ABSTRACTAcute pain is one of the most unpleasant sensations experienced by infants, toddlers, and children. Although there are a variety of safe non-pharmacological pain relief strategies available, they are not implemented consistently during painful office procedures.(1) A literature review revealed numerous effective non-pharmacological pain-relief strategies for infants, toddlers, and children. Two pamphlets were designed to educate practitioners on effective non-pharmacological pain-relief methods. Evaluation of education/implementation of the project will be examined with the use of a pre- and post-survey administered to providers.

PICO QUESTIONDo non-pharmacological pain interventions reduce discomfort associated with painful office procedures in infants, toddlers, and children compared to no pain intervention?

LITERATURE REVIEWThe literature demonstrated several similar themes, including the non-pharmacological methods used to treat pain along with the pain rating scale used to measure pain. Adequate non-pharmacological pain-relieving techniques differ by age and development.

• Pain reduction has a positive influence on infants and children and should be implemented if induction of pain is likely.(2)

• Physical and involuntary characteristics are used to assess and calculate pediatric pain levels.(3)

• Exposure to a painful stimulus can have a detrimental influence on how future painful stimuli is managed.(4) (5)

EFFECTIVE NON-PHARMACOLOGICAL PAIN INTERVENTIONS FOR INFANTS, TODDLERS, AND

CHILDREN IN THE CLINIC SETTINGEmily Bankhead, BSN, RN, MSN-FNP Student

Project Plan and Implementation

The project offers providers a resource they can use in their practice to alleviate acute pain perception with uncomfortable procedures performed in the office. Implementation will occur in several pediatric and family practice offices in order to obtain differing opinions about effectiveness. Implementation will include the following:• Assess provider knowledge and

implementation of non-pharmacological pain interventions in their practice by the administration of a pre-education survey

• Provide handout containing age-specific, non-pharmacological pain relief methods

• Verbal interviews will be conducted with pediatrician peers to determine the handout’s usefulness and credibility

Project Evaluation• The post-implementation survey will

be administered to evaluate education and implementation.

• Results from comparing this survey and the pre-education survey will be examined to determine if education and implementation have occurred in the provider’s practice.

• Verbal feedback from the providers will be obtained regarding the usefulness and credibility of the implementation handout, and after collaborative feedback, changes may be made to improve the handout’s information or flow.

THEORETICAL FRAMEWORKKatharine Kolcaba’s Theory of Comfort was used to guide the project and defines three types of comfort—relief, ease, and transcendence. The comfort state of relief can be demonstrated by easing the pain of a child undergoing a painful office procedure; whereas, the state of ease can be related to reducing anxiety. Lastly, transcendence is a state of comfort where the patient is able to rise above his or her challenges. (7) Infants and children will demonstrate this with a reduction in behavioral issues related to pain. With this reduction, cooperation during the painful procedure will increase and lead to a better patient-provider relationship.(8)

CONCLUSIONSWith the implementation of this project, providers caring for infants and children gained a resource that allows them to initiate non-pharmacological pain-reducing strategies into their practice. Execution of these pain-reducing strategies will facilitate the future healthcare outcome of their patients by establishing a positive healthcare foundation. This foundation ensures adherence to medical advice and that necessary and preventative procedures will be sought out in the future.(9)

REFERENCES1. American Academy of Pediatrics (AAP), Committee on Fetus and Newborn and Section on Anesthesiology and Pain Medicine. (2016). Prevention and management of procedural pain in the neonate: An update. Pediatrics, 137(2). doi:10.1542/peds.2015-42712. Opsasnick, A. M. (2013). Non-medicinal interventions to relieve neonatal procedural pain: An evidence summary. RN Idaho, 35(4),14.3. Hartley, K. A., Miller, C. S., & Gephart, S. M. (2015). Facilitated tucking to reduce pain in neonates: Evidence for best practice. Advances in Neonatal Care, 15(3), 201-208. doi: 10.1097/ANC.0000000000000193 4. Modarres, M., Jazayeri, A., Rahnama, P., & Montazeri, A. (2013). Breastfeeding and pain relief in full-term neonates during immunization injections: A clinical randomized trial. BMC Anesthesiology, 13(22). doi: 10.1186/1471-2253-13-225. Taddio, A., McMurtry, C. M., Shah, V., Riddell, R. P., Chambers, C. T., Noel, M., . . . HELPinKids&Adults. (2015). Reducing pain during vaccine injections: Clinical practice guideline. CMAJ : Canadian Medical Association Journal 187(13), 975-982. doi:10.1503/cmaj.1503916. American Academy of Pediatrics (AAP), Committee on Fetus and Newborn and Section on Anesthesiology and Pain Medicine. (2001). The assessment and management of acute pain in infants, children, and adolescents. Pediatrics, 108(3). doi: 10.1542/peds.108.3.7937. Petiprin, A. (2016). Kolcaba’s theory of comfort. Retrieved from http://www.nursing-theory.org/theories-and-models/kolcaba-theory-of-comfort.php8. Svendsen, E. J., & Bjørk, I. T. (2014). Experienced nurses' use of non-pharmacological approaches comprise more than relief from pain. Journal of Pediatric Nursing, 29(4), e19-e28. doi:10.1016/j.pedn.2014.01.0159. Jones, T., DeMore, M., Cohen, L. L., O’Connell, C., & Jones, D. (2008). Childhood healthcare experience, healthcare attitudes, and optimism as predictors of adolescents’ healthcare behavior. Journal of Clinical Psychology in Medical Settings, 15(3), 234–240. doi:10.1007/s10880-008-9126-7

Image 1. https://pixnio.com/science/medical-science/infants-and-young-children-need-to-be-vaccinated-because-the-diseases-prevented-by-vaccinationImage 2. https://theprivacyreport.com/tag/newborn-screening/Image 3. voices.wooster.edu/wp-signup.php?new=rubyjuniorisImage 4. http://www.rightparenting.com/upload/April29-2016-6-00pm1355290712.jpg

PROJECT METHODOLOGYIt is the responsibility of providers who are caring for infants and children to not only properly assess for pain but also anticipate when a procedure may be painful and initiate the proper pain-reducing intervention.(6) The purpose of this Master’s Project is to improve provider implementation of non-pharmacological interventions effective in treating pain in infants, toddlers, and children. The project also aims to increase provider awareness of pain in these populations. A provider pamphlet that can be used as a reference in practice will be presented to providers.Effective techniques:• Infants: breastfeeding, facilitated tucking, oral sucrose, non-nutritive sucking, swaddling, and

skin-to-skin contact • Toddlers and Children: music therapy, entertainment, distraction, virtual reality, blowing, and cold

with vibration

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