A Study Of The Construction Of A Pain Assessment Protocol In Children With Mechanical Ventilation

Objective: To understand the current status,influencing factors and obstacles of pain assessment practices among pediatric critical care nurses,summarize the best evidence for pain assessment in mechanically ventilated children using an evidence-based approach,and finally develop a pain assessment protocol for mechanically ventilated children through expert consensus.Methods: 1.A Chinese-version pain assessment nursing practice questionnaire was used to investigate the evidence-based practice and feasibility of pain assessment among pediatric critical care nurses in a tertiary Children’s Hospital in Shenzhen.SPSS26.0 was used for statistical analysis.2.Using the 6S model,literature searches were performed in databases such as Uptodate,JBI,Cochrane Library,BMJ Best Practice,CNKI and Wanfang to gather the best evidence for pain assessment in mechanically ventilated children.3.A preliminary protocol was created using a group conference method.Afterward,an expert conference was held to discuss and revise the draft protocol,integrate expert opinions,and formulate a final pain assessment protocol for mechanically ventilated children.Results: 1.The evidence-based practice score and feasibility score of pain assessment were 97.86±28.18 and 107.29±21.10 points,respectively.Education level,whether pain training was received,whether pain was listed as the fifth vital sign,and whether the department had established a pain system or norm were identified as influencing factors of evidence-based nursing practices(P<0.05).2.Through systematic literature search,a total of 15 articles were included,consisting of 5 guidelines,2 expert consensus,1 clinical decision-making,4 evidence summaries,and 3 systematic reviews.A total of 32 pieces of evidence were summarized across 6 aspects of pain management in mechanically ventilated pediatric patients,including tissue management,education and training,assessment principles,scale selection,assessment frequency,and assessment records.3.Based on the current status of pain assessment in critically ill pediatric nurses and the best available evidence,a preliminary proposal for a pain assessment plan was formulated.After discussion and deliberation at an expert meeting,the preliminary plan was modified and revised to form the final pain assessment plan for mechanically ventilated pediatric patients,comprising three first-level indicators,eight second-level indicators,and 21 third-level indicators.Conclusion: 1.The practical scores of pediatric critical care nurses in pain assessment are relatively low,and the clinical practice of pain assessment in critically ill pediatric patients is poor.Enhanced training is needed to improve the pain assessment skills of these nurses.Moreover,the department should attach importance to establishing norms and systems for pain management to promote their practical nursing of children’s pain.2.The best available evidence for pain assessment in mechanically ventilated pediatric patients provides sufficient and robust support for evidence-based programs,as well as potential methodological guidance and references for clinical practice of medical staff.3.Based on the current practice status of pediatric critical care nurses and the best evidence,the final pain assessment plan for mechanically ventilated pediatric patients was established using expert meeting method,comprising three first-level indicators,eight second-level indicators,and 21 third-level indicators.The content is comprehensive and specific,and the construction process is reliable,with good scientific and clinical feasibility.