Children's postoperative pro re nata (PRN) analgesia: Nurses' administration practices

Abstract

Aims and objectives:
This paper reports a study aimed at exploring the nursing practices associated with the administration of pro re nata (PRN) postoperative analgesia to children, and at gaining a preliminary understanding of the decisions that nurses make about this important intervention.

Background:
Nurses are responsible for assessing and administering the appropriate medication at the appropriate time to the child in pain. There was scant published research about the administration of postoperative PRN analgesia to children, or about the decision-making processes inherent in this aspect of clinical nursing care.

Design:
A sequential mixed methods explanatory study with two data collection phases - quantitative followed by qualitative - was conducted.

Results:
Nurses used multiple strategies to ascertain children's need for postoperative PRN analgesia, including reference to pain assessment tools, focussing on the behavioural cues of children, involving parents and children, and drawing upon personal and professional backgrounds and experience. Evaluation of the effectiveness of PRN postoperative analgesia was poorly communicated.

Conclusions:
Decision-making associated with the selection and administration of appropriate analgesia to children is complex. In-service education should be developed and offered to nurses working with children postoperatively to ensure the appropriate use of PRN pain relief.

Relevance to clinical practice:
Documentation surrounding this task is poor and needs to be addressed as a matter of urgency to ensure quality patient outcomes.

Authors

Wendy Smyth
School of Nursing, Nutrition and Midwifery, James Cook University, Townsville QLD

Janelle Toombes
Tropical Health Research Unit for Nursing and Midwifery Practice, Townsville Health Service District; School of Nursing, Nutrition and Midwifery, James Cook University, Townsville, Townsville QLD

Kim Usher
School of Nursing, Midwifery and Nutrition, James Cook University, Cairns QLD

References

Abu-Saad, H. H., & Hamers, J. P. H. (1997). Decision-making and paediatric pain: A review. Journal of Advanced Nursing, 26, 946-952.

Beggs, S. (2008). Paediatric analgesia. Australian Prescriber, 31, 63-65.

Belville, R. G., & Seupaul, R. A. (2005). Pain measurement in pediatric emergency care. A review of the Faces Pain Scale-Revised. Pediatric Emergency Care, 21, 90-93.

Botti, M., Bucknall, T., & Manias, E. (2004). The problem of postoperative pain: Issues for future research. International Journal of Nursing Practice, 10, 257-263.

Bucknall, T., Manias, E., & Botti, M. (2001). Acute pain management: Implications of scientific evidence for nursing practice in the postoperative context. International Journal of Nursing Practice, 7, 266-273.

Bucknall, T., Manias, E., & Botti, M. (2007). Nurses' reassessment of postoperative pain after analgesic administration. Clinical Journal of Pain, 23, 1-7.

Clabo, L. M. L. (2007). An ethnography of pain assessment and the role of social context on two postoperative units. Journal of Advanced Nursing, 61, 531-539.

Creswell, J. W. (2003). Research design: Qualitative, quantitative and mixed methods approaches. Thousand Oaks, CA: Sage.

Davis, L., Keogh, S., Watson, K., et al. (2005). Dishing the drugs: A qualitative study to explore paediatric nurses' attitudes and practice related to medication administration. Collegian: Journal of the Royal College of Nursing, Australia, 12, 15-20.

Di Maggio, T. J. (2002). Pediatric pain management. In B. St Marie (Ed.), American Society of Pain Management Nurses: Core curriculum for pain management nursing. Philadelphia: WB Saunders.

Dihle, A., Bjølseth, G., & Helseth, S. (2006). The gap between saying and doing in postoperative pain management. Journal of Clinical Nursing, 15, 469-479.

Geffen, J., Cameron, A., Sorensen, L., et al. (2002). Pro re nata medication for psychoses: The knowledge and beliefs of doctors and nurses. Australian and New Zealand Journal of Psychiatry, 36, 642-648.

Hamers, J. P. H., Abu-Saad, H. H., van den Hout, M. A., et al. (1998). Are children given insufficient pain-relieving medication postoperatively? Journal of Advanced Nursing, 27, 37-44.

Higgins, S. S., Turley, K. M., Harr, J., et al. (1999). Prescription and administration of around the clock analgesics in postoperative pediatric cardiovascular surgery patients. Progress in Cardiovascular Nursing, 14, 19-24.

Hockenberry, M. J., Wilson, D., Winkelstein, M. L., et al. (2003). Wong's nursing care of infants and children. St Louis: Mosby.

Johnson, C. C., Gagnon, A., Rennick, J., et al. (2007). One-on-one coaching to improve pain assessment and management practices of pediatric nurses. Journal of Pediatric Nursing, 22, 467-478.

Karimi, R., Parsa-Yekta, Z., Mehran, A., et al. (2002). Perspective of nurses on effective factors on their decision to administer PRN analgesics to children after surgery [Farsi]. HAYAT: The Journal of Tehran Faculty of Nursing & Midwifery, 8, 42-49.

Mac Lellan, K. (1997). A chart audit reviewing the prescription and administration trends of analgesia and the documentation of pain, after surgery. Journal of Advanced Nursing, 26, 345-350.

Manias, E. (2003). Medication trends and documentation of pain management following surgery. Nursing & Health Sciences, 5, 85-94.

Manias, E., Botti, M., & Bucknall, T. (2002). Observation of pain assessment and management - the complexities of clinical practice. Journal of Clinical Nursing, 11, 724-733.

Manias, E., Botti, M., & Bucknall, T. (2006). Patients' decision-making strategies for managing postoperative pain. Journal of Pain, 7, 428-437.

Nilsson, S., Finnstrom, B., & Kokinsky, E. (2008). The FLACC behavioral scale for procedural pain assessment in children aged 5-16 years. Pediatric Anesthesia, 18, 767-774.

Pölkki, T., Laukkala, H., Vehviläinen-Julkunen, K., et al. (2003). Factors infl uencing nurses' use of non-pharmacological pain alleviation methods in paediatric patients. Scandinavian Journal of Caring Sciences, 17, 373-383.

Richards, J., Sullivan, P., & Briggs, L. (2004). Evaluation of an educational intervention to improve paediatric pain management by nurses. Final report to funding body, Queensland Nursing Council. Brisbane: Royal Children's Hospital.

Schafheutle, E. I., Cantrill, J. A., & Noyce, P. R. (2001). Why is pain management suboptimal on surgical wards? Journal of Advanced Nursing, 33, 728-737.

Smeltzer, S. C., & Bare, B. G. (2000). Brunner and Suddarth's textbook of medical-surgical nursing. Philadelphia: Lippincott Williams & Wilkins.

Streubert Speziale, H. J., & Rinaldi Carpenter, D. (2003). Qualitative research in nursing: Advancing the humanistic imperative. Philadelphia: Lippincott Williams & Wilkins.

Twycross, A. (2002). Managing pain in children: An observational study. Nursing Times Research, 7, 164-178.

Twycross, A. (2007a). Children's nurses' post-operative pain management practices: An observational study. International Journal of Nursing Studies, 44, 869-881.

Twycross, A. (2007b). What is the impact of theoretical knowledge on children's nurses' post-operative pain management practices? An exploratory study. Nurse Education Today, 27, 697-707.

Usher, K., Lindsay, D., & Sellen, J. (2001). Mental health nurses' PRN psychotropic medication administration practices. Journal of Psychiatric and Mental Health Nursing, 8, 383-390.

Villarreal, M. C., Brown, C. M., & Lawson, K. A. (1998). Differences in morphine consumption administered by PCA and traditional IV methods in a pediatric population. Journal of Pharmaceutical Care in Pain & Symptom Control, 6, 75-94.

Vincent, C. V. H., & Denyes, M. J. (2004). Relieving children's pain: Nurses' abilities and analgesic administration practices. Journal of Pediatric Nursing, 19, 40-50.

Wong, D. L. (1995). Pediatric quick reference. St Louis: Mosby.

Yorke, J., Wallis, M., & McLean, B. (2004). Patients' perceptions of pain management after cardiac surgery in an Australian critical care unit. Heart and Lung, 33, 33-41.

Keywords

pro re nata; PRN; analgesia administration; pain relief; paediatric nursing; postoperative

Meta

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