Pain Management Practices in a Pediatric Emergency Room (PAMPER) Study: interventions with nurses.
OBJECTIVE
Children's pain in emergency departments (EDs) is poorly managed by nurses, despite evidence that pain is one of the most commonly presenting complaints of children attending the ED. Our objectives were 2-fold: to verify if tailored educational interventions with emergency pediatric nurses would improve nurses' knowledge of pain management and nurses' pain management practices (documentation of pain, administration of analgesics, nonpharmacological interventions).


METHODS
This intervention study with a pre-post design (baseline, immediately after the intervention [T-2], and 6 months after intervention [T-3]) used a sample of nurses (N = 50) and retrospective chart reviews of children (N = 450; 150 charts reviewed each at baseline, T-2, and T-3) who presented themselves in the ED with a diagnosis known to generate moderate to severe pain (burns, acute abdominal pain, deep lacerations, fracture, sprain). Principal outcomes: nurses' knowledge of pain management (Pediatric Nurses Knowledge and Attitudes Survey [PNKAS] on pain) and nurses' clinical practices of pain management (Pain Management Experience Evaluation [PMEE]).


RESULTS
Response rate on the PNKAS was 84% (42/50) at baseline and 50% (21/42) at T-2. Mean scores on PNKAS were 28.2 (SD, 4.9; max, 42.0) at baseline and 31.0 (SD, 4.6) at T-2. Results from paired t test showed significant difference between both times (t = -3.129, P = 0.005). Nurses who participated in the capsules improved their documentation of pain from baseline (59.3%) to T-2 (80.8%; chi = 12.993, P < 0.001) as well as from baseline (59.3%) to T-3 (89.1%; chi = 29.436, P < 0.001). In addition, nurses increased their nonpharmacological interventions from baseline (16.7%) to T-3 (31.9%; chi = 8.623, P = 0.003). Finally, we obtained significant differences on pain documentation between the group of nurses who attended at least 1 capsule and the group of nurses who did not attend any capsule at both times (T-2 and T-3; chi = 20.424, P < 0.001; chi = 33.333, P < 0.001, respectively).


CONCLUSIONS
The interventions contributed to the improvement of the nurses' knowledge of pain management and some of the practices over time. We believe that an intervention tailored to nurses' needs and schedule has more impact than just passive diffusion of educational content.
Le May
Sylvie
S
Université de Montréal, CP 6128, Succursale Centre-Ville, Montreal, QuebecH3C 3J7, Canada. sylvie.lemay@umontreal.ca
Johnston
C Celeste
CC
Choinière
Manon
M
Fortin
Christophe
C
Kudirka
Denise
D
Murray
Louise
L
Chalut
Dominic
D
D000328:Adult; D000698:Analgesia / Q000379:methods; D000700:Analgesics / Q000627:therapeutic use; D003625:Data Collection; D019468:Disease Management; D004509:Education, Nursing, Continuing / Q000379:methods*; D004521:Educational Measurement; D016529:Emergency Nursing / Q000193:education / Q000379:methods*; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D007722:Health Knowledge, Attitudes, Practice; D006776:Hospitals, Pediatric; D006801:Humans; D007318:Inservice Training; D008297:Male; D008875:Middle Aged; D009726:Nurses / Q000523:psychology; D015403:Nursing Evaluation Research; D010146:Pain / Q000188:drug therapy / Q000451:nursing*; D059408:Pain Management; D010371:Pediatric Nursing / Q000193:education / Q000379:methods*; D012189:Retrospective Studies
D000700:Analgesics