Susan M. Aitkenhead, RSCN.
Nurse Consultant in Paediatric Pain Management, Royal Hospital for Sick Children, Yorkhill NHS Trust, GlasgowTwenty years ago pain prevention in children was considered inadequate (Mather and Mackie, 1983). The reasons for this were:
The nurse role has been identified as 'pivotal to the success of an acute pain service. The nursing model (in which a nurse-led service educates and advises about pain management) will motivate ward nurses, develop nursing protocols for specific analgesic techniques, institute ward nurse education, and supervise the development of patient observation' (Lloyd-Thomas and Howard, 1994). The influence of a dedicated acute pain nurse can positively address 'deficiencies in knowledge of pain management among ward staff and patients' (Coleman and Booker-Milburn, 1996).
Much work has been done on the changing roles in nursing in recent years (Young et al, 2003; Pearson and Peels, 2002; Caplin-Davies, 1999; Castledine, 1998; Sutton and Smith, 1995).
Acute pain Local data on the paediatric pain management service relating to all aspects of service delivery were gathered. These included database records of all patient numbers, pain management techniques used and length of time in use, plus outcome measures, pain scores and any critical incidents. This showed that the need for acute pain management had increased since its inception, with the number of new patients rising from an initial 60 a month to 120 a month from 1994 to 2000.
Following the health needs assessment it was necessary to provide educational and clinical support on managing paediatric pain. Other health professionals wanted to be made aware of the choices of pain treatments.
The post was implemented in April 2001. The job description incorporated the components shown in Box 4. The role aims to act as an interface between primary, secondary and tertiary services. It aspires to link all settings and provide a wider base of care for all children with pain-management problems.
The postholder and trust carried out a training needs analysis. The local clinical services manager, who had previous strategic experience, facilitated the induction period and provided direction and mentorship. Many strategic skills are not taught in 'traditional' nursing career pathways.
An audit of the roles of nurse consultants in Scotland was commissioned by the Scottish Executive. The Royal Hospital for Sick Children in Glasgow agreed that such an audit would be useful, which is now ongoing. The aim of the audit, as defined by Professor Jean McIntosh of Glasgow Caledonian University, is to identify:
It is still relatively early to comment on the success of this role in paediatric pain management. Common problems associated with introducing a new post have arisen.
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