The purpose of this study was to examine how health-care providers in U.S. teaching hospitals assess and manage children's pain. A 59-item questionnaire was sent to institutions with pediatric residency programs listed in the 1992 National Residency Matching Program. Two hundred and twenty-seven questionnaires were sent and 113 were returned. Two-thirds were from nurses, one-third from physicians. Sixty percent of the respondents stated that they had standards of care or protocols for pain in their institutions, but only one-quarter reported that the standards were followed 80% or more of the time. Use of formal pain-assessment tools was reported by 73% of the sample. Respondents reported that the effectiveness of pain assessment and management was lower for infants and younger children. Only 35% of the sample indicated it was "likely" or "very likely" that parents would be involved in planning prior to a painful event. Several obstacles to adequate pain management were identified by the respondents: knowledge deficit, attitudes, and resources.

ISSUES AND PURPOSE. To evaluate the characteristics of vaso‐occlusive episodes, home management of pain and its impact on the daily activities, and a diary as a method of data collection. DESIGN AND METHODS. Forty‐six adolescents and 75 children were asked to complete daily diaries during the intervention period of a larger study. RESULTS. Mild pain was recorded 95% of the time; moderate pain, 3%; and severe pain, 1%. The pattern and location of pain varied greatly. Adolescents used more interventions than did children. When pain intensity was mild, 80% of the children/adolescents maintained school, social, and home activities, but decreased play/sport activities. When pain intensity was high, they decreased their participation in all activities. PRACTICE IMPLICATIONS. Sickle cell pain episodes are unpredictable and highly variable. Diaries can enhance children's and adolescents’documentation and communication about their pain experiences.

Although pain management is an important nursing responsibility, few interventions for minimizing distress of infants during painful procedures have been studied. Sixty infants, 2 through 6 months of age, were studied during a routine DPT immunization in order to examine (a) the effectiveness of cooling the skin in reducing distress behaviors and (b) the relationship between age and distress behavior. Infants were randomly assigned to experimental or control groups. Prior to the injection, the sites were sprayed for 2 to 3 s with either a skin refrigerant/anesthetic or compressed air. Behaviors were video- and audio-taped during and 60 s post injection, and coded for (a) facial expression, (b) cry, and (c) body movements. MANOVA revealed fewer distress behaviors following refrigerant spray and more complex, varied behavioral responses for older infants. The findings provide further evidence that infants perceive pain and that nursing interventions for pain reduction should be tested and extended to the very young.

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