Transforming acute pain management in children: A concept analysis to develop a new model of nurse, child and parent partnership

Abstract

Objectives:To identify the core components of acute pain management in children, re-conceptualise the process and update the existing model to inform nursing research and clinical practice.Background: Acute pain in hospitalised children remains suboptimal, despite extensive nursing research and education. Improvements require a patient-centred approach and a conceptual model which includes the role of parents and partnership.Design: Using Rodgers' Evolutionary method, a concept analysis was conducted to define the core components for effective acute pain management in children. Methods:A scoping review of peer-reviewed literature from 1990 through 2020 was conducted using the terms "pain management," "pain control," "pain treatment," "multi modal," and "concept*". Abstracts from 85 articles were initially reviewed with 30 articles retained for analysis. Core concepts were identified, defined and synthesised.The PRISMA 2020 checklist was used.Results: A new model was developed from a synthesis of past work which incorporates the role of parents, the complexity of the process and definitions for shared decision-making. Trust, safety, collaborative communication and genuine partnership were identified as the core components for effective pain management in children, with the triadic relationship of nurses, patients and parents in genuine partnership foundational to the nursing process. Conclusion: The new model for acute pain management in children transforms the nurse's role from gatekeeper to facilitator, shifting the process from nurse driven to patient-centred. The new collaborative model will promote shared decision-making for individualised pain assessments, interventions and evaluations. Relevance to clinical practice: Establishing the nurse, child, parent partnership as an essential foundation to pain management has the potential to expand pain | 5231 EULL et al.

Nurse experiences of partnership nursing when caring for children with long‐term conditions and their families: A qualitative systematic review

“…The lack of evidence or acknowledgement of a triadic child–parent–nurse partnership within the studies is cause for concern. Triadic models of care exist in other areas of health care (De Civita & Dobkin, 2004; Eull et al., 2023; Lenne et al., 2023; Williams et al., 2022). These models have a focus on building a partnership that uses shared decision‐making as well as understanding the unique needs a child may have due to their age, maturity or level of competence.…”

“…When caring for children and young people living with long‐term conditions, paediatric nurses need to focus on developing effective partnerships with both their paediatric patient (referred to as ‘children’ throughout this paper, but include infants, children and young people) and their family members (parents, guardians or caregivers; Eull et al., 2023; Vaknin & Zisk‐Rony, 2011). There is an important distinction in developing a partnership with parents, as parental involvement is necessary for all aspects of care, given the important relationship between parent/child and the legal requirements of parental consent for medical procedures and treatment (Library of Congress, 2015).…”

Pain management in hospitalized children: unveiling barriers from the nursing perspective

“…In addition to the aforementioned steps, a concept analysis recently recommended that the family be included at the center of the pain management steps, with the with a collaborative communication, in a trustworthy environment, with a genuine partnership (9) . The recognition of the family in this process aligns with the premises of Family-Centered Care, a philosophy that guides the work of pediatric nurses (10) , and their presence is considered as a non-pharmacological intervention for pain relief (11) .…”

From theory to practice: the inclusion of hospitalized children’s families in painful procedures

“…Considering this issue, international bodies have dedicated themselves to reformulating ideal pain management (assessment, intervention and reassessment), mainly in procedures. In a family concept analysis of pain management, genuine member participation, with collaborative communication, individualized in a safe environment and with the dyad inclusion (children, family and professional) at the center of the process, was portrayed as an essential attribute for the management stages to occur successfully ( 7 ) . This participation promotes a redefinition of the family from passive to active in care, which is consistent with the FCC principles ( 3 , 7 ) .…”