Pain Assessment and Management in Pediatric Intensive Care Units Around the World, an International, Multicenter Study

Paediatric Pain Management Experiences of Parents of Children in Botswana Referral Hospitals

AIM

To describe the experience and understanding of paediatric acute pain management practices by parents/guardians' of hospitalised children in Botswana.

DESIGN

Descriptive qualitative study.

METHODS

Face-to-face semistructured interviews were conducted in two public hospitals. Data were transcribed verbatim and analysed using thematic analysis.

RESULTS

A convenience sample of 19 parents/guardians, two fathers, one grandmother and 16 mothers who were recruited in 2019. Six major themes were identified with several subthemes. The themes were as follows: 'soldiering on with hope'-representing the parents/guardians overall general positive outlook; 'facing adversity'-highlighting parents/guardians responses to acute pain management; 'acceptance to nonacceptance of the reality of care'-parents/guardians view on the quality of pain care they received measured against their expectations; 'smiles to unending nightmares'-parents/guardians visualisation of the pain treatment outcomes; 'perceptions of child pain'-parents/guardians' knowledge of pain assessment and treatment strategies that they used or were being used by healthcare providers to their children and 'guarded empathy'-highlighting the intricacies of each child's response to pain. Parents/guardians in Botswana have both positive and negative experiences regarding child pain management in referral hospitals and recognise the need to adequately manage paediatric pain.

PATIENT OR PUBLIC CONTRIBUTION

The results show that parents/guardians in LMIC equally understand the children's pain management and should be involved in decision-making regarding pain management as equal partners. It further highlights the challenges faced by parents due to poorly and inadequately treated acute paediatric pain in hospital units and pushes for hospital policies that ensure that pain is adequately managed for all children.

Knowledge and practice of pediatric pain management and associated factors among nurses in Ethiopia: a systematic review and meta-analysis

BACKGROUND

The knowledge and practices of nurses are determinant factors of pediatric pain management, but there are no pooled results concerning prevalence and associated factors. Therefore, this systematic review and meta-analysis aimed to determine the pooled prevalence of good knowledge, good practices, and associated factors for pediatric pain management in Ethiopia.

METHODS

PubMed, Cochrane, Scopus, CINAHL, Google Scholar, and university repositories in Ethiopia were searched. It was reported based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and Newcastle-Ottawa Scale was used to assess the quality. Cross-sectional studies conducted any time were included. STATA 17 was used to analyze the data after extraction. Heterogeneity was assessed via I2 statistics, Galbraith plot and meta-regression. A random effects model was used in the presence of heterogeneity. Funnel plots and Egger's regression were used to assess publication bias. Subgroup analyses were conducted by the study period and sample size. Sensitivity analysis was also performed.

RESULTS

Nine studies with a total of 2355 nurses were included. The pooled prevalence of good knowledge and practices for pediatric pain management among nurses was 60% and 42%, respectively. The percentages were higher from 2015-2021 than from 2022-2024. Education, training, pain management protocols, and tools were the main variables analyzed. Hence, pre-service training (OR: 3.1, CI: 2.21-4.36), in-service training (OR: 3.04, CI: 1.78-5.18), and pain management protocol (OR: 2.53, CI: 1.59-4.03) were associated with good knowledge. MSc degrees (OR: 7.45, CI: 2.74-20.21), pre-service training (OR: 2.26, CI: 1.53-3.34), in-service training (OR: 3.27, CI: 1.72-6.25), presence of protocol (OR: 2.68, CI: 1.79-3.99), presence of tool (OR: 2.74, CI: 1.96-3.83), presence of policy (OR: 6.2, CI: 2.98, 12.91), knowledge of nurses (OR: 4.47, CI: 3.24, 6.18) and child cooperativeness (OR: 1.98, CI: 1.46, 2.67) were associated with good practices of pediatric pain management.

CONCLUSION

The pooled prevalence of good knowledge and good practices was low. Education, training, and the availability of pain management protocols were the most important factors. Therefore, education and training provisions should focus on nurses working in pediatric wards.

TRIAL REGISTRATION

PROSPERO registration number: CRD42024572462.

Non-pharmacological therapies for pain management in paediatric intensive care units: a protocol for a scoping review

INTRODUCTION

In critically ill children, pain management is complex owing to cognitive development and the nature of hospitalisation in paediatric intensive therapy units. Although there are many protocols and guidelines for pain control via pharmacological interventions, non-pharmacological practices should also be explored and disseminated for their potential benefit.

METHODS AND ANALYSIS

A systematic literature search will be performed using the following databases: Academic Search Premier, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, Excerpta Medica Database, Virtual Health Library, Medical Literature Analysis and Retrieval System Online, ScienceDirect, Scopus, Web of Science Core Collection, Theses from Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, Dart Europe, Open Access Theses and Dissertations and grey literature from Google Scholar. The research will consider quantitative and qualitative studies, mixed-method studies, systematic reviews, text articles, opinion articles, letters to editors and editorials in any language and from any database. The following will be eligible for inclusion: (1) newborns, infants, children and adolescents; and (2) non-pharmacological therapies used for pain in paediatric intensive care.

ETHICS AND DISSEMINATION

This study does not require ethical approval. The results of this research will be disseminated through social media channels and podcasts about pain in children.

TRIAL REGISTRATION NUMBER

This protocol has been registered with the Open Science Framework (DOI 10.17605/OSF.IO/DZHKT).

Video-Based versus On-Site Neonatal Pain Assessment in Neonatal Intensive Care Units: The Impact of Video-Based Neonatal Pain Assessment in Real-World Scenario on Pain Diagnosis and Its Artificial Intelligence Application

BACKGROUND

Neonatal pain assessment (NPA) represents a huge global problem of essential importance, as a timely and accurate assessment of neonatal pain is indispensable for implementing pain management.

PURPOSE

To investigate the consistency of pain scores derived through video-based NPA (VB-NPA) and on-site NPA (OS-NPA), providing the scientific foundation and feasibility of adopting VB-NPA results in a real-world scenario as the gold standard for neonatal pain in clinical studies and labels for artificial intelligence (AI)-based NPA (AI-NPA) applications.

SETTING

A total of 598 neonates were recruited from a pediatric hospital in China.

METHODS

This observational study recorded 598 neonates who underwent one of 10 painful procedures, including arterial blood sampling, heel blood sampling, fingertip blood sampling, intravenous injection, subcutaneous injection, peripheral intravenous cannulation, nasopharyngeal suctioning, retention enema, adhesive removal, and wound dressing. Two experienced nurses performed OS-NPA and VB-NPA at a 10-day interval through double-blind scoring using the Neonatal Infant Pain Scale to evaluate the pain level of the neonates. Intra-rater and inter-rater reliability were calculated and analyzed, and a paired samples t-test was used to explore the bias and consistency of the assessors' pain scores derived through OS-NPA and VB-NPA. The impact of different label sources was evaluated using three state-of-the-art AI methods trained with labels given by OS-NPA and VB-NPA, respectively.

RESULTS

The intra-rater reliability of the same assessor was 0.976-0.983 across different times, as measured by the intraclass correlation coefficient. The inter-rater reliability was 0.983 for single measures and 0.992 for average measures. No significant differences were observed between the OS-NPA scores and the assessment of an independent VB-NPA assessor. The different label sources only caused a limited accuracy loss of 0.022-0.044 for the three AI methods.

CONCLUSION

VB-NPA in a real-world scenario is an effective way to assess neonatal pain due to its high intra-rater and inter-rater reliability compared to OS-NPA and could be used for the labeling of large-scale NPA video databases for clinical studies and AI training.

Evaluation and Treatment of Pain in Fetuses, Neonates and Children

The perception of pain is individual and differs between children and adults. The structures required to feel pain are developed at 24 weeks of gestation. However, pain assessment is complicated, especially in neonates, infants and preschool-age children. Clinical scales adapted to age are the most used methods for assessing and monitoring the degree of pain in children. They evaluate several behavioral and/or physiological parameters related to pain. Some monitors detect the physiological changes that occur in association with painful stimuli, but they do not yet have a clear clinical use. Multimodal analgesia is recommended for pain treatment with non-pharmacological and pharmacological interventions. It is necessary to establish pharmacotherapeutic protocols for analgesia adjusted to the acute or chronic, type and intensity of pain, as well as age. The most used analgesics in children are paracetamol, ibuprofen, dipyrone, opioids (morphine and fentanyl) and local anesthetics. Patient-controlled analgesia is an adequate alternative for adolescent and older children in specific situations, such as after surgery. In patients with severe or persistent pain, it is very important to consult with specific pain services.

Stressful Experiences of Parents in the Paediatric Intensive Care Unit: Searching for the Most Intensive PICU Stressors

Hospitalization of a child in the paediatric intensive care unit (PICU) is extremely stressful, both for the child and for his or her family. The purpose of this study was to gain deeper insight into the stressful experiences of parents of children hospitalized in the PICU. This study included 96 parents. The data were collected using a translated and standardized scale "The Parental Stressor Scale: Paediatric Intensive Care Unit (PSS: PICU)". This study confirms high exposure of parents to numerous PICU stressors. The most intense PICU stressor for parents was child's breathing depending on the ventilator (4.22 ± 1.17), and the least intense was child's demanding behaviour (1.17 ± 0.33). A significant positive correlation between the level of parents' perceived stress and the number of their children was recorded (r = 0.240, p = 0.02), while there was no significant correlation between the level of stress and other sociodemographic variables. A significantly higher level of stress was experienced by parents with primary school education (p = 0.032) and parents who are not healthcare professionals (p < 0.01). It is necessary to establish a system that will enable continuous assessment of parents' stress levels and timely prevention of stressful experiences for parents in the PICU.

Pain assessment practice and associated factors among nurses working at adult care units in public hospitals in Wolaita Zone, Southern Ethiopia, 2021

BACKGROUND

Using standard pain assessment techniques is a cornerstone for effective pain management. Pain is not assessed in a standardized manner in numerous practice settings. The problem of applying pain assessment principles was found to be higher in low-income countries. Very limited evidence indicates the standard of pain assessment practice among nurses in Ethiopia. Therefore, the purpose of this study was to identify pain assessment practice and associated factors among nurses working at adult care units in public hospitals in the Wolaita Zone, Southern Ethiopia.

METHODS

A cross-sectional study was conducted among 290 nurses working at adult care units in public hospitals in Wolaita zone. Data were collected from February to March 2021. A structured self-administered questionnaire was used for data collection. Epi Data 4.6 was used to enter the data, and SPSS version 26 was used to analyze the data. A logistic regression model was used, and statistical significance was declared at P ≤ 0.05. An adjusted odds ratio with 95%CI was used to measure the degree of association.

RESULTS

A total of 267 nurses participated in the study, giving a response rate of 97.8%. Almost three-fourths (73.8%) of the study nurses reported that they assessed pain for their patients. Only 23.6% of the study nurses discussed pain assessment scores during a nurse-to-nurse report. Below, half (47.2%) of the study participants documented pain assessment scores. The proportion of nurses with good pain assessment practice was found to be 38.2%. The odds of having good pain assessment practice among nurses who received training on pain management was two times higher than its counterpart. The nurses who perceived organizational support were twice more likely to have good pain assessment practice than their counterparts.

CONCLUSION

Nurses' pain assessment practice was found to be low. Moreover, a substantial proportion of the study nurses did not discuss pain assessment scores during a nurse-to-nurse report with low documentation practice. Continuous professional development through in-service training and education is crucial to the improvement of nurses' pain assessment practice. Furthermore, ameliorating organizational support by means of a supportive working environment is suggested to the betterment of nurses' assessment practice.