# Pain Management in Paediatric Critical Care: A Cross‐Sectional Study

## TL;DR

This study explores how PICU nurses assess and manage pain in children, highlighting the need for better tools and standardized practices.

## Contribution

The study reveals new variations in pain management practices and identifies key facilitators for implementing evidence-based care.

## Key findings

- Nurses more often use behavioral scales than self-report for pain assessment.
- Premedication before painful procedures varies among nurses.
- Facilitators like charting systems and standardized tools are more valued than barriers.

## Abstract

Up to 24% of children admitted to the paediatric intensive care unit (PICU) experience moderate to severe pain. Nurses have the ethical responsibility to manage pain, which is often challenging due to a wide range of age, developmental ability, medical diseases and complex medical equipment. Limited research has been done, specifically in the PICU, related to pain management practices and barriers and facilitators.

The purpose of this study is to describe PICU nurses' current pain assessment and analgesic premedication practices, in addition to facilitators and barriers to pain management.

This study is a secondary analysis of a previous cross‐sectional study. PICU nurses were asked to complete a survey regarding their pain assessment practices, premedication practices, perceptions of patient behaviours indicative of pain and barriers and facilitators.

A total of 106 nurses responded. It was found that nurses more routinely use behavioural assessment scales compared to self‐report and do not regularly attempt to obtain a self‐report for those who are mechanically ventilated. The decision to premedicate prior to a painful procedure was variable. Nurses found only four patient behaviours as most commonly indicating pain. Lastly, facilitators were perceived more commonly present than barriers, with nurses valuing having a designated charting system and standardised assessment tools.

Overall, there is a need to leverage facilitators and minimise barriers to successfully implement evidence‐based pain management practices. Future research in the creation of clinician support tools, following the principles of implementation science, is needed.

Understanding current pain management practices better enables frontline nurses, educators and leaders to identify, implement and sustain evidence‐based pain management improvements.

What is known about the topic?
○Children seen in the paediatric intensive care unit (PICU) are known to experience pain and nurses are critical to assess and manage pain in a vulnerable population.○There is a wide variation in how nurses assess and manage pain across all children seen in the PICU and the degree to which evidence‐based practices are used.
What this paper adds?
○This study adds further variation in practices not previously reported, such as the use of pain medication prior to procedures and asking for a self‐report assessment for a child who is mechanically ventilated.○Key facilitators such as the use of protocols or guidelines and clear charting areas within the electronic health record were identified and should be used as leverage to better implement evidence‐based practices at the bedside.

What is known about the topic?
○Children seen in the paediatric intensive care unit (PICU) are known to experience pain and nurses are critical to assess and manage pain in a vulnerable population.○There is a wide variation in how nurses assess and manage pain across all children seen in the PICU and the degree to which evidence‐based practices are used.

Children seen in the paediatric intensive care unit (PICU) are known to experience pain and nurses are critical to assess and manage pain in a vulnerable population.

There is a wide variation in how nurses assess and manage pain across all children seen in the PICU and the degree to which evidence‐based practices are used.

What this paper adds?
○This study adds further variation in practices not previously reported, such as the use of pain medication prior to procedures and asking for a self‐report assessment for a child who is mechanically ventilated.○Key facilitators such as the use of protocols or guidelines and clear charting areas within the electronic health record were identified and should be used as leverage to better implement evidence‐based practices at the bedside.

This study adds further variation in practices not previously reported, such as the use of pain medication prior to procedures and asking for a self‐report assessment for a child who is mechanically ventilated.

Key facilitators such as the use of protocols or guidelines and clear charting areas within the electronic health record were identified and should be used as leverage to better implement evidence‐based practices at the bedside.