Don't forget to prepare kids for ED procedures
EDs often fail to manage pain of children undergoing painful procedures, which might mean the procedure can't be performed or the child might suffer needless discomfort, says Steven J. Weisman, MD, an ED physician at Children's Hospital of Wisconsin, Milwaukee.
Nonpharmacologic pain and stress management strategies should be part of standard ED protocols, Weisman argues. "I would say most EDs do not have this in place," he says. "Techniques are very simple, take no extra time at all, and are incredibly effective."
Weisman recommends that all ED nurses receive an hour or two of training in behavioral interventions, such as breathing techniques to distract children. "Every ED should be including these as part of its treatment algorithms," Weisman says. "If we are going to be putting sutures in a kid, it may mean we don't need to start an IV [intravenous line] and actually sedate them."
Here are four things that Carrie L. Baumann, RN, BSN, patient care supervisor for the ED at Children's Hospital Health System of Wisconsin, does to decrease a child's discomfort during procedures:
- The right words are used.
"Scripting is integral when speaking to a child regarding painful procedures," says Baumann. She avoids words such as "stick," "poke," or "hurt a lot." Instead she says, "This will help take some of the pain away," or "We can't make all the ouchies go away, but this will help."
- Multiple procedures are done simultaneously.
When ruling out sepsis in an infant, two nurses enter the room once everything is set up. After the straight cath is complete, then the IV is started, with a simultaneous lab draw done. At the same time, a topical anesthetic is placed on the baby's back to prepare for the lumbar puncture.
"We also group multiple intramuscular injections together with as many providers as needed, such as with antibiotics or rabies vaccinations," says Baumann. "At times, there can be three or four nurses in a room."
- A "comfort box" is used.
ED nurses placed multicolored lighted toys, bubble-blowing liquid, and age-appropriate books in a box for anyone to bring into a room during a procedure to help distract a child.
- Children are given choices.
"Sometimes just giving older children the option of sitting or lying down, or deciding where the IV will go, can make a difference in the way the pain is perceived," says Baumann.
EDs often fail to manage pain of children undergoing painful procedures, which might mean the procedure can't be performed or the child might suffer needless discomfort, says Steven J. Weisman, MD, an ED physician at Children's Hospital of Wisconsin, Milwaukee.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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