Differential medication of child versus adult postoperative patients: the effect of nurses' assumptions

Comparing processes of pediatric trauma care at children's hospitals versus adult hospitals

Comparing treatment of pediatric injury by hospital type or physician expertise has often created more controversy than conformity. Three key components that help define quality of care include infrastructure, process, and outcome. This report highlights studies that compared processes of care by physician and hospital expertise with regard to injured children. During the past 15 years, numerous studies have compared both hospital and physician expertise in the processes of pediatric trauma care. From these studies, it is clear that evaluation of processes of care is equally important as evaluating outcome, especially when mortality is the outcome variable. Future studies should examine other aspects of care in addition to surgical processes that might impact either rates of complications or long-term outcomes.

Defending against patients' pain: a qualitative analysis of nurses' responses to children's postoperative pain

OBJECTIVE

Cognitive approaches to clinical communication attribute deficits in communication to lack of skill. We examined, instead, emotional influences on communication by finding out how nurses construed patients who were in pain, and how these constructions were related to the emotional challenge of patients' pain and to deficits in clinical communication.

METHODS

Data, analyzed qualitatively, included: (i) direct observations of verbal interactions of 13 nurses with 16 children after orthopedic surgery; (ii) standardized open-ended interviews with the nurses, patients and parents.

RESULTS

Nurses tried to prevent children from displaying pain behavior. When pain behavior did occur, they construed pain as unreal, unwarranted or not deserving help. These findings were apparent in observations of, and interviews with, nurses and also in parents' and children's accounts of nurses' behavior.

CONCLUSION

We identified behavioral and cognitive strategies whereby clinicians defend themselves emotionally against patients' pain, and which compromise communication with patients in pain.

Pain in hospitalized children: pediatric nurses' beliefs and practices

A descriptive design was used to gather information regarding nurses' beliefs and documentation practices related to pain assessment and management in children. Pediatric nurses (n = 260) from eight hospital units completed a child and pain survey. Nurses' pain-related documentations on children (n = 153) were also examined. Results showed inconsistency between what nurses believe about pain assessment and management and their documentation of practice. Nurses believed that assessment is the first step toward alleviating pain in children. However, it was not evident in their documentations that nurses used developmentally appropriate tools for assessment or for evaluation of children's responses to pain management strategies.