Elizabeth McArthur, RSCN, BSc (Advanced Nursing); Frances Dooley, RSCN, RN, DipHE.
Elizabeth-Clinical Nurse Specialist, Paediatric Pain, Royal Liverpool Children’s Hospital, Liverpool; Frances-Ward Sister, Royal Liverpool Children’s Hospital, Liverpool
This case study highlights the difficulties experienced by health-care professionals caring for children with profound special needs, in particular, the problems encountered when the child’s pain and distress is not adequately assessed and managed.
An acute surgical wound colonised with methicillin-resistant Staphylococcus aureus A variety of treatments was used, including hydrocolloid, alginate and wound-cavity dressings. Initially, the wound was dressed with Granuflex (ConvaTec) and Steristrips (3M). The wound broke down at the lower end, allowing the femur to break through the skin surface. This was treated with Kaltostat rope (ConvaTec) and packed with Allevyn cavity dressing (Smith and Nephew). The wound bed was treated with Intrasite Gel (Smith and Nephew) and vancomycin.
No formal pain assessment was undertaken. There was no history of how Alice coped with pain or what behavioural cues she might display. Nolan et al (2000) advocate taking a pain history/questionnaire detailing how pain is manifested and what alleviates it. However, there are no validated pain assessment tools for use with children or adults with profound special needs (Biersdorff, 1994; Guisano et al, 1995; McGrath, et al, 1998; Oberlander et al, 1999).
On reflection, a very basic lesson was learnt by our involvement in Alice’s care. ‘Pain is whatever the person says it is,’ wrote McCaffrey and Beebe (1989), but what do we do about the child or adult who cannot tell you about it?
The authors would like to thank the patient, her family and the staff of D3 at Alder Hey Hospital.
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