Review Article| Volume 15, ISSUE 1, P365-379, March 2014

Increasing Nursing Treatment for Pediatric Procedural Pain

Published:August 20, 2012DOI:


      Procedural pain management is an underused practice in children. Despite the availability of efficacious treatments, many nurses do not provide adequate analgesia for painful interventions. Complementary therapies and nonpharmacologic interventions are additionally essential to managing pain. Owing to the increasing awareness of inadequate nursing utilization of pharmacologic measures for procedural pain, this paper focuses only on analgesic treatments. The aim of this review was to examine how varying degrees of quality improvement affect nursing utilization of treatments for routine pediatric procedural pain. A comprehensive search of databases including Cinahl, Medline/Pubmed, Web of Science, Google Scholar, Psycinfo, and Cochrane Library was performed. Sixty-two peer-reviewed research articles were examined. Ten articles focusing on quality improvement in pediatric pain management published in English from 2001 to 2011 were included. Three themes emerged: 1) increasing nursing knowledge; 2) nursing empowerment; and 3) protocol implementation. Research critique was completed with the use of guidelines and recommendations from
      • Creswell J.H.
      Research design: Qualitative, quantitative, and mixed methods approaches.
      • Garrard J.
      Health sciences literature review made easy: The matrix method.
      . The literature reveals that nurses still think that pediatric pain management is essential. Quality improvement increases nursing utilization of procedural pain treatments. Although increasing nursing knowledge improves pediatric pain management, it appears that nursing empowerment and protocol implementation increase nursing compliance more than just education alone. Nurses providing pain management can enhance their individual practice with quality improvement measures that may increase nursing adherence to institutional and nationally recommended pediatric procedural pain management guidelines.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Pain Management Nursing
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • American Academy of Pediatrics (AAP)
        The assessment and management of acute pain in infants, children and adolescents.
        Pediatrics. 2001; 8: 793-797
      1. Barone, M., McCall, J., Jenkins, M., & Warden, G. (2000). The development of an observational pain scale (OPAS) for pediatric burns. Abstract 230. Presented at the 32nd Annual Meeting of the American Burn Association.

        • Barnason S.
        • Merboth M.
        • Pozehl B.
        • Tietjen M.J.
        Utilizing an outcomes approach to improve pain management by nurses.
        Clinical Nurse Specialist. 1998; 12: 28-36
        • Biran V.
        • Gourrier E.
        • Cimerman P.
        • Walter-Nicolet E.
        • Mitanchez D.
        • Carbajal R.
        Analgesic effects of EMLA cream and oral sucrose during venipuncture in preterm infants.
        Pediatrics. 2011; 128: e63-e70
        • Blakeney P.
        • Marvin J.
        Itch man scale.
        Shriners Hospitals for Children, Galveston, TX, 2000
        • Brand K.
        • Court C.
        Pain assessment in children.
        Paediatric Anaesthesia. 2010; 11: 214-216
        • Beyer J.E.
        • Byers M.
        Knowledge of pediatric pain: The state of the art.
        Children’s Health Care. 1985; 13: 150-159
        • Czarnecki M.L.
        • Turner H.L.
        • Collins P.M.
        • Doellman D.
        • Wrona S.
        • Reynolds J.
        Procedural pain management: A position statement with clinical practice recommendations.
        Pain Management Nursing. 2011; 12: 95-111
        • Cregin R.
        • Rappaport A.S.
        • Montagnino G.
        • Sabogal G.
        • Moreau H.
        • Abularrage J.J.
        Improving pain management for pediatric patients undergoing nonurgent painful procedures.
        American Journal of Health System Pharmacy. 2008; 65: 723-727
        • Creswell J.H.
        Research design: Qualitative, quantitative, and mixed methods approaches.
        3rd ed. Sage, Thousand Oaks, CA2009
        • Dowden S.
        • McCarthy M.
        • Chalkiadis G.
        Achieving organizational change in pediatric pain management.
        Pain Research and Management. 2008; 13: 321-326
        • Eichenfield L.F.
        • Funk A.
        • Fallon-Friedlander S.
        • Cunningham B.B.
        A clinical study to evaluate the efficacy of ELA-Max (4% liposomal lidocaine) as compared with eutectic mixture of local anesthetics cream for pain reduction of venipuncture in children.
        Pediatrics. 2002; 109: 1093-1099
        • Eland J.
        Minimizing pain associated with pre-kindergarten intramuscular injections.
        Issues in Comprehensive Pediatric Nursing. 1981; 5: 361-372
        • Ellis J.A.
        • McCleary L.
        • Blouin R.
        • Dube K.
        • Rowley B.
        • MacNeil M.
        • Cooke C.
        Implementing best practice pain management in a pediatric hospital.
        Journal for Specialists in Pediatric Nursing. 2007; 12: 264-277
        • Ellis J.A.
        • Sharp D.
        • Newhook K.
        • Cohen K.
        Selling comfort: A survey of interventions for needle procedures in a pediatric hospital.
        Pain Management Nursing. 2004; 5: 144-152
        • Ellis J.A.
        • Tourigny J.
        • Fothergill-Bourbonnais F.
        • Casey A.
        • Dunning J.
        Pain assessment and management practices in Ottawa-Carleton: A survey. Unpublished manuscript. 1999;
        • Ely B.
        Pediatric nurses’ pain management practice: Barriers to change.
        Pediatric Nursing. 2001; 27: 473-480
        • Farion J.K.
        • Splinter K.L.
        • Newhook K.
        • Gaboury I.
        • Splinter W.
        The effect of vapocoolant spray on pain due to intravenous cannulation in children: A randomized control trial.
        Canadian Medical Association Journal. 2008; 179: 31-36
        • Fein J.A.
        • Gorelick M.H.
        The decision to use topical anesthetic for intravenous insertion in the pediatric emergency department.
        Academic Emergency Medicine. 2006; 13: 264-278
        • Finley G.A.
        • Forgeron P.
        • Arnaout M.
        Action research: Developing a pediatric cancer pain program in Jordan.
        Journal of Pain and Symptom Management. 2008; 35: 447-454
        • Garrard J.
        Health sciences literature review made easy: The matrix method.
        3rd ed. Jones & Bartlett Learning, Sudbury, MA2011
        • Johnston C.C.
        • Gagnon A.
        • Rennick J.
        • Rosmus C.
        • Patenaude H.
        • Ellis E.
        • Shapiro C.
        • Filion F.
        • Ritchie J.
        • Byron J.
        One-on-one coaching to improve pain assessment and management practices of pediatric nurses.
        Journal of Pediatric Nursing. 2007; 22: 467-478
        • Johnston C.C.
        • Stremler R.L.
        • Stevens B.J.
        • Horton L.J.
        Effectiveness of oral sucrose and simulated rocking on pain response in preterm neonates.
        Pain. 1997; 72: 193-199
        • Kavanagh T.
        • Stevens B.
        • Seers K.
        • Sidani S.
        • Watt-Watson J.
        Process evaluation of appreciative inquiry to translate pain management evidence into pediatric nursing practice.
        Implementation Science. 2010; 5: 1-13
        • Latimer M.A.
        • Johnston C.C.
        • Ritchie J.A.
        • Clarke S.P.
        • Gilin D.
        Factors Affecting delivery of evidence-based pain care in hospitalized neonates.
        Journal of Obstetric, Gynecological, and Neonatal Nursing. 2009; 38: 182-194
        • Manworren R.C.
        Pediatric nurses’ knowledge and attitudes survey regarding pain.
        Pediatric Nursing. 2000; 26: 610-614
        • Margolius F.
        • Hudson K.
        • Michel Y.
        Beliefs and perceptions about children in pain: A survey.
        Pediatric Nursing. 1995; 21: 111-118
        • May K.
        • Britt R.
        • Newman M.
        Pediatric Registered Nurse usage and perception of EMLA.
        Journal of Specialists in Pediatric Nursing. 1999; 4: 105-112
        • Meunier-Sham J.
        • Ryan K.
        Reducing pediatric pain during ED procedures with a nurse-driven protocol: An urban pediatric emergency department’s experience.
        Journal of Emergency Nursing. 2003; 29: 127-132
        • Miser A.W.
        • Goh T.S.
        • Dose A.
        • O’Fallon J.R.
        • Niedringhaus R.D.
        • Betcher D.L.
        • Simmons P.
        • MacKellar D.J.
        • Arnold M.
        • Loprinzi C.H.
        Trial of a topically administered local anesthetic (EMLA cream) for pain relief during central venous port access in children with cancer.
        Journal of Pain and Symptom Management. 1994; 9: 259-264
        • Ratcliff S.L.
        • Brown A.
        • Rosenberg L.
        • Rosenberg M.
        • Robert R.S.
        • Cuervo L.J.
        • Villarreal C.
        • Thomas C.R.
        • Meyer III, J.W.
        The effectiveness of a pain and anxiety protocol to treat the acute pediatric burn patient.
        Burns. 2006; 32: 554-562
        • Rieman M.T.
        • Gordon M.
        Pain management competency evidenced by a survey of pediatric nurses’ knowledge and attitudes.
        Pediatric Nursing. 2007; 33: 307-312
      2. Ritchie, J. A. (1989). Nurses assessment and management strategies for children’s pain. Unpublished manuscript.

        • Robins J.
        Post code ouch: A survey of neonatal pain management before painful procedures in the United Kingdom.
        Journal of Neonatal Nursing. 2007; 13: 113-117
        • Robert R.
        • Meyer III, W.J.
        • Villarreal C.
        • Blakeney P.E.
        • Desai M.
        • Herndon D.
        An approach to the timely treatment of acute stress disorder.
        Journal of Burn Care and Rehabilitation. 1999; 20: 250-258
        • Rogers T.L.
        • Ostrow T.L.
        The use of EMLA cream to decrease venipuncture pain in children.
        Journal of Pediatric Nursing. 2004; 19: 33-39
        • Romsing J.
        • Henneberg S.W.
        • Walther-Larson S.
        • Kjeldsen S.
        Tetracaine gel versus EMLA cream for percutaneous anesthesia in children.
        British Journal of Anaesthesia. 1999; 82: 637-638
        • Rycroft-Malone J.
        The PARIHS framework—A framework for guiding the implementation of evidence-based practice.
        Journal of Nursing Care Quality. 2004; 19: 297-304
        • Silverman W.
        • Kurtines W.
        Anxiety and phobic disorders: A pragmatic approach.
        Plenum Press, New York1996
        • Squire S.J.
        • Kirchhoff K.T.
        • Hissong K.
        Comparing two methods of topical anesthesia used before intravenous cannulation in pediatric patients.
        Journal of Pediatric Health Care. 2000; 14: 68-72
        • Treadwell M.J.
        • Franck L.S.
        • Vichinsky E.
        Using quality improvement strategies to enhance pediatric pain assessment.
        International Journal for Quality in Healthcare. 2002; 14: 39-47
        • Walco G.A.
        • Cassidy R.C.
        • Schechter N.L.
        Pain, hurt, and harm: The ethics of pain control in infants and children.
        The New England Journal of Medicine. 1994; 331: 541-544
        • Walk R.D.
        Self-ratings of fear in a fear-invoking situation.
        Journal of Abnormal Social Psychology. 1956; 52: 171-178
        • Ware L.J.
        • Bruckenthal P.
        • Davis G.C.
        • O’Conner-Von S.K.
        Factors that influence patient advocacy by pain management: Results of the American Society for Pain Management Nursing survey.
        Pain Management Nursing. 2011; 12: 25-32
        • Whaley L.
        • Wong D.
        Nursing care of infants and children.
        3rd ed. Mosby, St. Louis1987
        • Zeltzer L.K.
        • Altman A.
        • Cohen D.
        • LeBaron S.
        • Munuksela L.
        • Schechter N.L.
        Report of the subcommittee on the management of pain associated with procedures in children with cancer.
        Pediatrics. 1990; 86: 826-831