INDICATING PAIN IN PEDIATRIC ONCOLOGY PATIENTS

Meredith Goode

Sarah Harville

Morgan Moncus

Case Study

Nurses oftentimes struggle with how to indicate the pain level in pediatric oncology patients. In this case, the Medical Center has recently hired a nurse researcher. Ms. Jones asks staff nurses on a pediatric oncology unit to identify the “top” patient care problem on the unit. The nurses informed Ms. Jones that pain control is a huge problem for many children admitted to the oncology unit. Ms. Jones discovers that the nurses routinely use physiologic measures, such as heart rate and blood pressure, as indicators of pain. Occasionally the nurses rely on parents’ reports, but rarely do they consult the child.

Introduction

Cancer is a disease characterized by abnormal, uncontrolled cell division

Generally treated with antineoplastics, radiation therapy, and surgery

Adverse effects of chemotherapy: nausea, vomiting, alopecia, headache, bone marrow suppression, and even lead to death

Introduction

Cancer is the second most common cause of death among children ages 1-14 years

Children say pain is the worst part of treatment

Situation Focused Question

The focused question is what indicator should be used to identify pain in pediatric patients.

Targeted Resources/Evidence Search

CINAHL PubMed Key Search Words: pain management,

pediatrics, oncology

Targeted Resources/Evidence Search

Relevance of Evidence

Center for Disease Control and Prevention

Attitudes to and knowledge about pain and pain management, of nurses working with children with cancer: A comparative study between UK, South Africa, and Sweden

Evidence Based Practice for Health Professionals

Nursing a Concept-Based Approach to Learning

Author’s names, credentials, affiliations, and conflict of interest

1. Are the authors’ credentials and educational background appropriate to conduct this type of study? Yes, they have degrees range from RN to PhD and many have a background in pain management in children.

2. Are the authors affiliated with an educational program, health institution, or practice setting? Yes, they are affiliated with different hospitals in different countries, as well as, medical universities. Do the authors report a conflict of interest? No.

_X_ Strength _____Limitation _____Not evident _____Not applicable

Funding source(s) Does the funding source have a vested interest in a beneficial outcome of the study? Yes, the grant came from The Swedish Children’s Cancer Foundation and the topic of the article is pain in pediatric oncology patients.

_ X Strength __ _Limitation ____ Not evident _____Not applicable

Purpose 1. Is the intent of the study clearly stated? Yes, “the aim of the study was to identify and describe the knowledge and attitudes to pain and pain management among nurses working with children with cancer in three countries” measured with questionnaires in a quantitative manner.

2. Is the phenomenon being investigated identifiable? Yes, the phenomenon is pain management.

3. Is the population identifiable? Yes, the population is Ukrainian, South Africa and Swedish nurses working with children with cancer.

_X___Strength _____Limitation _____Not evident _____Not applicable

Hypotheses and research questions

1. If there are hypotheses, are they in alignment with the intended purpose of the study? No hypotheses stated.

2. If there are hypotheses, are the variable under study identifiable in the hypotheses No hypotheses stated.

3. If there are hypotheses, is one hypothesis written for each independent variable under study? There are no hypotheses stated.

4. Are the research questions in alignment with the intended purpose?

__ Strength __X_ Limitation _____Not evident _____Not applicable

Evidence Appraisal of a Quantitative Study

Course of Action

FLACC Scale

Conclusion• The FLACC scale should be implemented for use in the

pediatric oncology setting.• When using this scale the nurses will be able to better

assess the pain of the patient.• According to Manworren & Hynan (2003) this method

is specifically used in children aging from 0 to 7 years. • Pain will accurately be measured when all variables are

taken into consideration.• Nurses should continue to monitor heart rate, blood

pressure, and respirations, but should also consider the FLACC scale because it specifically determines pain levels.

• By combining these methods pain will be better controlled in pediatric oncology patients.

References

Center for Disease Control and Prevention, (2012). Cancer prevention and control. Retrieved from website: http://www.cdc.gov/cancer/index.htm

Enskar, K., Ljusegren, G., Berglund, G., Eaton, N., Harding, R., Mokoena, J…Moleki, M. (2007). Attitudes to and knowledge about pain and pain management, of nurses working with children with cancer: A comparative study between UK, South Africa, and Sweden. Journal of Research in Nursing, 12(5), 501-515. doi: 10.1177/1744987107080455

Howlette, B., Rogo, E., & Shelton, T. (2013). Evidence based practice for health professionals. (p. 90). Burlington, MA: Jones and Bartlett Learning.

Kelley, M., Demiris, G., Nguyen, H., Oliver, D., & Wittenberg-Lyles, E. (2013). Informal hospice caregiver pain management concerns: A qualitative study. Palliative Medicine, 27(7), 673-682. doi:10.1177/0269216313483660

Manworren, R., & Hynan, L. (2003). Practice applications of research. Clinical validation of FLACC: preverbal patient pain scale. Pediatric Nursing, 29(2), 140-146.

North Carolina Concept-Based Learning Editorial Board. (2011). Nursing a concept-based approach to learning. (Vol. 1, p. 121). Upper Saddle River, NJ: Pearson Education.