NURSES' ASSESSMENTS AND MANAGEMENT OF PAIN IN CHILDREN HAVING ORTHOPEDIC SURGERY

Abstract

The specific aims of this research project were to (a) describe selected verbal, nonverbal, and physiological arousal indicators of the child's pain; (b) describe which pain indicators were most influential to nurses in decision-making about interventions for managing the child's pain; (c) describe pain interventions used by nurses; (d) compare postoperative analgesic orders to recommended dosages for the children; and (e) explore relationships between the child's self-report of pain and medication dosages administered. Subjects included 19 children aged 5–17 years who experienced 20 orthopedic surgical procedures (one child had two surgeries one week apart). Data were collected by staff nurses for the first five days after surgery. Pain levels were reported using the Oucher Scale. Postoperative pain was reported at moderate levels and showed only a gradual decrease throughout the hospital stay. Nonverbal pain indicators included crying and tense face. The child's complaint of pain and reported Oucher scores were most influential in influencing nurses to intervene in the child's pain. Nonpharmacological comfort measures included positioning and reassurance. All children received medications for pain; 49% of the orders were within the recommended therapeutic dosage range. A small but significant correlation was found between the child's reported pain level and the morphine equivalents of pain medication received. Recommendations included development of nursing flow charts that provide space to record pain levels and nursing interventions, in-service education for nurses on nonpharmacological interventions, and further research with a larger sample and a single pain rating scale.

The authors would like to thank the staff nurses on 6NS and PICU, University Hospital, University of Nebraska Medical Center, who assisted with data collection, and Fannie Gaston-Johansson, DrMedSc, RN, for assistance with the research proposal.

Notes

The authors would like to thank the staff nurses on 6NS and PICU, University Hospital, University of Nebraska Medical Center, who assisted with data collection, and Fannie Gaston-Johansson, DrMedSc, RN, for assistance with the research proposal.