Pain Assesment Essays - Acute Pain, Medical Specialties,

Pain Assesment Running head: PAIN ASSESSMENT IN YOUNG CHILDREN Experiences of Nurses Using The Wisconsin Children's Hospital Pain Scale for Preverbal Children: A Descriptive Study Bradley University Experiences of Nurses Using the University of Wisconsin Children's Hospital Pain Scale for Preverbal Children: A Descriptive Study Most patients in the hospital setting experience pain. Pain is a subjective phenomenon that varies from person to person. The most relied upon indicator of pain is a patient's verbal report of the pain, but what happens when the patient cannot verbalize his pain? This is the case with infants and other nonverbal patients. They experience pain but are unable to tell a nurse where it hurts, how it hurts, and the intensity to which it hurts. O'Conner-Von (2000) stated if self-report is not available, physiologic or behavioral measures must be used (p. 1), and nurses are the key health care personnel responsible for continuous assessment in children in the health care setting (p. 1). Nurses need a reliable and continuous means of pain assessment for the preverbal population. A study of the pediatric pain practices of national health professionals showed that only twenty percent of the sample used a behavioral assessment scale (Broome, Richtsmeier, Maikler, & Alexander, 1996, p. 314). Investigation of the tools used to assess pain in the nonverbal population of the pediatric floors in hospitals located in a small Midwestern city revealed that no one method was being used in any of the hospitals. According to several pediatric nurses from various hospitals in the area, nurses were assessing the pain of the nonverbal population based on their own opinions as to whether or not the patient was in pain, how consolable the patient was, and the parent's report as to whether or not the patient was in pain. While this method of pain assessment can be accurate, it can also vary widely between nurses as no two nurses have the same perception or assessment of any one patient' s pain. In order to ensure that pain of a nonverbal child is being assessed every time by every nurse in a consistent manner, a pain assessment scale is necessary. The University of Wisconsin Children's Hospital (UWCH) Pain Scale for Preverbal and Nonverbal Children is a scale used to assess pain based on five categories: facial, vocal/cry, behaviorial/consolability, body movements/posture, and sleep (Soetenga, Frank, & Pellino, 1999, p. 3). This scale is in a column format due to previous reports that this form is easier to use in the clinical setting than scales that require the user to add up scores in each category to get an end result (p. 3). The purpose of this study is to describe the experiences of pediatric nurses at a regional medical center as they implement The University of Wisconsin Children's Hospital Pain Scale for Preverbal and Nonverbal Children on children between the ages of six and twelve months in the acute clinical setting. Review of Literature Infant pain has for the most part been inadequately assessed and poorly managed. This is largely due to myths that children cannot feel pain or if they do feel pain, are unable to remember the occurrence(McCaffery Soud Brown, 1997, p. 349). Recent studies have moved more toward the fetus having the anatomic and neurochemical abilities to experience discomfort as early as the second trimester (Soud & Rogers, 1998, p. 689.) The central nervous system is as mature as an adult's by 36 weeks gestation (Brown, 1997,p. 349), and at birth, an infant has comparable, if not more, numbers of nociceptive nerve endings on their skin surface as an adult (McCaffery & Pasero, 1999, p. 629). This suggests that infants are as capable as adults of experiences painful impulses. Studies have also shown that infants can in fact remember painful stimuli. Continual behavioral changes in infants after painful procedures indicate that the infants have some ability to remember the painful event (Soud & Roger s, 1998, p. 689). Infants also can develop behaviors, such as stiffening and withdrawal, in response to the anticipation of repeated painful stimuli such as a heel lance (McCaffery & Pasero, 1999, p. 630). As these myths have been discredited, more importance has been placed on assessing the pain