Journal article
Pain assessment & management decision-making in pediatric critical care
Journal of pediatric nursing, Vol.73, pp.e494-e502
11/2023
DOI: 10.1016/j.pedn.2023.10.020
PMID: 37884405
Abstract
The aim of this study was to explore how nurses in the Pediatric Intensive Care Unit (PICU) reach their pain management decisions in children who are mechanically ventilated and chemically paralyzed.
A qualitative descriptive design was used following a quantitative phase of a multi-method study. Eighteen PICU nurses participated in semi-structured interviews aiming at understanding how they assess pain and make management decisions. Content analysis was used to guide coding and generate themes.
Three major themes were identified: 1) Assessment or cues that nurses use to trigger a pain assessment; 2) Mental models or patterns that nurses create to interpret cues to guide decision-making; 3) External factors that inhibit or facilitate decision-making. Overall, nurses rely on physiological cues to assess pain. From there, a large amount of variation exists on how nurses interpret those cues to make their pain management decision. External factors such as unit culture, perceived barriers and facilitators, and the nurse's experiences impacted how decisions are made.
Variation exists in the mental models' nurses create to make their pain management decision in this population. Nurses reported confusion on pain and sedation scale selection and various documentation practices for pain assessment. “Assume pain present” was identified as a concept and documentation practice that may guide decisions; further research is needed.
Development of clinician decision support tools that not only aid their understanding of reliable pain cues but also help create clear documentation practices may help nurses make pain management decisions.
•To date, there is no valid method to assess pain in children who are mechanically ventilated and chemically paralyzed.•Nurses in the Pediatric Intensive Care Unit (PICU) report that they rely on physiological cues to assess pain.•PICU nurses use various mental models in decision-making when choosing to intervene for pain, such as trial and error.•“Assume pain present” is currently being used in various ways to document pain assessment in this population.
Details
- Title: Subtitle
- Pain assessment & management decision-making in pediatric critical care
- Creators
- Elyse Laures - University of Iowa College of Nursing, 50 Newton Drive, Iowa City, IA 52242, United States of AmericaJanet Williams - University of IowaAnn Marie McCarthy - University of Iowa
- Resource Type
- Journal article
- Publication Details
- Journal of pediatric nursing, Vol.73, pp.e494-e502
- Publisher
- Elsevier Inc
- DOI
- 10.1016/j.pedn.2023.10.020
- PMID
- 37884405
- ISSN
- 0882-5963
- eISSN
- 1532-8449
- Language
- English
- Electronic publication date
- 10/25/2023
- Date published
- 11/2023
- Academic Unit
- Nursing
- Record Identifier
- 9984503057702771
Metrics
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