Pain in the Pediatric Burn Patient: Nursing Assessment and Perception

Atchison, N.E.; Guercio, Phyllis; Monaco, Carla Alves

doi:10.3109/01460868609009066

Cited by 25 publications

(11 citation statements)

References 5 publications

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“…1981, Choiniere et al . 1989) and nurses (Atchison et al . 1986) as greater than the pain from the burn itself.…”

Section: Introductionmentioning

confidence: 99%

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Strategies used by burns nurses to cope with the infliction of pain on patients

Nagy

1999

Journal of Advanced Nursing

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The infliction of pain on patients is part of the daily routine for many nurses, particularly those who work in burns units, but there has been little help available for nurses to develop useful ways of coping with such circumstances. Few researchers have considered how the ways that nurses manage their feelings about pain may provide insights into the reasons why available pain control methods have not been fully practiced. The aim of this study was to identify the range of coping strategies used by nurses when conducting painful procedures. Nurses working in five burns units were interviewed about their feelings when it was necessary for them to inflict pain on patients in the course of giving patient care. Content analysis was used to identify the kinds of coping strategies used by nurses to manage their feelings about such situations. Fourteen kinds of strategy were identified and were then grouped into four categories: (i) distancing oneself from the patient's pain; (ii) engaging with the patient's pain; (iii) seeking social support and (iv) reconstructing the nurse's core role. The use of each of these categories of coping have implications for both the management of patient's pain and the nurse's emotional well-being. While distancing oneself from the patient's pain was the most prevalent way for nurses to cope with their feelings about causing pain to patients, all types of coping strategies had their advantages. It is possible that combinations of various strategies may be the most effective way for nurses to deal with their patients' pain.

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“…1981, Choiniere et al . 1989) and nurses (Atchison et al . 1986) as greater than the pain from the burn itself.…”

Section: Introductionmentioning

confidence: 99%

“…These nurses are involved in the most painful of all procedures, that of wound debridement. Debridement has been described by both patients (Perry et al 1981, Choiniere et al 1989) and nurses (Atchison et al 1986) as greater than the pain from the burn itself.…”

Section: Introductionmentioning

confidence: 99%

Strategies used by burns nurses to cope with the infliction of pain on patients

Nagy

1999

Journal of Advanced Nursing

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“…This is important as children under 5 years old have trouble accurately self-reporting pain intensity and young child pain can go unrecognized and untreated (Blount, Piira, Cohen, & Cheng, 2006;McGrath & Frager, 1996;Shacham & Daut, 1981). Clinicians can also underestimate burn pain (Atchison, Guercio, & Monaco, 1986;van der Does, 1989;Geisser, Bingham, & Robinson, 1995;Iafrati, 1986;Perry, 1984;Perry & Heidrich, 1982). The wider literature demonstrates while parent report is positively correlated to child self-report, parents of young children tend to underestimate child procedural pain (St-Laurent-Gagnon, Bernard-Bonnin, & Villeneuve, 1999;Zhou, Roberts, & Horgan, 2008).…”

Section: Discussionmentioning

confidence: 99%

The role of parental acute psychological distress in paediatric burn re‐epithelialization

Brown

Young

Kimble

et al. 2019

British J Health Psychol

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Objectives. Following a paediatric burn, parents commonly experience high levels of acute psychological distress, which has been shown to increase child psychological distress as well as child procedural distress. The influence of psychological stress and perceived pain on wound healing has been demonstrated in several laboratory and medical populations. This paper investigates the influence of parental acute psychological distress and procedural behaviour on the child's rate of re-epithelialization, after controlling for child procedural distress. Design. A prospective observational study with longitudinal outcome.Methods. Eighty-three parents of children 1-6 years old reported acute psychological distress (post-traumatic stress symptoms [PTSS], guilt, pre-procedural fear, general anxiety/depression symptoms) in relation to their child's burn. A researcher observed parent-child behaviour at the first dressing change, and parents and nurses reported child procedural distress (pre-, peak-, and post-procedural pain and fear). These variables, along with demographic and injury information, were tested for predicting time to re-epithelialization. Date of re-epithelialization was determined by the treating consultant.Results. Days to re-epithelialization ranged from 3 to 35 days post-injury. A hierarchical multiple regression analysis found wound depth and size significantly accounted for 28% of the variance in time to re-epithelialization. In Block 2, child peak-procedural pain significantly accounted for 6% additional variance. In Block 3, parental PTSS significantly accounted for 5% additional variance.Conclusions. Parental PTSS appears to be an important but under-recognized factor that may influence their child's burn re-epithelialization. Further investigation is required to understand the mechanisms contributing to this association.

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“…Some studies have suggested that burn patients have increased levels of anxiety, especially relating to treatment and outcome, and that these levels may increase overtime (3, 4). Burn pain is recognized as being maximal during therapeutic procedures (5), and wound debridement can be more painful than the burn injury itself (6). Uncontrolled acute burn pain increases the incidence of chronic pain and associated depression (7), and correlates with suicidal ideation at the time of discharge from hospital (8).…”

Section: Introductionmentioning

confidence: 99%

Effect of Gabapentin on Morphine Consumption and Pain after Surgical Debridement of Burn Wounds: A Double-Blind Randomized Clinical Trial Study

Rimaz

Alavi

Sedighinejad

et al. 2012

atr

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Background:Burn pain is recognized as being maximal during therapeutic procedures, and wound debridement can be more painful than the burn injury itself. Uncontrolled acute burn pain increases the stress response and the incidence of chronic pain and associated depression. Although opiates are excellent analgesics, they do not effectively prevent central sensitization to pain. The anticonvulsant gabapentin has been proven effective for treating neuropathic pain in large placebo-controlled clinical trials. Experimental and clinical studies have demonstrated antihyperalgesic effects in models with central neuronal sensitization. It has been suggested that central neuronal sensitization may play an important role in postoperative pain.Objectives:The aim of this study was to investigate the effect of gabapentin on morphine consumption and postoperative pain in burn patients undergoing resection of burn wounds.Patients and Methods:In a randomized, double-blind, placebo-controlled study, 50 burn patients received a single oral dose of gabapentin (1200mg) or placebo 2h before surgery. Anesthesia was induced with propofol and fentanyl and maintained by infusingpropofol, remifentanil, and 50% N2O in O2. All patients received patient-controlled analgesia with morphine at doses of 2.5 mg bolus and a lock-out time of 10 min for 24h before the operation. Pain was assessed on a visual analog scale (VAS) at rest and during movement at 1,4,8,12,16,20, and 24 h before the operation. Heart rate, oxygen saturation, mean arterial blood pressure, respiratory rate, sedation score, and morphine consumption were studied.Results:All the enrolled patients were able to complete the study; therefore, data from 50 patients wereanalyzed. The VAS scores at rest andduring movement at 1,4,8,12,16,20, and 24 h after the operation were significantly lower in the gabapentin group than in the placebo group (P < 0.05). Morphine consumption was significantly lessr in the gabapentin group than in the placebo group (P < 0.05). Sedation scores were similar in the 2 groups at all measured times. There were no differences in adverse effects between the groups.Conclusions:A single oral dose of 1200mg gabapentin resulted in a substantial reduction in postoperative morphine consumption and pain scores after surgical debridement in burn patients.

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Pain in the Pediatric Burn Patient: Nursing Assessment and Perception

Cited by 25 publications

References 5 publications

Strategies used by burns nurses to cope with the infliction of pain on patients

Strategies used by burns nurses to cope with the infliction of pain on patients

The role of parental acute psychological distress in paediatric burn re‐epithelialization

Effect of Gabapentin on Morphine Consumption and Pain after Surgical Debridement of Burn Wounds: A Double-Blind Randomized Clinical Trial Study

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