Describe the differences between acute and chronic pain to be able to document and treat pain appropriately.

Team Project Description

            We are the Southeast Region, and our group members consist of Jessica Wise, Danita Farley, Hope Bechard, Courtney Bodiford, and Amy Stierwalt. We are working on a pain management program for pediatric nurses at Moses Cone Hospital (MCH) in Greensboro, North Carolina. One of our group members works at this facility and helped us to decide on this topic, because she has recognized this as a knowledge deficit in the pediatric arena. In healthcare settings with no pediatric pain education training for pediatric nursing staff, it has been found that children are not adequately treated for pain (Ramira, Instone, & Clark, 2016).  The purpose of this educational training program is to improve nurses’ assessment and management of pediatric pain within the pediatric arena at MCH.  This can assist pediatric nursing staff in monitoring, assessing, treating, and documenting comfort and pain levels consistently across all pediatric units. Measurable outcomes would include a patient satisfaction score increase by 90 percent regarding pediatric pain management during their hospitalization or Emergency Department (ED) visit.

Organizational Framework, Mission/Vision/Philosophy

The curriculum development was guided by the organizational framework of Knowles’ Adult Learning Theory and Kirkpatrick’s Learning Evaluation Model. The use of an eclectic theory model allowed us to develop a program that “most accurately reflects the faculty’s beliefs about the practice and discipline of nursing” (Billings & Halstead, 2016, p. 106). The Knowles’ theory allows adult learners to build upon the knowledge and experience they already have. It also has six elements that include self-directedness, need to know, use of experience in learning, readiness to learn, orientation to learning, and internal motivation (Chang, 2010).  The Kirkpatrick Model has four levels: reaction, learning, behavior, and results (Billings & Halstead, 2016, p. 191). The use of these two models has allowed us to create a plan that is well rounded and meshes well with the mission, vision, and philosophy of MCH.

The mission of MCH is that “we serve our communities by preventing illness, restoring health and providing comfort, through exceptional people delivering exceptional care” (Cone Health, n.d., para 2 ). The mission helped guide us in development in that it is a gold standard at MCH to ensure we make our patients comfortable, no matter the age. The vision of MCH is to “be a national leader in delivering measurably superior healthcare” (Cone Health, n.d., para 3). This vision is important to us as we want our nurses to be educated and prepared for any pediatric pain issue that could arise. We also want our nurses to be recognized for their hard work by knowing that they are the best around. The philosophy of our program at MCH is a mixture of providing quality, innovation, teamwork, service, integrity, and compassion to all patients.

The MCH Pediatric Pain Program will have five sessions. The first and second session will be completed in the classroom as they will review the physiology of pain and causes of and factors affecting pain. The third session will discuss the techniques and tools for assessing pain. The fourth session will cover pharmacological and non-pharmacological treatment options for pediatric patients. The fifth session will review the pediatric pain order set. After these sessions, the nurse should feel competent and prepared to care for the needs of a pediatric patient with pain.

            The five sessions are:

Session 1: Physiology of Pain

• This lecture session will allow nurses to explore the definitions/concepts of pain, pain tolerance and pain threshold. The differences between acute and chronic pain will be described. The session will also review pain mechanisms both peripherally and centrally including the gate control theory (Kozier et al., 2010).
• Learning objectives: 

Nursing staff will:

•  Describe the differences between acute and chronic pain to be able to document and treat pain appropriately.
• State the definition of pain, pain tolerance and pain threshold.
• Differentiate between the presentations of pediatric pain as the child develops from newborn to adult.

Session 2: Causes of and Factors Affecting Pain

• This lecture and discussion session will explore common pain states including invasive procedures, burns, end of life care, postoperative, chronic disease, and cancer pain (Hockenberry & Wilson, 2011). This session will help nurses to understand their patient’s response to pain via the sympathetic and parasympathetic nervous system. Factors affecting pain including cultural values, the developmental stage, environment, past painful experiences and meaning of pain will also be discussed (Kozier et al., 2010).
• Learning objectives:  

Nursing staff will:

• Assess potential factors contributing to their patient’s pain.
• Explain the sympathetic and parasympathetic nervous system and how it responds to pain in the body.

Session 3: Assessment Techniques and Tools 

• This lecture, discussion, and role play session will provide students with the skills to choose an age-appropriate assessment scale (Hockenberry & Wilson, 2011). The acronym of PQRSTU will be taught to students to assess all aspects of pain. This session will review appropriate reassessment of pain guidelines (Kozier et al., 2010).
• Learning Objectives:

Nursing staff will:

• Describe the commonly used pain assessment scales.
• Demonstrate a pain assessment on patients of differing developmental milestones.
• State how often they should re-assess pain for documentation standards.

Session 4: Evidence-based non-pharmacological and pharmacological treatment options

• This lecture and skills lab session will describe both pharmacological and non-pharmacological treatment options for pain. This session will review common side effects and how to monitor for them when using treatment options (Hockenberry & Wilson, 2011). Nurses will have the opportunity to practice using all pain treatment options available at Moses Cone (MCH) including the buzzy bee, j-tips, PO, subcutaneous, and IV injections, and patient-controlled analgesia.
• Learning Objectives: 

Nursing staff will:

• Choose the appropriate therapy for the patient based on pain assessment and doctors’ orders.
• Demonstrate the appropriate administration of pain therapy.
• Compare treatment options to choose which is best for their patient.

Session 5: Session 5 Pediatric Pain Order Set Review

• This session will allow students time to become familiar with the new pain order set that will be used by the physicians. One of our pediatric physicians will be present to answer questions.
• Learning Objectives: 

Nursing staff will:

• Understand how to use the order set to treat pain in their pediatric patients.
• Learn to evaluate the pediatric pain order set to be able to recognize any errors.

References

Barry, M.A., Goldsworthy, S., & Goodridge, D. (2010). Medical-surgical nursing in Canada (2nd  ed.). Toronto, ON: Elsevier

Billings, D. M., & Halstead, J. A. (2016). Teaching in nursing: A guide for faculty (5th ed). St. Louis, MO: Elsevier.

Chang, S. (2010). Applications of Andragogy in Multi-Disciplined Teaching and Learning.  Journal of Adult Learning, 39(2): 25-35. Retrieved from https://files.eric.ed.gov/fulltext/EJ930244.pdf.

Cone Health. (n.d.).Welcome to Cone Health Orientation. Retrieved from https://www.conehealth.com/app/files/public/32/doc-clinical-observation-Welcome-to- Cone-Health-Orientation.pdf

Hockenberry, M.J., & Wilson, D. (2011). Wong’s nursing care of infants and children (9th ed.).  St. Louis, MO: Elsevier

Ramira, M. L., Instone, S., & Clark, M. J. (2016, January-February). Pediatric Pain Management: An Evidence-Based Approach. Pediatric Nursing, 42(1), 39-49. Retrieved from the Walden Library databases.