A Day in the Life of a CPNP My Practicum: A Day in the Life of a CPNP Craig Erickson, RN, CPN RN to BSN to MSN Student The University of Akron School of Nursing Lakewood Campus

My Location: Rainbow Babies & Children’s Hospital I completed my practicum at the area’s largest children’s hospital following a Certified Pediatric Nurse Practitioner managing pain in patients in all areas of the hospital.

My Preceptor: Jenessa Thirion, RN, MSN, CPNP – AC/PC Jenessa is a graduate of the University of Akron School of Nursing. She works as part of the Pain Team with three anesthesiologists and one other NP. She currently does research on a pain scale called “pieces of hurt,” nicknamed “the poker chip scale.” She is also involved in rolling out new pain policies concerning pain associated with needle sticks in children throughout the UH system. My Preceptor: Jenessa Thirion, RN, MSN, CPNP – AC/PC

My Project: Assessing Patient & Parental Knowledge of Pain Scales To help Jenessa better understand how well her orders are being followed on the floor I will be: Visiting patients on the pain service Assessing the patient’s and parent’s knowledge regarding the pain scale being used with their child Helping to fill any knowledge gaps the family has regarding pain and care by reinforcing teaching they receive from their nurse Reporting any pain concerns the family has back to Jenessa. My project has not taken place yet, but I am looking forward to helping the population Jenessa serves. My Project: Assessing Patient & Parental Knowledge of Pain Scales

Saw a certified pediatric nurse practitioner in an acute care setting Learned how many different hats a CPNP can wear – practitioner, nurse, educator, administrator, researcher, change agent Observed a CPNP recruit participants for a research study and conduct research on a vulnerable population practically applying the concepts learned in Inquiry I Learned a great deal about pain management in children that I can apply to my own practice including the use of a recent non- pharmacological device called Buzzy to prevent needle stick pain My Experience:

Saw how evidence-based practice is applied on a daily basis to dispel myths and to advance practice regarding children and pain Observed a quality improvement project in process and the difficulties associated with implementation as RB&C works to reduce pain associated with needle sticks through the institution of new policies based on recent research Learned about the use of different pain management techniques and the interplay between each to control pain including schedule II narcotics, acetaminophen, NSAIDS, and their use orally, intravenously, and in an epidural My Experience:

Following my presentation, I created a follow-up PowerPoint reviewing the specifics of what I had done. The slides that follow are from that presentation.

Assessing Patient & Parental Knowledge of Pain Scales My Project - Updated: Assessing Patient & Parental Knowledge of Pain Scales Craig Erickson, RN, CPN RN to BSN to MSN Student The University of Akron School of Nursing Lakewood Campus

To help Jenessa better understand how well her orders are being followed on the floor I: Visited patients on the pain service Assessed the patient’s and parent’s knowledge regarding the pain scale being used with their child Helped to fill any knowledge gaps the family has regarding pain and care by reinforcing teaching they received from their nurse My Presentation:

Because my small presentation to parents would change depending on the age of the patient consulted to the pain service, I needed to become familiar with each of the pain scales used at Rainbow Babies & Children’s Hospital: CRIES Scale (ages 0-1) FLACC Scale (ages 1-5) FACES Scale (ages 6-8) Numeric Scale (ages 8+) My Preparation:

The CRIES scale is a behavioral pain scale used in term infants. Scores are given in each of 5 areas and then summed: Crying Requires O2 for SaO2 <95% Increased vital signs (HR & BP) Expression Sleeplessness CRIES Scale (ages 0-1):

CRIES Scale (ages 0-1):

The FLACC scale is a behavioral pain scale used with toddlers and preschoolers. Scores are given in each of 5 areas and then summed. Face Legs Activity Cry Consolability FLACC Scale (ages 1-5):

FLACC Scale (ages 1-5):

The Faces scale is a self- report pain scale used with young school-aged children. Also known as the Wong- Baker Scale. Uses a series of illustrated faces that a child points to when determining amount of pain. FACES Scale (ages 6-8):

FACES Scale (ages 6-8):

Numeric Scale (ages 8+): The Numeric scale is a self-report pain scale used with early school aged children through adolescence. Also known as the Visual Analog Scale. This is the traditional pain scale most nurses are familiar with rating pain on a scale from 0-10 (no pain – worst possible pain) Numeric Scale (ages 8+):

Numeric Scale (ages 8+):

I worked with Jenessa to create a generic script that I could use when talking about pain and pain scales with patients and parents. Two scales were used during my clinical day FACES scale with an 8- year-old post-surgical patient Numeric scale with a 12- year-old post-surgical patient My Presentation:

I briefly described the scale being used with each patient. I discussed the frequency of pain assessment: 1 hour after medication or intervention is administered Every 4 hours if pain is consistent Every 8 hours if pain is inconsistent. My Presentation:

The patient or parent was instructed to notify the nurse if… pain was not getting better within an hour of an intervention. pain was increasing or unbearable because pain is easier to control when it is low than when it is high. My Presentation:

Parents and patients were shown a picture of the pain scale being used by their nurse. Parents and patients were given the opportunity to ask questions regarding the pain scale being used. I was as brief as possible, thanking parents and patients for their time. Both Jenessa Thirion, CPNP and Pam Bonnett were present during my presentations. My Presentation:

The presentations went well The presentations went well. One presentation was to a patient and the other was to a parent. Each verbalized an understanding of what they learned. Neither had any questions. It reinforced the need for me to educate patients and parents on everything I am doing, realizing they may not have the same background knowledge that I do. My Presentation: