TY - JOUR
T1 - Pain assessment and treatment in children with cognitive impairment
T2 - A survey of nurses' and physicians' beliefs
AU - Fanurik, Debra
AU - Koh, Jeffrey L.
AU - Schmitz, Michael L.
AU - Harrison, R. Dale
AU - Roberson, Paula K.
AU - Killebrew, Pamela
PY - 1999
Y1 - 1999
N2 - Objective: To gather information about healthcare providers' beliefs regarding pain and its treatment in children with cognitive impairment. Design: A survey consisting of two acute pain vignettes (a child undergoing surgery and a child undergoing an outpatient medical procedure) was completed by 440 nurses and 146 physicians at Arkansas Children's Hospital. Respondents completed one of four different surveys that systematically varied the child's level of cognitive impairment (none, mild, moderate, severe) in both vignettes. Questions addressed expected pain, pain assessment methods, pharmacologic regimens, and nonpharmacologic interventions. Results: In general, provider discipline and level of cognitive impairment did not significantly influence responses about pain experience and treatment. Potent analgesia, regularly scheduled dosing, and nonpainful administration were selected most frequently. Self-report of pain, patient-controlled analgesia, and behavioral interventions requiring higher cognitive skills were selected less frequently for children with more severe cognitive impairment. Conclusions: The presence of cognitive impairment appeared to influence provider decisions regarding the appropriateness of specific pain assessment and treatment methods requiring skills on the part of the child. Overall, healthcare provider views regarding analgesia and sedation were similar for all children, regardless of impairment. Whether these beliefs are consistent with clinical practice is yet to be documented.
AB - Objective: To gather information about healthcare providers' beliefs regarding pain and its treatment in children with cognitive impairment. Design: A survey consisting of two acute pain vignettes (a child undergoing surgery and a child undergoing an outpatient medical procedure) was completed by 440 nurses and 146 physicians at Arkansas Children's Hospital. Respondents completed one of four different surveys that systematically varied the child's level of cognitive impairment (none, mild, moderate, severe) in both vignettes. Questions addressed expected pain, pain assessment methods, pharmacologic regimens, and nonpharmacologic interventions. Results: In general, provider discipline and level of cognitive impairment did not significantly influence responses about pain experience and treatment. Potent analgesia, regularly scheduled dosing, and nonpainful administration were selected most frequently. Self-report of pain, patient-controlled analgesia, and behavioral interventions requiring higher cognitive skills were selected less frequently for children with more severe cognitive impairment. Conclusions: The presence of cognitive impairment appeared to influence provider decisions regarding the appropriateness of specific pain assessment and treatment methods requiring skills on the part of the child. Overall, healthcare provider views regarding analgesia and sedation were similar for all children, regardless of impairment. Whether these beliefs are consistent with clinical practice is yet to be documented.
KW - Children
KW - Cognitive impairment
KW - Developmental delay
KW - Postoperative pain
KW - Procedural pain
KW - Survey
UR - http://www.scopus.com/inward/record.url?scp=0033406351&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0033406351&partnerID=8YFLogxK
U2 - 10.1097/00002508-199912000-00007
DO - 10.1097/00002508-199912000-00007
M3 - Article
C2 - 10617259
AN - SCOPUS:0033406351
SN - 0749-8047
VL - 15
SP - 304
EP - 312
JO - Clinical Journal of Pain
JF - Clinical Journal of Pain
IS - 4
ER -