Introduction
Regardless of the achievements in the sphere of effective pain management techniques, pain in children frequently remains undertreated. This paper will discuss the underlying causes of the barriers to the global improvement of the current pain management practices in pediatric settings and the changes which can be made for adopting the philosophy prioritizing pain management.
Taking into account the impact of the cultural environment and the level of the practitioners’ competence and professional knowledge upon the quality of the medical outcomes, this paper explores the perceived and real barriers to pediatric pain management and the measures which need to be taken for improving the situation. In pediatric settings how can the data collection, staff consultation, cultural and organizational changes affect the perceived barriers to children’s pain management?
Main Body
The main purpose of this research project is to evaluate the existing pain management practices, identifying the existing deficiencies in the procedures and the measures in the frames of cultural and organizational changes which need to be taken for filling the gaps and improving the outcomes. Special consideration will be given to the perceived barriers, their underlying causes and the practical solutions for the problem of understated and undertreated children’s pain.
The original article by Dowden, McCarthy and Chalkiadis (2008) was aimed at exploring the main barriers to improvement of pain management within hospital settings, providing recommendations for improving the situation in a particular pediatric hospital in Melbourne and estimating the effects of the implemented changes. The research question posed in this original article is how the adoption of the philosophy prioritizing the pain management along with acknowledgement of the physical, social and psychological factors affecting the pain representation can foster the global improvement of the pain management strategies and outcomes.
This particular question is significant because the evidence shows that the problem of undertreated pain and ineffective pain management strategies are rooted deep in the imperfection of the health care organizations and the biases of the practitioners which can be affected through undertaking educational and consultation initiatives.
However, as it was stated by Henderson et al (2006), the integration of evidence into practice is a beneficial but time-consuming process because the immediate results of materialization of evidence-based practice are hardly identifiable. Dowden et al (2008) in their turn concluded that the achievement of organizational changes and global improvement of the pediatric pain management requires adoption of the upgraded philosophy prioritizing pain management which cannot be performed immediately.
Taking into account the gaps in theoretical knowledge regarding this issue, it can be stated that further empirical research is necessary for providing the insight into the major influential factors which need to be considered for handling the problem and developing the effective practical solutions for applying theoretical findings into practice. For this reason, this paper focuses on bridging the gap between theory and practice in terms of illuminating the results of empirical studies and their implications in clinical practice, namely the organizational and cultural changes which need to be taken for improving the quality of pediatric pain management.
The research articles by Twycross (2008), Ellis et al (2007) and MacLaren et al (2008) provide a valuable insight into the problem of the perceived barriers to effective pediatric pain management and the corresponding influential factors. The purpose of the study performed by Twycross (2008) was to establish the relationship between the importance of the pain management as perceived by individual practitioners and the quality of their professional services as well as the patient outcomes if any. The study by Ellis et al (2007) was aimed at estimating the preliminary effects of implementing a comprehensive program within a particular hospital setting upon the effectiveness of the applied pain management practices.
The purpose of the research conducted by MacLaren et al (2008) was to evaluate the changes in the nursing students’ perception of the importance of pediatric pain management after their participation in the didactic training program as compared to their pre-training perception. Thus, the three articles under consideration allow defining the major underlying causes of undertreated pediatric pain and evaluate the effectiveness of organizational changes in the form of the implementation of a comprehensive program within a particular program and educational initiatives for settling the problem of the perceived barriers to the effective pediatric pain management.
Each research article under consideration relates to a particular segment of the research problem, namely the perceived importance and barriers to effective intervention strategies as the underlying causes of ineffective pain management at pediatric settings, organizational and training measures as the steps towards adoption of a new philosophy emphasizing the importance of pain management.
The study by Twycross (2008) investigated the relationship between the practitioners’ perception of the pain management importance and the quality of their health care services. Then, the lack of the nurses’ awareness of children’s pain is recognized as one of the main underlying causes of ineffective pain management practices and the barrier to global improvement. The research conducted by Ellis et al (2007) presents systematic evaluation of the practical application of a comprehensive program within one clinical setting for shedding light upon the organizational changes which can be performed by the hospital administration as a part of the practical solution for the problem of undertreated pediatric pain. The study by MacLaren et al (2008) provides insight into the educational dimension which also can be involved into the solution of the problem.
Incorporating the elements of effective pediatric pain management strategies into the nursing educational programs is a significant step crucial for transforming the overall philosophy of health care organizations. Drawing attention of the junior nursing students to the importance of proper pediatric pain management can be more effective than changing their perception of its importance afterwards. However, taking into account the fact that the shift towards a new philosophy of pediatric pain management is a gradual process, it can be stated that changes need to be undertaken on various levels of the health care organizations for achieving the end goal of the global improvement of pain management practices.
The lack of the relationship between the perceived importance of pain management task and the observed clinical practices as the major findings of the research conducted by Twycross (2008) allow viewing the underlying causes of undertreated pediatric pain in their complexity, treating the priority attributed by nurses to pain management practices as important but not the only influential factor. The findings of Ellis et al (2007) demonstrated the advantages of training initiatives within pediatric settings which enhanced the quality of the current pain management practices through the improvement of the assessing, documenting and managing pediatric pain as the result of placing more emphasis upon pain management and peer support.
Regarding the findings of MacLaren et al (2008), the scholars established a direct relationship between the nursing students’ increased awareness of the problem and the most effective strategies which can be implemented for handling it. However, the results of the survey have demonstrated that the participation in the training program does not affect their attitudes towards pain management for children which can be explained with the design of the educational program.
Conclusion
Disregarding the value of these articles for investigating the main research problem, each of the studies under consideration has certain strengths and weaknesses. To begin with, the article by Twycross (2008) estimates perceived barriers to effective pain management as an important influential factor but does not limit the research scope to it. The major weakness of this research is the inappropriateness of the observational method for getting insight into the nurses’ feelings and thoughts regarding the importance of particular pain management task.
As to the study by Ellis et al (2007), it can be stated that this article contains valuable information on the practical implications of the organizational changes and identifies the improvements in current practices but underestimates the nursing environment as a significant aspect affecting the program outcomes which need to be taken into account before implementing similar programs in other settings.
The main disadvantage of the study by MacLaren et al (2008) is the lack of attention towards the attitudes parameter in the educational program, while the materials concerning the methods of improving the cognitive-behavioral pain management strategies is a valuable contribution this research.
In general, it can be concluded that the global improvement of the current pain management practices requires adoption of new philosophy and corresponding changes in organizational and educational spheres, while the barriers to implementation of these changes cannot b limited to nurses’ attitudes and need to be viewed in their complexity.
Reference List
Dowden, S., McCarthy, M. and Chalkiadis, G. (2008). Achieving organizational change in pediatric pain management. Pain Research and Management, 13(4): 321- 326.
Ellis, J., McCleary, L., Blouin, R., Rowley, B., MacNeil, M. and Cooke, C. (2007). Implementing best practice pain management in a pediatric hospital. Journal for Specialists in Pediatric Nursing, 12(4): 264- 277.
Henderson, A., Winch, S., Holzhauser, K., & DeVries, S. (2006). The motivation of health professionals to explore research evidence in their practice: an intervention study. Journal of Clinical Nursing, 15: 1559-1564.
MacLaren, J., Lindsey, C., Larkin, K. and Shelton, E. (2008). Training nursing students in evidence-based techniques for cognitive-behavioral pediatric pain management. Journal of Nursing Education, 47(8): 351-358.
Twycross, A. (2008). Does the perceived importance of a pain management task affect the quality of children’s nurse’s post-operative pain management practices? Journal of Clinical Nursing, 17: 3205 – 3216.