Transcript Comfort Function Goal

Comfort, Function and Pain in
Pediatric Patients
Joey Robinson, MSNEd,
Clinical Educator
PCMC, Surgical Services
June, 2007
Comfort and Pain
Management Goal
• This presentation is for pediatric nurses.
• Please review
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FAQ sheet
Teaching checklist Comfort
LTA Pain and Comfort Function Goals
CPG comfort link located in basic cares and
pain management documents
– This module takes approximately 15 minutes to
read.
Comfort and Pain
Management Goal
• Objectives
– The learner will be able to give examples of
comfort.
– The learner will be able to define the
difference between comfort, function and pain.
– The learner will be able incorporate the
principals of comfort, function and pain in
nursing plans of care.
Why is defining comfort,
function and pain important?
– In the past 15 years, in spite of efforts made
to alert health care providers to the problem
of under treated pain very little has changed.
– Children are routinely under medicated for pain
– At the heart of this issue is the failure to hold
members of the health care team accountable
for providing the best possible pain relief to
their patients (Apfelbaum, J.L. 2003, Whalen,
C.T. et al 2004).
Comfort and Function
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One solution to the problem of under-treated
pain has been to establish functional goals
Functional goals
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Routinely discussed with patients and families and be
part of the interdisciplinary plan list (IPL)
Related to surgery can be
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To control nausea and vomiting
Stand, crawl or ambulate after surgery with minimal
discomfort ( 3 – 4 might be appropriate).
When setting function goals a nurse needs to
remember that patients/families don’t necessarily
know either the importance of pain relief or how much
pain relief to expect (Pasero C., McCaffery, M., 2004).
Comfort and Pain
Management Goal
• Why is setting a pain management goal important?
– By setting pain rating goals that correspond to function,
patients/families learn no surgery and many diagnosis's are
not pain free and comfort helps their child recover faster
(Pasero C., McCaffery, M., 2004).
• Setting post operative and diagnosis related comfort
and function offers the nurse the opportunity to
discuss with the parents;
• Methods for comforting their child that have worked previously
– thumb sucking, blanket holding, patting, rocking, special item,
singing
• Pain behaviors/expression or history
– Grimacing, frowning, restlessness, crying, repetitive motion, howling
(cognitively impaired)
• Non-pharmacological methods of comfort – warm, cold, music,
distraction
Comfort and Pain
Management Goal
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The state of comfort is more than the
absence of discomfort.
Definition of comfort for nursing
(Kolcaba, 1994, 2001, 2003) is defined as
“the immediate state of being
strengthened through having the human
needs for relief, ease, and
transcendence addressed in four
contexts of experience (physical, psycho
spiritual, socio cultural and
environmental)” (2003, p. 251).
Comfort and Pain
Management Goal
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Pediatric nursing’s foundation facilitates
a child’s special self-comfort habits such
as:
Thumb sucking
Blanket holding
Rocking
Positioning for comfort
Advocating for the presence of family
(Stephens, Barkey & Hall, 1999).
Comfort and Pain
Management Goal
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Children and families want to be
comforted in stressful situations
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Prevention of discomforts, including
those related to physiological or
psychological stressors is easier than
treating discomforts. Prevention is
also better for children/families.
(Kolcaba, M., DiMarco, M., 2005),
Comfort and Pain
Management Goal
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Nurses facilitate a supportive
environment for recovery and
rehabilitation.
Nurses are coaches in pediatric settings,
assuring the child/family that (s)he can
recover, is safe, is protected from harm
and is capable to participate in the
treatment plan appropriate to her/his
developmental age (Kolcaba, M., DiMarco,
M., 2005).
Comfort and Comfort
Function Goal
• A 9 month old that has been
adequately medicated for a hernia
repair. (S)he has not been reunited
with his/her parent and has an IV in
his thumb sucking hand.
• Is this child in pain?
• Is this child comfortable?
Comfort and Pain
Management Goal
• Remember, if we treat the patient’s pain
and comfort, the perceptions of pediatric
pain management could be improved.
– Comfort is an important outcome to measure
for pediatric care and research.
• Linked to higher patient satisfaction ratios
• Linked to cost-benefits ratios (Kolcaba, 2003)
Comfort and Pain
Management Goal
• Please stop at this point and write down
one thing you will incorporate into your
practice regarding comfort and pain
management goals.
OR
• Briefly discuss comfort, function and and
pain management and its importance with a
colleague.
Implementation
– Pre-operatively/pre-procedure nurses
may
• discuss comfort and pain management goals
with the parent or child
• document this goal pre-operative/preprocedure
– Include information regarding:
• what comforts their child
• how they act when they are in pain
(especially cognitively impaired and
preverbal)
• special item they have brought to the
hospital to comfort their child.
Additionally
– This information should be communicated and
documented on the appropriate form
– During hand off communication this
information will be communicated to the next
care member of the team using SBAR under
• “personal belongings” anything that comforts the
child
• “pain” section where pain, comfort and function goals
are written.
Pain Management Goal
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Any pain score that exceeds goal requires
intervention.
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This intervention does not have to be pain medication!
It can be swaddled in a warm blanket, rocked and
burped. Anything that indicates to the patient and
family that comfort/pain has been addressed.
The intervention may include an explanation to patient
or family to better understand the patient will
continue to be upset until they get used to the feeling
of what’s “new”.
Comfort and Pain
Management Goal
• Comfort, function and pain will be
discussed with parents and patients
during routine care of the patient to
insure all these needs have been met.
• Goals and assessment will be
documented on IPL, flow sheet and
surgical forms
Comfort and Pain
Management Goal
• Patient education tools available for
use now include:
– Let’s Talk About Surgical Pain and
Comfort
– Pain management goals teaching
checklist
• Keep an eye out for the development
of upcoming patient education
Comfort and Pain
Management Goal
• Multi disciplinary tools are available
on the pediatric clinical program
page. Intermountain.net > Clinical
programs > Pediatric specialty >
Provider education
Comfort and Pain
Management Goal
• You should be able to:
– Implement comfort, function and pain into your
practice
– Find the FAQ sheet, Teaching checklist “Pain
Management Goals”, LTA “Surgical Pain and
Comfort Function Goals”, CPG under basic cares
– Discuss comfort, function and pain with a
colleague, educator or manager to increase
your learning retention.
Comfort and Pain
Management Goal
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References
Kolcaba, M., DiMarco, M., (2005), Comfort Theory and Its
Application to Pediatric Nursing, Pediatric Nursing, (31) 3 187193.
Pasero C., McCaffery, M., (2004) Comfort-Function Goals Pain
Control , AJN, (104) 9 77-79.
Apfelbaum, J.L. Postoperative pain experience:results for a
national survey suggest postoperative pain continues to be
undermanaged. Anesthesia Analog 2003:97 (2): 534-40
Whalen, C.T. et al, Pain and satisfaction with pain control in
hospitalized medical patients: no such thing as low risk. Arch
Internal Medicine 2004; 164 (2): 173-80.
Kolcaba, K. (1991) A Taxonomic Structure for the Concept
Comfort Journal of Nursing Scholarship, 23(4) 237-240