A New Model for Acute Pain Management in Children: Examining Patient Characteristics and Potential Implications for Research and Practice

Abstract

AbstractCurrent literature suggests that acute pain management in hospitalized children remains substandard, resulting in adverse physical, cognitive, and emotional effects for many children. Improvements to pediatric acute pain management require an updated conceptual model and validation of current assumptions from the literature. The purpose of the three studies in this dissertation was to advance the state of the science on acute pain management in hospitalized children through an updated conceptual model, a critical review of literature, and analysis of pain management data from a children's hospital. The new acute pain management model transforms the role of the nurse from gatekeeper to facilitator in genuine partnership with children and families. The critical review of the literature suggested that differences in medication type and frequency for acute pain are associated with children’s sex and race/ethnicity, however study limitations make it difficult to draw meaningful conclusions about potential disparities in acute pain management for children. Findings from a retrospective chart review suggested no differences by sex, race/ethnicity, or limited English proficiency (LEP) in the average number of pain assessments, medication by weight, or outcomes. The results from this study may indicate progress in the management of acute pain in hospitalized children, as children in this study demonstrated average pain intensity scores which typically indicate mild, well-controlled pain. Replication of this study in other hospitals is needed to determine organizational effects on pain outcomes. Future research should also focus on identifying the components needed to establish genuine partnerships with patients and families and the potential influence of parents on effective pain management.