INDICATING PAIN IN PEDIATRIC ONCOLOGY PATIENTS Meredith Goode Sarah Harville Morgan Moncus

Case Study Nurses oftentimes struggle with how to indicate the pain level in pediatric oncology patients. In this case, the Medical Center has recently hired a nurse researcher. Ms. Jones asks staff nurses on a pediatric oncology unit to identify the “top” patient care problem on the unit. The nurses informed Ms. Jones that pain control is a huge problem for many children admitted to the oncology unit. Ms. Jones discovers that the nurses routinely use physiologic measures, such as heart rate and blood pressure, as indicators of pain. Occasionally the nurses rely on parents’ reports, but rarely do they consult the child.

Introduction  Cancer is a disease characterized by abnormal, uncontrolled cell division  Generally treated with antineoplastics, radiation therapy, and surgery  Adverse effects of chemotherapy: nausea, vomiting, alopecia, headache, bone marrow suppression, and even lead to death

Introduction  Cancer is the second most common cause of death among children ages 1-14 years  Children say pain is the worst part of treatment

Situation Focused Question  The focused question is what indicator should be used to identify pain in pediatric patients.

Targeted Resources/Evidence Search  CINAHL  PubMed  Key Search Words: pain management, pediatrics, oncology

Targeted Resources/Evidence Search

Relevance of Evidence  Center for Disease Control and Prevention  Attitudes to and knowledge about pain and pain management, of nurses working with children with cancer: A comparative study between UK, South Africa, and Sweden  Evidence Based Practice for Health Professionals  Nursing a Concept-Based Approach to Learning

Evidence Appraisal of a Quantitative Study

Course of Action FLACC Scale

Conclusion The FLACC scale should be implemented for use in the pediatric oncology setting. When using this scale the nurses will be able to better assess the pain of the patient. According to Manworren & Hynan (2003) this method is specifically used in children aging from 0 to 7 years. Pain will accurately be measured when all variables are taken into consideration. Nurses should continue to monitor heart rate, blood pressure, and respirations, but should also consider the FLACC scale because it specifically determines pain levels. By combining these methods pain will be better controlled in pediatric oncology patients.

References  Center for Disease Control and Prevention, (2012). Cancer prevention and control. Retrieved from website:  Enskar, K., Ljusegren, G., Berglund, G., Eaton, N., Harding, R., Mokoena, J…Moleki, M. (2007). Attitudes to and knowledge about pain and pain management, of nurses working with children with cancer: A comparative study between UK, South Africa, and Sweden. Journal of Research in Nursing, 12(5), doi: /  Howlette, B., Rogo, E., & Shelton, T. (2013). Evidence based practice for health professionals. (p. 90). Burlington, MA: Jones and Bartlett Learning.  Kelley, M., Demiris, G., Nguyen, H., Oliver, D., & Wittenberg-Lyles, E. (2013). Informal hospice caregiver pain management concerns: A qualitative study. Palliative Medicine, 27(7), doi: /  Manworren, R., & Hynan, L. (2003). Practice applications of research. Clinical validation of FLACC: preverbal patient pain scale. Pediatric Nursing, 29(2),  North Carolina Concept-Based Learning Editorial Board. (2011). Nursing a concept- based approach to learning. (Vol. 1, p. 121). Upper Saddle River, NJ: Pearson Education.