Pain assessment in the pediatric intensive care unit

Children admitted to the Pediatric Intensive Care Unit (PICU) are critically-ill and vulnerable to pain. When a child cannot self-report their pain, a nurse must use various other means to assess pain. At times, a child requires the use of mechanical ventilation. Additionally, to maintain adequate oxygen levels, a child may require to be medically paralyzed which makes the child unable to move. Then, there is no valid method to assess and manage pain.

This dissertation aimed to discover how nurses are managing pain in children who cannot self-report their pain and cannot move. It was found that nurses reported using behavioral pain assessment scales. However, using this, the score would indicate no pain since the child cannot move. Additionally, some nurses used the term “assume pain present” but it is unknown how nurses are using it. During interviews, nurses described using physiological variables (heart rate) to assess pain which has limitations. Without a valid assessment method, nurses developed patterns of thinking, such as trial and error, to make decisions. “Assume pain present” was described here; however, variation existed between nurses. Potential exists for using “assume pain present” when situations that are known to be painful are present versus physiological variables that fluctuate constantly.

Overall, this dissertation indicates a need to develop a standard guideline on when and how to use “assume pain present” in clinical practice. Lastly, decision support tools need to be created to aid the PICU nurse to know when various pain assessment methods can be used.