.

Ethically, it is the right thing to do! Child Life studies have consistently shown certain measures increase comfort and decrease fear.

Lastly, happy children produce satisfied parents. Satisfied parents increase our patient satisfaction rates which impacts our work environment.

JACHO Pain Standards

“The Joint Commission's 2001 pain management standards state that every patient has a right to have his or her pain assessed and treated.”

Consequently, each child must be assessed for pain and this must be entered on the chart.

These charts are audited and available for JACHO inspection.

FLACC pain scale assessment

Flacc pain assessment includes five categories of pain behaviors:

facial expression

leg movement

activity

cry

consolability

Ouch!

Face pain scale assessment

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 Cope

Researchers have produced numerous studies to document ways to help children cope with pain they include the use of:

One Voice

Distraction

Explanations and reassurance

Limited choices

Comfort holds

Freezy spray and Sweet Ease

One Voice...

One voice should be heard during the procedure.

Need for parental involvement.

Educate the patient before the procedure about what is going to happen.

Validate a child with your words.

Offer the patient the most comfortable, non-threatening position.

Individualize your game plan

Choose appropriate distraction to be used.

Eliminate unnecessary staff who are not actively involved with the procedure.(Conklin, Debbie; CLS, BS)

Distractions...

Distracting a child during a painful procedure can help minimize the discomfort and decrease crying time.

Distractions vary with a child’s age.

Some common distractions include bubbles and books.

Explain and Reassure

Explain what we are going to do, “ I have to get a little blood in my tube so we can help you feel better.”

What it may feel like... “It may pinch a little, you may feel a little stick like a pin prick.”

Everyone’s jobs, “Mom’s job is to hug and hold you, your job is to be still like a statue and my job is to do this quickly so you can go home and feel better.”

Limited Choices

Giving a child limited choices helps them feel more in control.

“Would you like to sit up or lie down?”

“You must get this to help you stay healthy, do you want it in your arm or leg?

“Not getting the shot is not an option, would you like Freezy Spray?”

“Let’s see you can be still in Mom’s arms or the nurse may have to get help to hold you.”

Why Comfort Holds?

Fewer people are needed to complete a procedure

Children feel comforted and protected in their parents arms or laps.

Promotes close physical contact with a care giver.

Provides caregiver with an active role in supporting child in a positive way

Sitting position promotes sense of control for the child.

Don’t Forget:

Prepare the parent; do not just expect them to instinctively know how to hold their child. Show them the way. Explain the importance of holding them still, to protect the child, them and you! These are some effective comfort holds.

What we know...

Studies have shown that infants given Sweet Ease before a painful experience such as circumcisions, heel sticks, and shots comfort easier and quicker.

Designed for infants to six months old.

Recommended to be administered two minutes prior to the procedure.

Sweet Ease helps release the bodies own pain killers called endomorphins.

This only takes a moment and the results are twofold: it comforts the child and it makes the parents feel that they have received extra, special care.

Freezy spray serves a three fold purpose as well.

1) It numbs the skin.

2) It provides a distraction.

3) Parents feel as though their child’s pain is being addressed.

To use the stream (which is what we have) point it at one spot and spray for ten seconds. You may also employ the use of a cotton ball or alcohol swab.

Freezy Spray

Happy parents= high satisfaction

Any thing we do large or small to increase satisfaction rates impacts our overall rating. Let’s treat our clients as we would want our own families to be treated.

Introduce yourself, smile, and explain procedures to the adults and the children...

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 Voice

One Voice to explain and reassure

Nurture parental involvement

Educate

Validate

Offer comfort positions and choices

Individualize

Choose distractions

Eliminate unnecessary staff

Whenever possible use Freezy Spray and Sweet Ease

Impressions 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 of health care.

A positive experience can impact a family and ripple through the community.

Go the extra mile with pain assessment and intervention to help create an environment 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