Post on 04-Jan-2016
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
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
Author’s names, credentials, affiliations, and conflict of interest
1. Are the authors’ credentials and educational background appropriate to conduct this type of study? Yes, they have degrees range from RN to PhD and many have a background in pain management in children.
2. Are the authors affiliated with an educational program, health institution, or practice setting? Yes, they are affiliated with different hospitals in different countries, as well as, medical universities. Do the authors report a conflict of interest? No.
_X_ Strength _____Limitation _____Not evident _____Not applicable
Funding source(s) Does the funding source have a vested interest in a beneficial outcome of the study? Yes, the grant came from The Swedish Children’s Cancer Foundation and the topic of the article is pain in pediatric oncology patients.
_ X Strength __ _Limitation ____ Not evident _____Not applicable
Purpose 1. Is the intent of the study clearly stated? Yes, “the aim of the study was to identify and describe the knowledge and attitudes to pain and pain management among nurses working with children with cancer in three countries” measured with questionnaires in a quantitative manner.
2. Is the phenomenon being investigated identifiable? Yes, the phenomenon is pain management.
3. Is the population identifiable? Yes, the population is Ukrainian, South Africa and Swedish nurses working with children with cancer.
_X___Strength _____Limitation _____Not evident _____Not applicable
Hypotheses and research questions
1. If there are hypotheses, are they in alignment with the intended purpose of the study? No hypotheses stated.
2. If there are hypotheses, are the variable under study identifiable in the hypotheses No hypotheses stated.
3. If there are hypotheses, is one hypothesis written for each independent variable under study? There are no hypotheses stated.
4. Are the research questions in alignment with the intended purpose?
__ Strength __X_ Limitation _____Not evident _____Not applicable
Evidence Appraisal of a Quantitative Study
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: http://www.cdc.gov/cancer/index.htm
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), 501-515. doi: 10.1177/1744987107080455
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), 673-682. doi:10.1177/0269216313483660
Manworren, R., & Hynan, L. (2003). Practice applications of research. Clinical validation of FLACC: preverbal patient pain scale. Pediatric Nursing, 29(2), 140-146.
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.