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Evidence-Based Recommendations for Adjunct Non-Pharmacological

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Evidence-Based Recommendations for Adjunct Non-Pharmacological Evidence-Based Recommendations for Adjunct Non-Pharmacological Peri-Operative Pain Management in Pediatric Patients Kiersha Bechtel, BSN, RN-BC, Trish Bennett, MSN, RN, CCRN, Amanda Kateluzos, RN, Emily Nye, BSN, RN, CHFN, Kelsey Wesko, BSN, RN-BC Student nurses: Faith Beattie, MUNS; Olivia Jimenez, MUNS; Kimberly Thomas, MUNS Background & Significance Current standards of practice focus solely on analgesic medication for pain, without considering nonpharmacologic interventions. Prolonged pain in children can result in adverse psychological effects. It is crucial to determine effective pain management to provide patient-centered care. PICO Question Summary of Findings In perioperative pediatric patients, Infants: which nonpharmacologic interventions with - Quiet room: There was a weak correlation between the FLACC scores of patients pharmacotherapy decrease pain and increase in the quiet room and the dB level in the room (p = 0.0121) (MacKay et al., 2019). Level Number Overall - Skin to skin: After being held on the mother's chest skin to skin for 30 minutes, comfort compared to pharmacological of Quality pain scores were significantly decreased (p = 0.0001) (Listani, et. al., 2020). Sources therapy alone? Children: I 3 A-B - Statistically significant decrease in post-operative Methods of Literature Search Relaxation-guided imagery: pain in the experimental group using relaxation-guided imagery (p=0.001) Search Engines: PubMed and CINAHL (Vagnoli, Bettini, Amore, Masi, & Messeri, 2019). - Music and audiobook therapy: Statistically significant decrease in post-operative Search Terms: Post-operative pain, post-operative pain in the music and audiobook groups (p = 0.04). Linear regression analysis II 2 A-B comfort, infants, pediatrics, children, neonate, showed (p = 0.02) (Suresh, De Oliveira, & Suresh, 2015). audio, therapy, pain, surgery, comfort, - Themes showed families need education on options other than nonpharmacologic Education: medication for their child's pain (Harvey & Kovalesky, 2018). Article Appraisal Tool: Johns Hopkins Nursing III 1 B - Foot massage and positioning: Numerical pain score ratings decreased in children Evidence-Based Practice Model. who received foot massage and were positioned in semi-Fowlers post-operatively Articles Found: 818 (Woragidpoonpo et al., 2013). Articles Used: 6 Strengths and Limitations Recommendations Strengths: Consistent findings in high level evidence. Infants: Parent education on maintaining a quiet environment with decreased stimulation. Nurses should schedule time to assist mothers with understanding skin to skin contact. Both interventions decrease pain. Limitations: Small sample sizes, different ages used in different studies, some studies did not control for Children: Pre-operative pamphlets addressing music and audiobook therapy and guided imagery, as these interventions confounding variables. decrease pain post-operatively. Adult and child-friendly versions should be available to maximize understanding. References: Colourbox (2016). [Photograph] Institute of Health and Society. https://www.med.uio.no/helsam/english/research/projects/pediatric-pain-management-practices-postoperative/ Harvey, K.A., & Kovalesky, A. (2018). Post-operative pain and comfort in children after heart surgery: A comparison of nurses and families’ pre-operative expectations. Journal of Pediatric Nursing, 43, 9-15. https://doi.org/10.1016/j.pedn.2018.07.014 Lisanti, A.J., Demianczyk, A.C., Costarino, A., Vogiatzi, M.G., Hoffman, R., Quinn, R., Chittmans, J.L., & Medoff-Cooper, B. (2020). Skin-to-skin care is a safe and effective comfort measure for infants before and after neonatal cardiac surgery. Pediatric Critical Care Medicine, 21(9), 834-841. https://doi.org/10.1097/PCC.0000000000002493 MacKay, P., Rhulen, T., Crow, P., Hughes, J., Pfeiffer, K., & Hagler, K. (2019). The effect of a quiet environment on the comfort of post-operative infants and young children. Pediatric Nursing, 45(5), 244-249. Sunitha Suresh, B.S., De Oliveira, G.D., & Suresh, S. (2015). The effect of audio therapy to treat postoperative pain in children undergoing major surgery: A randomized controlled trial. Pediatric Surgery International, 31(2), 197-201. doi:10.1007/s00383-014-3649-9 Vagnoli, L., Bettini, A., Amore, E., Masi, S.D., & Messeri, A. (2019). Relaxation-guided imagery reduces postoperative anxiety and pain in children: A randomized study. European Journal of Pediatrics, 178, 913-921. https://doi.org/10.1007/s00431-019-03376-x Woragidpoonpol, P., Yenbut, J., Picheansathian, W., & Klunklin, P. (2013). Effectiveness of non-pharmacological interventions in relieving children’s postoperative pain: A systematic review. JBI Database of Systematic Reviews & Implementation Reports, 11(10), 117–156. https://doi-org./10.11124/jbisrir-2013-926.
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