Prescriptive theory of acute pain management in infants and children

Headnote

PURPOSE. To present a middle-range nursing theory of acute pain management that provides direction for practice and research.

CLIENT POPULATION. Patients from 6 months to 12 years old who have acute pain.

CONCLUSIONS. The potential of the proposed theory, Acute Pain Management in Infants and Children, is to assist nurses in managing clinical pain and to expand the knowledge and research base in children's pain.

PRACTICE IMPLICATIONS. To provide clinicians with prescriptions for pain reduction and a conceptual basis for pain interventions. Statement and theory testing are needed to determine adequacy of this theory for infants and children experiencing acute pain.

Key words: Acute pain, acute pain management, acute pain theory, children, infants, prescriptive theory, theory development.

Studies conducted in the late 1970s and early 1980s made it clear that children's pain was neglected and undertreated, and pain relief in children was a low priority (Beyer, DeGood, Ashley, & Russell, 1983; Eland & Anderson, 1977; Mather & Mackie, 1983). Despite recent technological advances in pain management and national guidelines for pain control (Acute Pain Management Guideline Panel, 1992a, b; Jacox et al., 1994), unmanaged pediatric pain endures, and countless infants and children still suffer needless pain. In a recent study, Altimier, Norwood, Dick, Holditch-Davis, and Lawless (1994) found that 56% of the administered doses of morphine ordered for a postoperative pediatric group were below the minimum recommended level. Other recent surveys and research also indicate that children's pain is undertreated and underassessed (Asprey, 1994; Bennett-Branson & Craig, 1993; Broome, Richtsmeier, Maikler, & Alexander, 1996; Tesler, Wilkie, Holzemer, & Savedra, 1994). The sobering fact is that 35% to 93% of hospitalized children experience pain, and the clinical management of their pain is inadequate (Hester, Foster, & Kristensen, 1990; Johnston, Abbott, Gray-Donald, & Jeans, 1992; Maunuksela, Saarinen, & Lahteenoja, 1990; Tesler et al.).

Pain theories to date generally have attempted to describe or explain the mechanisms of pain in children and the sensory, affective, and experiential components of pain (Stevens, Hunsberger, & Browne, 1987). If clinicians are to reduce pain in children, they need prescriptive theories of pain alleviation, not just descriptions and explanations of physiological processes, perceptual phenomena, and subjective experiences. Prescriptive theories of pain reduction can provide guidance for research on children's pain and...