Pain assessment and treatment in children with cognitive impairment: A survey of nurses' and physicians' beliefs

Objective: To gather information about healthcare providers' beliefs regard ing pain and its treatment in children with cognitive impairment. Design: A survey consisting of two acute pain vignettes (a child undergoing surgery and a child undergoing an outpatient medical procedure) was comple ted by 440 nurses and 146 physicians at Arkansas Children's Hospital. Respo ndents completed one of four different surveys that systematically varied t he child's level of cognitive impairment (none, mild, moderate, severe) in both vignettes. Questions addressed expected pain, pain assessment methods, pharmacologic regimens, and nonpharmacologic interventions. Results: In general, provider discipline and level of cognitive impairment did not significantly influence responses about pain experience and treatme nt. Potent analgesia, regularly scheduled dosing, and nonpainful administra tion were selected most Frequently. Self-report of pain, patient-controlled analgesia, and behavioral interventions requiring higher cognitive skills were selected less frequently for children with more severe cognitive impai rment. Conclusions: The presence of cognitive impairment appeared to influence pro vider decisions regarding the appropriateness of specific pain assessment a nd treatment methods requiring skills on the part of the child. Overall, he althcare provider views regarding analgesia and sedation were similar for a ll children, regardless of impairment. Whether these beliefs are consistent with clinical practice is yet to be documented.