Managing Pain in Children: Helping to Improve the Use of Evidence in Practice

Alison Twycross (@alitwy), Head of Department for Children’s Nursing and Professor of Children’s Nursing, London South Bank University

I have been editor of Evidence Based Nursing since August 2010 and during that time I have worked with a team of associate editors to make the evidence to guide practice more accessible to nurses working in clinical practice. Alongside this I have also carried out research relating to managing pain in children. My current research focuses on the management of acute, post-operative and cancer-related pain in children and in particular on supporting parents to manage their child’s pain at home. I have also edited three books pulling together the evidence for managing pain in children. Details of the 2014 book can be found at: http://eu.wiley.com/WileyCDA/WileyTitle/productCd-0470670541.html

As a nurse everything I do is about ensuring we provide patients with the best possible care. This is reflected in the research I have done over the last 20 years. Completed research includes several studies exploring aspects of pain management for the first time including:

  • Three observational studies that enabled a picture of paediatric pain management practices in the UK and Canada to be obtained (Twycross, 2007; Twycross et al., 2013b; Twycross et al., 2015a)
  • A study exploring surgeons’ perceptions of post-operative pain (Twycross et al., 2015c)
  • Developing a set of adverse event indicators (trigger tools) for paediatric post-operative and procedural pain supporting a paradigm shift to mismanaged pain being seen as a patient safety incident (Twycross et al., 2013a)
  • A study exploring parents’ attitudes to pain in children and pain medication in the UK (Twycross et al., 2015b)

The observational studies demonstrate that current practices confirm to clinical guidelines in some but not all areas and we still have:

  • Inconsistent pain assessment practices – for example, not all children have pain scores recorded
  • Pain management is seen by many nurses as synonymous with administering analgesic drugs
  • Decision-making about which pain relieving interventions to use is not guided by pain scores
  • Non-drug methods are not seen as a nursing role – instead they are seen as a parents’ role or something for the play specialist
  • Limited communication with child and parents about pain management
  • Limited documentation about pain management
  • Children experiencing moderate to severe pain unrelieved pain during a hospital stay

Other studies have also demonstrated that children are experiencing moderate to severe pain in hospital (Birnie et al., 2014; Kozlowski et al., 2014). This is despite the evidence to guide practice being readily available (Association of Paediatric Anaesthetists, 2012; Australian and New Zealand College of Anaesthetists and Faculty of Pain Medicine, 2015). The fact that we are still not using evidence in practice as effectively as we could is one of the things that encourages me to continue to do research and work to disseminate evidence to those working in clinical practice.

References

  • Association of Paediatric Anaesthetists. (2012) Good Practice in Postoperative and Procedural Pain Management, 2nd edition. Pediatric Anesthesia 22: 1-79.
  • Australian and New Zealand College of Anaesthetists and Faculty of Pain Medicine. (2015) Acute Pain Management: Scientific Evidence, Melbourne: Australian and New Zealand College of Anaesthetists.
  • Birnie KA, Chambers CT, Fernandez CV, et al. (2014) Hospitalized children continue to report undertreated and preventable pain. Pain Research and Management 19: 198-204.
  • Kozlowski LJ, Kost-Byerley S, Colantuoni E, et al. (2014) Pain prevalence, intensity, assessment and management in a hospitalized pediatric population. Pain Management Nursing 15: 22-35.
  • Twycross A. (2007) Children’s nurses’ post-operative pain management practices: An observational study. International Journal of Nursing Studies 44: 869-881.
  • Twycross A, Chorney J, McGrath PJ, et al. (2013a) A Delphi Study to Identify Adverse Event Indicators for Pediatric Post-operative and Procedural Pain. Pain Research and Management 18: e68-e74.
  • Twycross A, Finley GA and Latimer M. (2013b) Pediatric Nurses’ Postoperative Pain Management Practices: An Observational Study. Journal for Specialists in Pediatric Nursing 18: 189-201.
  • Twycross A, Forgeron P and Williams A. (2015a) Paediatric nurses’ post-operative pain management practices in hospital settings: A narrative review. International Journal of Nursing Studies 52: 836-863.
  • Twycross A, Williams A, Bolland R, et al. (2015b) Parents’ Attitudes Towards Children’s Pain and Analgesic Drugs. Journal of Child Health Care 19: 402-411.
  • Twycross A, Williams A and Finley GA. (2015c) Surgeons’ Aims and Pain Assessment Strategies When Managing Paediatric Post-Operative Pain: A Qualitative Study. Journal of Child Health Care 19: 513-523.