4 Bringing everyone’s views together

In this final section of the course, you will focus on bringing the views of nurses and parents/carers together and create actions for each to take to help build trust and improve the management of a child’s pain whilst in hospital.

Figure 6 Reducing a child’s level of pain is the target for everyone

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A healthcare professional sitting and smiling next to a bed with a young girl in it who is also smiling

Figure 6 Reducing a child’s level of pain is the target for everyone

Based on parent and nurse feedback (Simons et al., 2024; Simons and Plowright Pepper, 2024) the following are suggested as actions to take:

For parents/carers, parent/carer empowerment is strongly dependent on the relationship the parent/carer has with the nurse. Having parents/carers and nurses work together as a team is in the best interests of the child in pain.

Activity 4 PAIN mnemonic

Timing: This activity should take approximately 10 minutes

Watch this short animation for nurses and answer the following questions:

1. How useful is the PAIN mnemonic for nurses to help improve the management of children’s pain in hospital?
2. If you were given responsibility for sharing it with parents/carers, what method would you use and why?
3. What difference would each of the four sections of the mnemonic (PAIN) make to parents/carers?

Download this video clip.Video player: Animation 3

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Transcript: Animation 3

[MUSIC PLAYING]

SPEAKER:

When a child is in pain, the relationship between parents and nurses is really important. We’re working with nurses, parents, children, and young people to understand how we can better manage children’s pain in hospital.

Some parents told us they are reluctant to bother a busy nurse, which can lead to lots of waiting. If a parent is unable to get help and their child’s pain escalates, it can leave them feeling helpless and like they’re letting them down. Parents say that waiting for a nurse is stressful, and they try different ways to help their child.

Nurses empathise with parents and want to help. They tell parents, "It doesn’t matter if we’re busy. Come and find us. Just grab us." But despite these messages, parents assume nurses are busy elsewhere and remain concerned about adding to their workload. Getting a child pain relief is always top priority for a parent, but nurses are juggling multiple care priorities. Nurses told us they never want to leave a child in pain, but if they don’t know, other things that need recording, like fluid balance, can be given higher priority.

Pain is invisible. And some nurses told us that they used their own judgment. And if a child looked OK, they didn’t ask them about their pain. A child in pain, a busy nurse, and an anxious parent can lead to frustration, misunderstanding, and terse exchanges. So how can we communicate better to minimise this?

Nurses and parents said that feeling confident and empowered were key. For nurses, this confidence allows them to be flexible and use different strategies to help with the child’s pain. Parents told us these things gave them confidence: being reminded to seek help from a nurse, nurse is listening to them and their child and showing they understood, the use of pain scores, having information about pain relief medication, and pain relieving strategies.

Nurses can support parents to feel empowered by keeping these questions in mind. Does the parent know what to expect regarding pain? Does the parent know when to expect analgesia next? Has the nurse introduced themselves to the parent and child or young person? Does the parent know where to find a nurse when they need one? By working together and communicating better, we can reduce the number of children who experience pain in hospital.

[MUSIC PLAYING]

[TEXT ON SCREEN: Pain. Analgesia. Introduction. Needing help.]

End transcript: Animation 3

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Animation 3

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Discussion

Many studies have found a longstanding problem in how nurses and parents/carers communicate in relation to children’s pain. By consciously working together to communicate better, by nurses being proactive in their communication about pain, and by parents/carers feeling more confident in approaching a nurse when their child is in pain, there is a greater likelihood of preventing children in hospital experiencing unnecessary pain.