1.2 A pain management framework
An international study by Simons (2015) of 28 practitioners in the UK, Sweden and Australia explored innovations in pain management practice. The findings identified five key elements that contributed to the delivery of effective pain management to children in hospital, these being:
- distributed pain management with vision
- effective pain management with less stress
- pain management delivered with confidence
- individual approach to child and parent
- raising parents’ expectations of effective pain management.
Having identified these key elements for the delivery of effective pain management, a further study by Simons et al (2020) explored their relevance and practical application with UK based pain practitioners (n=43). The result of this multistage work is a central focus of this short course.
The 43 practitioners included Band 5 nurses, Advanced Nurse Practitioners (ANP), pain nurses and pain consultants working in the NHS. The findings demonstrated that the following elements were considered to be important: delivering pain management with confidence, supporting colleagues with protocols and guidance, adopting an individual approach to a child and family, and empowering parents to be involved in pain management.
These elements form the basis of a framework for children’s pain management, as illustrated in Figure 3. Each quadrant in Figure 3 is linked with the next but not necessarily a prerequisite of the subsequent quadrant. The four sections contribute to the effective management of children’s pain in hospital. You will explore the framework in more detail in Section 2 and 3 of this course.
Having stated earlier that there are guidelines that have been well researched and carefully developed it is important to ask: How can the framework above bring about change? The framework has a number of interconnected elements that focus on supporting health care staﬀ, helping them become conﬁdent, adopting an individual approach to children and families, and empowering parents to become more actively involved in their child’s pain management All of these processes are dependent on eﬀective leadership and robust education.
You may ask what difference will the framework make? It is intended to make children’s experience of pain in hospital better, and it is therefore aligned with The Lancet Child and Adolescent Health Commission (Ecclestone et al 2020) on delivering transformative action in paediatric pain, which has four transformative goals: Make pain matter; make pain understood; make pain visible; make pain better. Addressing these goals ‘will improve the lives of children and adolescents with pain and their families’ (Ecclestone et al 2020:1).