In this section
Note: This guideline is currently under review.
Definition of Terms
Assessment and Measurement
Children receiving health care are exposed to multiple and ongoing invasive medical procedures as part of their treatment . The pain associated with these medical procedures is reported as the most significant and distressing cause of pain for hospitalised children . The cumulative effects of these painful experiences can result in adverse psychological outcomes for the child and their family, including fear and the rapid development of conditioned anxiety response to medical procedures . The negative experiences associated with medical procedures can have a lifelong impact . Due to this, it is imperative that any exposure to a painful experience be the best experience possible for the child. Every child has a right to be kept from harm and it is the responsibility of health care professionals that ensure that every step is taken to protect children from unnecessary pain .The goal of procedural pain management at RCH is to minimise pain, distress and anxiety associated with medical procedures for children. Managing procedural pain is best done with a multimodal approach that combines pharmacological and non-pharmacological interventions. There are many simple and evidenced based interventions that have been demonstrated to reduce the pain and distress associated with medical procedures for children .
To aim of this guideline is to provide guidance to clinical staff regarding effective interventions to support the management of procedural pain and pain-related distress for children and young people receiving health care.
There are 6 essential elements of procedural pain management that have been demonstrated to reduce pain and distress associated with medical procedures: 1. Planning2. Preparation 3. Pharmacological4. Physical5. Psychological6. Promoting recovery and resilience
Optimal procedural pain management maintains the comfort of the child during the 3 distinct phases of a medical procedure: (1) before, (2) during and (3) after the medical procedure. The essential elements can be applied to the continuum of the medical procedure with each stage requiring differing priorities to ensure the ongoing comfort of the child. Adherence to these key principles at each stage of the medical procedure will enhance the success of a procedural pain management plan.
For more information on each phase of procedural pain management, please click the hyperlinks.
Planning for medical proceduresStep 1: Find out the child’s likes and dislikes Step 2: Assess previous procedural experiences Step 3: Establish a procedural support plan Step 4: Communicate the procedural support plan Step 5: Refer children at high risk for procedural pain and distressStep 6: Consult with the appropriate procedural support team
Preparing for medical proceduresStep 1: Prepare the child Step 2: Prepare the family Step 3: Prepare the environment Step 4: Prepare the procedural support team
It is recommended that a multimodal approach to pain management be provided to children receiving medical procedures.A multimodal approach to procedural pain management combines both pharmacological and non-pharmacological interventions with the purpose of targeting different areas involved in pain processing .
Principles of pharmacological pain management
Promote comfort of the childAssessment of procedural pain
Principles of non-pharmacological pain management
Non-pharmacological methods of managing procedural pain are interventions that target the contextual, physical, behavioral and psychological factors related to procedural pain or pain-related distress . This Clinical Practice Guideline provides recommendations for the non-pharmacological management of procedural pain with:
Promote resilience and recovery
Procedural Sedation for Ward and Ambulatory Areas procedure (RCH access only)
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The evidence table for this guideline can be viewed here.
Please remember to read the disclaimer.
development of this nursing guideline was coordinated by Karin Plummer, Clinical Nurse Consultant, Anaesthesia and Pain Management,
and approved by the Nursing Clinical Effectiveness Committee. Updated May 2016.