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Pain Management Practices in a Pediatric Emergency Room (PAMPER) Study: Interventions With Nurses

Le May, Sylvie RN, PhD*†; Johnston, C. Celeste RN, DEd†‡§; Choinière, Manon PhD∥¶; Fortin, Christophe PhD(c)∥#; Kudirka, Denise RN, MSc**; Murray, Louise RN, MSc**; Chalut, Dominic MD**

doi: 10.1097/PEC.0b013e3181b0a0af
Original Articles

Background and Aim: Children's pain in emergency departments (EDs) is poorly managed by nurses, despite evidence that pain is one of the most commonly presenting complaints of children attending the ED. Our objectives were 2-fold: to verify if tailored educational interventions with emergency pediatric nurses would improve nurses' knowledge of pain management and nurses' pain management practices (documentation of pain, administration of analgesics, nonpharmacological interventions).

Methods: This intervention study with a pre-post design (baseline, immediately after the intervention [T-2], and 6 months after intervention [T-3]) used a sample of nurses (N = 50) and retrospective chart reviews of children (N = 450; 150 charts reviewed each at baseline, T-2, and T-3) who presented themselves in the ED with a diagnosis known to generate moderate to severe pain (burns, acute abdominal pain, deep lacerations, fracture, sprain). Principal outcomes: nurses' knowledge of pain management (Pediatric Nurses Knowledge and Attitudes Survey [PNKAS] on pain) and nurses' clinical practices of pain management (Pain Management Experience Evaluation [PMEE]).

Results: Response rate on the PNKAS was 84% (42/50) at baseline and 50% (21/42) at T-2. Mean scores on PNKAS were 28.2 (SD, 4.9; max, 42.0) at baseline and 31.0 (SD, 4.6) at T-2. Results from paired t test showed significant difference between both times (t = −3.129, P = 0.005). Nurses who participated in the capsules improved their documentation of pain from baseline (59.3%) to T-2 (80.8%; χ2 = 12.993, P < 0.001) as well as from baseline (59.3%) to T-3 (89.1%; χ2 = 29.436, P < 0.001). In addition, nurses increased their nonpharmacological interventions from baseline (16.7%) to T-3 (31.9%; χ2 = 8.623, P = 0.003). Finally, we obtained significant differences on pain documentation between the group of nurses who attended at least 1 capsule and the group of nurses who did not attend any capsule at both times (T-2 and T-3; χ2 = 20.424, P < 0.001; χ2 = 33.333, P < 0.001, respectively).

Conclusions: The interventions contributed to the improvement of the nurses' knowledge of pain management and some of the practices over time. We believe that an intervention tailored to nurses' needs and schedule has more impact than just passive diffusion of educational content.

From the *Faculty of Nursing, University of Montreal; †CHU Sainte-Justine Research Centre; ‡School of Nursing McGill University; §Montreal Children's Hospital Research Institute; ∥Montreal Heart Institute Research Centre; ¶Faculty of Medicine, University of Montreal; #Université du Québec à Montréal; and **Montreal Children's Hospital, Montreal, Canada.

Reprints: Sylvie Le May, RN, PhD, Faculty of Nursing, Université de Montréal, CP 6128, Succursale Centre-Ville, Montreal, Quebec, Canada H3C 3J7 (e-mail:

Study supported by grants from Pain In Child Health, a strategic training group of the Canadian Institutes of Health Research, from Analyse et Évaluation des Interventions en Santé, a strategic training group from the Canadian Institutes of Health Research-Fonds de la Recherche en Santé du Québec, from the research center of the Montreal Children's Hospital, and from the Canadian Pain Society (Nursing Research Award).

© 2009 Lippincott Williams & Wilkins, Inc.