Pain care for children with cognitive impairment: A parent-nurse partnership.

PURPOSE: To explore nurses' experiences of establishing partnerships with parents for pain care of hospitalized children with cognitive impairment (CI) and identify related facilitators and barriers. DESIGN AND METHODS: In this qualitative, interpretive descriptive study, individual semi-structured interviews were conducted via videoconferencing with pediatric nurses from inpatient wards in a Canadian pediatric quaternary hospital. Verbatim transcripts were analyzed using an inductive, data-driven thematic analysis approach. RESULTS: Eleven nurses were interviewed. The overarching theme was Assessing Pain as an Outsider: "A Complete Guessing Game". Seven major themes were identified.: Relying on Parent Expertise for Pain Assessment, Brainstorming with Parents for Pain Treatment, Supporting Parents as Advocates for Pain Care, Individualizing Pain Care with Parents, Involving the Child in Pain Care: A Spectrum, Barriers to Partnership in Pain Care and Facilitators to Partnership in Pain Care. CONCLUSIONS: Nurses described the many ways they involve parents as partners in pain care. However, nurses shared strong feelings of uncertainty associated with pain care in children with CI. Consequently, nurses felt the need to rely on parents for appropriately assessing and treating pain in children with CI. Findings highlighted the practice and education gaps that may contribute to nurses' uncertainty and reliance on parents. PRACTICE IMPLICATIONS: By identifying related practice and education gaps, healthcare organizations can implement strategies to further support nurses in establishing partnerships and potentially optimize pain care practices.

Evaluating the French version of an online training course for a pediatric pain assessment scale / Évaluation de la version française d'une formation en ligne sur l'appropriation d'une échelle d'évaluation de la douleur pédiatrique

Context: There is no French-language training to educate nurses on the use of the Face, Legs, Activity, Cry, Consolability (FLACC) pain scale, whose scores guide the treatment of pediatric pain. Aims: The aim of this study was to evaluate a French online training program for the FLACC scale offered to Francophone undergraduate nursing students. Methods: Online training was offered to nursing students enrolled in a pediatric nursing course. Participants completed online questionnaires pre- and post-training to assess their perception of their knowledge and confidence, the accuracy of their pain assessment scores, as well as the usefulness and user-friendliness of the training. Results: The FLACC online training improved students' perceived knowledge (p = 0.0004) and confidence (p = 0.0053) in the FLACC pediatric pain scale. Students' accuracy of severe pain assessment scores significantly improved (p = 0.0159) and slightly improved for moderate pain (p = 0.6363). However, accuracy for mild pain assessment was slightly decreased post-training (p = 0.7686). Discussion: An improvement of the quality of videos linked to mild pain, and the quantity of videos for all levels of pain, is required for this study to be replicated among a larger sample. Conclusion: The online training fills the gap in nurses' lack of knowledge about the use of the FLACC pain scale and improves access to quality training in French.

Contexte: Il n'existe aucune formation pour éduquer les infirmières quant à l'utilisation de l'échelle d'évaluation de la douleur pédiatrique Faces-Legs-Activity-Cry-Consolability (FLACC), dont les scores obtenus guident le traitement adéquat de la douleur. Objectif: Cette étude visait à évaluer une formation en ligne portant sur l'échelle FLACC. Méthode: La formation a été offerte aux étudiantes inscrites à un cours de soins infirmiers pédiatriques offert lors de la 3e année du baccalauréat en sciences infirmières. Les participantes ont rempli des questionnaires en ligne avant et après la formation afin d'évaluer leur perception quant à leurs connaissances et leur confiance, l'exactitude de leurs scores d'évaluation de la douleur, ainsi que l'utilité et la fonctionnalité de la formation. Résultats: La formation augmente les connaissances (p = 0,0004) et la confiance (p = 0,0053), selon les participantes. Elle améliore l'exactitude des scores de l'évaluation de la douleur sévère des étudiantes (p = 0,0159) et celle des scores de douleur modérée (p = 0,6363), mais diminue l'exactitude de leurs scores de douleur faible (p = 0,7686). Discussion: La qualité des vidéos reliées à la douleur faible et la quantité des vidéos pour tous les niveaux de douleur devront être améliorées. Conclusion: La formation rehausse l'éducation quant à l'utilisation appropriée de l'échelle FLACC et accroît le nombre de formations de qualité en français.

Development and Pilot Evaluation of an Educational Tool for the FLACC Pain Scale.

BACKGROUND: The FLACC (Face, Legs, Activity, Cry, Consolability) pain scale is commonly used for pediatric pain assessment; however, no online educational tool exists to facilitate the use of the scale. AIMS: This study aimed to develop an online educational tool and evaluate its effect on nurse knowledge, user confidence, and scoring accuracy. DESIGN AND METHODS: In phase 1, semistructured interviews were conducted to identify preferred educational features and content. Eight informants were interviewed in phase 1. Recommendations informed the development of the educational tool. Data were analyzed via conventional content analysis. Phase 2 involved a pre-post evaluation of the tool through online surveys. Posteducational data were collected immediately after the tool was completed. Wilcoxon signed rank and McNemar-Bowker tests were used to compare pre- and post-training knowledge, confidence, and FLACC scores. Scoring accuracy was examined using percentage agreement and consensus analysis. RESULTS: Thirty-four nurses participated in phase 2. The educational tool significantly improved knowledge (p < .0001) and increased user confidence, although not to a significant level (p = .06). There was a significant improvement in correct assessment of moderate pain (p = .04). Almost all nurses correctly assessed severe pain before and after education (91%). However, there was a decrease in accurate assessment of mild pain (p = .01). CONCLUSIONS: Because the intervention improved knowledge, user confidence, and assessment accuracy of moderate pain, it would be useful to implement such a tool as part of clinician education. However, further modifications will be needed to improve assessment of mild pain.

Parent resources for early childhood vaccination: An online environmental scan.

BACKGROUND: Early childhood vaccination is one of the most important public health interventions. However, the injections are usually painful. Clinical practice guidelines recommend using pain management strategies for infants during vaccination. Public access to online health information has increased due to the advent of internet. Parents are likely to find thousands of websites, and online video platforms of variable quality. This study aims to identify and critically appraise the quality of online parent-targeted resources concerning early childhood vaccination and determine inclusion of recommended infant pain management strategies. METHODS: An environmental scan of two main internet sources was conducted: (a) Google, (b) Social Media networks. Resources including information relating to infant vaccination and available to Canadians were included. Characteristics of resources were collected. Resource quality was evaluated using the CDC Clear Communication Index. A CDC index score of 90% and above indicates the resource is as an acceptable public communication material. Means and standard deviations were used for normally distributed data; median and interquartile range (IQR) or numbers and proportions were used for data not normally distributed or presented in categorical format. RESULTS: We found 55 online resources in website format and 10 resources in video format. Overall, the mean score for the quality of resources was 60% ±â€¯0.19. Most resources were scored as moderate to low quality (33-87%). Only 5% of material scored as acceptable quality. In terms of content, 30 (46%) resources presented information about pain management strategies during vaccination, including breastfeeding (24, 37%), holding (27, 42%), and sweet solutions (22, 34%). The remaining 35 (54%) resources made no clear statement regarding any pain management strategies during vaccination. CONCLUSION: Most publicly accessible online parent-targeted vaccination resources were of poor quality and did not contain information related to the use of recommended pain management strategies during vaccination.