2.3 Supporting staff

The second section of the framework focuses on supporting staff with relevant guidance and protocols and builds on the first section by aiming to reduce stress and increase confidence. Managing children’s pain can be complex and HCPs need support to be able to do so effectively.

There was also the suggestion that improving access to protocols, dosing guidance, as well as training at induction would help to reduce stress. Protocols are well researched, and quality assured evidenced based guidance on specific aspects of care, one example being a protocol for the management of pain post tonsillectomy.

The ANPs noted that support was available to help with the stress of pain management: ‘support of the pain team, alongside protocols and procedures, result in less stress and an increase in confidence’.

Practitioners have recognised the complexity of pain and in particular certain painful situations that have been challenging. Examples are the pain post tonsillectomy, or acute sickle cell crisis. Both situations have had numerous studies undertaken to devise a regime in response the acute pain experience (Gostian et al 2020; Persino et al 2017) and academics have undertaken systematic reviews to identify the best approach to deliver effective pain management. Hospital trusts have clinical procedure guidelines that are used in-house to interpret and apply such guidance locally.

Figure 8: Section 2 of the Framework: Supporting staff with relevant practice guidance

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There are two boxes, with the following text, from left to right:

1. Supporting staff with relevant practice guidance.
2. Use evidence-based pain management protocols & guidance & tailor these as appropriate.

Figure 8: Section 2 of the Framework: Supporting staff with relevant practice guidance

Some participants called for additional in-service education on children’s pain, as seen in the findings from other research (Alotaibi et al 2019).

Stress could also be reduced if effective interventions were available for every individual child and being able to: ‘provide the right answers or the best answers that you can, or the best care and practice and alter things to reduce that stress’.

Activity 1: Effective pain management

Timing: 10 minutes

Watch this short video that explains the framework. Whilst you are watching it, you will see that there are four areas all of which link together to provide effective pain management.

While watching the video, consider the following questions and make some notes in the text box. These notes can only be accessed by you and you can refer back to these at any time (as long as you have enrolled on the course and have saved your response).

Do you agree with the elements of the pain framework?

What would need to happen where you work for all elements to be present in the management of children’s pain?

Download this video clip.Video player: Video 1: Paediatric pain Wellchild

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Transcript: Video 1: Paediatric pain Wellchild

Narrator

When children are in hospital, managing any pain they experience is essential, but it’s not always done effectively. Many parents leaving hospital report that their child experienced a lot of pain during their stay. But they also feel positive about the care they received, which means something isn’t working.

Following extensive research with pain specialists across the UK and internationally, we’ve developed a framework for delivering effective pain management for children. There are four components.

The first is creating knowledgeable, confident practitioners. Many nurses can feel nervous about giving too much pain medicine. And when nurses are not feeling confident, they may administer less than what’s being prescribed to be on the safe side.

The second element is the support given to those staff. Making sure they have access to relevant protocols ensures that they rely less on their own judgement and more on proven best practice. Pain protocols with well-evidenced guidelines for predictable scenarios are usually created by dedicated teams after a lot of hard work. But when the whole hospital implements them, they are shown to make effective pain management easier to achieve.

Thirdly, nurses need to involve parents and treat them as partners. After all, they have unique expertise when it comes to their child. But parents are often reluctant to point out that their child’s pain is not going away. So they need to be encouraged to speak up. Practitioners want to help. But if they don’t know a child is in pain, they can’t do anything about it.

Lastly, it’s important to take an individual approach to both the child and their family. Talking and listening to each child and finding out about their experience, understanding, fears, likes, and dislikes makes it more likely that their pain can be managed effectively.

To be effective, all four components need to happen with everyone at all levels playing their part. If all practitioners start using this framework together, it can contribute to managing children’s pain a lot more effectively.

[MUSIC PLAYING]

End transcript: Video 1: Paediatric pain Wellchild

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Video 1: Paediatric pain Wellchild

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