Using Pictures to Assess Pain Location in Children.

PURPOSE: This study uses the Pain Area Locator (PAL) tool, a picture communication aid with body and medical equipment icons, to identify pain location in postoperative pediatric patients and assesses discrepancies between nurses' pain location assessment and pain location identified using the PAL tool. DESIGN: This descriptive study used a quantitative, comparative design, with a convenience sample of pediatric postoperative patients undergoing same-day surgeries at a free-standing, acute care, Magnet designated pediatric hospital. METHODS: The child's pain location was assessed by asking the child to point to one of the 12 pictures on the PAL tool of where they hurt. FINDINGS: All 41 (100%) of the postoperative children in the study demonstrated ability to use the PAL tool. The child identified a pain location in 34 assessments (83%) when the nurse documented no pain location. CONCLUSIONS: This investigation expands on previous evidence supporting that children can use the PAL tool to identify the pain location postoperatively.

Use of picture communication aids to assess pain location in pediatric postoperative patients.

Children undergoing surgical procedures may have difficulty communicating. Augmentative and alternative communication (AAC) picture communication may provide a standard communication strategy for postoperative children and facilitate nurse-patient communication. The study purposes were to (1) determine if inconsistency exists between nurse assessments of pain location versus identification of pain location using AAC picture communication aids and (2) determine parent satisfaction with use of AAC picture communication aids. A convenience sample of patients aged 3 to 9 years were recruited in a Midwestern freestanding pediatric hospital's postanesthesia care unit (PACU). The patient's pain location was assessed using an AAC picture communication aid and compared with the PACU nurses' pain assessment. Nurses did not consistently document location of pain, and, when documented, the surgical site was inaccurately identified as the location of pain. Parent satisfaction was measured through completion of a 10-item satisfaction survey. Respondents were satisfied with the use of AAC picture communication aids.

Comparison of temporal artery to rectal temperature measurements in children up to 24 months.

This descriptive study compared temporal artery (TA) and rectal temperature measurements, patient comfort during temperature measurements, and nursing time required to obtain temperature measurements. Study participants (n = 40) included children 0-24 months old with fever higher than 38°C, admitted to a freestanding children's hospital in the Midwest. Statistical analysis of 450 paired TA and rectal temperature measurements revealed a 0.776 correlation, mean difference of 0.03°C, and 94.7% of measurements differing by less than 1.0°C. Patient comfort, measured via the Face, Legs, Activity, Cry, Consolability Scale, was enhanced with TA thermometry compared to rectal. TA thermometry resulted in an 87% savings of nursing time.

Evaluation through research of a three-track career ladder program for registered nurses.

A descriptive study design was employed to survey registered nurse participants in a career ladder program comprising of three tracks: clinical, education, and management. Findings indicate that participation allows nurses of varying education preparation and roles to demonstrate professional development. Implications for staff development include efficacy of the online survey technique, provision of a reliable tool to evaluate a career ladder, and evaluation of a career ladder that includes the staff development educator.

Atraumatic care: EMLA cream and application of heat to facilitate peripheral venous cannulation in children.

The purpose of this study was to investigate whether the application of heat placed to a child's potential intravenous (IV) site after the application of EMLA Cream™ decreases vasoconstriction, therefore promoting atraumatic care in the hospitalized pediatric patient. Venipuncture in children is a painful and frequently performed procedure. While use of EMLA Cream™ to reduce pain on insertion is a common practice with pediatric patients, no studies had measured venous size in relation to EMLA Cream™ and heat application. A descriptive quantitative design was used to examine the use of EMLA Cream™ and application of heat to facilitate venipuncture for peripheral venous cannulation. A convenience sample of 30 hospitalized Caucasian children, eight to twelve years old, participated. Vascular ultrasound directly measured the vein prior to and 1 hour after EMLA Cream™ application, as well as 2 minutes after heat application. Mean vein measurements were 0.243 cm prior to EMLA Cream™, 0.205 cm after EMLA Cream™ applied for 1 hour, and 0.253 cm after two minutes of heat. There was a significant increase in vein visualization from pre-application of heat to post application of heat with a success rate of 80% with the first time attempt of IV insertion. Therefore, application of heat counteracts the adverse effect of vasoconstriction that occurs with EMLA Cream™ application, potentially increasing peripheral venous cannulation success rates.