- Email: [email protected]
Implementation of a pain initiative in the pediatric stem cell transplant setting
Proceedings of the 23nd Annual APON Conference
conference are not currently involved in this current study, anti-CD45 m a y eventually be the conditioning therapy of choice. It is important for nurses to be updated on current research and advances in oncology treatment.
Implementation of a Pain Initiative in the Pediatric Stem Cell Transplant Setting
105
it is expected that transplant patients will remain more comfortable, use less narcotic analgesia, and have shorter hospital stays.
Implementation of a Proactive Educational Intervention Program
Kari L. Still, ND, RNC, C P O N , Natalie N. S k e r g a n , BSN, RN; D u k e University Health S y s t e m , D u r h a m , NC
T a m b r a Dahlheimer, CPNP, C P O N , Vicki S c h a e f e r s , CPNP, K a t h y S o m m e r , CPNP, C P O N , J a n Watterson, BA, B o n n i e C a r l s o n - G r e e n , PhD, LP; Children's H o s p i t a l s a n d Clinics, St. Paul, MN
Children undergoing bone marrow and stem cell transplantation for oncologic, metabolic, or genetic diseases frequently experience pain. This pain is related to invasive procedures and predictable or unforeseen side effects of treatment such as mucositis, organ pain, skin breakdown, and so on. Patients at Duke University Health System range in age from 4 weeks to 28 years. They receive autologous transplants or allogeneic transplants (from both related and alternative donors, including umbilical cord blood donors). Although almost all pediatric transplant patients receive patient-controlled analgesia (PCA), our health care team recognized that improvements could be m a d e in our current practice of pain management. A recent survey of hospitalized pediatric patients at Duke revealed that 61% of children report pain, the majority of which is reported to be moderate or severe. The average level of pain for children is 5.54 (on a scale of 0-10). A health-system-wide Pain Initiative was developed by a multidisciplinary task force and launched first in the oncology and pediatric clinical business units. All nursing and child life staff received education related to pain and its management. Pre- and posttesting was completed. Unit "Pain Champions" (1-2 RNs per unit or clinic) attended an intensive 2-day workshop. These Pain Champions helped to facilitate training of other staff, serve as patient advocates, and act as a link to the Pain Initiative. With enhanced staff understanding of the physiology of pain and pharmacologic and nonpharmacologic m e a n s of managing pain,
Children who have received cranial radiation for brain tumors or prophylactic central nervous system treatment for leukemia have been found to have difficulties with specific cognitive functions, particularly m e m o r y and attention; visual-spatial organization; and analysis, synthesis, and abstract thought. In some cases, overall IQ has declined. These complex, organically based learning disabilities b e c o m e manifest from months to many years after radiation treatment has been completed. Infants or very young children have more severe deficits than those patients who are treated when older. Children, their families, and their teachers m a y need assistance in identifying and intervening with school problems or academic concerns, especially if several years have p a s s e d since the completion of treatment. The program is designed to help children who have received cranial radiation or intrathecal chemotherapy achieve their maxim u m potential in school and to help them maintain their self-esteem. This prophylactic intervention program is designed to identify and address areas of academic concern before major problems develop. The interventions begin by educating parents and children prior to therapy. Regular contact is maintained with the patient and the school for a number of years. Specialized booklets that highlight specific teaching strategies have been developed and are provided to teachers and parents for use with these children. The social worker, education specialist, and neuropsychologist coordinate meetings with parents and school personnel to discuss the educational concerns
conference are not currently involved in this current study, anti-CD45 m a y eventually be the conditioning therapy of choice. It is important for nurses to be updated on current research and advances in oncology treatment.
Implementation of a Pain Initiative in the Pediatric Stem Cell Transplant Setting
105
it is expected that transplant patients will remain more comfortable, use less narcotic analgesia, and have shorter hospital stays.
Implementation of a Proactive Educational Intervention Program
Kari L. Still, ND, RNC, C P O N , Natalie N. S k e r g a n , BSN, RN; D u k e University Health S y s t e m , D u r h a m , NC
T a m b r a Dahlheimer, CPNP, C P O N , Vicki S c h a e f e r s , CPNP, K a t h y S o m m e r , CPNP, C P O N , J a n Watterson, BA, B o n n i e C a r l s o n - G r e e n , PhD, LP; Children's H o s p i t a l s a n d Clinics, St. Paul, MN
Children undergoing bone marrow and stem cell transplantation for oncologic, metabolic, or genetic diseases frequently experience pain. This pain is related to invasive procedures and predictable or unforeseen side effects of treatment such as mucositis, organ pain, skin breakdown, and so on. Patients at Duke University Health System range in age from 4 weeks to 28 years. They receive autologous transplants or allogeneic transplants (from both related and alternative donors, including umbilical cord blood donors). Although almost all pediatric transplant patients receive patient-controlled analgesia (PCA), our health care team recognized that improvements could be m a d e in our current practice of pain management. A recent survey of hospitalized pediatric patients at Duke revealed that 61% of children report pain, the majority of which is reported to be moderate or severe. The average level of pain for children is 5.54 (on a scale of 0-10). A health-system-wide Pain Initiative was developed by a multidisciplinary task force and launched first in the oncology and pediatric clinical business units. All nursing and child life staff received education related to pain and its management. Pre- and posttesting was completed. Unit "Pain Champions" (1-2 RNs per unit or clinic) attended an intensive 2-day workshop. These Pain Champions helped to facilitate training of other staff, serve as patient advocates, and act as a link to the Pain Initiative. With enhanced staff understanding of the physiology of pain and pharmacologic and nonpharmacologic m e a n s of managing pain,
Children who have received cranial radiation for brain tumors or prophylactic central nervous system treatment for leukemia have been found to have difficulties with specific cognitive functions, particularly m e m o r y and attention; visual-spatial organization; and analysis, synthesis, and abstract thought. In some cases, overall IQ has declined. These complex, organically based learning disabilities b e c o m e manifest from months to many years after radiation treatment has been completed. Infants or very young children have more severe deficits than those patients who are treated when older. Children, their families, and their teachers m a y need assistance in identifying and intervening with school problems or academic concerns, especially if several years have p a s s e d since the completion of treatment. The program is designed to help children who have received cranial radiation or intrathecal chemotherapy achieve their maxim u m potential in school and to help them maintain their self-esteem. This prophylactic intervention program is designed to identify and address areas of academic concern before major problems develop. The interventions begin by educating parents and children prior to therapy. Regular contact is maintained with the patient and the school for a number of years. Specialized booklets that highlight specific teaching strategies have been developed and are provided to teachers and parents for use with these children. The social worker, education specialist, and neuropsychologist coordinate meetings with parents and school personnel to discuss the educational concerns