Paediatric Nursing Skills for Australian Nurses

Introduction

Infants, children and young people experiencing acute and chronic illness unfortunately may experience pain as a consequence of the pathophysiology of their illness. Despite efforts to minimise physical and psychological harm, they may also experience pain due to the investigations and treatments they face. As nurses caring for paediatric patients, preventing, assessing and managing pain are clinical priorities, and this chapter will assist you to develop your skills in this important area of practice.

The consequences of poorly managed pain are significant for the child, family and healthcare agency. Physical and psychological consequences for children who experience pain may include fear, anxiety, the development of post-traumatic stress disorder (PTSD), an increased infection risk and wound-healing complications (Hovde et al., 2012). A variety of barriers exist regarding the provision of effective paediatric pain management, including nurse attitudes and knowledge, a lack of educational preparation and failure to use or administer correctly paediatric pain-assessment tools (Ekim & Ocakci, 2013; Manworren, 2000; Stanley & Pollard, 2013). It is therefore important to develop your skills in relation to paediatric pain assessment and management to ensure effective pain management for your paediatric patients.

Understanding pain

Pain is an intrinsic alert system designed to warn the body of danger or a decline in condition. The International Association for Study of Pain (IASP) officially defines pain as ‘an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage’ (IASP, Bogduk & Merskey, 1994). The acknowledgement of both a sensory and emotional experience being involved in the experience of pain necessitates accurate assessment of all factors that contribute to the pain experience for children, both physical and psychosocial (Saul, Peters & Bruce, 2016).

Nociception

Pain is generally categorised as either acute or chronic. Acute pain that occurs with a defined incident or actual or impending injury to the tissue is well localised, and subsides with tissue healing (Saul, Peters & Bruce, 2016). Chronic pain persists beyond the expected time for healing and is not consistently attributable to a defined incident (Saul, Peters & Bruce, 2016). Pain is experienced due to the presence of noxious stimuli, which results in the activation of peripheral receptors. The nerve cell endings that transmit the message of pain are called nociceptors, and are found throughout the body.