ABSTRACT
PURPOSE: This study aims to evaluate the implementation of a comprehensive program to improve pain management practices in a pediatric hospital. METHODS: The pretest posttest design used questionnaires, patient record audits, and postimplementation focus groups with 366 nurses and 8 physicians. RESULTS: Positive changes occurred in the use of pain scales and in valuing good pain management. The program was less effective in improving procedural pain management and pain documentation. PRACTICE IMPLICATIONS: Important program strengths were the "local champions" (Pain Resource Nurses) and the ongoing support and expertise of the pain committee. Systematic evaluation was important to document successes as well as areas requiring further focus.
Subject(s)
Benchmarking/organization & administration , Models, Nursing , Nursing Staff, Hospital , Pain , Pediatric Nursing , Attitude of Health Personnel , Child , Clinical Competence/standards , Documentation/standards , Education, Nursing, Continuing , Evidence-Based Medicine , Focus Groups , Health Knowledge, Attitudes, Practice , Hospitals, Pediatric , Humans , Nursing Assessment/standards , Nursing Audit , Nursing Evaluation Research , Nursing Records/standards , Nursing Staff, Hospital/education , Nursing Staff, Hospital/psychology , Ontario , Pain/diagnosis , Pain/prevention & control , Pain Measurement/nursing , Pain Measurement/standards , Pediatric Nursing/education , Pediatric Nursing/organization & administration , Practice Guidelines as Topic , Program Evaluation , Total Quality Management/organization & administrationABSTRACT
OBJECTIVES: A culturally relevant, evidence-based pain assessment scale in Inuktitut is needed. Psychometric properties and preferences for the Northern Pain Scale (NorthPS), a revised version of the Wong-Baker FACES scale, were examined. STUDY DESIGN: This repeated-measures, within-subjects study involved 2 face-to-face interviews held 2 weeks apart. METHODS: Participants were recruited from 2 schools and a community centre in Pangnirtung, Nunavut, Canada. Three pain scales (NorthPS, FACES and a numerical rating scale) were used to rate the pain portrayed in an adapted version of the Charleston Pediatric Pain Pictures (NorthCPPP, a series of 17 cartoon vignettes). RESULTS: The study involved 188 participants ranging in age from 5 to 83 years. Compared with the established FACES and numerical scales, the concurrent validity of the NorthPS was acceptable, with all 3 pain scales producing similar scores for the North CPPP vignettes. The youngest children were slightly more accurate during the second interview; otherwise, scoring accuracy was similar during both interviews. Accuracy was also similar across pain scales. Spearman correlations between NorthPS and other scales were lowest for the "No" pain vignettes, and for the youngest children. Internal consistency was acceptable for the NorthPS when compared with FACES and numerical scales. FACES was preferred by the majority of children and NorthPS was preferred by the majority of adults. CONCLUSIONS: NorthPS, a pain scale adapted to Inuit language and culture, was validated using the NorthCPPP with children and adults. The NorthPS is a well-understood, culturally and linguistically adapted option for the assessment of pain for Inuktitut speaking children and adults.
Subject(s)
Inuit , Pain Measurement/instrumentation , Psychometrics , Surveys and Questionnaires , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Female , Humans , Interviews as Topic , Male , Middle Aged , Severity of Illness Index , Young AdultABSTRACT
Pain resource nurses (PRNs), who act as pain management coaches or mentors for their colleagues, can contribute to effective pain management. The PRN's role has not been well evaluated in the context of pediatric nursing. Therefore, the objective of this study was to examine the PRN's role in a pediatric setting and, more specifically, to describe the role in terms of the activities PRNs engage in, the challenges they face, and the supports that help them fulfill their role. This research was part of an evaluation of the implementation of a comprehensive pain management program in a pediatric hospital. Focus groups were conducted with 18 PRNs six months after implementation of the PRN role. The essence of the role is to provide support for best-practice pain management to nurses and the multidisciplinary team. The PRNs described seven components of their role and specific strategies to operationalize their role. In addition, the PRNs faced challenges, including feeling disappointed when their expectations for better pain management were not met, experiencing difficulty fitting the activities into their busy workdays, facilitating their colleagues' improved pain management without also alienating them, and maintaining their enthusiasm and energy for the role. Pediatric nursing staff can effectively fill the role of the PRN. The role is multifaceted, and maintaining the role required commitment and enthusiasm on the part of the nurses, as well as commitment by their related institutions.