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Postoperative smerter hos barn og ungdom
Anja Hetland Smeland MSN PhD student Fag og forskningssykepleier KAB OUS mail anjsmeous-hfno
Bakgrunn
Smerte hos barn og ungdom undervurderes og underbehandles til tross for at det i dag finnes en mengde tilgjengelig forskning om temaet barn og smerte
Internasjonal forskning indikerer at sykepleieres holdninger og manglende kunnskap om smerte og smertebehandling til barn og ungdom kan vaeligre mulig aringrsak til at smerte undervurderes og underbehandles
Sykepleiere har en viktig rolle og ansvar i forhold til smerteharingndtering av barn og ungdom For aring moslashte disse utfordringene kreves kompetanse i forhold til smertevurdering og smertebehandling
Hvorfor er barns smerter fortsatt underbehandlet
bull Ulike myter amp holdninger
bull Manglende kompetanse om smertevurdering og smertehandling av barn
bull Manglende kompetanse om hvordan barns kognitive utvikling paringvirker barns forstaringelsen og uttrykk for smerte
bull Manglende bruk av systematiske observasjoner for aring vurdere smerte hos barn paring ulike alderstrinn
bull Manglende guidelines for smertebehandling av barn
bull Redsel blant helsepersonell for bivirkninger og avhengighet av opioider
Referanse (1-14 20-24 30-33 50)
Pediatric Pain Management Practices
in Postoperative Units
ndash an Intervention Study
Prosjektdeltakere
Anja Hetland Smeland Spesialsykepleier til barn Master i klinisk sykepleie Fag og forskningssykepleier KAB OUS Stipendiat
Tone Rustoslashen RN PhD seniorforsker og professor AKU Seksjon for forskning og utvikling Forskning Akuttklinikken og Avd for forskning og utvikling (hovedveileder)
Alison Twycross PhD DMS CertEd(HE) RGN RMN RSCN is a Reader in Childrenrsquos Nursing Faculty of Health Social Care and Education Kingston University and St Georgersquos University of London London United Kingdom (biveileder)
Prosjektdeltakere Stefan Lundeberg MD PhD Senior Consultant Pain Treatment
Service Astrid Lindgren Childrens Hospital Stockholm (Intervention study)
Hanne Reinertsen Assistant Professor Oslo and Akershus University college of applied Sciences (Intervention study)
Lill Nybro MSc student Intensive Care Nurse Oslo University Hospital (interview with children)
Torgun Naeligss MSc student Pediatric Nurse Oslo University Hospital (interview with children)
Eva Carlsen Pediatric Nurse Childrens Surgical Department Oslo University Hospital (facilitator Intervention study)
Hensikt
Kartlegge postoperativ smertebehandling av barn og
ungdom i Norge samt se om intervensjon med
sykepleiere og leger vil bedre smertebehandlingen
Metode
Design
Pre-post intervensjonsdesign med kontrollgruppe hvor det maringles ved tre perioder T-1 (baseline) T-2 (1 mnd etter intervensjonen) og T-3 (6 mnd etter intervensjonen)
Utvalg
bull 6 postoperative avdelinger
ndash 6 ulike universitetssykehus
ndash alle helseforetakene i Norge
ndash stoslashrste PO avd som har barn og ungdomspasienter
bull 3 avdelinger til intervensjonen
ndash tilfeldig valgt
ndash cluster randomisering
Faser Aktivitet Fase 1 Kartlegging av kunnskaper
og holdninger hos sykepleierne
Datainnsamling (baseline T-1) bull sposlashrreskjema PNKAS-N bull observasjonsstudie (alle avd) bull intervju av barn (10 barnavd ndash 2 avd)
Fase 2 Utvikling og gjennomfoslashring av intervensjonen
Utvikle intervensjon basert paring bull tidligere forskning bull resultatene fra baseline data bull tilbakemelding fra fag og ledelse Intervensjon bull temadag (undervisning og workshop) bull klinisk veiledning og reminders
Fase 3 Implementering og evaluering av intervensjonen
Datainnsamling (T-2 og T-3) 1 mnd og 6 mnd etter intervensjon sposlashrreskjema PNKAS-N (alle avd) observasjonsstudie (4 avd T-22 avd T-3) intervju av barn (10 barnavd - 2 avd T2)
Studien delt opp i 3 faser
Flowchart
Fase 1 Kartlegging
Forskningssposlashrsmaringl bull Hvilke kunnskaper og holdninger har sykepleiere til smerte hos barn og
ungdom
bull Hvordan praktiserer sykepleiere smerteharingndtering i postoperative avdelinger
bull Hva er barnas opplevelse av postoperativ smertebehandling
Datainnsamling bull Sposlashrreskjema PNKAS-N (alle avdelingene)
bull Observasjonsstudie (alle avdelingene)
bull Intervju av barn (to avdelinger)
Sposlashrreskjemaet bull Pediatric Nurses Knowledge and Attitudes Survey- Norsk
versjon (PNKAS-N)
ndash PNKAS-N bygger paring bull World Health Organization (WHO)
bull American Pain Society (APS)
bull The Agency for Health Care Policy and Research (AHCRP)
ndash PNKAS-N bestaringr av 40 sposlashrsmaringl bull 23 sposlashrsmaringlene er paringstander (santusant)
bull 13 er laquomultiple choiceraquo
bull fire casesposlashrsmaringl knyttet til pasienthistorier
bull Instrumentet ble oversatt til norsk og validert av Hovde i 2009
Observasjonsstudie
bull Ikke deltakende observasjon
bull Semistrukturert
bull Observasjons sjekkliste og feltnotater ndash Smertevurdering
ndash Ikke medikamentell smertelindring
ndash Medikamentell smertelindring
bull Pilottestet
bull Ca 6 tdag i 10 dager (ca 60 timer pr avd 360 timer totalt)
Intervju med barn
bull Semistrukturert
bull Intervjuguider (6-11 12-18) ndash Smerteopplevelsen
ndash Smertevurdering
ndash Ikke medikamentell smertelindring
ndash Medikamentell smertelindring
bull Pilottestet
bull Barn 6-18 aringr
bull 10 barnavd ndash to avdelinger (kontrollgruppeintervensjonsgruppe)
Fase 2 Utvikling av intervensjon
Baseres paring tidligere forskning resultatene fra fase 1 samt tilbakemeldinger fra fag og seksjonsledere
Intervensjonen bestod av
bullTemadag (seks timer)
ndash Undervisning og workshop
ndash Sykepleiere og leger
ndash Stefan Lundeberg og Hanne Reinertsen
bullVeiledning i praksis
ndash Klinisk veiledning i smertebehandling av barn
ndash Eva Carlsen
bullReminders
Fase 3 Evaluering av intervensjonen
Forskningssposlashrsmaringl
Vil intervensjonen oslashke sykepleieres kunnskaper og holdninger til smerte hos barn og ungdom
Vil intervensjonen bedre sykepleieres smerteharingndtering av barn og ungdom
Datainnsamling
bullT-2 1 mnd etter intervensjonen bull Sposlashrreskjema PKNAS-N (alle avd)
bull Observasjonsstudie (fire avd)
bull Intervju av barn (to avd)
bullT-3 6 mnd etter intervensjonen bull Sposlashrreskjema PKNAS-N (alle avd)
bull Observasjonsstudie (to avd)
Fremdriftsplan
Forarbeid November 2013 - juni 2014
Datainnsamling September - november 2014 T-1
Januar ndash februar 2015 Intervensjon
Mars ndash april 2015 T-2
September ndash oktober 2015 T-3
Analyse September 2015 - juli 2016
Artikkelskriving Januar ndash august 2015 artikkel 1
November 2015 ndash juni 2016 artikkel 2
August ndash desember 2016 artikkel 3
Tusen takk
Oppsummering Prosjektet er stoslashttet av
Nasjonalt kompetansenettverk for legemidler til barn
Kirurgisk avdeling for barn OUS
Norsk Sykepleierforbund
Sykehusbarn
Litteraturliste 1 Hauer J Jones BL amp Wolfe J Poplack D G Kim M S (2015) Evaluation and management of pain in children UpToDate httpwwwuptodatecomcontentsevaluation-
and-management-of-pain-in-childrensource=search_resultampsearch=PAIN+CHILDRENampselectedTitle=17E150
2 IASP (2011c) Acute Pain management in Newborn Infants Pain [Online] Tilgjengelig paring httpiaspfilescms-pluscomContentContentFoldersPublications2PainClinicalUpdatesArchivesPCU_19-6_final_12-8-11_1390260191290_1pdf [Lastet 14april 2014]
3 Bernadi M Catania G amp Tridello G (2007) Knowledge and attitudes about cancer pain management a national survey of Italian hospice nurses Cancer Nurs 30(2) E20-6
4 Coulling S (2005) Nurses and doctors knowledge of pain after surgery Nurs Stand 19(34) 41-49
5 Hovde K R Granheim T H Christophersen K-A amp Dihle A (2012) The Norwegian Version of the Pediatric Nursesrsquo Knowledge and attitudes Survey Regarding Pain Reliability and Validity Pedatric nursing 38 (5) 264-269
6 Hossain S (2010) Nursesrsquo Knowledge and Attitudes and Pain Management Practice of Post-Operative Children in Bangladesh Prince of Songkla University Nedlastet fra httpkbpsuacthpsukbbitstream201078261325999pdf
7 Huth M M Gregg T L Lin L (2010) Education changes Mexican nurses knowledge and attitudes regarding pediatric pain Pain Manag Nurs Dec11(4)201-8 doi 101016jpmn200911001
8 Lewthwaite B J Jabusch K M Wheeler B J Schnell-Hoehn K N Mills J Estrella-Holder E Fedorowicz A (2011) Nurses knowledge and attitudes regarding pain management in hospitalized adults J Contin Educ Nurs 42(6) 251-7 doi 10392800220124-20110103-03 Epub 2011 Jan 10
9 Manworren RC (2000) Pediatric nursesrsquo knowledge and attitudes survey regarding pain Pediatr Nurs 26 610-614
10 Rieman M T Gordon M amp Marvin J M (2007) Pediatric nursesrsquo knowledge and attitudes survey regarding pain a competency tool modification Pediatr Nurs 33 303-306
11 Simons JM amp MacDonald LM (2004) Pain assessment tools childrenrsquos nursesrsquo views Journal of Child Health Care 8 264 Doi 1011771367493504047317
12 Twycross A (2007) What is the impact of theoretical knowledge on childrenrsquos nursesrsquo post-operative pain management practices an exploratory study Nurse Educ Today 27 697-707
13 Smart S (2005) POST-OPERATIVE PAIN MANAGEMENT KNOWLEDGE AND ATTITUDES OF PAEDIATRIC NURSES- A NEW ZEALAND REGIONAL VIEW Victoria University of Wellington [Online] Tilgjengelig paring httpresearcharchivevuwacnzbitstreamhandle1006338thesispdfsequence=2 [Lastet 13april 2014]
14 Vincent C V H (2005) Nursesrsquo knowledge attitudes and practices regarding childrenrsquos pain MCN Am J Matern Child Nurs 30 177-183
15 Olsson G Jylli L (2001) Smaumlrta hos barn och ungdomar Lund Sverige Studentlitteratur
16 Peters J W Schouw R Anand K J van Dijk M Duivenvoorden H J Tibboel D (2005) Does neonatal surgery lead to increased pain sensitivity in later childhood Pain 114(3) 444-54
17 Anand K J S Gracia-Preats J A amp Kim M S (2015) Assessment of neonatal pain UpToDate httpwwwuptodatecomcontentsassessment-of-neonatal-pain
18 Anand K J S Gracia-Preats J A amp Kim M S (2015) Prevention and treatment of neonatal pain UpToDate httpwwwuptodatecomcontentsprevention-and-treatment-of-neonatal-painsource=related_link
19 IASP (2011a) Acute Pain and Surgery Global Year Against Acute Pain [Online] Tilgjengelig paring httpwwwiasp-painorgfilesContentContentFoldersGlobalYearAgainstPain2AcutePainFactSheets7-Surgerypdf [Lastet 14april 2014]
20 Howard R Carter B Curry J Jain A Liossi C Morton N Rivett K Rose M Tyrrell J Walker S Williams G (2012) Good Practice in Postoperative and Procedural pain management 2nd Edition Pediatric Anesthesia 22 1ndash79 doi 101111j1460-9592201203838x
21 IASP (2011b) Interventions Benefits and Barriers Global Year Against Acute Pain [Online] Tilgjengelig paring httpwwwiasp-painorgfilesContentContentFoldersGlobalYearAgainstPain2AcutePainFactSheets2-Interventionspdf [Lastet 14april 2014]
22 Benhamou D Berti M Brodner G De Andres J Draisci G Moreno-Azcoita M Neugebauer EA Schwenk W Torres LM Viel E (2007) Postoperative Analgesic THerapy Observational Survey (PATHOS) A practice pattern study in 7 CentralSouthern Eurpean countries Pain 136 134-141
23 Reinertsen H (2008) Smerte hos barn kap3I Rustoslashen T amp Wahl AK (red) Ulike tekster om smerte - fra nocisepsjon til livskvalitet Oslo Gyldendal Norsk Forlag AS
Litteraturliste 24 Smeland A amp Reinertsen H (2012) Smertevurdering og behandling av postoperative smerter hos barn Tidsskriftet Kirurgen 1 58-62 (5 s) [Online] Tilgjengelig paring
httpwwwkirurgennopdf1201 [Lastet 13april 2014]
25 Bringuier S Picot MC Dadure C et al (2009) A prospective comparison of post-surgical behavioral pain scales in preschoolers highlighting the risk of false evaluations Pain 145 60-68
26 Crelline D Sullivan T B Babl F E OSullivan R Hutchinson A (2007) Analysis of the validation of existing behavioral pain and distress scales for use in the procedural setting Pediatric Anesthesia 17 720-733
27 Ghai B Makkar JK amp Wig J (2008) Postoperative pain assessment in preverbal children and children with cognitive impairment Pediatric Anesthesia 18 462-477
28 Hicks CL von Baeyer CL Spafford P et al (2001) The Faces Pain Scale-Revised Toward a common metric in pain measurement Pain 93 173-183
29 Merkel SI Voepel-Lewis T amp Shayevitz et al (1997) The FLACC A Behavioral Scale for Scoring Postoperative Pain in Young Children Pediatric Nursing 23 293-7
30 Ellis J A McCleary L Blouin R Dube K Rowley B MacNeil M amp Cooke C (2007) Implementing best practice pain management in a pediatric hospital Journal for Specialists in Pediatric Nursing 12 264-277 doi101111j1744-6155200700121x
31 Johnston C C Gagnon A Rennick J Rosmus C Patenaude H Ellis J Shapiro C Filion F Ritchie J Byron J (2007) One-on-one coaching to improve pain assessment and management practices of pediatric nurses Journal of Pediatric Nursing 22 467-478 doi101016jpedn200707004
32 Le May S Johnston C C Choiniegravere M Fortin C Kudirka D Murray L Chalut D (2009) Pain Management Practices in a Pediatric Emergency Room (PAMPER) Study interventions with nurses Pediatr Emerg Care Aug25(8)498-503 doi 101097PEC0b013e3181b0a0af
33 Vincent C V H Wilkie D J amp Wang E (2011) Pediatric Nurses Beliefs and Pain Management Practices An Intervention Pilot West J Nurs Res 33 825 originally published online 20 December 2010
36 Twycross A Finley G A and Latimer M (2013) Pediatric nurses postoperative pain management practices An observational study Journal for Specialists in Pediatric Nursing 18 189ndash201 doi 101111jspn12026
42 Twycross A amp Finley G A (2013) Childrens and parents perceptions of postoperative pain management a mixed methods study Journal of Clinical Nursing 22(21-22) 3095-3108 doi 101111jocn12152 [Online] Tilgjengelig paring httponlinelibrarywileycomdoi101111jocn12152pdf (13042014)
43 Polkki T Pietila AM Vehvilainen-Julkunen K (2003) Hospitalized childrens descriptions of their experiences with postsurgical pain relieving methods Int J Nurs Stud Jan40(1)33-44 PubMed PMID 12550148 English
46 Abdalrahim MS Majali SA Stomberg MW Bergbom I (2011) The effect of postoperative pain management program on improving nurses knowledge and attitudes toward pain Nurse Educ Pract 2011 Jul11(4)250-5 doi 101016jnepr201011016 Epub 2010 Dec 24 httpwwwncbinlmnihgovpubmed21186139
47 IASP Pain definition IASP (International Association of the Study of Pain) Pain definition
48 Norsk Ledemiddelharingndbok Ulike smertetilstander [Online] Tilgjengelig paring httplegemiddelhandbokanoTerapi22816expand=1
49 Astrid Lindgrens Barnsjukhus ndash Riktlinjer foumlr smaumlrtbehandling
50 Groslashnseth R amp Markestad T (2011) Pediatri og pediatrisk sykepleie Bergen Fagbokforlaget Vigmostad amp Bjoslashrke AS httppediatriportfoliono
51 Hicks CL von Baeyer CL Spafford Pet al The Faces Pain Scale‐Revised Toward a common metric in pain measurement Pain 2001 93173‐183
52 Twycross A Why Managing Pain in Children Matters in Managing Pain in Children A Clinical Guide (eds A Twycross S J Dowden and E Bruce) Wiley‐Blackwell 2009 Oxford UK doi 1010029781444322743ch1
53 Von Bayer CL amp Spagrud LJ Systematic review of observational (behavioral) measures of pain for children and adolescents aged 3 to 18 years Pain 2007 127 140‐150
54 Voepel‐Lewis Terri RN MSN ZanottiJennifer RN MS CCRN CEN DammeyerJennifer A RN MSN and MerkelSandra RN MS (January 2010) Reliability and Validity of the Face Legs Activity Cry Consolability Behavioral Tool in Assessing Acute Pain in Critically Ill Patients American Journal of Critical Care 19 (1) 55ndash61
55 Merkel S Voepel‐Lewis T Shayevitz JR et al The FLACC A behavioural scale for scoring postoperative pain in young children Pediatric nursing 1997 23293‐797
56 McCaffery M amp Beebe F (1994) Pain‐Clinical Manual of for Nursing Practice Times Mirror International Publishers Ltd Norsk oversettelse Smerter Laeligrebok for helsepersonell Oslo Norge Gyldendal Norsk Forlag AS
57 Reinertsen H Christophersen K‐A Helseth S Vurdering av postoperativ smerte hos barn (0‐5 aringr) Validering og reliabilitetstesting av smertevurderingsverktoslashyet FLACC Sykepleien Forskning 2014 9 132‐140 httpwwwsykepleiennoforskningforskningsartikkel1466655validering‐og‐reliabilitetstesting‐av‐smertevurderingsverktoyet‐flacc
Litteraturliste 58 Stinson J (2009) Pain Assessment I Twycross A Dowden S J amp Bruce E Pain Assessment in Managing Pain in Children A Clinical Guide Oxford UK Wiley-Blackmell
59 Tomlinson D von Baeyer CL Stinson JN Sung L A systematic review of faces scales for the self‐report of pain intensity in children Pediatrics 2010 Nov126(5)e1168‐98 PubMed PMID 20921070 Epub 20101006 eng
60 Von Baeyer CL Childrens self‐reports of pain intensity scale selection limitations and interpretation Pain Res Manag 2006 Autumn11(3)157‐62 PubMed PMID 16960632 Pubmed Central PMCID PMC2539005 Epub 20060909 eng
61 Ghai B Makkar J K amp Wig J (2008) Postoperative pain assesment in preverbal children and children with cognitive impairment Pediatric Anesthesia 18 462‐477
62 Malvia S Voepel‐Lewis T Tait A R Merkel S Lauer A Munro H Farley F (2001) Pain management in children with and without cognitive impairment following spine fusion surgery Pediatric Anasthesia 11 453‐458
63 Malvia S Voepel‐Lewis T Burke C Merkel S amp Tait A R (2006) The revised FLACC observational pain tool improved reliability and validity for pain assesment in children with cognitive impairment Pediatric Anestesia 16 258‐265
64 McJunkins A Green A amp Anand KJS (2010) Pain Assesment in cognitively Impared Functionally Impared Children Pilot Study Results Journal of Pediatric Nursing 25 307‐309
65 McKearnan K A Kieckhefer G Engel J M Jensen M amp Labyak S (2004) Pain in Children with cerebral Palsy A Review Journal of Neuroscience Nursing Vol 36 no 5 s252‐259
66 Voepel‐Lewis T Malviya S Tait A Merkel S Forter R amp Krane E (2008) A comparison of the clinical utility of pain assesment tools for children with cognitive impairment Pediatric Anesthesiology 106 (1) 72‐78
67 Baulch I Assessment and management of pain in the paediatric patient Nursing standard 2010 2510 35-40
68 Twycross A Why Managing Pain in Children Matters in Managing Pain in Children A Clinical Guide (eds A Twycross S J Dowden and E Bruce) Wiley-Blackwell 2009 Oxford UK doi 1010029781444322743ch1
69 Schug SA amp Pogatzki-Zhan EM Chronic Pain after Surgery or Injury Pain 2011 Clinical Updates XIX 11-5
70 Fredheim OMS Borchgrevink PC amp Kvarstein G Behandling av postoperativ smerte i sykehus Tidsskr Nor Legeforen 2011 131 1772-6
71 Steward DL Welge J amp Myer C Steroids for improving recovery following tonsillectomy in children Cochrane Database of Systematic Reviews 2003 Issue 1Art NoCD003997 DOI10100214651858CD003997
72 Hong JY Han SW Kim WO et al Effect of dexamethasone in combination with caudal analgesia on postoperative pain control in day-case paediatric orchioplexy British Journal of Anesthesia 2010 105(4)506-10
73 Den Norske Legeforening (2009) Retningslinjer for smertelindring [Online] URL httpwww legeforeningennoasset42585142585_1pdf
74 Association of Paediatric Anaesthetists (2008) Good Practice in Postoperative and Procedural Pain [Online] URL httpwwwbritishpainsocietyorgbook_apa_part1pdf
75 European Society of Regional Aneasthesia (2005) Postoperative Pain Management ndash Good Clinical Practice General recommendations and principles for successful pain management [Online] URL httpwwwesraeuropeorgPostoperativePainManagementpdf
76 Monsen ALB Skadberg BT amp Groslashnlie I Smertebehandling Norsk Barnelegeforeningen 2011 [Online] URL httpwwwlegeforeningennoid1104250
77 Smeland A amp Reinertsen H (2012) Smertevurdering og behandling av postoperative smerter hos barn Tidsskriftet Kirurgen 1 58-62 (5 s) [Online] Tilgjengelig paring httpwwwkirurgennopdf1201
78 Standing JF Savage I Pritchard D et al Diclofenac for acute pain in children Cochrane Database of Systematic Reviews 2009 Issue 4 Art No CD005538 DOI 10100214651858CD005538pub2
79 Standing JF Tibboel D Korpela R et al Diclofenac pharmacokinetic meta-analysis and dose recommendations for surgical pain in children aged 1ndash12 years Pediatric Anesthesia 2011 21 316ndash324 doi 101111j1460-9592201003509x
80 Riad W amp Moussa A Pre-operative analgesia with rectal diclofenac andor paracetamol in children undergoing hernia repair Anaesthesia 2007 Dec62(12)1241-5
81 Hiller A Meretoja OA Korpela R et al The Anagesic Efficacy of Acetaminophen Ketoprofen or Their Combination for Pediatric Surgical Patients Having Soft Tissue or Orthopedic Procedures Anesth Analg 20061021365-71
82 Norsk legemiddelharingndbok Antidoter ndash alfabetisk oversikt bruksomraringde og dosering httplegemiddelhandbokanoGenerelle153557i153779
83 Norsk legemiddelharingndbok Barn og legemidler httplegemiddelhandbokanoGenerelle153109
84 SickKids Aboutkidshealthca Myths About Pain httpwwwaboutkidshealthcaEnResourceCentresPainPainAssessmentPagesMyths-About-Painaspx
85 Psykososial preoperativ forberedelse av barn 0ndash18 aringr httpwwwhelsebiblioteketnomicrositefagprosedyrerfagprosedyrerpsykososial-preoperativ-forberedelse-av-barn-018-C3A5r
86 Twycross A Why Managing Pain in Children Matters in Managing Pain in Children A Clinical Guide (eds ATwycross S J Dowden and E Bruce) Wiley‐Blackwell 2009 Oxford UK doi 1010029781444322743ch1
Bakgrunn
Smerte hos barn og ungdom undervurderes og underbehandles til tross for at det i dag finnes en mengde tilgjengelig forskning om temaet barn og smerte
Internasjonal forskning indikerer at sykepleieres holdninger og manglende kunnskap om smerte og smertebehandling til barn og ungdom kan vaeligre mulig aringrsak til at smerte undervurderes og underbehandles
Sykepleiere har en viktig rolle og ansvar i forhold til smerteharingndtering av barn og ungdom For aring moslashte disse utfordringene kreves kompetanse i forhold til smertevurdering og smertebehandling
Hvorfor er barns smerter fortsatt underbehandlet
bull Ulike myter amp holdninger
bull Manglende kompetanse om smertevurdering og smertehandling av barn
bull Manglende kompetanse om hvordan barns kognitive utvikling paringvirker barns forstaringelsen og uttrykk for smerte
bull Manglende bruk av systematiske observasjoner for aring vurdere smerte hos barn paring ulike alderstrinn
bull Manglende guidelines for smertebehandling av barn
bull Redsel blant helsepersonell for bivirkninger og avhengighet av opioider
Referanse (1-14 20-24 30-33 50)
Pediatric Pain Management Practices
in Postoperative Units
ndash an Intervention Study
Prosjektdeltakere
Anja Hetland Smeland Spesialsykepleier til barn Master i klinisk sykepleie Fag og forskningssykepleier KAB OUS Stipendiat
Tone Rustoslashen RN PhD seniorforsker og professor AKU Seksjon for forskning og utvikling Forskning Akuttklinikken og Avd for forskning og utvikling (hovedveileder)
Alison Twycross PhD DMS CertEd(HE) RGN RMN RSCN is a Reader in Childrenrsquos Nursing Faculty of Health Social Care and Education Kingston University and St Georgersquos University of London London United Kingdom (biveileder)
Prosjektdeltakere Stefan Lundeberg MD PhD Senior Consultant Pain Treatment
Service Astrid Lindgren Childrens Hospital Stockholm (Intervention study)
Hanne Reinertsen Assistant Professor Oslo and Akershus University college of applied Sciences (Intervention study)
Lill Nybro MSc student Intensive Care Nurse Oslo University Hospital (interview with children)
Torgun Naeligss MSc student Pediatric Nurse Oslo University Hospital (interview with children)
Eva Carlsen Pediatric Nurse Childrens Surgical Department Oslo University Hospital (facilitator Intervention study)
Hensikt
Kartlegge postoperativ smertebehandling av barn og
ungdom i Norge samt se om intervensjon med
sykepleiere og leger vil bedre smertebehandlingen
Metode
Design
Pre-post intervensjonsdesign med kontrollgruppe hvor det maringles ved tre perioder T-1 (baseline) T-2 (1 mnd etter intervensjonen) og T-3 (6 mnd etter intervensjonen)
Utvalg
bull 6 postoperative avdelinger
ndash 6 ulike universitetssykehus
ndash alle helseforetakene i Norge
ndash stoslashrste PO avd som har barn og ungdomspasienter
bull 3 avdelinger til intervensjonen
ndash tilfeldig valgt
ndash cluster randomisering
Faser Aktivitet Fase 1 Kartlegging av kunnskaper
og holdninger hos sykepleierne
Datainnsamling (baseline T-1) bull sposlashrreskjema PNKAS-N bull observasjonsstudie (alle avd) bull intervju av barn (10 barnavd ndash 2 avd)
Fase 2 Utvikling og gjennomfoslashring av intervensjonen
Utvikle intervensjon basert paring bull tidligere forskning bull resultatene fra baseline data bull tilbakemelding fra fag og ledelse Intervensjon bull temadag (undervisning og workshop) bull klinisk veiledning og reminders
Fase 3 Implementering og evaluering av intervensjonen
Datainnsamling (T-2 og T-3) 1 mnd og 6 mnd etter intervensjon sposlashrreskjema PNKAS-N (alle avd) observasjonsstudie (4 avd T-22 avd T-3) intervju av barn (10 barnavd - 2 avd T2)
Studien delt opp i 3 faser
Flowchart
Fase 1 Kartlegging
Forskningssposlashrsmaringl bull Hvilke kunnskaper og holdninger har sykepleiere til smerte hos barn og
ungdom
bull Hvordan praktiserer sykepleiere smerteharingndtering i postoperative avdelinger
bull Hva er barnas opplevelse av postoperativ smertebehandling
Datainnsamling bull Sposlashrreskjema PNKAS-N (alle avdelingene)
bull Observasjonsstudie (alle avdelingene)
bull Intervju av barn (to avdelinger)
Sposlashrreskjemaet bull Pediatric Nurses Knowledge and Attitudes Survey- Norsk
versjon (PNKAS-N)
ndash PNKAS-N bygger paring bull World Health Organization (WHO)
bull American Pain Society (APS)
bull The Agency for Health Care Policy and Research (AHCRP)
ndash PNKAS-N bestaringr av 40 sposlashrsmaringl bull 23 sposlashrsmaringlene er paringstander (santusant)
bull 13 er laquomultiple choiceraquo
bull fire casesposlashrsmaringl knyttet til pasienthistorier
bull Instrumentet ble oversatt til norsk og validert av Hovde i 2009
Observasjonsstudie
bull Ikke deltakende observasjon
bull Semistrukturert
bull Observasjons sjekkliste og feltnotater ndash Smertevurdering
ndash Ikke medikamentell smertelindring
ndash Medikamentell smertelindring
bull Pilottestet
bull Ca 6 tdag i 10 dager (ca 60 timer pr avd 360 timer totalt)
Intervju med barn
bull Semistrukturert
bull Intervjuguider (6-11 12-18) ndash Smerteopplevelsen
ndash Smertevurdering
ndash Ikke medikamentell smertelindring
ndash Medikamentell smertelindring
bull Pilottestet
bull Barn 6-18 aringr
bull 10 barnavd ndash to avdelinger (kontrollgruppeintervensjonsgruppe)
Fase 2 Utvikling av intervensjon
Baseres paring tidligere forskning resultatene fra fase 1 samt tilbakemeldinger fra fag og seksjonsledere
Intervensjonen bestod av
bullTemadag (seks timer)
ndash Undervisning og workshop
ndash Sykepleiere og leger
ndash Stefan Lundeberg og Hanne Reinertsen
bullVeiledning i praksis
ndash Klinisk veiledning i smertebehandling av barn
ndash Eva Carlsen
bullReminders
Fase 3 Evaluering av intervensjonen
Forskningssposlashrsmaringl
Vil intervensjonen oslashke sykepleieres kunnskaper og holdninger til smerte hos barn og ungdom
Vil intervensjonen bedre sykepleieres smerteharingndtering av barn og ungdom
Datainnsamling
bullT-2 1 mnd etter intervensjonen bull Sposlashrreskjema PKNAS-N (alle avd)
bull Observasjonsstudie (fire avd)
bull Intervju av barn (to avd)
bullT-3 6 mnd etter intervensjonen bull Sposlashrreskjema PKNAS-N (alle avd)
bull Observasjonsstudie (to avd)
Fremdriftsplan
Forarbeid November 2013 - juni 2014
Datainnsamling September - november 2014 T-1
Januar ndash februar 2015 Intervensjon
Mars ndash april 2015 T-2
September ndash oktober 2015 T-3
Analyse September 2015 - juli 2016
Artikkelskriving Januar ndash august 2015 artikkel 1
November 2015 ndash juni 2016 artikkel 2
August ndash desember 2016 artikkel 3
Tusen takk
Oppsummering Prosjektet er stoslashttet av
Nasjonalt kompetansenettverk for legemidler til barn
Kirurgisk avdeling for barn OUS
Norsk Sykepleierforbund
Sykehusbarn
Litteraturliste 1 Hauer J Jones BL amp Wolfe J Poplack D G Kim M S (2015) Evaluation and management of pain in children UpToDate httpwwwuptodatecomcontentsevaluation-
and-management-of-pain-in-childrensource=search_resultampsearch=PAIN+CHILDRENampselectedTitle=17E150
2 IASP (2011c) Acute Pain management in Newborn Infants Pain [Online] Tilgjengelig paring httpiaspfilescms-pluscomContentContentFoldersPublications2PainClinicalUpdatesArchivesPCU_19-6_final_12-8-11_1390260191290_1pdf [Lastet 14april 2014]
3 Bernadi M Catania G amp Tridello G (2007) Knowledge and attitudes about cancer pain management a national survey of Italian hospice nurses Cancer Nurs 30(2) E20-6
4 Coulling S (2005) Nurses and doctors knowledge of pain after surgery Nurs Stand 19(34) 41-49
5 Hovde K R Granheim T H Christophersen K-A amp Dihle A (2012) The Norwegian Version of the Pediatric Nursesrsquo Knowledge and attitudes Survey Regarding Pain Reliability and Validity Pedatric nursing 38 (5) 264-269
6 Hossain S (2010) Nursesrsquo Knowledge and Attitudes and Pain Management Practice of Post-Operative Children in Bangladesh Prince of Songkla University Nedlastet fra httpkbpsuacthpsukbbitstream201078261325999pdf
7 Huth M M Gregg T L Lin L (2010) Education changes Mexican nurses knowledge and attitudes regarding pediatric pain Pain Manag Nurs Dec11(4)201-8 doi 101016jpmn200911001
8 Lewthwaite B J Jabusch K M Wheeler B J Schnell-Hoehn K N Mills J Estrella-Holder E Fedorowicz A (2011) Nurses knowledge and attitudes regarding pain management in hospitalized adults J Contin Educ Nurs 42(6) 251-7 doi 10392800220124-20110103-03 Epub 2011 Jan 10
9 Manworren RC (2000) Pediatric nursesrsquo knowledge and attitudes survey regarding pain Pediatr Nurs 26 610-614
10 Rieman M T Gordon M amp Marvin J M (2007) Pediatric nursesrsquo knowledge and attitudes survey regarding pain a competency tool modification Pediatr Nurs 33 303-306
11 Simons JM amp MacDonald LM (2004) Pain assessment tools childrenrsquos nursesrsquo views Journal of Child Health Care 8 264 Doi 1011771367493504047317
12 Twycross A (2007) What is the impact of theoretical knowledge on childrenrsquos nursesrsquo post-operative pain management practices an exploratory study Nurse Educ Today 27 697-707
13 Smart S (2005) POST-OPERATIVE PAIN MANAGEMENT KNOWLEDGE AND ATTITUDES OF PAEDIATRIC NURSES- A NEW ZEALAND REGIONAL VIEW Victoria University of Wellington [Online] Tilgjengelig paring httpresearcharchivevuwacnzbitstreamhandle1006338thesispdfsequence=2 [Lastet 13april 2014]
14 Vincent C V H (2005) Nursesrsquo knowledge attitudes and practices regarding childrenrsquos pain MCN Am J Matern Child Nurs 30 177-183
15 Olsson G Jylli L (2001) Smaumlrta hos barn och ungdomar Lund Sverige Studentlitteratur
16 Peters J W Schouw R Anand K J van Dijk M Duivenvoorden H J Tibboel D (2005) Does neonatal surgery lead to increased pain sensitivity in later childhood Pain 114(3) 444-54
17 Anand K J S Gracia-Preats J A amp Kim M S (2015) Assessment of neonatal pain UpToDate httpwwwuptodatecomcontentsassessment-of-neonatal-pain
18 Anand K J S Gracia-Preats J A amp Kim M S (2015) Prevention and treatment of neonatal pain UpToDate httpwwwuptodatecomcontentsprevention-and-treatment-of-neonatal-painsource=related_link
19 IASP (2011a) Acute Pain and Surgery Global Year Against Acute Pain [Online] Tilgjengelig paring httpwwwiasp-painorgfilesContentContentFoldersGlobalYearAgainstPain2AcutePainFactSheets7-Surgerypdf [Lastet 14april 2014]
20 Howard R Carter B Curry J Jain A Liossi C Morton N Rivett K Rose M Tyrrell J Walker S Williams G (2012) Good Practice in Postoperative and Procedural pain management 2nd Edition Pediatric Anesthesia 22 1ndash79 doi 101111j1460-9592201203838x
21 IASP (2011b) Interventions Benefits and Barriers Global Year Against Acute Pain [Online] Tilgjengelig paring httpwwwiasp-painorgfilesContentContentFoldersGlobalYearAgainstPain2AcutePainFactSheets2-Interventionspdf [Lastet 14april 2014]
22 Benhamou D Berti M Brodner G De Andres J Draisci G Moreno-Azcoita M Neugebauer EA Schwenk W Torres LM Viel E (2007) Postoperative Analgesic THerapy Observational Survey (PATHOS) A practice pattern study in 7 CentralSouthern Eurpean countries Pain 136 134-141
23 Reinertsen H (2008) Smerte hos barn kap3I Rustoslashen T amp Wahl AK (red) Ulike tekster om smerte - fra nocisepsjon til livskvalitet Oslo Gyldendal Norsk Forlag AS
Litteraturliste 24 Smeland A amp Reinertsen H (2012) Smertevurdering og behandling av postoperative smerter hos barn Tidsskriftet Kirurgen 1 58-62 (5 s) [Online] Tilgjengelig paring
httpwwwkirurgennopdf1201 [Lastet 13april 2014]
25 Bringuier S Picot MC Dadure C et al (2009) A prospective comparison of post-surgical behavioral pain scales in preschoolers highlighting the risk of false evaluations Pain 145 60-68
26 Crelline D Sullivan T B Babl F E OSullivan R Hutchinson A (2007) Analysis of the validation of existing behavioral pain and distress scales for use in the procedural setting Pediatric Anesthesia 17 720-733
27 Ghai B Makkar JK amp Wig J (2008) Postoperative pain assessment in preverbal children and children with cognitive impairment Pediatric Anesthesia 18 462-477
28 Hicks CL von Baeyer CL Spafford P et al (2001) The Faces Pain Scale-Revised Toward a common metric in pain measurement Pain 93 173-183
29 Merkel SI Voepel-Lewis T amp Shayevitz et al (1997) The FLACC A Behavioral Scale for Scoring Postoperative Pain in Young Children Pediatric Nursing 23 293-7
30 Ellis J A McCleary L Blouin R Dube K Rowley B MacNeil M amp Cooke C (2007) Implementing best practice pain management in a pediatric hospital Journal for Specialists in Pediatric Nursing 12 264-277 doi101111j1744-6155200700121x
31 Johnston C C Gagnon A Rennick J Rosmus C Patenaude H Ellis J Shapiro C Filion F Ritchie J Byron J (2007) One-on-one coaching to improve pain assessment and management practices of pediatric nurses Journal of Pediatric Nursing 22 467-478 doi101016jpedn200707004
32 Le May S Johnston C C Choiniegravere M Fortin C Kudirka D Murray L Chalut D (2009) Pain Management Practices in a Pediatric Emergency Room (PAMPER) Study interventions with nurses Pediatr Emerg Care Aug25(8)498-503 doi 101097PEC0b013e3181b0a0af
33 Vincent C V H Wilkie D J amp Wang E (2011) Pediatric Nurses Beliefs and Pain Management Practices An Intervention Pilot West J Nurs Res 33 825 originally published online 20 December 2010
36 Twycross A Finley G A and Latimer M (2013) Pediatric nurses postoperative pain management practices An observational study Journal for Specialists in Pediatric Nursing 18 189ndash201 doi 101111jspn12026
42 Twycross A amp Finley G A (2013) Childrens and parents perceptions of postoperative pain management a mixed methods study Journal of Clinical Nursing 22(21-22) 3095-3108 doi 101111jocn12152 [Online] Tilgjengelig paring httponlinelibrarywileycomdoi101111jocn12152pdf (13042014)
43 Polkki T Pietila AM Vehvilainen-Julkunen K (2003) Hospitalized childrens descriptions of their experiences with postsurgical pain relieving methods Int J Nurs Stud Jan40(1)33-44 PubMed PMID 12550148 English
46 Abdalrahim MS Majali SA Stomberg MW Bergbom I (2011) The effect of postoperative pain management program on improving nurses knowledge and attitudes toward pain Nurse Educ Pract 2011 Jul11(4)250-5 doi 101016jnepr201011016 Epub 2010 Dec 24 httpwwwncbinlmnihgovpubmed21186139
47 IASP Pain definition IASP (International Association of the Study of Pain) Pain definition
48 Norsk Ledemiddelharingndbok Ulike smertetilstander [Online] Tilgjengelig paring httplegemiddelhandbokanoTerapi22816expand=1
49 Astrid Lindgrens Barnsjukhus ndash Riktlinjer foumlr smaumlrtbehandling
50 Groslashnseth R amp Markestad T (2011) Pediatri og pediatrisk sykepleie Bergen Fagbokforlaget Vigmostad amp Bjoslashrke AS httppediatriportfoliono
51 Hicks CL von Baeyer CL Spafford Pet al The Faces Pain Scale‐Revised Toward a common metric in pain measurement Pain 2001 93173‐183
52 Twycross A Why Managing Pain in Children Matters in Managing Pain in Children A Clinical Guide (eds A Twycross S J Dowden and E Bruce) Wiley‐Blackwell 2009 Oxford UK doi 1010029781444322743ch1
53 Von Bayer CL amp Spagrud LJ Systematic review of observational (behavioral) measures of pain for children and adolescents aged 3 to 18 years Pain 2007 127 140‐150
54 Voepel‐Lewis Terri RN MSN ZanottiJennifer RN MS CCRN CEN DammeyerJennifer A RN MSN and MerkelSandra RN MS (January 2010) Reliability and Validity of the Face Legs Activity Cry Consolability Behavioral Tool in Assessing Acute Pain in Critically Ill Patients American Journal of Critical Care 19 (1) 55ndash61
55 Merkel S Voepel‐Lewis T Shayevitz JR et al The FLACC A behavioural scale for scoring postoperative pain in young children Pediatric nursing 1997 23293‐797
56 McCaffery M amp Beebe F (1994) Pain‐Clinical Manual of for Nursing Practice Times Mirror International Publishers Ltd Norsk oversettelse Smerter Laeligrebok for helsepersonell Oslo Norge Gyldendal Norsk Forlag AS
57 Reinertsen H Christophersen K‐A Helseth S Vurdering av postoperativ smerte hos barn (0‐5 aringr) Validering og reliabilitetstesting av smertevurderingsverktoslashyet FLACC Sykepleien Forskning 2014 9 132‐140 httpwwwsykepleiennoforskningforskningsartikkel1466655validering‐og‐reliabilitetstesting‐av‐smertevurderingsverktoyet‐flacc
Litteraturliste 58 Stinson J (2009) Pain Assessment I Twycross A Dowden S J amp Bruce E Pain Assessment in Managing Pain in Children A Clinical Guide Oxford UK Wiley-Blackmell
59 Tomlinson D von Baeyer CL Stinson JN Sung L A systematic review of faces scales for the self‐report of pain intensity in children Pediatrics 2010 Nov126(5)e1168‐98 PubMed PMID 20921070 Epub 20101006 eng
60 Von Baeyer CL Childrens self‐reports of pain intensity scale selection limitations and interpretation Pain Res Manag 2006 Autumn11(3)157‐62 PubMed PMID 16960632 Pubmed Central PMCID PMC2539005 Epub 20060909 eng
61 Ghai B Makkar J K amp Wig J (2008) Postoperative pain assesment in preverbal children and children with cognitive impairment Pediatric Anesthesia 18 462‐477
62 Malvia S Voepel‐Lewis T Tait A R Merkel S Lauer A Munro H Farley F (2001) Pain management in children with and without cognitive impairment following spine fusion surgery Pediatric Anasthesia 11 453‐458
63 Malvia S Voepel‐Lewis T Burke C Merkel S amp Tait A R (2006) The revised FLACC observational pain tool improved reliability and validity for pain assesment in children with cognitive impairment Pediatric Anestesia 16 258‐265
64 McJunkins A Green A amp Anand KJS (2010) Pain Assesment in cognitively Impared Functionally Impared Children Pilot Study Results Journal of Pediatric Nursing 25 307‐309
65 McKearnan K A Kieckhefer G Engel J M Jensen M amp Labyak S (2004) Pain in Children with cerebral Palsy A Review Journal of Neuroscience Nursing Vol 36 no 5 s252‐259
66 Voepel‐Lewis T Malviya S Tait A Merkel S Forter R amp Krane E (2008) A comparison of the clinical utility of pain assesment tools for children with cognitive impairment Pediatric Anesthesiology 106 (1) 72‐78
67 Baulch I Assessment and management of pain in the paediatric patient Nursing standard 2010 2510 35-40
68 Twycross A Why Managing Pain in Children Matters in Managing Pain in Children A Clinical Guide (eds A Twycross S J Dowden and E Bruce) Wiley-Blackwell 2009 Oxford UK doi 1010029781444322743ch1
69 Schug SA amp Pogatzki-Zhan EM Chronic Pain after Surgery or Injury Pain 2011 Clinical Updates XIX 11-5
70 Fredheim OMS Borchgrevink PC amp Kvarstein G Behandling av postoperativ smerte i sykehus Tidsskr Nor Legeforen 2011 131 1772-6
71 Steward DL Welge J amp Myer C Steroids for improving recovery following tonsillectomy in children Cochrane Database of Systematic Reviews 2003 Issue 1Art NoCD003997 DOI10100214651858CD003997
72 Hong JY Han SW Kim WO et al Effect of dexamethasone in combination with caudal analgesia on postoperative pain control in day-case paediatric orchioplexy British Journal of Anesthesia 2010 105(4)506-10
73 Den Norske Legeforening (2009) Retningslinjer for smertelindring [Online] URL httpwww legeforeningennoasset42585142585_1pdf
74 Association of Paediatric Anaesthetists (2008) Good Practice in Postoperative and Procedural Pain [Online] URL httpwwwbritishpainsocietyorgbook_apa_part1pdf
75 European Society of Regional Aneasthesia (2005) Postoperative Pain Management ndash Good Clinical Practice General recommendations and principles for successful pain management [Online] URL httpwwwesraeuropeorgPostoperativePainManagementpdf
76 Monsen ALB Skadberg BT amp Groslashnlie I Smertebehandling Norsk Barnelegeforeningen 2011 [Online] URL httpwwwlegeforeningennoid1104250
77 Smeland A amp Reinertsen H (2012) Smertevurdering og behandling av postoperative smerter hos barn Tidsskriftet Kirurgen 1 58-62 (5 s) [Online] Tilgjengelig paring httpwwwkirurgennopdf1201
78 Standing JF Savage I Pritchard D et al Diclofenac for acute pain in children Cochrane Database of Systematic Reviews 2009 Issue 4 Art No CD005538 DOI 10100214651858CD005538pub2
79 Standing JF Tibboel D Korpela R et al Diclofenac pharmacokinetic meta-analysis and dose recommendations for surgical pain in children aged 1ndash12 years Pediatric Anesthesia 2011 21 316ndash324 doi 101111j1460-9592201003509x
80 Riad W amp Moussa A Pre-operative analgesia with rectal diclofenac andor paracetamol in children undergoing hernia repair Anaesthesia 2007 Dec62(12)1241-5
81 Hiller A Meretoja OA Korpela R et al The Anagesic Efficacy of Acetaminophen Ketoprofen or Their Combination for Pediatric Surgical Patients Having Soft Tissue or Orthopedic Procedures Anesth Analg 20061021365-71
82 Norsk legemiddelharingndbok Antidoter ndash alfabetisk oversikt bruksomraringde og dosering httplegemiddelhandbokanoGenerelle153557i153779
83 Norsk legemiddelharingndbok Barn og legemidler httplegemiddelhandbokanoGenerelle153109
84 SickKids Aboutkidshealthca Myths About Pain httpwwwaboutkidshealthcaEnResourceCentresPainPainAssessmentPagesMyths-About-Painaspx
85 Psykososial preoperativ forberedelse av barn 0ndash18 aringr httpwwwhelsebiblioteketnomicrositefagprosedyrerfagprosedyrerpsykososial-preoperativ-forberedelse-av-barn-018-C3A5r
86 Twycross A Why Managing Pain in Children Matters in Managing Pain in Children A Clinical Guide (eds ATwycross S J Dowden and E Bruce) Wiley‐Blackwell 2009 Oxford UK doi 1010029781444322743ch1
Sykepleiere har en viktig rolle og ansvar i forhold til smerteharingndtering av barn og ungdom For aring moslashte disse utfordringene kreves kompetanse i forhold til smertevurdering og smertebehandling
Hvorfor er barns smerter fortsatt underbehandlet
bull Ulike myter amp holdninger
bull Manglende kompetanse om smertevurdering og smertehandling av barn
bull Manglende kompetanse om hvordan barns kognitive utvikling paringvirker barns forstaringelsen og uttrykk for smerte
bull Manglende bruk av systematiske observasjoner for aring vurdere smerte hos barn paring ulike alderstrinn
bull Manglende guidelines for smertebehandling av barn
bull Redsel blant helsepersonell for bivirkninger og avhengighet av opioider
Referanse (1-14 20-24 30-33 50)
Pediatric Pain Management Practices
in Postoperative Units
ndash an Intervention Study
Prosjektdeltakere
Anja Hetland Smeland Spesialsykepleier til barn Master i klinisk sykepleie Fag og forskningssykepleier KAB OUS Stipendiat
Tone Rustoslashen RN PhD seniorforsker og professor AKU Seksjon for forskning og utvikling Forskning Akuttklinikken og Avd for forskning og utvikling (hovedveileder)
Alison Twycross PhD DMS CertEd(HE) RGN RMN RSCN is a Reader in Childrenrsquos Nursing Faculty of Health Social Care and Education Kingston University and St Georgersquos University of London London United Kingdom (biveileder)
Prosjektdeltakere Stefan Lundeberg MD PhD Senior Consultant Pain Treatment
Service Astrid Lindgren Childrens Hospital Stockholm (Intervention study)
Hanne Reinertsen Assistant Professor Oslo and Akershus University college of applied Sciences (Intervention study)
Lill Nybro MSc student Intensive Care Nurse Oslo University Hospital (interview with children)
Torgun Naeligss MSc student Pediatric Nurse Oslo University Hospital (interview with children)
Eva Carlsen Pediatric Nurse Childrens Surgical Department Oslo University Hospital (facilitator Intervention study)
Hensikt
Kartlegge postoperativ smertebehandling av barn og
ungdom i Norge samt se om intervensjon med
sykepleiere og leger vil bedre smertebehandlingen
Metode
Design
Pre-post intervensjonsdesign med kontrollgruppe hvor det maringles ved tre perioder T-1 (baseline) T-2 (1 mnd etter intervensjonen) og T-3 (6 mnd etter intervensjonen)
Utvalg
bull 6 postoperative avdelinger
ndash 6 ulike universitetssykehus
ndash alle helseforetakene i Norge
ndash stoslashrste PO avd som har barn og ungdomspasienter
bull 3 avdelinger til intervensjonen
ndash tilfeldig valgt
ndash cluster randomisering
Faser Aktivitet Fase 1 Kartlegging av kunnskaper
og holdninger hos sykepleierne
Datainnsamling (baseline T-1) bull sposlashrreskjema PNKAS-N bull observasjonsstudie (alle avd) bull intervju av barn (10 barnavd ndash 2 avd)
Fase 2 Utvikling og gjennomfoslashring av intervensjonen
Utvikle intervensjon basert paring bull tidligere forskning bull resultatene fra baseline data bull tilbakemelding fra fag og ledelse Intervensjon bull temadag (undervisning og workshop) bull klinisk veiledning og reminders
Fase 3 Implementering og evaluering av intervensjonen
Datainnsamling (T-2 og T-3) 1 mnd og 6 mnd etter intervensjon sposlashrreskjema PNKAS-N (alle avd) observasjonsstudie (4 avd T-22 avd T-3) intervju av barn (10 barnavd - 2 avd T2)
Studien delt opp i 3 faser
Flowchart
Fase 1 Kartlegging
Forskningssposlashrsmaringl bull Hvilke kunnskaper og holdninger har sykepleiere til smerte hos barn og
ungdom
bull Hvordan praktiserer sykepleiere smerteharingndtering i postoperative avdelinger
bull Hva er barnas opplevelse av postoperativ smertebehandling
Datainnsamling bull Sposlashrreskjema PNKAS-N (alle avdelingene)
bull Observasjonsstudie (alle avdelingene)
bull Intervju av barn (to avdelinger)
Sposlashrreskjemaet bull Pediatric Nurses Knowledge and Attitudes Survey- Norsk
versjon (PNKAS-N)
ndash PNKAS-N bygger paring bull World Health Organization (WHO)
bull American Pain Society (APS)
bull The Agency for Health Care Policy and Research (AHCRP)
ndash PNKAS-N bestaringr av 40 sposlashrsmaringl bull 23 sposlashrsmaringlene er paringstander (santusant)
bull 13 er laquomultiple choiceraquo
bull fire casesposlashrsmaringl knyttet til pasienthistorier
bull Instrumentet ble oversatt til norsk og validert av Hovde i 2009
Observasjonsstudie
bull Ikke deltakende observasjon
bull Semistrukturert
bull Observasjons sjekkliste og feltnotater ndash Smertevurdering
ndash Ikke medikamentell smertelindring
ndash Medikamentell smertelindring
bull Pilottestet
bull Ca 6 tdag i 10 dager (ca 60 timer pr avd 360 timer totalt)
Intervju med barn
bull Semistrukturert
bull Intervjuguider (6-11 12-18) ndash Smerteopplevelsen
ndash Smertevurdering
ndash Ikke medikamentell smertelindring
ndash Medikamentell smertelindring
bull Pilottestet
bull Barn 6-18 aringr
bull 10 barnavd ndash to avdelinger (kontrollgruppeintervensjonsgruppe)
Fase 2 Utvikling av intervensjon
Baseres paring tidligere forskning resultatene fra fase 1 samt tilbakemeldinger fra fag og seksjonsledere
Intervensjonen bestod av
bullTemadag (seks timer)
ndash Undervisning og workshop
ndash Sykepleiere og leger
ndash Stefan Lundeberg og Hanne Reinertsen
bullVeiledning i praksis
ndash Klinisk veiledning i smertebehandling av barn
ndash Eva Carlsen
bullReminders
Fase 3 Evaluering av intervensjonen
Forskningssposlashrsmaringl
Vil intervensjonen oslashke sykepleieres kunnskaper og holdninger til smerte hos barn og ungdom
Vil intervensjonen bedre sykepleieres smerteharingndtering av barn og ungdom
Datainnsamling
bullT-2 1 mnd etter intervensjonen bull Sposlashrreskjema PKNAS-N (alle avd)
bull Observasjonsstudie (fire avd)
bull Intervju av barn (to avd)
bullT-3 6 mnd etter intervensjonen bull Sposlashrreskjema PKNAS-N (alle avd)
bull Observasjonsstudie (to avd)
Fremdriftsplan
Forarbeid November 2013 - juni 2014
Datainnsamling September - november 2014 T-1
Januar ndash februar 2015 Intervensjon
Mars ndash april 2015 T-2
September ndash oktober 2015 T-3
Analyse September 2015 - juli 2016
Artikkelskriving Januar ndash august 2015 artikkel 1
November 2015 ndash juni 2016 artikkel 2
August ndash desember 2016 artikkel 3
Tusen takk
Oppsummering Prosjektet er stoslashttet av
Nasjonalt kompetansenettverk for legemidler til barn
Kirurgisk avdeling for barn OUS
Norsk Sykepleierforbund
Sykehusbarn
Litteraturliste 1 Hauer J Jones BL amp Wolfe J Poplack D G Kim M S (2015) Evaluation and management of pain in children UpToDate httpwwwuptodatecomcontentsevaluation-
and-management-of-pain-in-childrensource=search_resultampsearch=PAIN+CHILDRENampselectedTitle=17E150
2 IASP (2011c) Acute Pain management in Newborn Infants Pain [Online] Tilgjengelig paring httpiaspfilescms-pluscomContentContentFoldersPublications2PainClinicalUpdatesArchivesPCU_19-6_final_12-8-11_1390260191290_1pdf [Lastet 14april 2014]
3 Bernadi M Catania G amp Tridello G (2007) Knowledge and attitudes about cancer pain management a national survey of Italian hospice nurses Cancer Nurs 30(2) E20-6
4 Coulling S (2005) Nurses and doctors knowledge of pain after surgery Nurs Stand 19(34) 41-49
5 Hovde K R Granheim T H Christophersen K-A amp Dihle A (2012) The Norwegian Version of the Pediatric Nursesrsquo Knowledge and attitudes Survey Regarding Pain Reliability and Validity Pedatric nursing 38 (5) 264-269
6 Hossain S (2010) Nursesrsquo Knowledge and Attitudes and Pain Management Practice of Post-Operative Children in Bangladesh Prince of Songkla University Nedlastet fra httpkbpsuacthpsukbbitstream201078261325999pdf
7 Huth M M Gregg T L Lin L (2010) Education changes Mexican nurses knowledge and attitudes regarding pediatric pain Pain Manag Nurs Dec11(4)201-8 doi 101016jpmn200911001
8 Lewthwaite B J Jabusch K M Wheeler B J Schnell-Hoehn K N Mills J Estrella-Holder E Fedorowicz A (2011) Nurses knowledge and attitudes regarding pain management in hospitalized adults J Contin Educ Nurs 42(6) 251-7 doi 10392800220124-20110103-03 Epub 2011 Jan 10
9 Manworren RC (2000) Pediatric nursesrsquo knowledge and attitudes survey regarding pain Pediatr Nurs 26 610-614
10 Rieman M T Gordon M amp Marvin J M (2007) Pediatric nursesrsquo knowledge and attitudes survey regarding pain a competency tool modification Pediatr Nurs 33 303-306
11 Simons JM amp MacDonald LM (2004) Pain assessment tools childrenrsquos nursesrsquo views Journal of Child Health Care 8 264 Doi 1011771367493504047317
12 Twycross A (2007) What is the impact of theoretical knowledge on childrenrsquos nursesrsquo post-operative pain management practices an exploratory study Nurse Educ Today 27 697-707
13 Smart S (2005) POST-OPERATIVE PAIN MANAGEMENT KNOWLEDGE AND ATTITUDES OF PAEDIATRIC NURSES- A NEW ZEALAND REGIONAL VIEW Victoria University of Wellington [Online] Tilgjengelig paring httpresearcharchivevuwacnzbitstreamhandle1006338thesispdfsequence=2 [Lastet 13april 2014]
14 Vincent C V H (2005) Nursesrsquo knowledge attitudes and practices regarding childrenrsquos pain MCN Am J Matern Child Nurs 30 177-183
15 Olsson G Jylli L (2001) Smaumlrta hos barn och ungdomar Lund Sverige Studentlitteratur
16 Peters J W Schouw R Anand K J van Dijk M Duivenvoorden H J Tibboel D (2005) Does neonatal surgery lead to increased pain sensitivity in later childhood Pain 114(3) 444-54
17 Anand K J S Gracia-Preats J A amp Kim M S (2015) Assessment of neonatal pain UpToDate httpwwwuptodatecomcontentsassessment-of-neonatal-pain
18 Anand K J S Gracia-Preats J A amp Kim M S (2015) Prevention and treatment of neonatal pain UpToDate httpwwwuptodatecomcontentsprevention-and-treatment-of-neonatal-painsource=related_link
19 IASP (2011a) Acute Pain and Surgery Global Year Against Acute Pain [Online] Tilgjengelig paring httpwwwiasp-painorgfilesContentContentFoldersGlobalYearAgainstPain2AcutePainFactSheets7-Surgerypdf [Lastet 14april 2014]
20 Howard R Carter B Curry J Jain A Liossi C Morton N Rivett K Rose M Tyrrell J Walker S Williams G (2012) Good Practice in Postoperative and Procedural pain management 2nd Edition Pediatric Anesthesia 22 1ndash79 doi 101111j1460-9592201203838x
21 IASP (2011b) Interventions Benefits and Barriers Global Year Against Acute Pain [Online] Tilgjengelig paring httpwwwiasp-painorgfilesContentContentFoldersGlobalYearAgainstPain2AcutePainFactSheets2-Interventionspdf [Lastet 14april 2014]
22 Benhamou D Berti M Brodner G De Andres J Draisci G Moreno-Azcoita M Neugebauer EA Schwenk W Torres LM Viel E (2007) Postoperative Analgesic THerapy Observational Survey (PATHOS) A practice pattern study in 7 CentralSouthern Eurpean countries Pain 136 134-141
23 Reinertsen H (2008) Smerte hos barn kap3I Rustoslashen T amp Wahl AK (red) Ulike tekster om smerte - fra nocisepsjon til livskvalitet Oslo Gyldendal Norsk Forlag AS
Litteraturliste 24 Smeland A amp Reinertsen H (2012) Smertevurdering og behandling av postoperative smerter hos barn Tidsskriftet Kirurgen 1 58-62 (5 s) [Online] Tilgjengelig paring
httpwwwkirurgennopdf1201 [Lastet 13april 2014]
25 Bringuier S Picot MC Dadure C et al (2009) A prospective comparison of post-surgical behavioral pain scales in preschoolers highlighting the risk of false evaluations Pain 145 60-68
26 Crelline D Sullivan T B Babl F E OSullivan R Hutchinson A (2007) Analysis of the validation of existing behavioral pain and distress scales for use in the procedural setting Pediatric Anesthesia 17 720-733
27 Ghai B Makkar JK amp Wig J (2008) Postoperative pain assessment in preverbal children and children with cognitive impairment Pediatric Anesthesia 18 462-477
28 Hicks CL von Baeyer CL Spafford P et al (2001) The Faces Pain Scale-Revised Toward a common metric in pain measurement Pain 93 173-183
29 Merkel SI Voepel-Lewis T amp Shayevitz et al (1997) The FLACC A Behavioral Scale for Scoring Postoperative Pain in Young Children Pediatric Nursing 23 293-7
30 Ellis J A McCleary L Blouin R Dube K Rowley B MacNeil M amp Cooke C (2007) Implementing best practice pain management in a pediatric hospital Journal for Specialists in Pediatric Nursing 12 264-277 doi101111j1744-6155200700121x
31 Johnston C C Gagnon A Rennick J Rosmus C Patenaude H Ellis J Shapiro C Filion F Ritchie J Byron J (2007) One-on-one coaching to improve pain assessment and management practices of pediatric nurses Journal of Pediatric Nursing 22 467-478 doi101016jpedn200707004
32 Le May S Johnston C C Choiniegravere M Fortin C Kudirka D Murray L Chalut D (2009) Pain Management Practices in a Pediatric Emergency Room (PAMPER) Study interventions with nurses Pediatr Emerg Care Aug25(8)498-503 doi 101097PEC0b013e3181b0a0af
33 Vincent C V H Wilkie D J amp Wang E (2011) Pediatric Nurses Beliefs and Pain Management Practices An Intervention Pilot West J Nurs Res 33 825 originally published online 20 December 2010
36 Twycross A Finley G A and Latimer M (2013) Pediatric nurses postoperative pain management practices An observational study Journal for Specialists in Pediatric Nursing 18 189ndash201 doi 101111jspn12026
42 Twycross A amp Finley G A (2013) Childrens and parents perceptions of postoperative pain management a mixed methods study Journal of Clinical Nursing 22(21-22) 3095-3108 doi 101111jocn12152 [Online] Tilgjengelig paring httponlinelibrarywileycomdoi101111jocn12152pdf (13042014)
43 Polkki T Pietila AM Vehvilainen-Julkunen K (2003) Hospitalized childrens descriptions of their experiences with postsurgical pain relieving methods Int J Nurs Stud Jan40(1)33-44 PubMed PMID 12550148 English
46 Abdalrahim MS Majali SA Stomberg MW Bergbom I (2011) The effect of postoperative pain management program on improving nurses knowledge and attitudes toward pain Nurse Educ Pract 2011 Jul11(4)250-5 doi 101016jnepr201011016 Epub 2010 Dec 24 httpwwwncbinlmnihgovpubmed21186139
47 IASP Pain definition IASP (International Association of the Study of Pain) Pain definition
48 Norsk Ledemiddelharingndbok Ulike smertetilstander [Online] Tilgjengelig paring httplegemiddelhandbokanoTerapi22816expand=1
49 Astrid Lindgrens Barnsjukhus ndash Riktlinjer foumlr smaumlrtbehandling
50 Groslashnseth R amp Markestad T (2011) Pediatri og pediatrisk sykepleie Bergen Fagbokforlaget Vigmostad amp Bjoslashrke AS httppediatriportfoliono
51 Hicks CL von Baeyer CL Spafford Pet al The Faces Pain Scale‐Revised Toward a common metric in pain measurement Pain 2001 93173‐183
52 Twycross A Why Managing Pain in Children Matters in Managing Pain in Children A Clinical Guide (eds A Twycross S J Dowden and E Bruce) Wiley‐Blackwell 2009 Oxford UK doi 1010029781444322743ch1
53 Von Bayer CL amp Spagrud LJ Systematic review of observational (behavioral) measures of pain for children and adolescents aged 3 to 18 years Pain 2007 127 140‐150
54 Voepel‐Lewis Terri RN MSN ZanottiJennifer RN MS CCRN CEN DammeyerJennifer A RN MSN and MerkelSandra RN MS (January 2010) Reliability and Validity of the Face Legs Activity Cry Consolability Behavioral Tool in Assessing Acute Pain in Critically Ill Patients American Journal of Critical Care 19 (1) 55ndash61
55 Merkel S Voepel‐Lewis T Shayevitz JR et al The FLACC A behavioural scale for scoring postoperative pain in young children Pediatric nursing 1997 23293‐797
56 McCaffery M amp Beebe F (1994) Pain‐Clinical Manual of for Nursing Practice Times Mirror International Publishers Ltd Norsk oversettelse Smerter Laeligrebok for helsepersonell Oslo Norge Gyldendal Norsk Forlag AS
57 Reinertsen H Christophersen K‐A Helseth S Vurdering av postoperativ smerte hos barn (0‐5 aringr) Validering og reliabilitetstesting av smertevurderingsverktoslashyet FLACC Sykepleien Forskning 2014 9 132‐140 httpwwwsykepleiennoforskningforskningsartikkel1466655validering‐og‐reliabilitetstesting‐av‐smertevurderingsverktoyet‐flacc
Litteraturliste 58 Stinson J (2009) Pain Assessment I Twycross A Dowden S J amp Bruce E Pain Assessment in Managing Pain in Children A Clinical Guide Oxford UK Wiley-Blackmell
59 Tomlinson D von Baeyer CL Stinson JN Sung L A systematic review of faces scales for the self‐report of pain intensity in children Pediatrics 2010 Nov126(5)e1168‐98 PubMed PMID 20921070 Epub 20101006 eng
60 Von Baeyer CL Childrens self‐reports of pain intensity scale selection limitations and interpretation Pain Res Manag 2006 Autumn11(3)157‐62 PubMed PMID 16960632 Pubmed Central PMCID PMC2539005 Epub 20060909 eng
61 Ghai B Makkar J K amp Wig J (2008) Postoperative pain assesment in preverbal children and children with cognitive impairment Pediatric Anesthesia 18 462‐477
62 Malvia S Voepel‐Lewis T Tait A R Merkel S Lauer A Munro H Farley F (2001) Pain management in children with and without cognitive impairment following spine fusion surgery Pediatric Anasthesia 11 453‐458
63 Malvia S Voepel‐Lewis T Burke C Merkel S amp Tait A R (2006) The revised FLACC observational pain tool improved reliability and validity for pain assesment in children with cognitive impairment Pediatric Anestesia 16 258‐265
64 McJunkins A Green A amp Anand KJS (2010) Pain Assesment in cognitively Impared Functionally Impared Children Pilot Study Results Journal of Pediatric Nursing 25 307‐309
65 McKearnan K A Kieckhefer G Engel J M Jensen M amp Labyak S (2004) Pain in Children with cerebral Palsy A Review Journal of Neuroscience Nursing Vol 36 no 5 s252‐259
66 Voepel‐Lewis T Malviya S Tait A Merkel S Forter R amp Krane E (2008) A comparison of the clinical utility of pain assesment tools for children with cognitive impairment Pediatric Anesthesiology 106 (1) 72‐78
67 Baulch I Assessment and management of pain in the paediatric patient Nursing standard 2010 2510 35-40
68 Twycross A Why Managing Pain in Children Matters in Managing Pain in Children A Clinical Guide (eds A Twycross S J Dowden and E Bruce) Wiley-Blackwell 2009 Oxford UK doi 1010029781444322743ch1
69 Schug SA amp Pogatzki-Zhan EM Chronic Pain after Surgery or Injury Pain 2011 Clinical Updates XIX 11-5
70 Fredheim OMS Borchgrevink PC amp Kvarstein G Behandling av postoperativ smerte i sykehus Tidsskr Nor Legeforen 2011 131 1772-6
71 Steward DL Welge J amp Myer C Steroids for improving recovery following tonsillectomy in children Cochrane Database of Systematic Reviews 2003 Issue 1Art NoCD003997 DOI10100214651858CD003997
72 Hong JY Han SW Kim WO et al Effect of dexamethasone in combination with caudal analgesia on postoperative pain control in day-case paediatric orchioplexy British Journal of Anesthesia 2010 105(4)506-10
73 Den Norske Legeforening (2009) Retningslinjer for smertelindring [Online] URL httpwww legeforeningennoasset42585142585_1pdf
74 Association of Paediatric Anaesthetists (2008) Good Practice in Postoperative and Procedural Pain [Online] URL httpwwwbritishpainsocietyorgbook_apa_part1pdf
75 European Society of Regional Aneasthesia (2005) Postoperative Pain Management ndash Good Clinical Practice General recommendations and principles for successful pain management [Online] URL httpwwwesraeuropeorgPostoperativePainManagementpdf
76 Monsen ALB Skadberg BT amp Groslashnlie I Smertebehandling Norsk Barnelegeforeningen 2011 [Online] URL httpwwwlegeforeningennoid1104250
77 Smeland A amp Reinertsen H (2012) Smertevurdering og behandling av postoperative smerter hos barn Tidsskriftet Kirurgen 1 58-62 (5 s) [Online] Tilgjengelig paring httpwwwkirurgennopdf1201
78 Standing JF Savage I Pritchard D et al Diclofenac for acute pain in children Cochrane Database of Systematic Reviews 2009 Issue 4 Art No CD005538 DOI 10100214651858CD005538pub2
79 Standing JF Tibboel D Korpela R et al Diclofenac pharmacokinetic meta-analysis and dose recommendations for surgical pain in children aged 1ndash12 years Pediatric Anesthesia 2011 21 316ndash324 doi 101111j1460-9592201003509x
80 Riad W amp Moussa A Pre-operative analgesia with rectal diclofenac andor paracetamol in children undergoing hernia repair Anaesthesia 2007 Dec62(12)1241-5
81 Hiller A Meretoja OA Korpela R et al The Anagesic Efficacy of Acetaminophen Ketoprofen or Their Combination for Pediatric Surgical Patients Having Soft Tissue or Orthopedic Procedures Anesth Analg 20061021365-71
82 Norsk legemiddelharingndbok Antidoter ndash alfabetisk oversikt bruksomraringde og dosering httplegemiddelhandbokanoGenerelle153557i153779
83 Norsk legemiddelharingndbok Barn og legemidler httplegemiddelhandbokanoGenerelle153109
84 SickKids Aboutkidshealthca Myths About Pain httpwwwaboutkidshealthcaEnResourceCentresPainPainAssessmentPagesMyths-About-Painaspx
85 Psykososial preoperativ forberedelse av barn 0ndash18 aringr httpwwwhelsebiblioteketnomicrositefagprosedyrerfagprosedyrerpsykososial-preoperativ-forberedelse-av-barn-018-C3A5r
86 Twycross A Why Managing Pain in Children Matters in Managing Pain in Children A Clinical Guide (eds ATwycross S J Dowden and E Bruce) Wiley‐Blackwell 2009 Oxford UK doi 1010029781444322743ch1
Hvorfor er barns smerter fortsatt underbehandlet
bull Ulike myter amp holdninger
bull Manglende kompetanse om smertevurdering og smertehandling av barn
bull Manglende kompetanse om hvordan barns kognitive utvikling paringvirker barns forstaringelsen og uttrykk for smerte
bull Manglende bruk av systematiske observasjoner for aring vurdere smerte hos barn paring ulike alderstrinn
bull Manglende guidelines for smertebehandling av barn
bull Redsel blant helsepersonell for bivirkninger og avhengighet av opioider
Referanse (1-14 20-24 30-33 50)
Pediatric Pain Management Practices
in Postoperative Units
ndash an Intervention Study
Prosjektdeltakere
Anja Hetland Smeland Spesialsykepleier til barn Master i klinisk sykepleie Fag og forskningssykepleier KAB OUS Stipendiat
Tone Rustoslashen RN PhD seniorforsker og professor AKU Seksjon for forskning og utvikling Forskning Akuttklinikken og Avd for forskning og utvikling (hovedveileder)
Alison Twycross PhD DMS CertEd(HE) RGN RMN RSCN is a Reader in Childrenrsquos Nursing Faculty of Health Social Care and Education Kingston University and St Georgersquos University of London London United Kingdom (biveileder)
Prosjektdeltakere Stefan Lundeberg MD PhD Senior Consultant Pain Treatment
Service Astrid Lindgren Childrens Hospital Stockholm (Intervention study)
Hanne Reinertsen Assistant Professor Oslo and Akershus University college of applied Sciences (Intervention study)
Lill Nybro MSc student Intensive Care Nurse Oslo University Hospital (interview with children)
Torgun Naeligss MSc student Pediatric Nurse Oslo University Hospital (interview with children)
Eva Carlsen Pediatric Nurse Childrens Surgical Department Oslo University Hospital (facilitator Intervention study)
Hensikt
Kartlegge postoperativ smertebehandling av barn og
ungdom i Norge samt se om intervensjon med
sykepleiere og leger vil bedre smertebehandlingen
Metode
Design
Pre-post intervensjonsdesign med kontrollgruppe hvor det maringles ved tre perioder T-1 (baseline) T-2 (1 mnd etter intervensjonen) og T-3 (6 mnd etter intervensjonen)
Utvalg
bull 6 postoperative avdelinger
ndash 6 ulike universitetssykehus
ndash alle helseforetakene i Norge
ndash stoslashrste PO avd som har barn og ungdomspasienter
bull 3 avdelinger til intervensjonen
ndash tilfeldig valgt
ndash cluster randomisering
Faser Aktivitet Fase 1 Kartlegging av kunnskaper
og holdninger hos sykepleierne
Datainnsamling (baseline T-1) bull sposlashrreskjema PNKAS-N bull observasjonsstudie (alle avd) bull intervju av barn (10 barnavd ndash 2 avd)
Fase 2 Utvikling og gjennomfoslashring av intervensjonen
Utvikle intervensjon basert paring bull tidligere forskning bull resultatene fra baseline data bull tilbakemelding fra fag og ledelse Intervensjon bull temadag (undervisning og workshop) bull klinisk veiledning og reminders
Fase 3 Implementering og evaluering av intervensjonen
Datainnsamling (T-2 og T-3) 1 mnd og 6 mnd etter intervensjon sposlashrreskjema PNKAS-N (alle avd) observasjonsstudie (4 avd T-22 avd T-3) intervju av barn (10 barnavd - 2 avd T2)
Studien delt opp i 3 faser
Flowchart
Fase 1 Kartlegging
Forskningssposlashrsmaringl bull Hvilke kunnskaper og holdninger har sykepleiere til smerte hos barn og
ungdom
bull Hvordan praktiserer sykepleiere smerteharingndtering i postoperative avdelinger
bull Hva er barnas opplevelse av postoperativ smertebehandling
Datainnsamling bull Sposlashrreskjema PNKAS-N (alle avdelingene)
bull Observasjonsstudie (alle avdelingene)
bull Intervju av barn (to avdelinger)
Sposlashrreskjemaet bull Pediatric Nurses Knowledge and Attitudes Survey- Norsk
versjon (PNKAS-N)
ndash PNKAS-N bygger paring bull World Health Organization (WHO)
bull American Pain Society (APS)
bull The Agency for Health Care Policy and Research (AHCRP)
ndash PNKAS-N bestaringr av 40 sposlashrsmaringl bull 23 sposlashrsmaringlene er paringstander (santusant)
bull 13 er laquomultiple choiceraquo
bull fire casesposlashrsmaringl knyttet til pasienthistorier
bull Instrumentet ble oversatt til norsk og validert av Hovde i 2009
Observasjonsstudie
bull Ikke deltakende observasjon
bull Semistrukturert
bull Observasjons sjekkliste og feltnotater ndash Smertevurdering
ndash Ikke medikamentell smertelindring
ndash Medikamentell smertelindring
bull Pilottestet
bull Ca 6 tdag i 10 dager (ca 60 timer pr avd 360 timer totalt)
Intervju med barn
bull Semistrukturert
bull Intervjuguider (6-11 12-18) ndash Smerteopplevelsen
ndash Smertevurdering
ndash Ikke medikamentell smertelindring
ndash Medikamentell smertelindring
bull Pilottestet
bull Barn 6-18 aringr
bull 10 barnavd ndash to avdelinger (kontrollgruppeintervensjonsgruppe)
Fase 2 Utvikling av intervensjon
Baseres paring tidligere forskning resultatene fra fase 1 samt tilbakemeldinger fra fag og seksjonsledere
Intervensjonen bestod av
bullTemadag (seks timer)
ndash Undervisning og workshop
ndash Sykepleiere og leger
ndash Stefan Lundeberg og Hanne Reinertsen
bullVeiledning i praksis
ndash Klinisk veiledning i smertebehandling av barn
ndash Eva Carlsen
bullReminders
Fase 3 Evaluering av intervensjonen
Forskningssposlashrsmaringl
Vil intervensjonen oslashke sykepleieres kunnskaper og holdninger til smerte hos barn og ungdom
Vil intervensjonen bedre sykepleieres smerteharingndtering av barn og ungdom
Datainnsamling
bullT-2 1 mnd etter intervensjonen bull Sposlashrreskjema PKNAS-N (alle avd)
bull Observasjonsstudie (fire avd)
bull Intervju av barn (to avd)
bullT-3 6 mnd etter intervensjonen bull Sposlashrreskjema PKNAS-N (alle avd)
bull Observasjonsstudie (to avd)
Fremdriftsplan
Forarbeid November 2013 - juni 2014
Datainnsamling September - november 2014 T-1
Januar ndash februar 2015 Intervensjon
Mars ndash april 2015 T-2
September ndash oktober 2015 T-3
Analyse September 2015 - juli 2016
Artikkelskriving Januar ndash august 2015 artikkel 1
November 2015 ndash juni 2016 artikkel 2
August ndash desember 2016 artikkel 3
Tusen takk
Oppsummering Prosjektet er stoslashttet av
Nasjonalt kompetansenettverk for legemidler til barn
Kirurgisk avdeling for barn OUS
Norsk Sykepleierforbund
Sykehusbarn
Litteraturliste 1 Hauer J Jones BL amp Wolfe J Poplack D G Kim M S (2015) Evaluation and management of pain in children UpToDate httpwwwuptodatecomcontentsevaluation-
and-management-of-pain-in-childrensource=search_resultampsearch=PAIN+CHILDRENampselectedTitle=17E150
2 IASP (2011c) Acute Pain management in Newborn Infants Pain [Online] Tilgjengelig paring httpiaspfilescms-pluscomContentContentFoldersPublications2PainClinicalUpdatesArchivesPCU_19-6_final_12-8-11_1390260191290_1pdf [Lastet 14april 2014]
3 Bernadi M Catania G amp Tridello G (2007) Knowledge and attitudes about cancer pain management a national survey of Italian hospice nurses Cancer Nurs 30(2) E20-6
4 Coulling S (2005) Nurses and doctors knowledge of pain after surgery Nurs Stand 19(34) 41-49
5 Hovde K R Granheim T H Christophersen K-A amp Dihle A (2012) The Norwegian Version of the Pediatric Nursesrsquo Knowledge and attitudes Survey Regarding Pain Reliability and Validity Pedatric nursing 38 (5) 264-269
6 Hossain S (2010) Nursesrsquo Knowledge and Attitudes and Pain Management Practice of Post-Operative Children in Bangladesh Prince of Songkla University Nedlastet fra httpkbpsuacthpsukbbitstream201078261325999pdf
7 Huth M M Gregg T L Lin L (2010) Education changes Mexican nurses knowledge and attitudes regarding pediatric pain Pain Manag Nurs Dec11(4)201-8 doi 101016jpmn200911001
8 Lewthwaite B J Jabusch K M Wheeler B J Schnell-Hoehn K N Mills J Estrella-Holder E Fedorowicz A (2011) Nurses knowledge and attitudes regarding pain management in hospitalized adults J Contin Educ Nurs 42(6) 251-7 doi 10392800220124-20110103-03 Epub 2011 Jan 10
9 Manworren RC (2000) Pediatric nursesrsquo knowledge and attitudes survey regarding pain Pediatr Nurs 26 610-614
10 Rieman M T Gordon M amp Marvin J M (2007) Pediatric nursesrsquo knowledge and attitudes survey regarding pain a competency tool modification Pediatr Nurs 33 303-306
11 Simons JM amp MacDonald LM (2004) Pain assessment tools childrenrsquos nursesrsquo views Journal of Child Health Care 8 264 Doi 1011771367493504047317
12 Twycross A (2007) What is the impact of theoretical knowledge on childrenrsquos nursesrsquo post-operative pain management practices an exploratory study Nurse Educ Today 27 697-707
13 Smart S (2005) POST-OPERATIVE PAIN MANAGEMENT KNOWLEDGE AND ATTITUDES OF PAEDIATRIC NURSES- A NEW ZEALAND REGIONAL VIEW Victoria University of Wellington [Online] Tilgjengelig paring httpresearcharchivevuwacnzbitstreamhandle1006338thesispdfsequence=2 [Lastet 13april 2014]
14 Vincent C V H (2005) Nursesrsquo knowledge attitudes and practices regarding childrenrsquos pain MCN Am J Matern Child Nurs 30 177-183
15 Olsson G Jylli L (2001) Smaumlrta hos barn och ungdomar Lund Sverige Studentlitteratur
16 Peters J W Schouw R Anand K J van Dijk M Duivenvoorden H J Tibboel D (2005) Does neonatal surgery lead to increased pain sensitivity in later childhood Pain 114(3) 444-54
17 Anand K J S Gracia-Preats J A amp Kim M S (2015) Assessment of neonatal pain UpToDate httpwwwuptodatecomcontentsassessment-of-neonatal-pain
18 Anand K J S Gracia-Preats J A amp Kim M S (2015) Prevention and treatment of neonatal pain UpToDate httpwwwuptodatecomcontentsprevention-and-treatment-of-neonatal-painsource=related_link
19 IASP (2011a) Acute Pain and Surgery Global Year Against Acute Pain [Online] Tilgjengelig paring httpwwwiasp-painorgfilesContentContentFoldersGlobalYearAgainstPain2AcutePainFactSheets7-Surgerypdf [Lastet 14april 2014]
20 Howard R Carter B Curry J Jain A Liossi C Morton N Rivett K Rose M Tyrrell J Walker S Williams G (2012) Good Practice in Postoperative and Procedural pain management 2nd Edition Pediatric Anesthesia 22 1ndash79 doi 101111j1460-9592201203838x
21 IASP (2011b) Interventions Benefits and Barriers Global Year Against Acute Pain [Online] Tilgjengelig paring httpwwwiasp-painorgfilesContentContentFoldersGlobalYearAgainstPain2AcutePainFactSheets2-Interventionspdf [Lastet 14april 2014]
22 Benhamou D Berti M Brodner G De Andres J Draisci G Moreno-Azcoita M Neugebauer EA Schwenk W Torres LM Viel E (2007) Postoperative Analgesic THerapy Observational Survey (PATHOS) A practice pattern study in 7 CentralSouthern Eurpean countries Pain 136 134-141
23 Reinertsen H (2008) Smerte hos barn kap3I Rustoslashen T amp Wahl AK (red) Ulike tekster om smerte - fra nocisepsjon til livskvalitet Oslo Gyldendal Norsk Forlag AS
Litteraturliste 24 Smeland A amp Reinertsen H (2012) Smertevurdering og behandling av postoperative smerter hos barn Tidsskriftet Kirurgen 1 58-62 (5 s) [Online] Tilgjengelig paring
httpwwwkirurgennopdf1201 [Lastet 13april 2014]
25 Bringuier S Picot MC Dadure C et al (2009) A prospective comparison of post-surgical behavioral pain scales in preschoolers highlighting the risk of false evaluations Pain 145 60-68
26 Crelline D Sullivan T B Babl F E OSullivan R Hutchinson A (2007) Analysis of the validation of existing behavioral pain and distress scales for use in the procedural setting Pediatric Anesthesia 17 720-733
27 Ghai B Makkar JK amp Wig J (2008) Postoperative pain assessment in preverbal children and children with cognitive impairment Pediatric Anesthesia 18 462-477
28 Hicks CL von Baeyer CL Spafford P et al (2001) The Faces Pain Scale-Revised Toward a common metric in pain measurement Pain 93 173-183
29 Merkel SI Voepel-Lewis T amp Shayevitz et al (1997) The FLACC A Behavioral Scale for Scoring Postoperative Pain in Young Children Pediatric Nursing 23 293-7
30 Ellis J A McCleary L Blouin R Dube K Rowley B MacNeil M amp Cooke C (2007) Implementing best practice pain management in a pediatric hospital Journal for Specialists in Pediatric Nursing 12 264-277 doi101111j1744-6155200700121x
31 Johnston C C Gagnon A Rennick J Rosmus C Patenaude H Ellis J Shapiro C Filion F Ritchie J Byron J (2007) One-on-one coaching to improve pain assessment and management practices of pediatric nurses Journal of Pediatric Nursing 22 467-478 doi101016jpedn200707004
32 Le May S Johnston C C Choiniegravere M Fortin C Kudirka D Murray L Chalut D (2009) Pain Management Practices in a Pediatric Emergency Room (PAMPER) Study interventions with nurses Pediatr Emerg Care Aug25(8)498-503 doi 101097PEC0b013e3181b0a0af
33 Vincent C V H Wilkie D J amp Wang E (2011) Pediatric Nurses Beliefs and Pain Management Practices An Intervention Pilot West J Nurs Res 33 825 originally published online 20 December 2010
36 Twycross A Finley G A and Latimer M (2013) Pediatric nurses postoperative pain management practices An observational study Journal for Specialists in Pediatric Nursing 18 189ndash201 doi 101111jspn12026
42 Twycross A amp Finley G A (2013) Childrens and parents perceptions of postoperative pain management a mixed methods study Journal of Clinical Nursing 22(21-22) 3095-3108 doi 101111jocn12152 [Online] Tilgjengelig paring httponlinelibrarywileycomdoi101111jocn12152pdf (13042014)
43 Polkki T Pietila AM Vehvilainen-Julkunen K (2003) Hospitalized childrens descriptions of their experiences with postsurgical pain relieving methods Int J Nurs Stud Jan40(1)33-44 PubMed PMID 12550148 English
46 Abdalrahim MS Majali SA Stomberg MW Bergbom I (2011) The effect of postoperative pain management program on improving nurses knowledge and attitudes toward pain Nurse Educ Pract 2011 Jul11(4)250-5 doi 101016jnepr201011016 Epub 2010 Dec 24 httpwwwncbinlmnihgovpubmed21186139
47 IASP Pain definition IASP (International Association of the Study of Pain) Pain definition
48 Norsk Ledemiddelharingndbok Ulike smertetilstander [Online] Tilgjengelig paring httplegemiddelhandbokanoTerapi22816expand=1
49 Astrid Lindgrens Barnsjukhus ndash Riktlinjer foumlr smaumlrtbehandling
50 Groslashnseth R amp Markestad T (2011) Pediatri og pediatrisk sykepleie Bergen Fagbokforlaget Vigmostad amp Bjoslashrke AS httppediatriportfoliono
51 Hicks CL von Baeyer CL Spafford Pet al The Faces Pain Scale‐Revised Toward a common metric in pain measurement Pain 2001 93173‐183
52 Twycross A Why Managing Pain in Children Matters in Managing Pain in Children A Clinical Guide (eds A Twycross S J Dowden and E Bruce) Wiley‐Blackwell 2009 Oxford UK doi 1010029781444322743ch1
53 Von Bayer CL amp Spagrud LJ Systematic review of observational (behavioral) measures of pain for children and adolescents aged 3 to 18 years Pain 2007 127 140‐150
54 Voepel‐Lewis Terri RN MSN ZanottiJennifer RN MS CCRN CEN DammeyerJennifer A RN MSN and MerkelSandra RN MS (January 2010) Reliability and Validity of the Face Legs Activity Cry Consolability Behavioral Tool in Assessing Acute Pain in Critically Ill Patients American Journal of Critical Care 19 (1) 55ndash61
55 Merkel S Voepel‐Lewis T Shayevitz JR et al The FLACC A behavioural scale for scoring postoperative pain in young children Pediatric nursing 1997 23293‐797
56 McCaffery M amp Beebe F (1994) Pain‐Clinical Manual of for Nursing Practice Times Mirror International Publishers Ltd Norsk oversettelse Smerter Laeligrebok for helsepersonell Oslo Norge Gyldendal Norsk Forlag AS
57 Reinertsen H Christophersen K‐A Helseth S Vurdering av postoperativ smerte hos barn (0‐5 aringr) Validering og reliabilitetstesting av smertevurderingsverktoslashyet FLACC Sykepleien Forskning 2014 9 132‐140 httpwwwsykepleiennoforskningforskningsartikkel1466655validering‐og‐reliabilitetstesting‐av‐smertevurderingsverktoyet‐flacc
Litteraturliste 58 Stinson J (2009) Pain Assessment I Twycross A Dowden S J amp Bruce E Pain Assessment in Managing Pain in Children A Clinical Guide Oxford UK Wiley-Blackmell
59 Tomlinson D von Baeyer CL Stinson JN Sung L A systematic review of faces scales for the self‐report of pain intensity in children Pediatrics 2010 Nov126(5)e1168‐98 PubMed PMID 20921070 Epub 20101006 eng
60 Von Baeyer CL Childrens self‐reports of pain intensity scale selection limitations and interpretation Pain Res Manag 2006 Autumn11(3)157‐62 PubMed PMID 16960632 Pubmed Central PMCID PMC2539005 Epub 20060909 eng
61 Ghai B Makkar J K amp Wig J (2008) Postoperative pain assesment in preverbal children and children with cognitive impairment Pediatric Anesthesia 18 462‐477
62 Malvia S Voepel‐Lewis T Tait A R Merkel S Lauer A Munro H Farley F (2001) Pain management in children with and without cognitive impairment following spine fusion surgery Pediatric Anasthesia 11 453‐458
63 Malvia S Voepel‐Lewis T Burke C Merkel S amp Tait A R (2006) The revised FLACC observational pain tool improved reliability and validity for pain assesment in children with cognitive impairment Pediatric Anestesia 16 258‐265
64 McJunkins A Green A amp Anand KJS (2010) Pain Assesment in cognitively Impared Functionally Impared Children Pilot Study Results Journal of Pediatric Nursing 25 307‐309
65 McKearnan K A Kieckhefer G Engel J M Jensen M amp Labyak S (2004) Pain in Children with cerebral Palsy A Review Journal of Neuroscience Nursing Vol 36 no 5 s252‐259
66 Voepel‐Lewis T Malviya S Tait A Merkel S Forter R amp Krane E (2008) A comparison of the clinical utility of pain assesment tools for children with cognitive impairment Pediatric Anesthesiology 106 (1) 72‐78
67 Baulch I Assessment and management of pain in the paediatric patient Nursing standard 2010 2510 35-40
68 Twycross A Why Managing Pain in Children Matters in Managing Pain in Children A Clinical Guide (eds A Twycross S J Dowden and E Bruce) Wiley-Blackwell 2009 Oxford UK doi 1010029781444322743ch1
69 Schug SA amp Pogatzki-Zhan EM Chronic Pain after Surgery or Injury Pain 2011 Clinical Updates XIX 11-5
70 Fredheim OMS Borchgrevink PC amp Kvarstein G Behandling av postoperativ smerte i sykehus Tidsskr Nor Legeforen 2011 131 1772-6
71 Steward DL Welge J amp Myer C Steroids for improving recovery following tonsillectomy in children Cochrane Database of Systematic Reviews 2003 Issue 1Art NoCD003997 DOI10100214651858CD003997
72 Hong JY Han SW Kim WO et al Effect of dexamethasone in combination with caudal analgesia on postoperative pain control in day-case paediatric orchioplexy British Journal of Anesthesia 2010 105(4)506-10
73 Den Norske Legeforening (2009) Retningslinjer for smertelindring [Online] URL httpwww legeforeningennoasset42585142585_1pdf
74 Association of Paediatric Anaesthetists (2008) Good Practice in Postoperative and Procedural Pain [Online] URL httpwwwbritishpainsocietyorgbook_apa_part1pdf
75 European Society of Regional Aneasthesia (2005) Postoperative Pain Management ndash Good Clinical Practice General recommendations and principles for successful pain management [Online] URL httpwwwesraeuropeorgPostoperativePainManagementpdf
76 Monsen ALB Skadberg BT amp Groslashnlie I Smertebehandling Norsk Barnelegeforeningen 2011 [Online] URL httpwwwlegeforeningennoid1104250
77 Smeland A amp Reinertsen H (2012) Smertevurdering og behandling av postoperative smerter hos barn Tidsskriftet Kirurgen 1 58-62 (5 s) [Online] Tilgjengelig paring httpwwwkirurgennopdf1201
78 Standing JF Savage I Pritchard D et al Diclofenac for acute pain in children Cochrane Database of Systematic Reviews 2009 Issue 4 Art No CD005538 DOI 10100214651858CD005538pub2
79 Standing JF Tibboel D Korpela R et al Diclofenac pharmacokinetic meta-analysis and dose recommendations for surgical pain in children aged 1ndash12 years Pediatric Anesthesia 2011 21 316ndash324 doi 101111j1460-9592201003509x
80 Riad W amp Moussa A Pre-operative analgesia with rectal diclofenac andor paracetamol in children undergoing hernia repair Anaesthesia 2007 Dec62(12)1241-5
81 Hiller A Meretoja OA Korpela R et al The Anagesic Efficacy of Acetaminophen Ketoprofen or Their Combination for Pediatric Surgical Patients Having Soft Tissue or Orthopedic Procedures Anesth Analg 20061021365-71
82 Norsk legemiddelharingndbok Antidoter ndash alfabetisk oversikt bruksomraringde og dosering httplegemiddelhandbokanoGenerelle153557i153779
83 Norsk legemiddelharingndbok Barn og legemidler httplegemiddelhandbokanoGenerelle153109
84 SickKids Aboutkidshealthca Myths About Pain httpwwwaboutkidshealthcaEnResourceCentresPainPainAssessmentPagesMyths-About-Painaspx
85 Psykososial preoperativ forberedelse av barn 0ndash18 aringr httpwwwhelsebiblioteketnomicrositefagprosedyrerfagprosedyrerpsykososial-preoperativ-forberedelse-av-barn-018-C3A5r
86 Twycross A Why Managing Pain in Children Matters in Managing Pain in Children A Clinical Guide (eds ATwycross S J Dowden and E Bruce) Wiley‐Blackwell 2009 Oxford UK doi 1010029781444322743ch1
Pediatric Pain Management Practices
in Postoperative Units
ndash an Intervention Study
Prosjektdeltakere
Anja Hetland Smeland Spesialsykepleier til barn Master i klinisk sykepleie Fag og forskningssykepleier KAB OUS Stipendiat
Tone Rustoslashen RN PhD seniorforsker og professor AKU Seksjon for forskning og utvikling Forskning Akuttklinikken og Avd for forskning og utvikling (hovedveileder)
Alison Twycross PhD DMS CertEd(HE) RGN RMN RSCN is a Reader in Childrenrsquos Nursing Faculty of Health Social Care and Education Kingston University and St Georgersquos University of London London United Kingdom (biveileder)
Prosjektdeltakere Stefan Lundeberg MD PhD Senior Consultant Pain Treatment
Service Astrid Lindgren Childrens Hospital Stockholm (Intervention study)
Hanne Reinertsen Assistant Professor Oslo and Akershus University college of applied Sciences (Intervention study)
Lill Nybro MSc student Intensive Care Nurse Oslo University Hospital (interview with children)
Torgun Naeligss MSc student Pediatric Nurse Oslo University Hospital (interview with children)
Eva Carlsen Pediatric Nurse Childrens Surgical Department Oslo University Hospital (facilitator Intervention study)
Hensikt
Kartlegge postoperativ smertebehandling av barn og
ungdom i Norge samt se om intervensjon med
sykepleiere og leger vil bedre smertebehandlingen
Metode
Design
Pre-post intervensjonsdesign med kontrollgruppe hvor det maringles ved tre perioder T-1 (baseline) T-2 (1 mnd etter intervensjonen) og T-3 (6 mnd etter intervensjonen)
Utvalg
bull 6 postoperative avdelinger
ndash 6 ulike universitetssykehus
ndash alle helseforetakene i Norge
ndash stoslashrste PO avd som har barn og ungdomspasienter
bull 3 avdelinger til intervensjonen
ndash tilfeldig valgt
ndash cluster randomisering
Faser Aktivitet Fase 1 Kartlegging av kunnskaper
og holdninger hos sykepleierne
Datainnsamling (baseline T-1) bull sposlashrreskjema PNKAS-N bull observasjonsstudie (alle avd) bull intervju av barn (10 barnavd ndash 2 avd)
Fase 2 Utvikling og gjennomfoslashring av intervensjonen
Utvikle intervensjon basert paring bull tidligere forskning bull resultatene fra baseline data bull tilbakemelding fra fag og ledelse Intervensjon bull temadag (undervisning og workshop) bull klinisk veiledning og reminders
Fase 3 Implementering og evaluering av intervensjonen
Datainnsamling (T-2 og T-3) 1 mnd og 6 mnd etter intervensjon sposlashrreskjema PNKAS-N (alle avd) observasjonsstudie (4 avd T-22 avd T-3) intervju av barn (10 barnavd - 2 avd T2)
Studien delt opp i 3 faser
Flowchart
Fase 1 Kartlegging
Forskningssposlashrsmaringl bull Hvilke kunnskaper og holdninger har sykepleiere til smerte hos barn og
ungdom
bull Hvordan praktiserer sykepleiere smerteharingndtering i postoperative avdelinger
bull Hva er barnas opplevelse av postoperativ smertebehandling
Datainnsamling bull Sposlashrreskjema PNKAS-N (alle avdelingene)
bull Observasjonsstudie (alle avdelingene)
bull Intervju av barn (to avdelinger)
Sposlashrreskjemaet bull Pediatric Nurses Knowledge and Attitudes Survey- Norsk
versjon (PNKAS-N)
ndash PNKAS-N bygger paring bull World Health Organization (WHO)
bull American Pain Society (APS)
bull The Agency for Health Care Policy and Research (AHCRP)
ndash PNKAS-N bestaringr av 40 sposlashrsmaringl bull 23 sposlashrsmaringlene er paringstander (santusant)
bull 13 er laquomultiple choiceraquo
bull fire casesposlashrsmaringl knyttet til pasienthistorier
bull Instrumentet ble oversatt til norsk og validert av Hovde i 2009
Observasjonsstudie
bull Ikke deltakende observasjon
bull Semistrukturert
bull Observasjons sjekkliste og feltnotater ndash Smertevurdering
ndash Ikke medikamentell smertelindring
ndash Medikamentell smertelindring
bull Pilottestet
bull Ca 6 tdag i 10 dager (ca 60 timer pr avd 360 timer totalt)
Intervju med barn
bull Semistrukturert
bull Intervjuguider (6-11 12-18) ndash Smerteopplevelsen
ndash Smertevurdering
ndash Ikke medikamentell smertelindring
ndash Medikamentell smertelindring
bull Pilottestet
bull Barn 6-18 aringr
bull 10 barnavd ndash to avdelinger (kontrollgruppeintervensjonsgruppe)
Fase 2 Utvikling av intervensjon
Baseres paring tidligere forskning resultatene fra fase 1 samt tilbakemeldinger fra fag og seksjonsledere
Intervensjonen bestod av
bullTemadag (seks timer)
ndash Undervisning og workshop
ndash Sykepleiere og leger
ndash Stefan Lundeberg og Hanne Reinertsen
bullVeiledning i praksis
ndash Klinisk veiledning i smertebehandling av barn
ndash Eva Carlsen
bullReminders
Fase 3 Evaluering av intervensjonen
Forskningssposlashrsmaringl
Vil intervensjonen oslashke sykepleieres kunnskaper og holdninger til smerte hos barn og ungdom
Vil intervensjonen bedre sykepleieres smerteharingndtering av barn og ungdom
Datainnsamling
bullT-2 1 mnd etter intervensjonen bull Sposlashrreskjema PKNAS-N (alle avd)
bull Observasjonsstudie (fire avd)
bull Intervju av barn (to avd)
bullT-3 6 mnd etter intervensjonen bull Sposlashrreskjema PKNAS-N (alle avd)
bull Observasjonsstudie (to avd)
Fremdriftsplan
Forarbeid November 2013 - juni 2014
Datainnsamling September - november 2014 T-1
Januar ndash februar 2015 Intervensjon
Mars ndash april 2015 T-2
September ndash oktober 2015 T-3
Analyse September 2015 - juli 2016
Artikkelskriving Januar ndash august 2015 artikkel 1
November 2015 ndash juni 2016 artikkel 2
August ndash desember 2016 artikkel 3
Tusen takk
Oppsummering Prosjektet er stoslashttet av
Nasjonalt kompetansenettverk for legemidler til barn
Kirurgisk avdeling for barn OUS
Norsk Sykepleierforbund
Sykehusbarn
Litteraturliste 1 Hauer J Jones BL amp Wolfe J Poplack D G Kim M S (2015) Evaluation and management of pain in children UpToDate httpwwwuptodatecomcontentsevaluation-
and-management-of-pain-in-childrensource=search_resultampsearch=PAIN+CHILDRENampselectedTitle=17E150
2 IASP (2011c) Acute Pain management in Newborn Infants Pain [Online] Tilgjengelig paring httpiaspfilescms-pluscomContentContentFoldersPublications2PainClinicalUpdatesArchivesPCU_19-6_final_12-8-11_1390260191290_1pdf [Lastet 14april 2014]
3 Bernadi M Catania G amp Tridello G (2007) Knowledge and attitudes about cancer pain management a national survey of Italian hospice nurses Cancer Nurs 30(2) E20-6
4 Coulling S (2005) Nurses and doctors knowledge of pain after surgery Nurs Stand 19(34) 41-49
5 Hovde K R Granheim T H Christophersen K-A amp Dihle A (2012) The Norwegian Version of the Pediatric Nursesrsquo Knowledge and attitudes Survey Regarding Pain Reliability and Validity Pedatric nursing 38 (5) 264-269
6 Hossain S (2010) Nursesrsquo Knowledge and Attitudes and Pain Management Practice of Post-Operative Children in Bangladesh Prince of Songkla University Nedlastet fra httpkbpsuacthpsukbbitstream201078261325999pdf
7 Huth M M Gregg T L Lin L (2010) Education changes Mexican nurses knowledge and attitudes regarding pediatric pain Pain Manag Nurs Dec11(4)201-8 doi 101016jpmn200911001
8 Lewthwaite B J Jabusch K M Wheeler B J Schnell-Hoehn K N Mills J Estrella-Holder E Fedorowicz A (2011) Nurses knowledge and attitudes regarding pain management in hospitalized adults J Contin Educ Nurs 42(6) 251-7 doi 10392800220124-20110103-03 Epub 2011 Jan 10
9 Manworren RC (2000) Pediatric nursesrsquo knowledge and attitudes survey regarding pain Pediatr Nurs 26 610-614
10 Rieman M T Gordon M amp Marvin J M (2007) Pediatric nursesrsquo knowledge and attitudes survey regarding pain a competency tool modification Pediatr Nurs 33 303-306
11 Simons JM amp MacDonald LM (2004) Pain assessment tools childrenrsquos nursesrsquo views Journal of Child Health Care 8 264 Doi 1011771367493504047317
12 Twycross A (2007) What is the impact of theoretical knowledge on childrenrsquos nursesrsquo post-operative pain management practices an exploratory study Nurse Educ Today 27 697-707
13 Smart S (2005) POST-OPERATIVE PAIN MANAGEMENT KNOWLEDGE AND ATTITUDES OF PAEDIATRIC NURSES- A NEW ZEALAND REGIONAL VIEW Victoria University of Wellington [Online] Tilgjengelig paring httpresearcharchivevuwacnzbitstreamhandle1006338thesispdfsequence=2 [Lastet 13april 2014]
14 Vincent C V H (2005) Nursesrsquo knowledge attitudes and practices regarding childrenrsquos pain MCN Am J Matern Child Nurs 30 177-183
15 Olsson G Jylli L (2001) Smaumlrta hos barn och ungdomar Lund Sverige Studentlitteratur
16 Peters J W Schouw R Anand K J van Dijk M Duivenvoorden H J Tibboel D (2005) Does neonatal surgery lead to increased pain sensitivity in later childhood Pain 114(3) 444-54
17 Anand K J S Gracia-Preats J A amp Kim M S (2015) Assessment of neonatal pain UpToDate httpwwwuptodatecomcontentsassessment-of-neonatal-pain
18 Anand K J S Gracia-Preats J A amp Kim M S (2015) Prevention and treatment of neonatal pain UpToDate httpwwwuptodatecomcontentsprevention-and-treatment-of-neonatal-painsource=related_link
19 IASP (2011a) Acute Pain and Surgery Global Year Against Acute Pain [Online] Tilgjengelig paring httpwwwiasp-painorgfilesContentContentFoldersGlobalYearAgainstPain2AcutePainFactSheets7-Surgerypdf [Lastet 14april 2014]
20 Howard R Carter B Curry J Jain A Liossi C Morton N Rivett K Rose M Tyrrell J Walker S Williams G (2012) Good Practice in Postoperative and Procedural pain management 2nd Edition Pediatric Anesthesia 22 1ndash79 doi 101111j1460-9592201203838x
21 IASP (2011b) Interventions Benefits and Barriers Global Year Against Acute Pain [Online] Tilgjengelig paring httpwwwiasp-painorgfilesContentContentFoldersGlobalYearAgainstPain2AcutePainFactSheets2-Interventionspdf [Lastet 14april 2014]
22 Benhamou D Berti M Brodner G De Andres J Draisci G Moreno-Azcoita M Neugebauer EA Schwenk W Torres LM Viel E (2007) Postoperative Analgesic THerapy Observational Survey (PATHOS) A practice pattern study in 7 CentralSouthern Eurpean countries Pain 136 134-141
23 Reinertsen H (2008) Smerte hos barn kap3I Rustoslashen T amp Wahl AK (red) Ulike tekster om smerte - fra nocisepsjon til livskvalitet Oslo Gyldendal Norsk Forlag AS
Litteraturliste 24 Smeland A amp Reinertsen H (2012) Smertevurdering og behandling av postoperative smerter hos barn Tidsskriftet Kirurgen 1 58-62 (5 s) [Online] Tilgjengelig paring
httpwwwkirurgennopdf1201 [Lastet 13april 2014]
25 Bringuier S Picot MC Dadure C et al (2009) A prospective comparison of post-surgical behavioral pain scales in preschoolers highlighting the risk of false evaluations Pain 145 60-68
26 Crelline D Sullivan T B Babl F E OSullivan R Hutchinson A (2007) Analysis of the validation of existing behavioral pain and distress scales for use in the procedural setting Pediatric Anesthesia 17 720-733
27 Ghai B Makkar JK amp Wig J (2008) Postoperative pain assessment in preverbal children and children with cognitive impairment Pediatric Anesthesia 18 462-477
28 Hicks CL von Baeyer CL Spafford P et al (2001) The Faces Pain Scale-Revised Toward a common metric in pain measurement Pain 93 173-183
29 Merkel SI Voepel-Lewis T amp Shayevitz et al (1997) The FLACC A Behavioral Scale for Scoring Postoperative Pain in Young Children Pediatric Nursing 23 293-7
30 Ellis J A McCleary L Blouin R Dube K Rowley B MacNeil M amp Cooke C (2007) Implementing best practice pain management in a pediatric hospital Journal for Specialists in Pediatric Nursing 12 264-277 doi101111j1744-6155200700121x
31 Johnston C C Gagnon A Rennick J Rosmus C Patenaude H Ellis J Shapiro C Filion F Ritchie J Byron J (2007) One-on-one coaching to improve pain assessment and management practices of pediatric nurses Journal of Pediatric Nursing 22 467-478 doi101016jpedn200707004
32 Le May S Johnston C C Choiniegravere M Fortin C Kudirka D Murray L Chalut D (2009) Pain Management Practices in a Pediatric Emergency Room (PAMPER) Study interventions with nurses Pediatr Emerg Care Aug25(8)498-503 doi 101097PEC0b013e3181b0a0af
33 Vincent C V H Wilkie D J amp Wang E (2011) Pediatric Nurses Beliefs and Pain Management Practices An Intervention Pilot West J Nurs Res 33 825 originally published online 20 December 2010
36 Twycross A Finley G A and Latimer M (2013) Pediatric nurses postoperative pain management practices An observational study Journal for Specialists in Pediatric Nursing 18 189ndash201 doi 101111jspn12026
42 Twycross A amp Finley G A (2013) Childrens and parents perceptions of postoperative pain management a mixed methods study Journal of Clinical Nursing 22(21-22) 3095-3108 doi 101111jocn12152 [Online] Tilgjengelig paring httponlinelibrarywileycomdoi101111jocn12152pdf (13042014)
43 Polkki T Pietila AM Vehvilainen-Julkunen K (2003) Hospitalized childrens descriptions of their experiences with postsurgical pain relieving methods Int J Nurs Stud Jan40(1)33-44 PubMed PMID 12550148 English
46 Abdalrahim MS Majali SA Stomberg MW Bergbom I (2011) The effect of postoperative pain management program on improving nurses knowledge and attitudes toward pain Nurse Educ Pract 2011 Jul11(4)250-5 doi 101016jnepr201011016 Epub 2010 Dec 24 httpwwwncbinlmnihgovpubmed21186139
47 IASP Pain definition IASP (International Association of the Study of Pain) Pain definition
48 Norsk Ledemiddelharingndbok Ulike smertetilstander [Online] Tilgjengelig paring httplegemiddelhandbokanoTerapi22816expand=1
49 Astrid Lindgrens Barnsjukhus ndash Riktlinjer foumlr smaumlrtbehandling
50 Groslashnseth R amp Markestad T (2011) Pediatri og pediatrisk sykepleie Bergen Fagbokforlaget Vigmostad amp Bjoslashrke AS httppediatriportfoliono
51 Hicks CL von Baeyer CL Spafford Pet al The Faces Pain Scale‐Revised Toward a common metric in pain measurement Pain 2001 93173‐183
52 Twycross A Why Managing Pain in Children Matters in Managing Pain in Children A Clinical Guide (eds A Twycross S J Dowden and E Bruce) Wiley‐Blackwell 2009 Oxford UK doi 1010029781444322743ch1
53 Von Bayer CL amp Spagrud LJ Systematic review of observational (behavioral) measures of pain for children and adolescents aged 3 to 18 years Pain 2007 127 140‐150
54 Voepel‐Lewis Terri RN MSN ZanottiJennifer RN MS CCRN CEN DammeyerJennifer A RN MSN and MerkelSandra RN MS (January 2010) Reliability and Validity of the Face Legs Activity Cry Consolability Behavioral Tool in Assessing Acute Pain in Critically Ill Patients American Journal of Critical Care 19 (1) 55ndash61
55 Merkel S Voepel‐Lewis T Shayevitz JR et al The FLACC A behavioural scale for scoring postoperative pain in young children Pediatric nursing 1997 23293‐797
56 McCaffery M amp Beebe F (1994) Pain‐Clinical Manual of for Nursing Practice Times Mirror International Publishers Ltd Norsk oversettelse Smerter Laeligrebok for helsepersonell Oslo Norge Gyldendal Norsk Forlag AS
57 Reinertsen H Christophersen K‐A Helseth S Vurdering av postoperativ smerte hos barn (0‐5 aringr) Validering og reliabilitetstesting av smertevurderingsverktoslashyet FLACC Sykepleien Forskning 2014 9 132‐140 httpwwwsykepleiennoforskningforskningsartikkel1466655validering‐og‐reliabilitetstesting‐av‐smertevurderingsverktoyet‐flacc
Litteraturliste 58 Stinson J (2009) Pain Assessment I Twycross A Dowden S J amp Bruce E Pain Assessment in Managing Pain in Children A Clinical Guide Oxford UK Wiley-Blackmell
59 Tomlinson D von Baeyer CL Stinson JN Sung L A systematic review of faces scales for the self‐report of pain intensity in children Pediatrics 2010 Nov126(5)e1168‐98 PubMed PMID 20921070 Epub 20101006 eng
60 Von Baeyer CL Childrens self‐reports of pain intensity scale selection limitations and interpretation Pain Res Manag 2006 Autumn11(3)157‐62 PubMed PMID 16960632 Pubmed Central PMCID PMC2539005 Epub 20060909 eng
61 Ghai B Makkar J K amp Wig J (2008) Postoperative pain assesment in preverbal children and children with cognitive impairment Pediatric Anesthesia 18 462‐477
62 Malvia S Voepel‐Lewis T Tait A R Merkel S Lauer A Munro H Farley F (2001) Pain management in children with and without cognitive impairment following spine fusion surgery Pediatric Anasthesia 11 453‐458
63 Malvia S Voepel‐Lewis T Burke C Merkel S amp Tait A R (2006) The revised FLACC observational pain tool improved reliability and validity for pain assesment in children with cognitive impairment Pediatric Anestesia 16 258‐265
64 McJunkins A Green A amp Anand KJS (2010) Pain Assesment in cognitively Impared Functionally Impared Children Pilot Study Results Journal of Pediatric Nursing 25 307‐309
65 McKearnan K A Kieckhefer G Engel J M Jensen M amp Labyak S (2004) Pain in Children with cerebral Palsy A Review Journal of Neuroscience Nursing Vol 36 no 5 s252‐259
66 Voepel‐Lewis T Malviya S Tait A Merkel S Forter R amp Krane E (2008) A comparison of the clinical utility of pain assesment tools for children with cognitive impairment Pediatric Anesthesiology 106 (1) 72‐78
67 Baulch I Assessment and management of pain in the paediatric patient Nursing standard 2010 2510 35-40
68 Twycross A Why Managing Pain in Children Matters in Managing Pain in Children A Clinical Guide (eds A Twycross S J Dowden and E Bruce) Wiley-Blackwell 2009 Oxford UK doi 1010029781444322743ch1
69 Schug SA amp Pogatzki-Zhan EM Chronic Pain after Surgery or Injury Pain 2011 Clinical Updates XIX 11-5
70 Fredheim OMS Borchgrevink PC amp Kvarstein G Behandling av postoperativ smerte i sykehus Tidsskr Nor Legeforen 2011 131 1772-6
71 Steward DL Welge J amp Myer C Steroids for improving recovery following tonsillectomy in children Cochrane Database of Systematic Reviews 2003 Issue 1Art NoCD003997 DOI10100214651858CD003997
72 Hong JY Han SW Kim WO et al Effect of dexamethasone in combination with caudal analgesia on postoperative pain control in day-case paediatric orchioplexy British Journal of Anesthesia 2010 105(4)506-10
73 Den Norske Legeforening (2009) Retningslinjer for smertelindring [Online] URL httpwww legeforeningennoasset42585142585_1pdf
74 Association of Paediatric Anaesthetists (2008) Good Practice in Postoperative and Procedural Pain [Online] URL httpwwwbritishpainsocietyorgbook_apa_part1pdf
75 European Society of Regional Aneasthesia (2005) Postoperative Pain Management ndash Good Clinical Practice General recommendations and principles for successful pain management [Online] URL httpwwwesraeuropeorgPostoperativePainManagementpdf
76 Monsen ALB Skadberg BT amp Groslashnlie I Smertebehandling Norsk Barnelegeforeningen 2011 [Online] URL httpwwwlegeforeningennoid1104250
77 Smeland A amp Reinertsen H (2012) Smertevurdering og behandling av postoperative smerter hos barn Tidsskriftet Kirurgen 1 58-62 (5 s) [Online] Tilgjengelig paring httpwwwkirurgennopdf1201
78 Standing JF Savage I Pritchard D et al Diclofenac for acute pain in children Cochrane Database of Systematic Reviews 2009 Issue 4 Art No CD005538 DOI 10100214651858CD005538pub2
79 Standing JF Tibboel D Korpela R et al Diclofenac pharmacokinetic meta-analysis and dose recommendations for surgical pain in children aged 1ndash12 years Pediatric Anesthesia 2011 21 316ndash324 doi 101111j1460-9592201003509x
80 Riad W amp Moussa A Pre-operative analgesia with rectal diclofenac andor paracetamol in children undergoing hernia repair Anaesthesia 2007 Dec62(12)1241-5
81 Hiller A Meretoja OA Korpela R et al The Anagesic Efficacy of Acetaminophen Ketoprofen or Their Combination for Pediatric Surgical Patients Having Soft Tissue or Orthopedic Procedures Anesth Analg 20061021365-71
82 Norsk legemiddelharingndbok Antidoter ndash alfabetisk oversikt bruksomraringde og dosering httplegemiddelhandbokanoGenerelle153557i153779
83 Norsk legemiddelharingndbok Barn og legemidler httplegemiddelhandbokanoGenerelle153109
84 SickKids Aboutkidshealthca Myths About Pain httpwwwaboutkidshealthcaEnResourceCentresPainPainAssessmentPagesMyths-About-Painaspx
85 Psykososial preoperativ forberedelse av barn 0ndash18 aringr httpwwwhelsebiblioteketnomicrositefagprosedyrerfagprosedyrerpsykososial-preoperativ-forberedelse-av-barn-018-C3A5r
86 Twycross A Why Managing Pain in Children Matters in Managing Pain in Children A Clinical Guide (eds ATwycross S J Dowden and E Bruce) Wiley‐Blackwell 2009 Oxford UK doi 1010029781444322743ch1
Prosjektdeltakere
Anja Hetland Smeland Spesialsykepleier til barn Master i klinisk sykepleie Fag og forskningssykepleier KAB OUS Stipendiat
Tone Rustoslashen RN PhD seniorforsker og professor AKU Seksjon for forskning og utvikling Forskning Akuttklinikken og Avd for forskning og utvikling (hovedveileder)
Alison Twycross PhD DMS CertEd(HE) RGN RMN RSCN is a Reader in Childrenrsquos Nursing Faculty of Health Social Care and Education Kingston University and St Georgersquos University of London London United Kingdom (biveileder)
Prosjektdeltakere Stefan Lundeberg MD PhD Senior Consultant Pain Treatment
Service Astrid Lindgren Childrens Hospital Stockholm (Intervention study)
Hanne Reinertsen Assistant Professor Oslo and Akershus University college of applied Sciences (Intervention study)
Lill Nybro MSc student Intensive Care Nurse Oslo University Hospital (interview with children)
Torgun Naeligss MSc student Pediatric Nurse Oslo University Hospital (interview with children)
Eva Carlsen Pediatric Nurse Childrens Surgical Department Oslo University Hospital (facilitator Intervention study)
Hensikt
Kartlegge postoperativ smertebehandling av barn og
ungdom i Norge samt se om intervensjon med
sykepleiere og leger vil bedre smertebehandlingen
Metode
Design
Pre-post intervensjonsdesign med kontrollgruppe hvor det maringles ved tre perioder T-1 (baseline) T-2 (1 mnd etter intervensjonen) og T-3 (6 mnd etter intervensjonen)
Utvalg
bull 6 postoperative avdelinger
ndash 6 ulike universitetssykehus
ndash alle helseforetakene i Norge
ndash stoslashrste PO avd som har barn og ungdomspasienter
bull 3 avdelinger til intervensjonen
ndash tilfeldig valgt
ndash cluster randomisering
Faser Aktivitet Fase 1 Kartlegging av kunnskaper
og holdninger hos sykepleierne
Datainnsamling (baseline T-1) bull sposlashrreskjema PNKAS-N bull observasjonsstudie (alle avd) bull intervju av barn (10 barnavd ndash 2 avd)
Fase 2 Utvikling og gjennomfoslashring av intervensjonen
Utvikle intervensjon basert paring bull tidligere forskning bull resultatene fra baseline data bull tilbakemelding fra fag og ledelse Intervensjon bull temadag (undervisning og workshop) bull klinisk veiledning og reminders
Fase 3 Implementering og evaluering av intervensjonen
Datainnsamling (T-2 og T-3) 1 mnd og 6 mnd etter intervensjon sposlashrreskjema PNKAS-N (alle avd) observasjonsstudie (4 avd T-22 avd T-3) intervju av barn (10 barnavd - 2 avd T2)
Studien delt opp i 3 faser
Flowchart
Fase 1 Kartlegging
Forskningssposlashrsmaringl bull Hvilke kunnskaper og holdninger har sykepleiere til smerte hos barn og
ungdom
bull Hvordan praktiserer sykepleiere smerteharingndtering i postoperative avdelinger
bull Hva er barnas opplevelse av postoperativ smertebehandling
Datainnsamling bull Sposlashrreskjema PNKAS-N (alle avdelingene)
bull Observasjonsstudie (alle avdelingene)
bull Intervju av barn (to avdelinger)
Sposlashrreskjemaet bull Pediatric Nurses Knowledge and Attitudes Survey- Norsk
versjon (PNKAS-N)
ndash PNKAS-N bygger paring bull World Health Organization (WHO)
bull American Pain Society (APS)
bull The Agency for Health Care Policy and Research (AHCRP)
ndash PNKAS-N bestaringr av 40 sposlashrsmaringl bull 23 sposlashrsmaringlene er paringstander (santusant)
bull 13 er laquomultiple choiceraquo
bull fire casesposlashrsmaringl knyttet til pasienthistorier
bull Instrumentet ble oversatt til norsk og validert av Hovde i 2009
Observasjonsstudie
bull Ikke deltakende observasjon
bull Semistrukturert
bull Observasjons sjekkliste og feltnotater ndash Smertevurdering
ndash Ikke medikamentell smertelindring
ndash Medikamentell smertelindring
bull Pilottestet
bull Ca 6 tdag i 10 dager (ca 60 timer pr avd 360 timer totalt)
Intervju med barn
bull Semistrukturert
bull Intervjuguider (6-11 12-18) ndash Smerteopplevelsen
ndash Smertevurdering
ndash Ikke medikamentell smertelindring
ndash Medikamentell smertelindring
bull Pilottestet
bull Barn 6-18 aringr
bull 10 barnavd ndash to avdelinger (kontrollgruppeintervensjonsgruppe)
Fase 2 Utvikling av intervensjon
Baseres paring tidligere forskning resultatene fra fase 1 samt tilbakemeldinger fra fag og seksjonsledere
Intervensjonen bestod av
bullTemadag (seks timer)
ndash Undervisning og workshop
ndash Sykepleiere og leger
ndash Stefan Lundeberg og Hanne Reinertsen
bullVeiledning i praksis
ndash Klinisk veiledning i smertebehandling av barn
ndash Eva Carlsen
bullReminders
Fase 3 Evaluering av intervensjonen
Forskningssposlashrsmaringl
Vil intervensjonen oslashke sykepleieres kunnskaper og holdninger til smerte hos barn og ungdom
Vil intervensjonen bedre sykepleieres smerteharingndtering av barn og ungdom
Datainnsamling
bullT-2 1 mnd etter intervensjonen bull Sposlashrreskjema PKNAS-N (alle avd)
bull Observasjonsstudie (fire avd)
bull Intervju av barn (to avd)
bullT-3 6 mnd etter intervensjonen bull Sposlashrreskjema PKNAS-N (alle avd)
bull Observasjonsstudie (to avd)
Fremdriftsplan
Forarbeid November 2013 - juni 2014
Datainnsamling September - november 2014 T-1
Januar ndash februar 2015 Intervensjon
Mars ndash april 2015 T-2
September ndash oktober 2015 T-3
Analyse September 2015 - juli 2016
Artikkelskriving Januar ndash august 2015 artikkel 1
November 2015 ndash juni 2016 artikkel 2
August ndash desember 2016 artikkel 3
Tusen takk
Oppsummering Prosjektet er stoslashttet av
Nasjonalt kompetansenettverk for legemidler til barn
Kirurgisk avdeling for barn OUS
Norsk Sykepleierforbund
Sykehusbarn
Litteraturliste 1 Hauer J Jones BL amp Wolfe J Poplack D G Kim M S (2015) Evaluation and management of pain in children UpToDate httpwwwuptodatecomcontentsevaluation-
and-management-of-pain-in-childrensource=search_resultampsearch=PAIN+CHILDRENampselectedTitle=17E150
2 IASP (2011c) Acute Pain management in Newborn Infants Pain [Online] Tilgjengelig paring httpiaspfilescms-pluscomContentContentFoldersPublications2PainClinicalUpdatesArchivesPCU_19-6_final_12-8-11_1390260191290_1pdf [Lastet 14april 2014]
3 Bernadi M Catania G amp Tridello G (2007) Knowledge and attitudes about cancer pain management a national survey of Italian hospice nurses Cancer Nurs 30(2) E20-6
4 Coulling S (2005) Nurses and doctors knowledge of pain after surgery Nurs Stand 19(34) 41-49
5 Hovde K R Granheim T H Christophersen K-A amp Dihle A (2012) The Norwegian Version of the Pediatric Nursesrsquo Knowledge and attitudes Survey Regarding Pain Reliability and Validity Pedatric nursing 38 (5) 264-269
6 Hossain S (2010) Nursesrsquo Knowledge and Attitudes and Pain Management Practice of Post-Operative Children in Bangladesh Prince of Songkla University Nedlastet fra httpkbpsuacthpsukbbitstream201078261325999pdf
7 Huth M M Gregg T L Lin L (2010) Education changes Mexican nurses knowledge and attitudes regarding pediatric pain Pain Manag Nurs Dec11(4)201-8 doi 101016jpmn200911001
8 Lewthwaite B J Jabusch K M Wheeler B J Schnell-Hoehn K N Mills J Estrella-Holder E Fedorowicz A (2011) Nurses knowledge and attitudes regarding pain management in hospitalized adults J Contin Educ Nurs 42(6) 251-7 doi 10392800220124-20110103-03 Epub 2011 Jan 10
9 Manworren RC (2000) Pediatric nursesrsquo knowledge and attitudes survey regarding pain Pediatr Nurs 26 610-614
10 Rieman M T Gordon M amp Marvin J M (2007) Pediatric nursesrsquo knowledge and attitudes survey regarding pain a competency tool modification Pediatr Nurs 33 303-306
11 Simons JM amp MacDonald LM (2004) Pain assessment tools childrenrsquos nursesrsquo views Journal of Child Health Care 8 264 Doi 1011771367493504047317
12 Twycross A (2007) What is the impact of theoretical knowledge on childrenrsquos nursesrsquo post-operative pain management practices an exploratory study Nurse Educ Today 27 697-707
13 Smart S (2005) POST-OPERATIVE PAIN MANAGEMENT KNOWLEDGE AND ATTITUDES OF PAEDIATRIC NURSES- A NEW ZEALAND REGIONAL VIEW Victoria University of Wellington [Online] Tilgjengelig paring httpresearcharchivevuwacnzbitstreamhandle1006338thesispdfsequence=2 [Lastet 13april 2014]
14 Vincent C V H (2005) Nursesrsquo knowledge attitudes and practices regarding childrenrsquos pain MCN Am J Matern Child Nurs 30 177-183
15 Olsson G Jylli L (2001) Smaumlrta hos barn och ungdomar Lund Sverige Studentlitteratur
16 Peters J W Schouw R Anand K J van Dijk M Duivenvoorden H J Tibboel D (2005) Does neonatal surgery lead to increased pain sensitivity in later childhood Pain 114(3) 444-54
17 Anand K J S Gracia-Preats J A amp Kim M S (2015) Assessment of neonatal pain UpToDate httpwwwuptodatecomcontentsassessment-of-neonatal-pain
18 Anand K J S Gracia-Preats J A amp Kim M S (2015) Prevention and treatment of neonatal pain UpToDate httpwwwuptodatecomcontentsprevention-and-treatment-of-neonatal-painsource=related_link
19 IASP (2011a) Acute Pain and Surgery Global Year Against Acute Pain [Online] Tilgjengelig paring httpwwwiasp-painorgfilesContentContentFoldersGlobalYearAgainstPain2AcutePainFactSheets7-Surgerypdf [Lastet 14april 2014]
20 Howard R Carter B Curry J Jain A Liossi C Morton N Rivett K Rose M Tyrrell J Walker S Williams G (2012) Good Practice in Postoperative and Procedural pain management 2nd Edition Pediatric Anesthesia 22 1ndash79 doi 101111j1460-9592201203838x
21 IASP (2011b) Interventions Benefits and Barriers Global Year Against Acute Pain [Online] Tilgjengelig paring httpwwwiasp-painorgfilesContentContentFoldersGlobalYearAgainstPain2AcutePainFactSheets2-Interventionspdf [Lastet 14april 2014]
22 Benhamou D Berti M Brodner G De Andres J Draisci G Moreno-Azcoita M Neugebauer EA Schwenk W Torres LM Viel E (2007) Postoperative Analgesic THerapy Observational Survey (PATHOS) A practice pattern study in 7 CentralSouthern Eurpean countries Pain 136 134-141
23 Reinertsen H (2008) Smerte hos barn kap3I Rustoslashen T amp Wahl AK (red) Ulike tekster om smerte - fra nocisepsjon til livskvalitet Oslo Gyldendal Norsk Forlag AS
Litteraturliste 24 Smeland A amp Reinertsen H (2012) Smertevurdering og behandling av postoperative smerter hos barn Tidsskriftet Kirurgen 1 58-62 (5 s) [Online] Tilgjengelig paring
httpwwwkirurgennopdf1201 [Lastet 13april 2014]
25 Bringuier S Picot MC Dadure C et al (2009) A prospective comparison of post-surgical behavioral pain scales in preschoolers highlighting the risk of false evaluations Pain 145 60-68
26 Crelline D Sullivan T B Babl F E OSullivan R Hutchinson A (2007) Analysis of the validation of existing behavioral pain and distress scales for use in the procedural setting Pediatric Anesthesia 17 720-733
27 Ghai B Makkar JK amp Wig J (2008) Postoperative pain assessment in preverbal children and children with cognitive impairment Pediatric Anesthesia 18 462-477
28 Hicks CL von Baeyer CL Spafford P et al (2001) The Faces Pain Scale-Revised Toward a common metric in pain measurement Pain 93 173-183
29 Merkel SI Voepel-Lewis T amp Shayevitz et al (1997) The FLACC A Behavioral Scale for Scoring Postoperative Pain in Young Children Pediatric Nursing 23 293-7
30 Ellis J A McCleary L Blouin R Dube K Rowley B MacNeil M amp Cooke C (2007) Implementing best practice pain management in a pediatric hospital Journal for Specialists in Pediatric Nursing 12 264-277 doi101111j1744-6155200700121x
31 Johnston C C Gagnon A Rennick J Rosmus C Patenaude H Ellis J Shapiro C Filion F Ritchie J Byron J (2007) One-on-one coaching to improve pain assessment and management practices of pediatric nurses Journal of Pediatric Nursing 22 467-478 doi101016jpedn200707004
32 Le May S Johnston C C Choiniegravere M Fortin C Kudirka D Murray L Chalut D (2009) Pain Management Practices in a Pediatric Emergency Room (PAMPER) Study interventions with nurses Pediatr Emerg Care Aug25(8)498-503 doi 101097PEC0b013e3181b0a0af
33 Vincent C V H Wilkie D J amp Wang E (2011) Pediatric Nurses Beliefs and Pain Management Practices An Intervention Pilot West J Nurs Res 33 825 originally published online 20 December 2010
36 Twycross A Finley G A and Latimer M (2013) Pediatric nurses postoperative pain management practices An observational study Journal for Specialists in Pediatric Nursing 18 189ndash201 doi 101111jspn12026
42 Twycross A amp Finley G A (2013) Childrens and parents perceptions of postoperative pain management a mixed methods study Journal of Clinical Nursing 22(21-22) 3095-3108 doi 101111jocn12152 [Online] Tilgjengelig paring httponlinelibrarywileycomdoi101111jocn12152pdf (13042014)
43 Polkki T Pietila AM Vehvilainen-Julkunen K (2003) Hospitalized childrens descriptions of their experiences with postsurgical pain relieving methods Int J Nurs Stud Jan40(1)33-44 PubMed PMID 12550148 English
46 Abdalrahim MS Majali SA Stomberg MW Bergbom I (2011) The effect of postoperative pain management program on improving nurses knowledge and attitudes toward pain Nurse Educ Pract 2011 Jul11(4)250-5 doi 101016jnepr201011016 Epub 2010 Dec 24 httpwwwncbinlmnihgovpubmed21186139
47 IASP Pain definition IASP (International Association of the Study of Pain) Pain definition
48 Norsk Ledemiddelharingndbok Ulike smertetilstander [Online] Tilgjengelig paring httplegemiddelhandbokanoTerapi22816expand=1
49 Astrid Lindgrens Barnsjukhus ndash Riktlinjer foumlr smaumlrtbehandling
50 Groslashnseth R amp Markestad T (2011) Pediatri og pediatrisk sykepleie Bergen Fagbokforlaget Vigmostad amp Bjoslashrke AS httppediatriportfoliono
51 Hicks CL von Baeyer CL Spafford Pet al The Faces Pain Scale‐Revised Toward a common metric in pain measurement Pain 2001 93173‐183
52 Twycross A Why Managing Pain in Children Matters in Managing Pain in Children A Clinical Guide (eds A Twycross S J Dowden and E Bruce) Wiley‐Blackwell 2009 Oxford UK doi 1010029781444322743ch1
53 Von Bayer CL amp Spagrud LJ Systematic review of observational (behavioral) measures of pain for children and adolescents aged 3 to 18 years Pain 2007 127 140‐150
54 Voepel‐Lewis Terri RN MSN ZanottiJennifer RN MS CCRN CEN DammeyerJennifer A RN MSN and MerkelSandra RN MS (January 2010) Reliability and Validity of the Face Legs Activity Cry Consolability Behavioral Tool in Assessing Acute Pain in Critically Ill Patients American Journal of Critical Care 19 (1) 55ndash61
55 Merkel S Voepel‐Lewis T Shayevitz JR et al The FLACC A behavioural scale for scoring postoperative pain in young children Pediatric nursing 1997 23293‐797
56 McCaffery M amp Beebe F (1994) Pain‐Clinical Manual of for Nursing Practice Times Mirror International Publishers Ltd Norsk oversettelse Smerter Laeligrebok for helsepersonell Oslo Norge Gyldendal Norsk Forlag AS
57 Reinertsen H Christophersen K‐A Helseth S Vurdering av postoperativ smerte hos barn (0‐5 aringr) Validering og reliabilitetstesting av smertevurderingsverktoslashyet FLACC Sykepleien Forskning 2014 9 132‐140 httpwwwsykepleiennoforskningforskningsartikkel1466655validering‐og‐reliabilitetstesting‐av‐smertevurderingsverktoyet‐flacc
Litteraturliste 58 Stinson J (2009) Pain Assessment I Twycross A Dowden S J amp Bruce E Pain Assessment in Managing Pain in Children A Clinical Guide Oxford UK Wiley-Blackmell
59 Tomlinson D von Baeyer CL Stinson JN Sung L A systematic review of faces scales for the self‐report of pain intensity in children Pediatrics 2010 Nov126(5)e1168‐98 PubMed PMID 20921070 Epub 20101006 eng
60 Von Baeyer CL Childrens self‐reports of pain intensity scale selection limitations and interpretation Pain Res Manag 2006 Autumn11(3)157‐62 PubMed PMID 16960632 Pubmed Central PMCID PMC2539005 Epub 20060909 eng
61 Ghai B Makkar J K amp Wig J (2008) Postoperative pain assesment in preverbal children and children with cognitive impairment Pediatric Anesthesia 18 462‐477
62 Malvia S Voepel‐Lewis T Tait A R Merkel S Lauer A Munro H Farley F (2001) Pain management in children with and without cognitive impairment following spine fusion surgery Pediatric Anasthesia 11 453‐458
63 Malvia S Voepel‐Lewis T Burke C Merkel S amp Tait A R (2006) The revised FLACC observational pain tool improved reliability and validity for pain assesment in children with cognitive impairment Pediatric Anestesia 16 258‐265
64 McJunkins A Green A amp Anand KJS (2010) Pain Assesment in cognitively Impared Functionally Impared Children Pilot Study Results Journal of Pediatric Nursing 25 307‐309
65 McKearnan K A Kieckhefer G Engel J M Jensen M amp Labyak S (2004) Pain in Children with cerebral Palsy A Review Journal of Neuroscience Nursing Vol 36 no 5 s252‐259
66 Voepel‐Lewis T Malviya S Tait A Merkel S Forter R amp Krane E (2008) A comparison of the clinical utility of pain assesment tools for children with cognitive impairment Pediatric Anesthesiology 106 (1) 72‐78
67 Baulch I Assessment and management of pain in the paediatric patient Nursing standard 2010 2510 35-40
68 Twycross A Why Managing Pain in Children Matters in Managing Pain in Children A Clinical Guide (eds A Twycross S J Dowden and E Bruce) Wiley-Blackwell 2009 Oxford UK doi 1010029781444322743ch1
69 Schug SA amp Pogatzki-Zhan EM Chronic Pain after Surgery or Injury Pain 2011 Clinical Updates XIX 11-5
70 Fredheim OMS Borchgrevink PC amp Kvarstein G Behandling av postoperativ smerte i sykehus Tidsskr Nor Legeforen 2011 131 1772-6
71 Steward DL Welge J amp Myer C Steroids for improving recovery following tonsillectomy in children Cochrane Database of Systematic Reviews 2003 Issue 1Art NoCD003997 DOI10100214651858CD003997
72 Hong JY Han SW Kim WO et al Effect of dexamethasone in combination with caudal analgesia on postoperative pain control in day-case paediatric orchioplexy British Journal of Anesthesia 2010 105(4)506-10
73 Den Norske Legeforening (2009) Retningslinjer for smertelindring [Online] URL httpwww legeforeningennoasset42585142585_1pdf
74 Association of Paediatric Anaesthetists (2008) Good Practice in Postoperative and Procedural Pain [Online] URL httpwwwbritishpainsocietyorgbook_apa_part1pdf
75 European Society of Regional Aneasthesia (2005) Postoperative Pain Management ndash Good Clinical Practice General recommendations and principles for successful pain management [Online] URL httpwwwesraeuropeorgPostoperativePainManagementpdf
76 Monsen ALB Skadberg BT amp Groslashnlie I Smertebehandling Norsk Barnelegeforeningen 2011 [Online] URL httpwwwlegeforeningennoid1104250
77 Smeland A amp Reinertsen H (2012) Smertevurdering og behandling av postoperative smerter hos barn Tidsskriftet Kirurgen 1 58-62 (5 s) [Online] Tilgjengelig paring httpwwwkirurgennopdf1201
78 Standing JF Savage I Pritchard D et al Diclofenac for acute pain in children Cochrane Database of Systematic Reviews 2009 Issue 4 Art No CD005538 DOI 10100214651858CD005538pub2
79 Standing JF Tibboel D Korpela R et al Diclofenac pharmacokinetic meta-analysis and dose recommendations for surgical pain in children aged 1ndash12 years Pediatric Anesthesia 2011 21 316ndash324 doi 101111j1460-9592201003509x
80 Riad W amp Moussa A Pre-operative analgesia with rectal diclofenac andor paracetamol in children undergoing hernia repair Anaesthesia 2007 Dec62(12)1241-5
81 Hiller A Meretoja OA Korpela R et al The Anagesic Efficacy of Acetaminophen Ketoprofen or Their Combination for Pediatric Surgical Patients Having Soft Tissue or Orthopedic Procedures Anesth Analg 20061021365-71
82 Norsk legemiddelharingndbok Antidoter ndash alfabetisk oversikt bruksomraringde og dosering httplegemiddelhandbokanoGenerelle153557i153779
83 Norsk legemiddelharingndbok Barn og legemidler httplegemiddelhandbokanoGenerelle153109
84 SickKids Aboutkidshealthca Myths About Pain httpwwwaboutkidshealthcaEnResourceCentresPainPainAssessmentPagesMyths-About-Painaspx
85 Psykososial preoperativ forberedelse av barn 0ndash18 aringr httpwwwhelsebiblioteketnomicrositefagprosedyrerfagprosedyrerpsykososial-preoperativ-forberedelse-av-barn-018-C3A5r
86 Twycross A Why Managing Pain in Children Matters in Managing Pain in Children A Clinical Guide (eds ATwycross S J Dowden and E Bruce) Wiley‐Blackwell 2009 Oxford UK doi 1010029781444322743ch1
Prosjektdeltakere Stefan Lundeberg MD PhD Senior Consultant Pain Treatment
Service Astrid Lindgren Childrens Hospital Stockholm (Intervention study)
Hanne Reinertsen Assistant Professor Oslo and Akershus University college of applied Sciences (Intervention study)
Lill Nybro MSc student Intensive Care Nurse Oslo University Hospital (interview with children)
Torgun Naeligss MSc student Pediatric Nurse Oslo University Hospital (interview with children)
Eva Carlsen Pediatric Nurse Childrens Surgical Department Oslo University Hospital (facilitator Intervention study)
Hensikt
Kartlegge postoperativ smertebehandling av barn og
ungdom i Norge samt se om intervensjon med
sykepleiere og leger vil bedre smertebehandlingen
Metode
Design
Pre-post intervensjonsdesign med kontrollgruppe hvor det maringles ved tre perioder T-1 (baseline) T-2 (1 mnd etter intervensjonen) og T-3 (6 mnd etter intervensjonen)
Utvalg
bull 6 postoperative avdelinger
ndash 6 ulike universitetssykehus
ndash alle helseforetakene i Norge
ndash stoslashrste PO avd som har barn og ungdomspasienter
bull 3 avdelinger til intervensjonen
ndash tilfeldig valgt
ndash cluster randomisering
Faser Aktivitet Fase 1 Kartlegging av kunnskaper
og holdninger hos sykepleierne
Datainnsamling (baseline T-1) bull sposlashrreskjema PNKAS-N bull observasjonsstudie (alle avd) bull intervju av barn (10 barnavd ndash 2 avd)
Fase 2 Utvikling og gjennomfoslashring av intervensjonen
Utvikle intervensjon basert paring bull tidligere forskning bull resultatene fra baseline data bull tilbakemelding fra fag og ledelse Intervensjon bull temadag (undervisning og workshop) bull klinisk veiledning og reminders
Fase 3 Implementering og evaluering av intervensjonen
Datainnsamling (T-2 og T-3) 1 mnd og 6 mnd etter intervensjon sposlashrreskjema PNKAS-N (alle avd) observasjonsstudie (4 avd T-22 avd T-3) intervju av barn (10 barnavd - 2 avd T2)
Studien delt opp i 3 faser
Flowchart
Fase 1 Kartlegging
Forskningssposlashrsmaringl bull Hvilke kunnskaper og holdninger har sykepleiere til smerte hos barn og
ungdom
bull Hvordan praktiserer sykepleiere smerteharingndtering i postoperative avdelinger
bull Hva er barnas opplevelse av postoperativ smertebehandling
Datainnsamling bull Sposlashrreskjema PNKAS-N (alle avdelingene)
bull Observasjonsstudie (alle avdelingene)
bull Intervju av barn (to avdelinger)
Sposlashrreskjemaet bull Pediatric Nurses Knowledge and Attitudes Survey- Norsk
versjon (PNKAS-N)
ndash PNKAS-N bygger paring bull World Health Organization (WHO)
bull American Pain Society (APS)
bull The Agency for Health Care Policy and Research (AHCRP)
ndash PNKAS-N bestaringr av 40 sposlashrsmaringl bull 23 sposlashrsmaringlene er paringstander (santusant)
bull 13 er laquomultiple choiceraquo
bull fire casesposlashrsmaringl knyttet til pasienthistorier
bull Instrumentet ble oversatt til norsk og validert av Hovde i 2009
Observasjonsstudie
bull Ikke deltakende observasjon
bull Semistrukturert
bull Observasjons sjekkliste og feltnotater ndash Smertevurdering
ndash Ikke medikamentell smertelindring
ndash Medikamentell smertelindring
bull Pilottestet
bull Ca 6 tdag i 10 dager (ca 60 timer pr avd 360 timer totalt)
Intervju med barn
bull Semistrukturert
bull Intervjuguider (6-11 12-18) ndash Smerteopplevelsen
ndash Smertevurdering
ndash Ikke medikamentell smertelindring
ndash Medikamentell smertelindring
bull Pilottestet
bull Barn 6-18 aringr
bull 10 barnavd ndash to avdelinger (kontrollgruppeintervensjonsgruppe)
Fase 2 Utvikling av intervensjon
Baseres paring tidligere forskning resultatene fra fase 1 samt tilbakemeldinger fra fag og seksjonsledere
Intervensjonen bestod av
bullTemadag (seks timer)
ndash Undervisning og workshop
ndash Sykepleiere og leger
ndash Stefan Lundeberg og Hanne Reinertsen
bullVeiledning i praksis
ndash Klinisk veiledning i smertebehandling av barn
ndash Eva Carlsen
bullReminders
Fase 3 Evaluering av intervensjonen
Forskningssposlashrsmaringl
Vil intervensjonen oslashke sykepleieres kunnskaper og holdninger til smerte hos barn og ungdom
Vil intervensjonen bedre sykepleieres smerteharingndtering av barn og ungdom
Datainnsamling
bullT-2 1 mnd etter intervensjonen bull Sposlashrreskjema PKNAS-N (alle avd)
bull Observasjonsstudie (fire avd)
bull Intervju av barn (to avd)
bullT-3 6 mnd etter intervensjonen bull Sposlashrreskjema PKNAS-N (alle avd)
bull Observasjonsstudie (to avd)
Fremdriftsplan
Forarbeid November 2013 - juni 2014
Datainnsamling September - november 2014 T-1
Januar ndash februar 2015 Intervensjon
Mars ndash april 2015 T-2
September ndash oktober 2015 T-3
Analyse September 2015 - juli 2016
Artikkelskriving Januar ndash august 2015 artikkel 1
November 2015 ndash juni 2016 artikkel 2
August ndash desember 2016 artikkel 3
Tusen takk
Oppsummering Prosjektet er stoslashttet av
Nasjonalt kompetansenettverk for legemidler til barn
Kirurgisk avdeling for barn OUS
Norsk Sykepleierforbund
Sykehusbarn
Litteraturliste 1 Hauer J Jones BL amp Wolfe J Poplack D G Kim M S (2015) Evaluation and management of pain in children UpToDate httpwwwuptodatecomcontentsevaluation-
and-management-of-pain-in-childrensource=search_resultampsearch=PAIN+CHILDRENampselectedTitle=17E150
2 IASP (2011c) Acute Pain management in Newborn Infants Pain [Online] Tilgjengelig paring httpiaspfilescms-pluscomContentContentFoldersPublications2PainClinicalUpdatesArchivesPCU_19-6_final_12-8-11_1390260191290_1pdf [Lastet 14april 2014]
3 Bernadi M Catania G amp Tridello G (2007) Knowledge and attitudes about cancer pain management a national survey of Italian hospice nurses Cancer Nurs 30(2) E20-6
4 Coulling S (2005) Nurses and doctors knowledge of pain after surgery Nurs Stand 19(34) 41-49
5 Hovde K R Granheim T H Christophersen K-A amp Dihle A (2012) The Norwegian Version of the Pediatric Nursesrsquo Knowledge and attitudes Survey Regarding Pain Reliability and Validity Pedatric nursing 38 (5) 264-269
6 Hossain S (2010) Nursesrsquo Knowledge and Attitudes and Pain Management Practice of Post-Operative Children in Bangladesh Prince of Songkla University Nedlastet fra httpkbpsuacthpsukbbitstream201078261325999pdf
7 Huth M M Gregg T L Lin L (2010) Education changes Mexican nurses knowledge and attitudes regarding pediatric pain Pain Manag Nurs Dec11(4)201-8 doi 101016jpmn200911001
8 Lewthwaite B J Jabusch K M Wheeler B J Schnell-Hoehn K N Mills J Estrella-Holder E Fedorowicz A (2011) Nurses knowledge and attitudes regarding pain management in hospitalized adults J Contin Educ Nurs 42(6) 251-7 doi 10392800220124-20110103-03 Epub 2011 Jan 10
9 Manworren RC (2000) Pediatric nursesrsquo knowledge and attitudes survey regarding pain Pediatr Nurs 26 610-614
10 Rieman M T Gordon M amp Marvin J M (2007) Pediatric nursesrsquo knowledge and attitudes survey regarding pain a competency tool modification Pediatr Nurs 33 303-306
11 Simons JM amp MacDonald LM (2004) Pain assessment tools childrenrsquos nursesrsquo views Journal of Child Health Care 8 264 Doi 1011771367493504047317
12 Twycross A (2007) What is the impact of theoretical knowledge on childrenrsquos nursesrsquo post-operative pain management practices an exploratory study Nurse Educ Today 27 697-707
13 Smart S (2005) POST-OPERATIVE PAIN MANAGEMENT KNOWLEDGE AND ATTITUDES OF PAEDIATRIC NURSES- A NEW ZEALAND REGIONAL VIEW Victoria University of Wellington [Online] Tilgjengelig paring httpresearcharchivevuwacnzbitstreamhandle1006338thesispdfsequence=2 [Lastet 13april 2014]
14 Vincent C V H (2005) Nursesrsquo knowledge attitudes and practices regarding childrenrsquos pain MCN Am J Matern Child Nurs 30 177-183
15 Olsson G Jylli L (2001) Smaumlrta hos barn och ungdomar Lund Sverige Studentlitteratur
16 Peters J W Schouw R Anand K J van Dijk M Duivenvoorden H J Tibboel D (2005) Does neonatal surgery lead to increased pain sensitivity in later childhood Pain 114(3) 444-54
17 Anand K J S Gracia-Preats J A amp Kim M S (2015) Assessment of neonatal pain UpToDate httpwwwuptodatecomcontentsassessment-of-neonatal-pain
18 Anand K J S Gracia-Preats J A amp Kim M S (2015) Prevention and treatment of neonatal pain UpToDate httpwwwuptodatecomcontentsprevention-and-treatment-of-neonatal-painsource=related_link
19 IASP (2011a) Acute Pain and Surgery Global Year Against Acute Pain [Online] Tilgjengelig paring httpwwwiasp-painorgfilesContentContentFoldersGlobalYearAgainstPain2AcutePainFactSheets7-Surgerypdf [Lastet 14april 2014]
20 Howard R Carter B Curry J Jain A Liossi C Morton N Rivett K Rose M Tyrrell J Walker S Williams G (2012) Good Practice in Postoperative and Procedural pain management 2nd Edition Pediatric Anesthesia 22 1ndash79 doi 101111j1460-9592201203838x
21 IASP (2011b) Interventions Benefits and Barriers Global Year Against Acute Pain [Online] Tilgjengelig paring httpwwwiasp-painorgfilesContentContentFoldersGlobalYearAgainstPain2AcutePainFactSheets2-Interventionspdf [Lastet 14april 2014]
22 Benhamou D Berti M Brodner G De Andres J Draisci G Moreno-Azcoita M Neugebauer EA Schwenk W Torres LM Viel E (2007) Postoperative Analgesic THerapy Observational Survey (PATHOS) A practice pattern study in 7 CentralSouthern Eurpean countries Pain 136 134-141
23 Reinertsen H (2008) Smerte hos barn kap3I Rustoslashen T amp Wahl AK (red) Ulike tekster om smerte - fra nocisepsjon til livskvalitet Oslo Gyldendal Norsk Forlag AS
Litteraturliste 24 Smeland A amp Reinertsen H (2012) Smertevurdering og behandling av postoperative smerter hos barn Tidsskriftet Kirurgen 1 58-62 (5 s) [Online] Tilgjengelig paring
httpwwwkirurgennopdf1201 [Lastet 13april 2014]
25 Bringuier S Picot MC Dadure C et al (2009) A prospective comparison of post-surgical behavioral pain scales in preschoolers highlighting the risk of false evaluations Pain 145 60-68
26 Crelline D Sullivan T B Babl F E OSullivan R Hutchinson A (2007) Analysis of the validation of existing behavioral pain and distress scales for use in the procedural setting Pediatric Anesthesia 17 720-733
27 Ghai B Makkar JK amp Wig J (2008) Postoperative pain assessment in preverbal children and children with cognitive impairment Pediatric Anesthesia 18 462-477
28 Hicks CL von Baeyer CL Spafford P et al (2001) The Faces Pain Scale-Revised Toward a common metric in pain measurement Pain 93 173-183
29 Merkel SI Voepel-Lewis T amp Shayevitz et al (1997) The FLACC A Behavioral Scale for Scoring Postoperative Pain in Young Children Pediatric Nursing 23 293-7
30 Ellis J A McCleary L Blouin R Dube K Rowley B MacNeil M amp Cooke C (2007) Implementing best practice pain management in a pediatric hospital Journal for Specialists in Pediatric Nursing 12 264-277 doi101111j1744-6155200700121x
31 Johnston C C Gagnon A Rennick J Rosmus C Patenaude H Ellis J Shapiro C Filion F Ritchie J Byron J (2007) One-on-one coaching to improve pain assessment and management practices of pediatric nurses Journal of Pediatric Nursing 22 467-478 doi101016jpedn200707004
32 Le May S Johnston C C Choiniegravere M Fortin C Kudirka D Murray L Chalut D (2009) Pain Management Practices in a Pediatric Emergency Room (PAMPER) Study interventions with nurses Pediatr Emerg Care Aug25(8)498-503 doi 101097PEC0b013e3181b0a0af
33 Vincent C V H Wilkie D J amp Wang E (2011) Pediatric Nurses Beliefs and Pain Management Practices An Intervention Pilot West J Nurs Res 33 825 originally published online 20 December 2010
36 Twycross A Finley G A and Latimer M (2013) Pediatric nurses postoperative pain management practices An observational study Journal for Specialists in Pediatric Nursing 18 189ndash201 doi 101111jspn12026
42 Twycross A amp Finley G A (2013) Childrens and parents perceptions of postoperative pain management a mixed methods study Journal of Clinical Nursing 22(21-22) 3095-3108 doi 101111jocn12152 [Online] Tilgjengelig paring httponlinelibrarywileycomdoi101111jocn12152pdf (13042014)
43 Polkki T Pietila AM Vehvilainen-Julkunen K (2003) Hospitalized childrens descriptions of their experiences with postsurgical pain relieving methods Int J Nurs Stud Jan40(1)33-44 PubMed PMID 12550148 English
46 Abdalrahim MS Majali SA Stomberg MW Bergbom I (2011) The effect of postoperative pain management program on improving nurses knowledge and attitudes toward pain Nurse Educ Pract 2011 Jul11(4)250-5 doi 101016jnepr201011016 Epub 2010 Dec 24 httpwwwncbinlmnihgovpubmed21186139
47 IASP Pain definition IASP (International Association of the Study of Pain) Pain definition
48 Norsk Ledemiddelharingndbok Ulike smertetilstander [Online] Tilgjengelig paring httplegemiddelhandbokanoTerapi22816expand=1
49 Astrid Lindgrens Barnsjukhus ndash Riktlinjer foumlr smaumlrtbehandling
50 Groslashnseth R amp Markestad T (2011) Pediatri og pediatrisk sykepleie Bergen Fagbokforlaget Vigmostad amp Bjoslashrke AS httppediatriportfoliono
51 Hicks CL von Baeyer CL Spafford Pet al The Faces Pain Scale‐Revised Toward a common metric in pain measurement Pain 2001 93173‐183
52 Twycross A Why Managing Pain in Children Matters in Managing Pain in Children A Clinical Guide (eds A Twycross S J Dowden and E Bruce) Wiley‐Blackwell 2009 Oxford UK doi 1010029781444322743ch1
53 Von Bayer CL amp Spagrud LJ Systematic review of observational (behavioral) measures of pain for children and adolescents aged 3 to 18 years Pain 2007 127 140‐150
54 Voepel‐Lewis Terri RN MSN ZanottiJennifer RN MS CCRN CEN DammeyerJennifer A RN MSN and MerkelSandra RN MS (January 2010) Reliability and Validity of the Face Legs Activity Cry Consolability Behavioral Tool in Assessing Acute Pain in Critically Ill Patients American Journal of Critical Care 19 (1) 55ndash61
55 Merkel S Voepel‐Lewis T Shayevitz JR et al The FLACC A behavioural scale for scoring postoperative pain in young children Pediatric nursing 1997 23293‐797
56 McCaffery M amp Beebe F (1994) Pain‐Clinical Manual of for Nursing Practice Times Mirror International Publishers Ltd Norsk oversettelse Smerter Laeligrebok for helsepersonell Oslo Norge Gyldendal Norsk Forlag AS
57 Reinertsen H Christophersen K‐A Helseth S Vurdering av postoperativ smerte hos barn (0‐5 aringr) Validering og reliabilitetstesting av smertevurderingsverktoslashyet FLACC Sykepleien Forskning 2014 9 132‐140 httpwwwsykepleiennoforskningforskningsartikkel1466655validering‐og‐reliabilitetstesting‐av‐smertevurderingsverktoyet‐flacc
Litteraturliste 58 Stinson J (2009) Pain Assessment I Twycross A Dowden S J amp Bruce E Pain Assessment in Managing Pain in Children A Clinical Guide Oxford UK Wiley-Blackmell
59 Tomlinson D von Baeyer CL Stinson JN Sung L A systematic review of faces scales for the self‐report of pain intensity in children Pediatrics 2010 Nov126(5)e1168‐98 PubMed PMID 20921070 Epub 20101006 eng
60 Von Baeyer CL Childrens self‐reports of pain intensity scale selection limitations and interpretation Pain Res Manag 2006 Autumn11(3)157‐62 PubMed PMID 16960632 Pubmed Central PMCID PMC2539005 Epub 20060909 eng
61 Ghai B Makkar J K amp Wig J (2008) Postoperative pain assesment in preverbal children and children with cognitive impairment Pediatric Anesthesia 18 462‐477
62 Malvia S Voepel‐Lewis T Tait A R Merkel S Lauer A Munro H Farley F (2001) Pain management in children with and without cognitive impairment following spine fusion surgery Pediatric Anasthesia 11 453‐458
63 Malvia S Voepel‐Lewis T Burke C Merkel S amp Tait A R (2006) The revised FLACC observational pain tool improved reliability and validity for pain assesment in children with cognitive impairment Pediatric Anestesia 16 258‐265
64 McJunkins A Green A amp Anand KJS (2010) Pain Assesment in cognitively Impared Functionally Impared Children Pilot Study Results Journal of Pediatric Nursing 25 307‐309
65 McKearnan K A Kieckhefer G Engel J M Jensen M amp Labyak S (2004) Pain in Children with cerebral Palsy A Review Journal of Neuroscience Nursing Vol 36 no 5 s252‐259
66 Voepel‐Lewis T Malviya S Tait A Merkel S Forter R amp Krane E (2008) A comparison of the clinical utility of pain assesment tools for children with cognitive impairment Pediatric Anesthesiology 106 (1) 72‐78
67 Baulch I Assessment and management of pain in the paediatric patient Nursing standard 2010 2510 35-40
68 Twycross A Why Managing Pain in Children Matters in Managing Pain in Children A Clinical Guide (eds A Twycross S J Dowden and E Bruce) Wiley-Blackwell 2009 Oxford UK doi 1010029781444322743ch1
69 Schug SA amp Pogatzki-Zhan EM Chronic Pain after Surgery or Injury Pain 2011 Clinical Updates XIX 11-5
70 Fredheim OMS Borchgrevink PC amp Kvarstein G Behandling av postoperativ smerte i sykehus Tidsskr Nor Legeforen 2011 131 1772-6
71 Steward DL Welge J amp Myer C Steroids for improving recovery following tonsillectomy in children Cochrane Database of Systematic Reviews 2003 Issue 1Art NoCD003997 DOI10100214651858CD003997
72 Hong JY Han SW Kim WO et al Effect of dexamethasone in combination with caudal analgesia on postoperative pain control in day-case paediatric orchioplexy British Journal of Anesthesia 2010 105(4)506-10
73 Den Norske Legeforening (2009) Retningslinjer for smertelindring [Online] URL httpwww legeforeningennoasset42585142585_1pdf
74 Association of Paediatric Anaesthetists (2008) Good Practice in Postoperative and Procedural Pain [Online] URL httpwwwbritishpainsocietyorgbook_apa_part1pdf
75 European Society of Regional Aneasthesia (2005) Postoperative Pain Management ndash Good Clinical Practice General recommendations and principles for successful pain management [Online] URL httpwwwesraeuropeorgPostoperativePainManagementpdf
76 Monsen ALB Skadberg BT amp Groslashnlie I Smertebehandling Norsk Barnelegeforeningen 2011 [Online] URL httpwwwlegeforeningennoid1104250
77 Smeland A amp Reinertsen H (2012) Smertevurdering og behandling av postoperative smerter hos barn Tidsskriftet Kirurgen 1 58-62 (5 s) [Online] Tilgjengelig paring httpwwwkirurgennopdf1201
78 Standing JF Savage I Pritchard D et al Diclofenac for acute pain in children Cochrane Database of Systematic Reviews 2009 Issue 4 Art No CD005538 DOI 10100214651858CD005538pub2
79 Standing JF Tibboel D Korpela R et al Diclofenac pharmacokinetic meta-analysis and dose recommendations for surgical pain in children aged 1ndash12 years Pediatric Anesthesia 2011 21 316ndash324 doi 101111j1460-9592201003509x
80 Riad W amp Moussa A Pre-operative analgesia with rectal diclofenac andor paracetamol in children undergoing hernia repair Anaesthesia 2007 Dec62(12)1241-5
81 Hiller A Meretoja OA Korpela R et al The Anagesic Efficacy of Acetaminophen Ketoprofen or Their Combination for Pediatric Surgical Patients Having Soft Tissue or Orthopedic Procedures Anesth Analg 20061021365-71
82 Norsk legemiddelharingndbok Antidoter ndash alfabetisk oversikt bruksomraringde og dosering httplegemiddelhandbokanoGenerelle153557i153779
83 Norsk legemiddelharingndbok Barn og legemidler httplegemiddelhandbokanoGenerelle153109
84 SickKids Aboutkidshealthca Myths About Pain httpwwwaboutkidshealthcaEnResourceCentresPainPainAssessmentPagesMyths-About-Painaspx
85 Psykososial preoperativ forberedelse av barn 0ndash18 aringr httpwwwhelsebiblioteketnomicrositefagprosedyrerfagprosedyrerpsykososial-preoperativ-forberedelse-av-barn-018-C3A5r
86 Twycross A Why Managing Pain in Children Matters in Managing Pain in Children A Clinical Guide (eds ATwycross S J Dowden and E Bruce) Wiley‐Blackwell 2009 Oxford UK doi 1010029781444322743ch1
Hensikt
Kartlegge postoperativ smertebehandling av barn og
ungdom i Norge samt se om intervensjon med
sykepleiere og leger vil bedre smertebehandlingen
Metode
Design
Pre-post intervensjonsdesign med kontrollgruppe hvor det maringles ved tre perioder T-1 (baseline) T-2 (1 mnd etter intervensjonen) og T-3 (6 mnd etter intervensjonen)
Utvalg
bull 6 postoperative avdelinger
ndash 6 ulike universitetssykehus
ndash alle helseforetakene i Norge
ndash stoslashrste PO avd som har barn og ungdomspasienter
bull 3 avdelinger til intervensjonen
ndash tilfeldig valgt
ndash cluster randomisering
Faser Aktivitet Fase 1 Kartlegging av kunnskaper
og holdninger hos sykepleierne
Datainnsamling (baseline T-1) bull sposlashrreskjema PNKAS-N bull observasjonsstudie (alle avd) bull intervju av barn (10 barnavd ndash 2 avd)
Fase 2 Utvikling og gjennomfoslashring av intervensjonen
Utvikle intervensjon basert paring bull tidligere forskning bull resultatene fra baseline data bull tilbakemelding fra fag og ledelse Intervensjon bull temadag (undervisning og workshop) bull klinisk veiledning og reminders
Fase 3 Implementering og evaluering av intervensjonen
Datainnsamling (T-2 og T-3) 1 mnd og 6 mnd etter intervensjon sposlashrreskjema PNKAS-N (alle avd) observasjonsstudie (4 avd T-22 avd T-3) intervju av barn (10 barnavd - 2 avd T2)
Studien delt opp i 3 faser
Flowchart
Fase 1 Kartlegging
Forskningssposlashrsmaringl bull Hvilke kunnskaper og holdninger har sykepleiere til smerte hos barn og
ungdom
bull Hvordan praktiserer sykepleiere smerteharingndtering i postoperative avdelinger
bull Hva er barnas opplevelse av postoperativ smertebehandling
Datainnsamling bull Sposlashrreskjema PNKAS-N (alle avdelingene)
bull Observasjonsstudie (alle avdelingene)
bull Intervju av barn (to avdelinger)
Sposlashrreskjemaet bull Pediatric Nurses Knowledge and Attitudes Survey- Norsk
versjon (PNKAS-N)
ndash PNKAS-N bygger paring bull World Health Organization (WHO)
bull American Pain Society (APS)
bull The Agency for Health Care Policy and Research (AHCRP)
ndash PNKAS-N bestaringr av 40 sposlashrsmaringl bull 23 sposlashrsmaringlene er paringstander (santusant)
bull 13 er laquomultiple choiceraquo
bull fire casesposlashrsmaringl knyttet til pasienthistorier
bull Instrumentet ble oversatt til norsk og validert av Hovde i 2009
Observasjonsstudie
bull Ikke deltakende observasjon
bull Semistrukturert
bull Observasjons sjekkliste og feltnotater ndash Smertevurdering
ndash Ikke medikamentell smertelindring
ndash Medikamentell smertelindring
bull Pilottestet
bull Ca 6 tdag i 10 dager (ca 60 timer pr avd 360 timer totalt)
Intervju med barn
bull Semistrukturert
bull Intervjuguider (6-11 12-18) ndash Smerteopplevelsen
ndash Smertevurdering
ndash Ikke medikamentell smertelindring
ndash Medikamentell smertelindring
bull Pilottestet
bull Barn 6-18 aringr
bull 10 barnavd ndash to avdelinger (kontrollgruppeintervensjonsgruppe)
Fase 2 Utvikling av intervensjon
Baseres paring tidligere forskning resultatene fra fase 1 samt tilbakemeldinger fra fag og seksjonsledere
Intervensjonen bestod av
bullTemadag (seks timer)
ndash Undervisning og workshop
ndash Sykepleiere og leger
ndash Stefan Lundeberg og Hanne Reinertsen
bullVeiledning i praksis
ndash Klinisk veiledning i smertebehandling av barn
ndash Eva Carlsen
bullReminders
Fase 3 Evaluering av intervensjonen
Forskningssposlashrsmaringl
Vil intervensjonen oslashke sykepleieres kunnskaper og holdninger til smerte hos barn og ungdom
Vil intervensjonen bedre sykepleieres smerteharingndtering av barn og ungdom
Datainnsamling
bullT-2 1 mnd etter intervensjonen bull Sposlashrreskjema PKNAS-N (alle avd)
bull Observasjonsstudie (fire avd)
bull Intervju av barn (to avd)
bullT-3 6 mnd etter intervensjonen bull Sposlashrreskjema PKNAS-N (alle avd)
bull Observasjonsstudie (to avd)
Fremdriftsplan
Forarbeid November 2013 - juni 2014
Datainnsamling September - november 2014 T-1
Januar ndash februar 2015 Intervensjon
Mars ndash april 2015 T-2
September ndash oktober 2015 T-3
Analyse September 2015 - juli 2016
Artikkelskriving Januar ndash august 2015 artikkel 1
November 2015 ndash juni 2016 artikkel 2
August ndash desember 2016 artikkel 3
Tusen takk
Oppsummering Prosjektet er stoslashttet av
Nasjonalt kompetansenettverk for legemidler til barn
Kirurgisk avdeling for barn OUS
Norsk Sykepleierforbund
Sykehusbarn
Litteraturliste 1 Hauer J Jones BL amp Wolfe J Poplack D G Kim M S (2015) Evaluation and management of pain in children UpToDate httpwwwuptodatecomcontentsevaluation-
and-management-of-pain-in-childrensource=search_resultampsearch=PAIN+CHILDRENampselectedTitle=17E150
2 IASP (2011c) Acute Pain management in Newborn Infants Pain [Online] Tilgjengelig paring httpiaspfilescms-pluscomContentContentFoldersPublications2PainClinicalUpdatesArchivesPCU_19-6_final_12-8-11_1390260191290_1pdf [Lastet 14april 2014]
3 Bernadi M Catania G amp Tridello G (2007) Knowledge and attitudes about cancer pain management a national survey of Italian hospice nurses Cancer Nurs 30(2) E20-6
4 Coulling S (2005) Nurses and doctors knowledge of pain after surgery Nurs Stand 19(34) 41-49
5 Hovde K R Granheim T H Christophersen K-A amp Dihle A (2012) The Norwegian Version of the Pediatric Nursesrsquo Knowledge and attitudes Survey Regarding Pain Reliability and Validity Pedatric nursing 38 (5) 264-269
6 Hossain S (2010) Nursesrsquo Knowledge and Attitudes and Pain Management Practice of Post-Operative Children in Bangladesh Prince of Songkla University Nedlastet fra httpkbpsuacthpsukbbitstream201078261325999pdf
7 Huth M M Gregg T L Lin L (2010) Education changes Mexican nurses knowledge and attitudes regarding pediatric pain Pain Manag Nurs Dec11(4)201-8 doi 101016jpmn200911001
8 Lewthwaite B J Jabusch K M Wheeler B J Schnell-Hoehn K N Mills J Estrella-Holder E Fedorowicz A (2011) Nurses knowledge and attitudes regarding pain management in hospitalized adults J Contin Educ Nurs 42(6) 251-7 doi 10392800220124-20110103-03 Epub 2011 Jan 10
9 Manworren RC (2000) Pediatric nursesrsquo knowledge and attitudes survey regarding pain Pediatr Nurs 26 610-614
10 Rieman M T Gordon M amp Marvin J M (2007) Pediatric nursesrsquo knowledge and attitudes survey regarding pain a competency tool modification Pediatr Nurs 33 303-306
11 Simons JM amp MacDonald LM (2004) Pain assessment tools childrenrsquos nursesrsquo views Journal of Child Health Care 8 264 Doi 1011771367493504047317
12 Twycross A (2007) What is the impact of theoretical knowledge on childrenrsquos nursesrsquo post-operative pain management practices an exploratory study Nurse Educ Today 27 697-707
13 Smart S (2005) POST-OPERATIVE PAIN MANAGEMENT KNOWLEDGE AND ATTITUDES OF PAEDIATRIC NURSES- A NEW ZEALAND REGIONAL VIEW Victoria University of Wellington [Online] Tilgjengelig paring httpresearcharchivevuwacnzbitstreamhandle1006338thesispdfsequence=2 [Lastet 13april 2014]
14 Vincent C V H (2005) Nursesrsquo knowledge attitudes and practices regarding childrenrsquos pain MCN Am J Matern Child Nurs 30 177-183
15 Olsson G Jylli L (2001) Smaumlrta hos barn och ungdomar Lund Sverige Studentlitteratur
16 Peters J W Schouw R Anand K J van Dijk M Duivenvoorden H J Tibboel D (2005) Does neonatal surgery lead to increased pain sensitivity in later childhood Pain 114(3) 444-54
17 Anand K J S Gracia-Preats J A amp Kim M S (2015) Assessment of neonatal pain UpToDate httpwwwuptodatecomcontentsassessment-of-neonatal-pain
18 Anand K J S Gracia-Preats J A amp Kim M S (2015) Prevention and treatment of neonatal pain UpToDate httpwwwuptodatecomcontentsprevention-and-treatment-of-neonatal-painsource=related_link
19 IASP (2011a) Acute Pain and Surgery Global Year Against Acute Pain [Online] Tilgjengelig paring httpwwwiasp-painorgfilesContentContentFoldersGlobalYearAgainstPain2AcutePainFactSheets7-Surgerypdf [Lastet 14april 2014]
20 Howard R Carter B Curry J Jain A Liossi C Morton N Rivett K Rose M Tyrrell J Walker S Williams G (2012) Good Practice in Postoperative and Procedural pain management 2nd Edition Pediatric Anesthesia 22 1ndash79 doi 101111j1460-9592201203838x
21 IASP (2011b) Interventions Benefits and Barriers Global Year Against Acute Pain [Online] Tilgjengelig paring httpwwwiasp-painorgfilesContentContentFoldersGlobalYearAgainstPain2AcutePainFactSheets2-Interventionspdf [Lastet 14april 2014]
22 Benhamou D Berti M Brodner G De Andres J Draisci G Moreno-Azcoita M Neugebauer EA Schwenk W Torres LM Viel E (2007) Postoperative Analgesic THerapy Observational Survey (PATHOS) A practice pattern study in 7 CentralSouthern Eurpean countries Pain 136 134-141
23 Reinertsen H (2008) Smerte hos barn kap3I Rustoslashen T amp Wahl AK (red) Ulike tekster om smerte - fra nocisepsjon til livskvalitet Oslo Gyldendal Norsk Forlag AS
Litteraturliste 24 Smeland A amp Reinertsen H (2012) Smertevurdering og behandling av postoperative smerter hos barn Tidsskriftet Kirurgen 1 58-62 (5 s) [Online] Tilgjengelig paring
httpwwwkirurgennopdf1201 [Lastet 13april 2014]
25 Bringuier S Picot MC Dadure C et al (2009) A prospective comparison of post-surgical behavioral pain scales in preschoolers highlighting the risk of false evaluations Pain 145 60-68
26 Crelline D Sullivan T B Babl F E OSullivan R Hutchinson A (2007) Analysis of the validation of existing behavioral pain and distress scales for use in the procedural setting Pediatric Anesthesia 17 720-733
27 Ghai B Makkar JK amp Wig J (2008) Postoperative pain assessment in preverbal children and children with cognitive impairment Pediatric Anesthesia 18 462-477
28 Hicks CL von Baeyer CL Spafford P et al (2001) The Faces Pain Scale-Revised Toward a common metric in pain measurement Pain 93 173-183
29 Merkel SI Voepel-Lewis T amp Shayevitz et al (1997) The FLACC A Behavioral Scale for Scoring Postoperative Pain in Young Children Pediatric Nursing 23 293-7
30 Ellis J A McCleary L Blouin R Dube K Rowley B MacNeil M amp Cooke C (2007) Implementing best practice pain management in a pediatric hospital Journal for Specialists in Pediatric Nursing 12 264-277 doi101111j1744-6155200700121x
31 Johnston C C Gagnon A Rennick J Rosmus C Patenaude H Ellis J Shapiro C Filion F Ritchie J Byron J (2007) One-on-one coaching to improve pain assessment and management practices of pediatric nurses Journal of Pediatric Nursing 22 467-478 doi101016jpedn200707004
32 Le May S Johnston C C Choiniegravere M Fortin C Kudirka D Murray L Chalut D (2009) Pain Management Practices in a Pediatric Emergency Room (PAMPER) Study interventions with nurses Pediatr Emerg Care Aug25(8)498-503 doi 101097PEC0b013e3181b0a0af
33 Vincent C V H Wilkie D J amp Wang E (2011) Pediatric Nurses Beliefs and Pain Management Practices An Intervention Pilot West J Nurs Res 33 825 originally published online 20 December 2010
36 Twycross A Finley G A and Latimer M (2013) Pediatric nurses postoperative pain management practices An observational study Journal for Specialists in Pediatric Nursing 18 189ndash201 doi 101111jspn12026
42 Twycross A amp Finley G A (2013) Childrens and parents perceptions of postoperative pain management a mixed methods study Journal of Clinical Nursing 22(21-22) 3095-3108 doi 101111jocn12152 [Online] Tilgjengelig paring httponlinelibrarywileycomdoi101111jocn12152pdf (13042014)
43 Polkki T Pietila AM Vehvilainen-Julkunen K (2003) Hospitalized childrens descriptions of their experiences with postsurgical pain relieving methods Int J Nurs Stud Jan40(1)33-44 PubMed PMID 12550148 English
46 Abdalrahim MS Majali SA Stomberg MW Bergbom I (2011) The effect of postoperative pain management program on improving nurses knowledge and attitudes toward pain Nurse Educ Pract 2011 Jul11(4)250-5 doi 101016jnepr201011016 Epub 2010 Dec 24 httpwwwncbinlmnihgovpubmed21186139
47 IASP Pain definition IASP (International Association of the Study of Pain) Pain definition
48 Norsk Ledemiddelharingndbok Ulike smertetilstander [Online] Tilgjengelig paring httplegemiddelhandbokanoTerapi22816expand=1
49 Astrid Lindgrens Barnsjukhus ndash Riktlinjer foumlr smaumlrtbehandling
50 Groslashnseth R amp Markestad T (2011) Pediatri og pediatrisk sykepleie Bergen Fagbokforlaget Vigmostad amp Bjoslashrke AS httppediatriportfoliono
51 Hicks CL von Baeyer CL Spafford Pet al The Faces Pain Scale‐Revised Toward a common metric in pain measurement Pain 2001 93173‐183
52 Twycross A Why Managing Pain in Children Matters in Managing Pain in Children A Clinical Guide (eds A Twycross S J Dowden and E Bruce) Wiley‐Blackwell 2009 Oxford UK doi 1010029781444322743ch1
53 Von Bayer CL amp Spagrud LJ Systematic review of observational (behavioral) measures of pain for children and adolescents aged 3 to 18 years Pain 2007 127 140‐150
54 Voepel‐Lewis Terri RN MSN ZanottiJennifer RN MS CCRN CEN DammeyerJennifer A RN MSN and MerkelSandra RN MS (January 2010) Reliability and Validity of the Face Legs Activity Cry Consolability Behavioral Tool in Assessing Acute Pain in Critically Ill Patients American Journal of Critical Care 19 (1) 55ndash61
55 Merkel S Voepel‐Lewis T Shayevitz JR et al The FLACC A behavioural scale for scoring postoperative pain in young children Pediatric nursing 1997 23293‐797
56 McCaffery M amp Beebe F (1994) Pain‐Clinical Manual of for Nursing Practice Times Mirror International Publishers Ltd Norsk oversettelse Smerter Laeligrebok for helsepersonell Oslo Norge Gyldendal Norsk Forlag AS
57 Reinertsen H Christophersen K‐A Helseth S Vurdering av postoperativ smerte hos barn (0‐5 aringr) Validering og reliabilitetstesting av smertevurderingsverktoslashyet FLACC Sykepleien Forskning 2014 9 132‐140 httpwwwsykepleiennoforskningforskningsartikkel1466655validering‐og‐reliabilitetstesting‐av‐smertevurderingsverktoyet‐flacc
Litteraturliste 58 Stinson J (2009) Pain Assessment I Twycross A Dowden S J amp Bruce E Pain Assessment in Managing Pain in Children A Clinical Guide Oxford UK Wiley-Blackmell
59 Tomlinson D von Baeyer CL Stinson JN Sung L A systematic review of faces scales for the self‐report of pain intensity in children Pediatrics 2010 Nov126(5)e1168‐98 PubMed PMID 20921070 Epub 20101006 eng
60 Von Baeyer CL Childrens self‐reports of pain intensity scale selection limitations and interpretation Pain Res Manag 2006 Autumn11(3)157‐62 PubMed PMID 16960632 Pubmed Central PMCID PMC2539005 Epub 20060909 eng
61 Ghai B Makkar J K amp Wig J (2008) Postoperative pain assesment in preverbal children and children with cognitive impairment Pediatric Anesthesia 18 462‐477
62 Malvia S Voepel‐Lewis T Tait A R Merkel S Lauer A Munro H Farley F (2001) Pain management in children with and without cognitive impairment following spine fusion surgery Pediatric Anasthesia 11 453‐458
63 Malvia S Voepel‐Lewis T Burke C Merkel S amp Tait A R (2006) The revised FLACC observational pain tool improved reliability and validity for pain assesment in children with cognitive impairment Pediatric Anestesia 16 258‐265
64 McJunkins A Green A amp Anand KJS (2010) Pain Assesment in cognitively Impared Functionally Impared Children Pilot Study Results Journal of Pediatric Nursing 25 307‐309
65 McKearnan K A Kieckhefer G Engel J M Jensen M amp Labyak S (2004) Pain in Children with cerebral Palsy A Review Journal of Neuroscience Nursing Vol 36 no 5 s252‐259
66 Voepel‐Lewis T Malviya S Tait A Merkel S Forter R amp Krane E (2008) A comparison of the clinical utility of pain assesment tools for children with cognitive impairment Pediatric Anesthesiology 106 (1) 72‐78
67 Baulch I Assessment and management of pain in the paediatric patient Nursing standard 2010 2510 35-40
68 Twycross A Why Managing Pain in Children Matters in Managing Pain in Children A Clinical Guide (eds A Twycross S J Dowden and E Bruce) Wiley-Blackwell 2009 Oxford UK doi 1010029781444322743ch1
69 Schug SA amp Pogatzki-Zhan EM Chronic Pain after Surgery or Injury Pain 2011 Clinical Updates XIX 11-5
70 Fredheim OMS Borchgrevink PC amp Kvarstein G Behandling av postoperativ smerte i sykehus Tidsskr Nor Legeforen 2011 131 1772-6
71 Steward DL Welge J amp Myer C Steroids for improving recovery following tonsillectomy in children Cochrane Database of Systematic Reviews 2003 Issue 1Art NoCD003997 DOI10100214651858CD003997
72 Hong JY Han SW Kim WO et al Effect of dexamethasone in combination with caudal analgesia on postoperative pain control in day-case paediatric orchioplexy British Journal of Anesthesia 2010 105(4)506-10
73 Den Norske Legeforening (2009) Retningslinjer for smertelindring [Online] URL httpwww legeforeningennoasset42585142585_1pdf
74 Association of Paediatric Anaesthetists (2008) Good Practice in Postoperative and Procedural Pain [Online] URL httpwwwbritishpainsocietyorgbook_apa_part1pdf
75 European Society of Regional Aneasthesia (2005) Postoperative Pain Management ndash Good Clinical Practice General recommendations and principles for successful pain management [Online] URL httpwwwesraeuropeorgPostoperativePainManagementpdf
76 Monsen ALB Skadberg BT amp Groslashnlie I Smertebehandling Norsk Barnelegeforeningen 2011 [Online] URL httpwwwlegeforeningennoid1104250
77 Smeland A amp Reinertsen H (2012) Smertevurdering og behandling av postoperative smerter hos barn Tidsskriftet Kirurgen 1 58-62 (5 s) [Online] Tilgjengelig paring httpwwwkirurgennopdf1201
78 Standing JF Savage I Pritchard D et al Diclofenac for acute pain in children Cochrane Database of Systematic Reviews 2009 Issue 4 Art No CD005538 DOI 10100214651858CD005538pub2
79 Standing JF Tibboel D Korpela R et al Diclofenac pharmacokinetic meta-analysis and dose recommendations for surgical pain in children aged 1ndash12 years Pediatric Anesthesia 2011 21 316ndash324 doi 101111j1460-9592201003509x
80 Riad W amp Moussa A Pre-operative analgesia with rectal diclofenac andor paracetamol in children undergoing hernia repair Anaesthesia 2007 Dec62(12)1241-5
81 Hiller A Meretoja OA Korpela R et al The Anagesic Efficacy of Acetaminophen Ketoprofen or Their Combination for Pediatric Surgical Patients Having Soft Tissue or Orthopedic Procedures Anesth Analg 20061021365-71
82 Norsk legemiddelharingndbok Antidoter ndash alfabetisk oversikt bruksomraringde og dosering httplegemiddelhandbokanoGenerelle153557i153779
83 Norsk legemiddelharingndbok Barn og legemidler httplegemiddelhandbokanoGenerelle153109
84 SickKids Aboutkidshealthca Myths About Pain httpwwwaboutkidshealthcaEnResourceCentresPainPainAssessmentPagesMyths-About-Painaspx
85 Psykososial preoperativ forberedelse av barn 0ndash18 aringr httpwwwhelsebiblioteketnomicrositefagprosedyrerfagprosedyrerpsykososial-preoperativ-forberedelse-av-barn-018-C3A5r
86 Twycross A Why Managing Pain in Children Matters in Managing Pain in Children A Clinical Guide (eds ATwycross S J Dowden and E Bruce) Wiley‐Blackwell 2009 Oxford UK doi 1010029781444322743ch1
Metode
Design
Pre-post intervensjonsdesign med kontrollgruppe hvor det maringles ved tre perioder T-1 (baseline) T-2 (1 mnd etter intervensjonen) og T-3 (6 mnd etter intervensjonen)
Utvalg
bull 6 postoperative avdelinger
ndash 6 ulike universitetssykehus
ndash alle helseforetakene i Norge
ndash stoslashrste PO avd som har barn og ungdomspasienter
bull 3 avdelinger til intervensjonen
ndash tilfeldig valgt
ndash cluster randomisering
Faser Aktivitet Fase 1 Kartlegging av kunnskaper
og holdninger hos sykepleierne
Datainnsamling (baseline T-1) bull sposlashrreskjema PNKAS-N bull observasjonsstudie (alle avd) bull intervju av barn (10 barnavd ndash 2 avd)
Fase 2 Utvikling og gjennomfoslashring av intervensjonen
Utvikle intervensjon basert paring bull tidligere forskning bull resultatene fra baseline data bull tilbakemelding fra fag og ledelse Intervensjon bull temadag (undervisning og workshop) bull klinisk veiledning og reminders
Fase 3 Implementering og evaluering av intervensjonen
Datainnsamling (T-2 og T-3) 1 mnd og 6 mnd etter intervensjon sposlashrreskjema PNKAS-N (alle avd) observasjonsstudie (4 avd T-22 avd T-3) intervju av barn (10 barnavd - 2 avd T2)
Studien delt opp i 3 faser
Flowchart
Fase 1 Kartlegging
Forskningssposlashrsmaringl bull Hvilke kunnskaper og holdninger har sykepleiere til smerte hos barn og
ungdom
bull Hvordan praktiserer sykepleiere smerteharingndtering i postoperative avdelinger
bull Hva er barnas opplevelse av postoperativ smertebehandling
Datainnsamling bull Sposlashrreskjema PNKAS-N (alle avdelingene)
bull Observasjonsstudie (alle avdelingene)
bull Intervju av barn (to avdelinger)
Sposlashrreskjemaet bull Pediatric Nurses Knowledge and Attitudes Survey- Norsk
versjon (PNKAS-N)
ndash PNKAS-N bygger paring bull World Health Organization (WHO)
bull American Pain Society (APS)
bull The Agency for Health Care Policy and Research (AHCRP)
ndash PNKAS-N bestaringr av 40 sposlashrsmaringl bull 23 sposlashrsmaringlene er paringstander (santusant)
bull 13 er laquomultiple choiceraquo
bull fire casesposlashrsmaringl knyttet til pasienthistorier
bull Instrumentet ble oversatt til norsk og validert av Hovde i 2009
Observasjonsstudie
bull Ikke deltakende observasjon
bull Semistrukturert
bull Observasjons sjekkliste og feltnotater ndash Smertevurdering
ndash Ikke medikamentell smertelindring
ndash Medikamentell smertelindring
bull Pilottestet
bull Ca 6 tdag i 10 dager (ca 60 timer pr avd 360 timer totalt)
Intervju med barn
bull Semistrukturert
bull Intervjuguider (6-11 12-18) ndash Smerteopplevelsen
ndash Smertevurdering
ndash Ikke medikamentell smertelindring
ndash Medikamentell smertelindring
bull Pilottestet
bull Barn 6-18 aringr
bull 10 barnavd ndash to avdelinger (kontrollgruppeintervensjonsgruppe)
Fase 2 Utvikling av intervensjon
Baseres paring tidligere forskning resultatene fra fase 1 samt tilbakemeldinger fra fag og seksjonsledere
Intervensjonen bestod av
bullTemadag (seks timer)
ndash Undervisning og workshop
ndash Sykepleiere og leger
ndash Stefan Lundeberg og Hanne Reinertsen
bullVeiledning i praksis
ndash Klinisk veiledning i smertebehandling av barn
ndash Eva Carlsen
bullReminders
Fase 3 Evaluering av intervensjonen
Forskningssposlashrsmaringl
Vil intervensjonen oslashke sykepleieres kunnskaper og holdninger til smerte hos barn og ungdom
Vil intervensjonen bedre sykepleieres smerteharingndtering av barn og ungdom
Datainnsamling
bullT-2 1 mnd etter intervensjonen bull Sposlashrreskjema PKNAS-N (alle avd)
bull Observasjonsstudie (fire avd)
bull Intervju av barn (to avd)
bullT-3 6 mnd etter intervensjonen bull Sposlashrreskjema PKNAS-N (alle avd)
bull Observasjonsstudie (to avd)
Fremdriftsplan
Forarbeid November 2013 - juni 2014
Datainnsamling September - november 2014 T-1
Januar ndash februar 2015 Intervensjon
Mars ndash april 2015 T-2
September ndash oktober 2015 T-3
Analyse September 2015 - juli 2016
Artikkelskriving Januar ndash august 2015 artikkel 1
November 2015 ndash juni 2016 artikkel 2
August ndash desember 2016 artikkel 3
Tusen takk
Oppsummering Prosjektet er stoslashttet av
Nasjonalt kompetansenettverk for legemidler til barn
Kirurgisk avdeling for barn OUS
Norsk Sykepleierforbund
Sykehusbarn
Litteraturliste 1 Hauer J Jones BL amp Wolfe J Poplack D G Kim M S (2015) Evaluation and management of pain in children UpToDate httpwwwuptodatecomcontentsevaluation-
and-management-of-pain-in-childrensource=search_resultampsearch=PAIN+CHILDRENampselectedTitle=17E150
2 IASP (2011c) Acute Pain management in Newborn Infants Pain [Online] Tilgjengelig paring httpiaspfilescms-pluscomContentContentFoldersPublications2PainClinicalUpdatesArchivesPCU_19-6_final_12-8-11_1390260191290_1pdf [Lastet 14april 2014]
3 Bernadi M Catania G amp Tridello G (2007) Knowledge and attitudes about cancer pain management a national survey of Italian hospice nurses Cancer Nurs 30(2) E20-6
4 Coulling S (2005) Nurses and doctors knowledge of pain after surgery Nurs Stand 19(34) 41-49
5 Hovde K R Granheim T H Christophersen K-A amp Dihle A (2012) The Norwegian Version of the Pediatric Nursesrsquo Knowledge and attitudes Survey Regarding Pain Reliability and Validity Pedatric nursing 38 (5) 264-269
6 Hossain S (2010) Nursesrsquo Knowledge and Attitudes and Pain Management Practice of Post-Operative Children in Bangladesh Prince of Songkla University Nedlastet fra httpkbpsuacthpsukbbitstream201078261325999pdf
7 Huth M M Gregg T L Lin L (2010) Education changes Mexican nurses knowledge and attitudes regarding pediatric pain Pain Manag Nurs Dec11(4)201-8 doi 101016jpmn200911001
8 Lewthwaite B J Jabusch K M Wheeler B J Schnell-Hoehn K N Mills J Estrella-Holder E Fedorowicz A (2011) Nurses knowledge and attitudes regarding pain management in hospitalized adults J Contin Educ Nurs 42(6) 251-7 doi 10392800220124-20110103-03 Epub 2011 Jan 10
9 Manworren RC (2000) Pediatric nursesrsquo knowledge and attitudes survey regarding pain Pediatr Nurs 26 610-614
10 Rieman M T Gordon M amp Marvin J M (2007) Pediatric nursesrsquo knowledge and attitudes survey regarding pain a competency tool modification Pediatr Nurs 33 303-306
11 Simons JM amp MacDonald LM (2004) Pain assessment tools childrenrsquos nursesrsquo views Journal of Child Health Care 8 264 Doi 1011771367493504047317
12 Twycross A (2007) What is the impact of theoretical knowledge on childrenrsquos nursesrsquo post-operative pain management practices an exploratory study Nurse Educ Today 27 697-707
13 Smart S (2005) POST-OPERATIVE PAIN MANAGEMENT KNOWLEDGE AND ATTITUDES OF PAEDIATRIC NURSES- A NEW ZEALAND REGIONAL VIEW Victoria University of Wellington [Online] Tilgjengelig paring httpresearcharchivevuwacnzbitstreamhandle1006338thesispdfsequence=2 [Lastet 13april 2014]
14 Vincent C V H (2005) Nursesrsquo knowledge attitudes and practices regarding childrenrsquos pain MCN Am J Matern Child Nurs 30 177-183
15 Olsson G Jylli L (2001) Smaumlrta hos barn och ungdomar Lund Sverige Studentlitteratur
16 Peters J W Schouw R Anand K J van Dijk M Duivenvoorden H J Tibboel D (2005) Does neonatal surgery lead to increased pain sensitivity in later childhood Pain 114(3) 444-54
17 Anand K J S Gracia-Preats J A amp Kim M S (2015) Assessment of neonatal pain UpToDate httpwwwuptodatecomcontentsassessment-of-neonatal-pain
18 Anand K J S Gracia-Preats J A amp Kim M S (2015) Prevention and treatment of neonatal pain UpToDate httpwwwuptodatecomcontentsprevention-and-treatment-of-neonatal-painsource=related_link
19 IASP (2011a) Acute Pain and Surgery Global Year Against Acute Pain [Online] Tilgjengelig paring httpwwwiasp-painorgfilesContentContentFoldersGlobalYearAgainstPain2AcutePainFactSheets7-Surgerypdf [Lastet 14april 2014]
20 Howard R Carter B Curry J Jain A Liossi C Morton N Rivett K Rose M Tyrrell J Walker S Williams G (2012) Good Practice in Postoperative and Procedural pain management 2nd Edition Pediatric Anesthesia 22 1ndash79 doi 101111j1460-9592201203838x
21 IASP (2011b) Interventions Benefits and Barriers Global Year Against Acute Pain [Online] Tilgjengelig paring httpwwwiasp-painorgfilesContentContentFoldersGlobalYearAgainstPain2AcutePainFactSheets2-Interventionspdf [Lastet 14april 2014]
22 Benhamou D Berti M Brodner G De Andres J Draisci G Moreno-Azcoita M Neugebauer EA Schwenk W Torres LM Viel E (2007) Postoperative Analgesic THerapy Observational Survey (PATHOS) A practice pattern study in 7 CentralSouthern Eurpean countries Pain 136 134-141
23 Reinertsen H (2008) Smerte hos barn kap3I Rustoslashen T amp Wahl AK (red) Ulike tekster om smerte - fra nocisepsjon til livskvalitet Oslo Gyldendal Norsk Forlag AS
Litteraturliste 24 Smeland A amp Reinertsen H (2012) Smertevurdering og behandling av postoperative smerter hos barn Tidsskriftet Kirurgen 1 58-62 (5 s) [Online] Tilgjengelig paring
httpwwwkirurgennopdf1201 [Lastet 13april 2014]
25 Bringuier S Picot MC Dadure C et al (2009) A prospective comparison of post-surgical behavioral pain scales in preschoolers highlighting the risk of false evaluations Pain 145 60-68
26 Crelline D Sullivan T B Babl F E OSullivan R Hutchinson A (2007) Analysis of the validation of existing behavioral pain and distress scales for use in the procedural setting Pediatric Anesthesia 17 720-733
27 Ghai B Makkar JK amp Wig J (2008) Postoperative pain assessment in preverbal children and children with cognitive impairment Pediatric Anesthesia 18 462-477
28 Hicks CL von Baeyer CL Spafford P et al (2001) The Faces Pain Scale-Revised Toward a common metric in pain measurement Pain 93 173-183
29 Merkel SI Voepel-Lewis T amp Shayevitz et al (1997) The FLACC A Behavioral Scale for Scoring Postoperative Pain in Young Children Pediatric Nursing 23 293-7
30 Ellis J A McCleary L Blouin R Dube K Rowley B MacNeil M amp Cooke C (2007) Implementing best practice pain management in a pediatric hospital Journal for Specialists in Pediatric Nursing 12 264-277 doi101111j1744-6155200700121x
31 Johnston C C Gagnon A Rennick J Rosmus C Patenaude H Ellis J Shapiro C Filion F Ritchie J Byron J (2007) One-on-one coaching to improve pain assessment and management practices of pediatric nurses Journal of Pediatric Nursing 22 467-478 doi101016jpedn200707004
32 Le May S Johnston C C Choiniegravere M Fortin C Kudirka D Murray L Chalut D (2009) Pain Management Practices in a Pediatric Emergency Room (PAMPER) Study interventions with nurses Pediatr Emerg Care Aug25(8)498-503 doi 101097PEC0b013e3181b0a0af
33 Vincent C V H Wilkie D J amp Wang E (2011) Pediatric Nurses Beliefs and Pain Management Practices An Intervention Pilot West J Nurs Res 33 825 originally published online 20 December 2010
36 Twycross A Finley G A and Latimer M (2013) Pediatric nurses postoperative pain management practices An observational study Journal for Specialists in Pediatric Nursing 18 189ndash201 doi 101111jspn12026
42 Twycross A amp Finley G A (2013) Childrens and parents perceptions of postoperative pain management a mixed methods study Journal of Clinical Nursing 22(21-22) 3095-3108 doi 101111jocn12152 [Online] Tilgjengelig paring httponlinelibrarywileycomdoi101111jocn12152pdf (13042014)
43 Polkki T Pietila AM Vehvilainen-Julkunen K (2003) Hospitalized childrens descriptions of their experiences with postsurgical pain relieving methods Int J Nurs Stud Jan40(1)33-44 PubMed PMID 12550148 English
46 Abdalrahim MS Majali SA Stomberg MW Bergbom I (2011) The effect of postoperative pain management program on improving nurses knowledge and attitudes toward pain Nurse Educ Pract 2011 Jul11(4)250-5 doi 101016jnepr201011016 Epub 2010 Dec 24 httpwwwncbinlmnihgovpubmed21186139
47 IASP Pain definition IASP (International Association of the Study of Pain) Pain definition
48 Norsk Ledemiddelharingndbok Ulike smertetilstander [Online] Tilgjengelig paring httplegemiddelhandbokanoTerapi22816expand=1
49 Astrid Lindgrens Barnsjukhus ndash Riktlinjer foumlr smaumlrtbehandling
50 Groslashnseth R amp Markestad T (2011) Pediatri og pediatrisk sykepleie Bergen Fagbokforlaget Vigmostad amp Bjoslashrke AS httppediatriportfoliono
51 Hicks CL von Baeyer CL Spafford Pet al The Faces Pain Scale‐Revised Toward a common metric in pain measurement Pain 2001 93173‐183
52 Twycross A Why Managing Pain in Children Matters in Managing Pain in Children A Clinical Guide (eds A Twycross S J Dowden and E Bruce) Wiley‐Blackwell 2009 Oxford UK doi 1010029781444322743ch1
53 Von Bayer CL amp Spagrud LJ Systematic review of observational (behavioral) measures of pain for children and adolescents aged 3 to 18 years Pain 2007 127 140‐150
54 Voepel‐Lewis Terri RN MSN ZanottiJennifer RN MS CCRN CEN DammeyerJennifer A RN MSN and MerkelSandra RN MS (January 2010) Reliability and Validity of the Face Legs Activity Cry Consolability Behavioral Tool in Assessing Acute Pain in Critically Ill Patients American Journal of Critical Care 19 (1) 55ndash61
55 Merkel S Voepel‐Lewis T Shayevitz JR et al The FLACC A behavioural scale for scoring postoperative pain in young children Pediatric nursing 1997 23293‐797
56 McCaffery M amp Beebe F (1994) Pain‐Clinical Manual of for Nursing Practice Times Mirror International Publishers Ltd Norsk oversettelse Smerter Laeligrebok for helsepersonell Oslo Norge Gyldendal Norsk Forlag AS
57 Reinertsen H Christophersen K‐A Helseth S Vurdering av postoperativ smerte hos barn (0‐5 aringr) Validering og reliabilitetstesting av smertevurderingsverktoslashyet FLACC Sykepleien Forskning 2014 9 132‐140 httpwwwsykepleiennoforskningforskningsartikkel1466655validering‐og‐reliabilitetstesting‐av‐smertevurderingsverktoyet‐flacc
Litteraturliste 58 Stinson J (2009) Pain Assessment I Twycross A Dowden S J amp Bruce E Pain Assessment in Managing Pain in Children A Clinical Guide Oxford UK Wiley-Blackmell
59 Tomlinson D von Baeyer CL Stinson JN Sung L A systematic review of faces scales for the self‐report of pain intensity in children Pediatrics 2010 Nov126(5)e1168‐98 PubMed PMID 20921070 Epub 20101006 eng
60 Von Baeyer CL Childrens self‐reports of pain intensity scale selection limitations and interpretation Pain Res Manag 2006 Autumn11(3)157‐62 PubMed PMID 16960632 Pubmed Central PMCID PMC2539005 Epub 20060909 eng
61 Ghai B Makkar J K amp Wig J (2008) Postoperative pain assesment in preverbal children and children with cognitive impairment Pediatric Anesthesia 18 462‐477
62 Malvia S Voepel‐Lewis T Tait A R Merkel S Lauer A Munro H Farley F (2001) Pain management in children with and without cognitive impairment following spine fusion surgery Pediatric Anasthesia 11 453‐458
63 Malvia S Voepel‐Lewis T Burke C Merkel S amp Tait A R (2006) The revised FLACC observational pain tool improved reliability and validity for pain assesment in children with cognitive impairment Pediatric Anestesia 16 258‐265
64 McJunkins A Green A amp Anand KJS (2010) Pain Assesment in cognitively Impared Functionally Impared Children Pilot Study Results Journal of Pediatric Nursing 25 307‐309
65 McKearnan K A Kieckhefer G Engel J M Jensen M amp Labyak S (2004) Pain in Children with cerebral Palsy A Review Journal of Neuroscience Nursing Vol 36 no 5 s252‐259
66 Voepel‐Lewis T Malviya S Tait A Merkel S Forter R amp Krane E (2008) A comparison of the clinical utility of pain assesment tools for children with cognitive impairment Pediatric Anesthesiology 106 (1) 72‐78
67 Baulch I Assessment and management of pain in the paediatric patient Nursing standard 2010 2510 35-40
68 Twycross A Why Managing Pain in Children Matters in Managing Pain in Children A Clinical Guide (eds A Twycross S J Dowden and E Bruce) Wiley-Blackwell 2009 Oxford UK doi 1010029781444322743ch1
69 Schug SA amp Pogatzki-Zhan EM Chronic Pain after Surgery or Injury Pain 2011 Clinical Updates XIX 11-5
70 Fredheim OMS Borchgrevink PC amp Kvarstein G Behandling av postoperativ smerte i sykehus Tidsskr Nor Legeforen 2011 131 1772-6
71 Steward DL Welge J amp Myer C Steroids for improving recovery following tonsillectomy in children Cochrane Database of Systematic Reviews 2003 Issue 1Art NoCD003997 DOI10100214651858CD003997
72 Hong JY Han SW Kim WO et al Effect of dexamethasone in combination with caudal analgesia on postoperative pain control in day-case paediatric orchioplexy British Journal of Anesthesia 2010 105(4)506-10
73 Den Norske Legeforening (2009) Retningslinjer for smertelindring [Online] URL httpwww legeforeningennoasset42585142585_1pdf
74 Association of Paediatric Anaesthetists (2008) Good Practice in Postoperative and Procedural Pain [Online] URL httpwwwbritishpainsocietyorgbook_apa_part1pdf
75 European Society of Regional Aneasthesia (2005) Postoperative Pain Management ndash Good Clinical Practice General recommendations and principles for successful pain management [Online] URL httpwwwesraeuropeorgPostoperativePainManagementpdf
76 Monsen ALB Skadberg BT amp Groslashnlie I Smertebehandling Norsk Barnelegeforeningen 2011 [Online] URL httpwwwlegeforeningennoid1104250
77 Smeland A amp Reinertsen H (2012) Smertevurdering og behandling av postoperative smerter hos barn Tidsskriftet Kirurgen 1 58-62 (5 s) [Online] Tilgjengelig paring httpwwwkirurgennopdf1201
78 Standing JF Savage I Pritchard D et al Diclofenac for acute pain in children Cochrane Database of Systematic Reviews 2009 Issue 4 Art No CD005538 DOI 10100214651858CD005538pub2
79 Standing JF Tibboel D Korpela R et al Diclofenac pharmacokinetic meta-analysis and dose recommendations for surgical pain in children aged 1ndash12 years Pediatric Anesthesia 2011 21 316ndash324 doi 101111j1460-9592201003509x
80 Riad W amp Moussa A Pre-operative analgesia with rectal diclofenac andor paracetamol in children undergoing hernia repair Anaesthesia 2007 Dec62(12)1241-5
81 Hiller A Meretoja OA Korpela R et al The Anagesic Efficacy of Acetaminophen Ketoprofen or Their Combination for Pediatric Surgical Patients Having Soft Tissue or Orthopedic Procedures Anesth Analg 20061021365-71
82 Norsk legemiddelharingndbok Antidoter ndash alfabetisk oversikt bruksomraringde og dosering httplegemiddelhandbokanoGenerelle153557i153779
83 Norsk legemiddelharingndbok Barn og legemidler httplegemiddelhandbokanoGenerelle153109
84 SickKids Aboutkidshealthca Myths About Pain httpwwwaboutkidshealthcaEnResourceCentresPainPainAssessmentPagesMyths-About-Painaspx
85 Psykososial preoperativ forberedelse av barn 0ndash18 aringr httpwwwhelsebiblioteketnomicrositefagprosedyrerfagprosedyrerpsykososial-preoperativ-forberedelse-av-barn-018-C3A5r
86 Twycross A Why Managing Pain in Children Matters in Managing Pain in Children A Clinical Guide (eds ATwycross S J Dowden and E Bruce) Wiley‐Blackwell 2009 Oxford UK doi 1010029781444322743ch1
Utvalg
bull 6 postoperative avdelinger
ndash 6 ulike universitetssykehus
ndash alle helseforetakene i Norge
ndash stoslashrste PO avd som har barn og ungdomspasienter
bull 3 avdelinger til intervensjonen
ndash tilfeldig valgt
ndash cluster randomisering
Faser Aktivitet Fase 1 Kartlegging av kunnskaper
og holdninger hos sykepleierne
Datainnsamling (baseline T-1) bull sposlashrreskjema PNKAS-N bull observasjonsstudie (alle avd) bull intervju av barn (10 barnavd ndash 2 avd)
Fase 2 Utvikling og gjennomfoslashring av intervensjonen
Utvikle intervensjon basert paring bull tidligere forskning bull resultatene fra baseline data bull tilbakemelding fra fag og ledelse Intervensjon bull temadag (undervisning og workshop) bull klinisk veiledning og reminders
Fase 3 Implementering og evaluering av intervensjonen
Datainnsamling (T-2 og T-3) 1 mnd og 6 mnd etter intervensjon sposlashrreskjema PNKAS-N (alle avd) observasjonsstudie (4 avd T-22 avd T-3) intervju av barn (10 barnavd - 2 avd T2)
Studien delt opp i 3 faser
Flowchart
Fase 1 Kartlegging
Forskningssposlashrsmaringl bull Hvilke kunnskaper og holdninger har sykepleiere til smerte hos barn og
ungdom
bull Hvordan praktiserer sykepleiere smerteharingndtering i postoperative avdelinger
bull Hva er barnas opplevelse av postoperativ smertebehandling
Datainnsamling bull Sposlashrreskjema PNKAS-N (alle avdelingene)
bull Observasjonsstudie (alle avdelingene)
bull Intervju av barn (to avdelinger)
Sposlashrreskjemaet bull Pediatric Nurses Knowledge and Attitudes Survey- Norsk
versjon (PNKAS-N)
ndash PNKAS-N bygger paring bull World Health Organization (WHO)
bull American Pain Society (APS)
bull The Agency for Health Care Policy and Research (AHCRP)
ndash PNKAS-N bestaringr av 40 sposlashrsmaringl bull 23 sposlashrsmaringlene er paringstander (santusant)
bull 13 er laquomultiple choiceraquo
bull fire casesposlashrsmaringl knyttet til pasienthistorier
bull Instrumentet ble oversatt til norsk og validert av Hovde i 2009
Observasjonsstudie
bull Ikke deltakende observasjon
bull Semistrukturert
bull Observasjons sjekkliste og feltnotater ndash Smertevurdering
ndash Ikke medikamentell smertelindring
ndash Medikamentell smertelindring
bull Pilottestet
bull Ca 6 tdag i 10 dager (ca 60 timer pr avd 360 timer totalt)
Intervju med barn
bull Semistrukturert
bull Intervjuguider (6-11 12-18) ndash Smerteopplevelsen
ndash Smertevurdering
ndash Ikke medikamentell smertelindring
ndash Medikamentell smertelindring
bull Pilottestet
bull Barn 6-18 aringr
bull 10 barnavd ndash to avdelinger (kontrollgruppeintervensjonsgruppe)
Fase 2 Utvikling av intervensjon
Baseres paring tidligere forskning resultatene fra fase 1 samt tilbakemeldinger fra fag og seksjonsledere
Intervensjonen bestod av
bullTemadag (seks timer)
ndash Undervisning og workshop
ndash Sykepleiere og leger
ndash Stefan Lundeberg og Hanne Reinertsen
bullVeiledning i praksis
ndash Klinisk veiledning i smertebehandling av barn
ndash Eva Carlsen
bullReminders
Fase 3 Evaluering av intervensjonen
Forskningssposlashrsmaringl
Vil intervensjonen oslashke sykepleieres kunnskaper og holdninger til smerte hos barn og ungdom
Vil intervensjonen bedre sykepleieres smerteharingndtering av barn og ungdom
Datainnsamling
bullT-2 1 mnd etter intervensjonen bull Sposlashrreskjema PKNAS-N (alle avd)
bull Observasjonsstudie (fire avd)
bull Intervju av barn (to avd)
bullT-3 6 mnd etter intervensjonen bull Sposlashrreskjema PKNAS-N (alle avd)
bull Observasjonsstudie (to avd)
Fremdriftsplan
Forarbeid November 2013 - juni 2014
Datainnsamling September - november 2014 T-1
Januar ndash februar 2015 Intervensjon
Mars ndash april 2015 T-2
September ndash oktober 2015 T-3
Analyse September 2015 - juli 2016
Artikkelskriving Januar ndash august 2015 artikkel 1
November 2015 ndash juni 2016 artikkel 2
August ndash desember 2016 artikkel 3
Tusen takk
Oppsummering Prosjektet er stoslashttet av
Nasjonalt kompetansenettverk for legemidler til barn
Kirurgisk avdeling for barn OUS
Norsk Sykepleierforbund
Sykehusbarn
Litteraturliste 1 Hauer J Jones BL amp Wolfe J Poplack D G Kim M S (2015) Evaluation and management of pain in children UpToDate httpwwwuptodatecomcontentsevaluation-
and-management-of-pain-in-childrensource=search_resultampsearch=PAIN+CHILDRENampselectedTitle=17E150
2 IASP (2011c) Acute Pain management in Newborn Infants Pain [Online] Tilgjengelig paring httpiaspfilescms-pluscomContentContentFoldersPublications2PainClinicalUpdatesArchivesPCU_19-6_final_12-8-11_1390260191290_1pdf [Lastet 14april 2014]
3 Bernadi M Catania G amp Tridello G (2007) Knowledge and attitudes about cancer pain management a national survey of Italian hospice nurses Cancer Nurs 30(2) E20-6
4 Coulling S (2005) Nurses and doctors knowledge of pain after surgery Nurs Stand 19(34) 41-49
5 Hovde K R Granheim T H Christophersen K-A amp Dihle A (2012) The Norwegian Version of the Pediatric Nursesrsquo Knowledge and attitudes Survey Regarding Pain Reliability and Validity Pedatric nursing 38 (5) 264-269
6 Hossain S (2010) Nursesrsquo Knowledge and Attitudes and Pain Management Practice of Post-Operative Children in Bangladesh Prince of Songkla University Nedlastet fra httpkbpsuacthpsukbbitstream201078261325999pdf
7 Huth M M Gregg T L Lin L (2010) Education changes Mexican nurses knowledge and attitudes regarding pediatric pain Pain Manag Nurs Dec11(4)201-8 doi 101016jpmn200911001
8 Lewthwaite B J Jabusch K M Wheeler B J Schnell-Hoehn K N Mills J Estrella-Holder E Fedorowicz A (2011) Nurses knowledge and attitudes regarding pain management in hospitalized adults J Contin Educ Nurs 42(6) 251-7 doi 10392800220124-20110103-03 Epub 2011 Jan 10
9 Manworren RC (2000) Pediatric nursesrsquo knowledge and attitudes survey regarding pain Pediatr Nurs 26 610-614
10 Rieman M T Gordon M amp Marvin J M (2007) Pediatric nursesrsquo knowledge and attitudes survey regarding pain a competency tool modification Pediatr Nurs 33 303-306
11 Simons JM amp MacDonald LM (2004) Pain assessment tools childrenrsquos nursesrsquo views Journal of Child Health Care 8 264 Doi 1011771367493504047317
12 Twycross A (2007) What is the impact of theoretical knowledge on childrenrsquos nursesrsquo post-operative pain management practices an exploratory study Nurse Educ Today 27 697-707
13 Smart S (2005) POST-OPERATIVE PAIN MANAGEMENT KNOWLEDGE AND ATTITUDES OF PAEDIATRIC NURSES- A NEW ZEALAND REGIONAL VIEW Victoria University of Wellington [Online] Tilgjengelig paring httpresearcharchivevuwacnzbitstreamhandle1006338thesispdfsequence=2 [Lastet 13april 2014]
14 Vincent C V H (2005) Nursesrsquo knowledge attitudes and practices regarding childrenrsquos pain MCN Am J Matern Child Nurs 30 177-183
15 Olsson G Jylli L (2001) Smaumlrta hos barn och ungdomar Lund Sverige Studentlitteratur
16 Peters J W Schouw R Anand K J van Dijk M Duivenvoorden H J Tibboel D (2005) Does neonatal surgery lead to increased pain sensitivity in later childhood Pain 114(3) 444-54
17 Anand K J S Gracia-Preats J A amp Kim M S (2015) Assessment of neonatal pain UpToDate httpwwwuptodatecomcontentsassessment-of-neonatal-pain
18 Anand K J S Gracia-Preats J A amp Kim M S (2015) Prevention and treatment of neonatal pain UpToDate httpwwwuptodatecomcontentsprevention-and-treatment-of-neonatal-painsource=related_link
19 IASP (2011a) Acute Pain and Surgery Global Year Against Acute Pain [Online] Tilgjengelig paring httpwwwiasp-painorgfilesContentContentFoldersGlobalYearAgainstPain2AcutePainFactSheets7-Surgerypdf [Lastet 14april 2014]
20 Howard R Carter B Curry J Jain A Liossi C Morton N Rivett K Rose M Tyrrell J Walker S Williams G (2012) Good Practice in Postoperative and Procedural pain management 2nd Edition Pediatric Anesthesia 22 1ndash79 doi 101111j1460-9592201203838x
21 IASP (2011b) Interventions Benefits and Barriers Global Year Against Acute Pain [Online] Tilgjengelig paring httpwwwiasp-painorgfilesContentContentFoldersGlobalYearAgainstPain2AcutePainFactSheets2-Interventionspdf [Lastet 14april 2014]
22 Benhamou D Berti M Brodner G De Andres J Draisci G Moreno-Azcoita M Neugebauer EA Schwenk W Torres LM Viel E (2007) Postoperative Analgesic THerapy Observational Survey (PATHOS) A practice pattern study in 7 CentralSouthern Eurpean countries Pain 136 134-141
23 Reinertsen H (2008) Smerte hos barn kap3I Rustoslashen T amp Wahl AK (red) Ulike tekster om smerte - fra nocisepsjon til livskvalitet Oslo Gyldendal Norsk Forlag AS
Litteraturliste 24 Smeland A amp Reinertsen H (2012) Smertevurdering og behandling av postoperative smerter hos barn Tidsskriftet Kirurgen 1 58-62 (5 s) [Online] Tilgjengelig paring
httpwwwkirurgennopdf1201 [Lastet 13april 2014]
25 Bringuier S Picot MC Dadure C et al (2009) A prospective comparison of post-surgical behavioral pain scales in preschoolers highlighting the risk of false evaluations Pain 145 60-68
26 Crelline D Sullivan T B Babl F E OSullivan R Hutchinson A (2007) Analysis of the validation of existing behavioral pain and distress scales for use in the procedural setting Pediatric Anesthesia 17 720-733
27 Ghai B Makkar JK amp Wig J (2008) Postoperative pain assessment in preverbal children and children with cognitive impairment Pediatric Anesthesia 18 462-477
28 Hicks CL von Baeyer CL Spafford P et al (2001) The Faces Pain Scale-Revised Toward a common metric in pain measurement Pain 93 173-183
29 Merkel SI Voepel-Lewis T amp Shayevitz et al (1997) The FLACC A Behavioral Scale for Scoring Postoperative Pain in Young Children Pediatric Nursing 23 293-7
30 Ellis J A McCleary L Blouin R Dube K Rowley B MacNeil M amp Cooke C (2007) Implementing best practice pain management in a pediatric hospital Journal for Specialists in Pediatric Nursing 12 264-277 doi101111j1744-6155200700121x
31 Johnston C C Gagnon A Rennick J Rosmus C Patenaude H Ellis J Shapiro C Filion F Ritchie J Byron J (2007) One-on-one coaching to improve pain assessment and management practices of pediatric nurses Journal of Pediatric Nursing 22 467-478 doi101016jpedn200707004
32 Le May S Johnston C C Choiniegravere M Fortin C Kudirka D Murray L Chalut D (2009) Pain Management Practices in a Pediatric Emergency Room (PAMPER) Study interventions with nurses Pediatr Emerg Care Aug25(8)498-503 doi 101097PEC0b013e3181b0a0af
33 Vincent C V H Wilkie D J amp Wang E (2011) Pediatric Nurses Beliefs and Pain Management Practices An Intervention Pilot West J Nurs Res 33 825 originally published online 20 December 2010
36 Twycross A Finley G A and Latimer M (2013) Pediatric nurses postoperative pain management practices An observational study Journal for Specialists in Pediatric Nursing 18 189ndash201 doi 101111jspn12026
42 Twycross A amp Finley G A (2013) Childrens and parents perceptions of postoperative pain management a mixed methods study Journal of Clinical Nursing 22(21-22) 3095-3108 doi 101111jocn12152 [Online] Tilgjengelig paring httponlinelibrarywileycomdoi101111jocn12152pdf (13042014)
43 Polkki T Pietila AM Vehvilainen-Julkunen K (2003) Hospitalized childrens descriptions of their experiences with postsurgical pain relieving methods Int J Nurs Stud Jan40(1)33-44 PubMed PMID 12550148 English
46 Abdalrahim MS Majali SA Stomberg MW Bergbom I (2011) The effect of postoperative pain management program on improving nurses knowledge and attitudes toward pain Nurse Educ Pract 2011 Jul11(4)250-5 doi 101016jnepr201011016 Epub 2010 Dec 24 httpwwwncbinlmnihgovpubmed21186139
47 IASP Pain definition IASP (International Association of the Study of Pain) Pain definition
48 Norsk Ledemiddelharingndbok Ulike smertetilstander [Online] Tilgjengelig paring httplegemiddelhandbokanoTerapi22816expand=1
49 Astrid Lindgrens Barnsjukhus ndash Riktlinjer foumlr smaumlrtbehandling
50 Groslashnseth R amp Markestad T (2011) Pediatri og pediatrisk sykepleie Bergen Fagbokforlaget Vigmostad amp Bjoslashrke AS httppediatriportfoliono
51 Hicks CL von Baeyer CL Spafford Pet al The Faces Pain Scale‐Revised Toward a common metric in pain measurement Pain 2001 93173‐183
52 Twycross A Why Managing Pain in Children Matters in Managing Pain in Children A Clinical Guide (eds A Twycross S J Dowden and E Bruce) Wiley‐Blackwell 2009 Oxford UK doi 1010029781444322743ch1
53 Von Bayer CL amp Spagrud LJ Systematic review of observational (behavioral) measures of pain for children and adolescents aged 3 to 18 years Pain 2007 127 140‐150
54 Voepel‐Lewis Terri RN MSN ZanottiJennifer RN MS CCRN CEN DammeyerJennifer A RN MSN and MerkelSandra RN MS (January 2010) Reliability and Validity of the Face Legs Activity Cry Consolability Behavioral Tool in Assessing Acute Pain in Critically Ill Patients American Journal of Critical Care 19 (1) 55ndash61
55 Merkel S Voepel‐Lewis T Shayevitz JR et al The FLACC A behavioural scale for scoring postoperative pain in young children Pediatric nursing 1997 23293‐797
56 McCaffery M amp Beebe F (1994) Pain‐Clinical Manual of for Nursing Practice Times Mirror International Publishers Ltd Norsk oversettelse Smerter Laeligrebok for helsepersonell Oslo Norge Gyldendal Norsk Forlag AS
57 Reinertsen H Christophersen K‐A Helseth S Vurdering av postoperativ smerte hos barn (0‐5 aringr) Validering og reliabilitetstesting av smertevurderingsverktoslashyet FLACC Sykepleien Forskning 2014 9 132‐140 httpwwwsykepleiennoforskningforskningsartikkel1466655validering‐og‐reliabilitetstesting‐av‐smertevurderingsverktoyet‐flacc
Litteraturliste 58 Stinson J (2009) Pain Assessment I Twycross A Dowden S J amp Bruce E Pain Assessment in Managing Pain in Children A Clinical Guide Oxford UK Wiley-Blackmell
59 Tomlinson D von Baeyer CL Stinson JN Sung L A systematic review of faces scales for the self‐report of pain intensity in children Pediatrics 2010 Nov126(5)e1168‐98 PubMed PMID 20921070 Epub 20101006 eng
60 Von Baeyer CL Childrens self‐reports of pain intensity scale selection limitations and interpretation Pain Res Manag 2006 Autumn11(3)157‐62 PubMed PMID 16960632 Pubmed Central PMCID PMC2539005 Epub 20060909 eng
61 Ghai B Makkar J K amp Wig J (2008) Postoperative pain assesment in preverbal children and children with cognitive impairment Pediatric Anesthesia 18 462‐477
62 Malvia S Voepel‐Lewis T Tait A R Merkel S Lauer A Munro H Farley F (2001) Pain management in children with and without cognitive impairment following spine fusion surgery Pediatric Anasthesia 11 453‐458
63 Malvia S Voepel‐Lewis T Burke C Merkel S amp Tait A R (2006) The revised FLACC observational pain tool improved reliability and validity for pain assesment in children with cognitive impairment Pediatric Anestesia 16 258‐265
64 McJunkins A Green A amp Anand KJS (2010) Pain Assesment in cognitively Impared Functionally Impared Children Pilot Study Results Journal of Pediatric Nursing 25 307‐309
65 McKearnan K A Kieckhefer G Engel J M Jensen M amp Labyak S (2004) Pain in Children with cerebral Palsy A Review Journal of Neuroscience Nursing Vol 36 no 5 s252‐259
66 Voepel‐Lewis T Malviya S Tait A Merkel S Forter R amp Krane E (2008) A comparison of the clinical utility of pain assesment tools for children with cognitive impairment Pediatric Anesthesiology 106 (1) 72‐78
67 Baulch I Assessment and management of pain in the paediatric patient Nursing standard 2010 2510 35-40
68 Twycross A Why Managing Pain in Children Matters in Managing Pain in Children A Clinical Guide (eds A Twycross S J Dowden and E Bruce) Wiley-Blackwell 2009 Oxford UK doi 1010029781444322743ch1
69 Schug SA amp Pogatzki-Zhan EM Chronic Pain after Surgery or Injury Pain 2011 Clinical Updates XIX 11-5
70 Fredheim OMS Borchgrevink PC amp Kvarstein G Behandling av postoperativ smerte i sykehus Tidsskr Nor Legeforen 2011 131 1772-6
71 Steward DL Welge J amp Myer C Steroids for improving recovery following tonsillectomy in children Cochrane Database of Systematic Reviews 2003 Issue 1Art NoCD003997 DOI10100214651858CD003997
72 Hong JY Han SW Kim WO et al Effect of dexamethasone in combination with caudal analgesia on postoperative pain control in day-case paediatric orchioplexy British Journal of Anesthesia 2010 105(4)506-10
73 Den Norske Legeforening (2009) Retningslinjer for smertelindring [Online] URL httpwww legeforeningennoasset42585142585_1pdf
74 Association of Paediatric Anaesthetists (2008) Good Practice in Postoperative and Procedural Pain [Online] URL httpwwwbritishpainsocietyorgbook_apa_part1pdf
75 European Society of Regional Aneasthesia (2005) Postoperative Pain Management ndash Good Clinical Practice General recommendations and principles for successful pain management [Online] URL httpwwwesraeuropeorgPostoperativePainManagementpdf
76 Monsen ALB Skadberg BT amp Groslashnlie I Smertebehandling Norsk Barnelegeforeningen 2011 [Online] URL httpwwwlegeforeningennoid1104250
77 Smeland A amp Reinertsen H (2012) Smertevurdering og behandling av postoperative smerter hos barn Tidsskriftet Kirurgen 1 58-62 (5 s) [Online] Tilgjengelig paring httpwwwkirurgennopdf1201
78 Standing JF Savage I Pritchard D et al Diclofenac for acute pain in children Cochrane Database of Systematic Reviews 2009 Issue 4 Art No CD005538 DOI 10100214651858CD005538pub2
79 Standing JF Tibboel D Korpela R et al Diclofenac pharmacokinetic meta-analysis and dose recommendations for surgical pain in children aged 1ndash12 years Pediatric Anesthesia 2011 21 316ndash324 doi 101111j1460-9592201003509x
80 Riad W amp Moussa A Pre-operative analgesia with rectal diclofenac andor paracetamol in children undergoing hernia repair Anaesthesia 2007 Dec62(12)1241-5
81 Hiller A Meretoja OA Korpela R et al The Anagesic Efficacy of Acetaminophen Ketoprofen or Their Combination for Pediatric Surgical Patients Having Soft Tissue or Orthopedic Procedures Anesth Analg 20061021365-71
82 Norsk legemiddelharingndbok Antidoter ndash alfabetisk oversikt bruksomraringde og dosering httplegemiddelhandbokanoGenerelle153557i153779
83 Norsk legemiddelharingndbok Barn og legemidler httplegemiddelhandbokanoGenerelle153109
84 SickKids Aboutkidshealthca Myths About Pain httpwwwaboutkidshealthcaEnResourceCentresPainPainAssessmentPagesMyths-About-Painaspx
85 Psykososial preoperativ forberedelse av barn 0ndash18 aringr httpwwwhelsebiblioteketnomicrositefagprosedyrerfagprosedyrerpsykososial-preoperativ-forberedelse-av-barn-018-C3A5r
86 Twycross A Why Managing Pain in Children Matters in Managing Pain in Children A Clinical Guide (eds ATwycross S J Dowden and E Bruce) Wiley‐Blackwell 2009 Oxford UK doi 1010029781444322743ch1
Faser Aktivitet Fase 1 Kartlegging av kunnskaper
og holdninger hos sykepleierne
Datainnsamling (baseline T-1) bull sposlashrreskjema PNKAS-N bull observasjonsstudie (alle avd) bull intervju av barn (10 barnavd ndash 2 avd)
Fase 2 Utvikling og gjennomfoslashring av intervensjonen
Utvikle intervensjon basert paring bull tidligere forskning bull resultatene fra baseline data bull tilbakemelding fra fag og ledelse Intervensjon bull temadag (undervisning og workshop) bull klinisk veiledning og reminders
Fase 3 Implementering og evaluering av intervensjonen
Datainnsamling (T-2 og T-3) 1 mnd og 6 mnd etter intervensjon sposlashrreskjema PNKAS-N (alle avd) observasjonsstudie (4 avd T-22 avd T-3) intervju av barn (10 barnavd - 2 avd T2)
Studien delt opp i 3 faser
Flowchart
Fase 1 Kartlegging
Forskningssposlashrsmaringl bull Hvilke kunnskaper og holdninger har sykepleiere til smerte hos barn og
ungdom
bull Hvordan praktiserer sykepleiere smerteharingndtering i postoperative avdelinger
bull Hva er barnas opplevelse av postoperativ smertebehandling
Datainnsamling bull Sposlashrreskjema PNKAS-N (alle avdelingene)
bull Observasjonsstudie (alle avdelingene)
bull Intervju av barn (to avdelinger)
Sposlashrreskjemaet bull Pediatric Nurses Knowledge and Attitudes Survey- Norsk
versjon (PNKAS-N)
ndash PNKAS-N bygger paring bull World Health Organization (WHO)
bull American Pain Society (APS)
bull The Agency for Health Care Policy and Research (AHCRP)
ndash PNKAS-N bestaringr av 40 sposlashrsmaringl bull 23 sposlashrsmaringlene er paringstander (santusant)
bull 13 er laquomultiple choiceraquo
bull fire casesposlashrsmaringl knyttet til pasienthistorier
bull Instrumentet ble oversatt til norsk og validert av Hovde i 2009
Observasjonsstudie
bull Ikke deltakende observasjon
bull Semistrukturert
bull Observasjons sjekkliste og feltnotater ndash Smertevurdering
ndash Ikke medikamentell smertelindring
ndash Medikamentell smertelindring
bull Pilottestet
bull Ca 6 tdag i 10 dager (ca 60 timer pr avd 360 timer totalt)
Intervju med barn
bull Semistrukturert
bull Intervjuguider (6-11 12-18) ndash Smerteopplevelsen
ndash Smertevurdering
ndash Ikke medikamentell smertelindring
ndash Medikamentell smertelindring
bull Pilottestet
bull Barn 6-18 aringr
bull 10 barnavd ndash to avdelinger (kontrollgruppeintervensjonsgruppe)
Fase 2 Utvikling av intervensjon
Baseres paring tidligere forskning resultatene fra fase 1 samt tilbakemeldinger fra fag og seksjonsledere
Intervensjonen bestod av
bullTemadag (seks timer)
ndash Undervisning og workshop
ndash Sykepleiere og leger
ndash Stefan Lundeberg og Hanne Reinertsen
bullVeiledning i praksis
ndash Klinisk veiledning i smertebehandling av barn
ndash Eva Carlsen
bullReminders
Fase 3 Evaluering av intervensjonen
Forskningssposlashrsmaringl
Vil intervensjonen oslashke sykepleieres kunnskaper og holdninger til smerte hos barn og ungdom
Vil intervensjonen bedre sykepleieres smerteharingndtering av barn og ungdom
Datainnsamling
bullT-2 1 mnd etter intervensjonen bull Sposlashrreskjema PKNAS-N (alle avd)
bull Observasjonsstudie (fire avd)
bull Intervju av barn (to avd)
bullT-3 6 mnd etter intervensjonen bull Sposlashrreskjema PKNAS-N (alle avd)
bull Observasjonsstudie (to avd)
Fremdriftsplan
Forarbeid November 2013 - juni 2014
Datainnsamling September - november 2014 T-1
Januar ndash februar 2015 Intervensjon
Mars ndash april 2015 T-2
September ndash oktober 2015 T-3
Analyse September 2015 - juli 2016
Artikkelskriving Januar ndash august 2015 artikkel 1
November 2015 ndash juni 2016 artikkel 2
August ndash desember 2016 artikkel 3
Tusen takk
Oppsummering Prosjektet er stoslashttet av
Nasjonalt kompetansenettverk for legemidler til barn
Kirurgisk avdeling for barn OUS
Norsk Sykepleierforbund
Sykehusbarn
Litteraturliste 1 Hauer J Jones BL amp Wolfe J Poplack D G Kim M S (2015) Evaluation and management of pain in children UpToDate httpwwwuptodatecomcontentsevaluation-
and-management-of-pain-in-childrensource=search_resultampsearch=PAIN+CHILDRENampselectedTitle=17E150
2 IASP (2011c) Acute Pain management in Newborn Infants Pain [Online] Tilgjengelig paring httpiaspfilescms-pluscomContentContentFoldersPublications2PainClinicalUpdatesArchivesPCU_19-6_final_12-8-11_1390260191290_1pdf [Lastet 14april 2014]
3 Bernadi M Catania G amp Tridello G (2007) Knowledge and attitudes about cancer pain management a national survey of Italian hospice nurses Cancer Nurs 30(2) E20-6
4 Coulling S (2005) Nurses and doctors knowledge of pain after surgery Nurs Stand 19(34) 41-49
5 Hovde K R Granheim T H Christophersen K-A amp Dihle A (2012) The Norwegian Version of the Pediatric Nursesrsquo Knowledge and attitudes Survey Regarding Pain Reliability and Validity Pedatric nursing 38 (5) 264-269
6 Hossain S (2010) Nursesrsquo Knowledge and Attitudes and Pain Management Practice of Post-Operative Children in Bangladesh Prince of Songkla University Nedlastet fra httpkbpsuacthpsukbbitstream201078261325999pdf
7 Huth M M Gregg T L Lin L (2010) Education changes Mexican nurses knowledge and attitudes regarding pediatric pain Pain Manag Nurs Dec11(4)201-8 doi 101016jpmn200911001
8 Lewthwaite B J Jabusch K M Wheeler B J Schnell-Hoehn K N Mills J Estrella-Holder E Fedorowicz A (2011) Nurses knowledge and attitudes regarding pain management in hospitalized adults J Contin Educ Nurs 42(6) 251-7 doi 10392800220124-20110103-03 Epub 2011 Jan 10
9 Manworren RC (2000) Pediatric nursesrsquo knowledge and attitudes survey regarding pain Pediatr Nurs 26 610-614
10 Rieman M T Gordon M amp Marvin J M (2007) Pediatric nursesrsquo knowledge and attitudes survey regarding pain a competency tool modification Pediatr Nurs 33 303-306
11 Simons JM amp MacDonald LM (2004) Pain assessment tools childrenrsquos nursesrsquo views Journal of Child Health Care 8 264 Doi 1011771367493504047317
12 Twycross A (2007) What is the impact of theoretical knowledge on childrenrsquos nursesrsquo post-operative pain management practices an exploratory study Nurse Educ Today 27 697-707
13 Smart S (2005) POST-OPERATIVE PAIN MANAGEMENT KNOWLEDGE AND ATTITUDES OF PAEDIATRIC NURSES- A NEW ZEALAND REGIONAL VIEW Victoria University of Wellington [Online] Tilgjengelig paring httpresearcharchivevuwacnzbitstreamhandle1006338thesispdfsequence=2 [Lastet 13april 2014]
14 Vincent C V H (2005) Nursesrsquo knowledge attitudes and practices regarding childrenrsquos pain MCN Am J Matern Child Nurs 30 177-183
15 Olsson G Jylli L (2001) Smaumlrta hos barn och ungdomar Lund Sverige Studentlitteratur
16 Peters J W Schouw R Anand K J van Dijk M Duivenvoorden H J Tibboel D (2005) Does neonatal surgery lead to increased pain sensitivity in later childhood Pain 114(3) 444-54
17 Anand K J S Gracia-Preats J A amp Kim M S (2015) Assessment of neonatal pain UpToDate httpwwwuptodatecomcontentsassessment-of-neonatal-pain
18 Anand K J S Gracia-Preats J A amp Kim M S (2015) Prevention and treatment of neonatal pain UpToDate httpwwwuptodatecomcontentsprevention-and-treatment-of-neonatal-painsource=related_link
19 IASP (2011a) Acute Pain and Surgery Global Year Against Acute Pain [Online] Tilgjengelig paring httpwwwiasp-painorgfilesContentContentFoldersGlobalYearAgainstPain2AcutePainFactSheets7-Surgerypdf [Lastet 14april 2014]
20 Howard R Carter B Curry J Jain A Liossi C Morton N Rivett K Rose M Tyrrell J Walker S Williams G (2012) Good Practice in Postoperative and Procedural pain management 2nd Edition Pediatric Anesthesia 22 1ndash79 doi 101111j1460-9592201203838x
21 IASP (2011b) Interventions Benefits and Barriers Global Year Against Acute Pain [Online] Tilgjengelig paring httpwwwiasp-painorgfilesContentContentFoldersGlobalYearAgainstPain2AcutePainFactSheets2-Interventionspdf [Lastet 14april 2014]
22 Benhamou D Berti M Brodner G De Andres J Draisci G Moreno-Azcoita M Neugebauer EA Schwenk W Torres LM Viel E (2007) Postoperative Analgesic THerapy Observational Survey (PATHOS) A practice pattern study in 7 CentralSouthern Eurpean countries Pain 136 134-141
23 Reinertsen H (2008) Smerte hos barn kap3I Rustoslashen T amp Wahl AK (red) Ulike tekster om smerte - fra nocisepsjon til livskvalitet Oslo Gyldendal Norsk Forlag AS
Litteraturliste 24 Smeland A amp Reinertsen H (2012) Smertevurdering og behandling av postoperative smerter hos barn Tidsskriftet Kirurgen 1 58-62 (5 s) [Online] Tilgjengelig paring
httpwwwkirurgennopdf1201 [Lastet 13april 2014]
25 Bringuier S Picot MC Dadure C et al (2009) A prospective comparison of post-surgical behavioral pain scales in preschoolers highlighting the risk of false evaluations Pain 145 60-68
26 Crelline D Sullivan T B Babl F E OSullivan R Hutchinson A (2007) Analysis of the validation of existing behavioral pain and distress scales for use in the procedural setting Pediatric Anesthesia 17 720-733
27 Ghai B Makkar JK amp Wig J (2008) Postoperative pain assessment in preverbal children and children with cognitive impairment Pediatric Anesthesia 18 462-477
28 Hicks CL von Baeyer CL Spafford P et al (2001) The Faces Pain Scale-Revised Toward a common metric in pain measurement Pain 93 173-183
29 Merkel SI Voepel-Lewis T amp Shayevitz et al (1997) The FLACC A Behavioral Scale for Scoring Postoperative Pain in Young Children Pediatric Nursing 23 293-7
30 Ellis J A McCleary L Blouin R Dube K Rowley B MacNeil M amp Cooke C (2007) Implementing best practice pain management in a pediatric hospital Journal for Specialists in Pediatric Nursing 12 264-277 doi101111j1744-6155200700121x
31 Johnston C C Gagnon A Rennick J Rosmus C Patenaude H Ellis J Shapiro C Filion F Ritchie J Byron J (2007) One-on-one coaching to improve pain assessment and management practices of pediatric nurses Journal of Pediatric Nursing 22 467-478 doi101016jpedn200707004
32 Le May S Johnston C C Choiniegravere M Fortin C Kudirka D Murray L Chalut D (2009) Pain Management Practices in a Pediatric Emergency Room (PAMPER) Study interventions with nurses Pediatr Emerg Care Aug25(8)498-503 doi 101097PEC0b013e3181b0a0af
33 Vincent C V H Wilkie D J amp Wang E (2011) Pediatric Nurses Beliefs and Pain Management Practices An Intervention Pilot West J Nurs Res 33 825 originally published online 20 December 2010
36 Twycross A Finley G A and Latimer M (2013) Pediatric nurses postoperative pain management practices An observational study Journal for Specialists in Pediatric Nursing 18 189ndash201 doi 101111jspn12026
42 Twycross A amp Finley G A (2013) Childrens and parents perceptions of postoperative pain management a mixed methods study Journal of Clinical Nursing 22(21-22) 3095-3108 doi 101111jocn12152 [Online] Tilgjengelig paring httponlinelibrarywileycomdoi101111jocn12152pdf (13042014)
43 Polkki T Pietila AM Vehvilainen-Julkunen K (2003) Hospitalized childrens descriptions of their experiences with postsurgical pain relieving methods Int J Nurs Stud Jan40(1)33-44 PubMed PMID 12550148 English
46 Abdalrahim MS Majali SA Stomberg MW Bergbom I (2011) The effect of postoperative pain management program on improving nurses knowledge and attitudes toward pain Nurse Educ Pract 2011 Jul11(4)250-5 doi 101016jnepr201011016 Epub 2010 Dec 24 httpwwwncbinlmnihgovpubmed21186139
47 IASP Pain definition IASP (International Association of the Study of Pain) Pain definition
48 Norsk Ledemiddelharingndbok Ulike smertetilstander [Online] Tilgjengelig paring httplegemiddelhandbokanoTerapi22816expand=1
49 Astrid Lindgrens Barnsjukhus ndash Riktlinjer foumlr smaumlrtbehandling
50 Groslashnseth R amp Markestad T (2011) Pediatri og pediatrisk sykepleie Bergen Fagbokforlaget Vigmostad amp Bjoslashrke AS httppediatriportfoliono
51 Hicks CL von Baeyer CL Spafford Pet al The Faces Pain Scale‐Revised Toward a common metric in pain measurement Pain 2001 93173‐183
52 Twycross A Why Managing Pain in Children Matters in Managing Pain in Children A Clinical Guide (eds A Twycross S J Dowden and E Bruce) Wiley‐Blackwell 2009 Oxford UK doi 1010029781444322743ch1
53 Von Bayer CL amp Spagrud LJ Systematic review of observational (behavioral) measures of pain for children and adolescents aged 3 to 18 years Pain 2007 127 140‐150
54 Voepel‐Lewis Terri RN MSN ZanottiJennifer RN MS CCRN CEN DammeyerJennifer A RN MSN and MerkelSandra RN MS (January 2010) Reliability and Validity of the Face Legs Activity Cry Consolability Behavioral Tool in Assessing Acute Pain in Critically Ill Patients American Journal of Critical Care 19 (1) 55ndash61
55 Merkel S Voepel‐Lewis T Shayevitz JR et al The FLACC A behavioural scale for scoring postoperative pain in young children Pediatric nursing 1997 23293‐797
56 McCaffery M amp Beebe F (1994) Pain‐Clinical Manual of for Nursing Practice Times Mirror International Publishers Ltd Norsk oversettelse Smerter Laeligrebok for helsepersonell Oslo Norge Gyldendal Norsk Forlag AS
57 Reinertsen H Christophersen K‐A Helseth S Vurdering av postoperativ smerte hos barn (0‐5 aringr) Validering og reliabilitetstesting av smertevurderingsverktoslashyet FLACC Sykepleien Forskning 2014 9 132‐140 httpwwwsykepleiennoforskningforskningsartikkel1466655validering‐og‐reliabilitetstesting‐av‐smertevurderingsverktoyet‐flacc
Litteraturliste 58 Stinson J (2009) Pain Assessment I Twycross A Dowden S J amp Bruce E Pain Assessment in Managing Pain in Children A Clinical Guide Oxford UK Wiley-Blackmell
59 Tomlinson D von Baeyer CL Stinson JN Sung L A systematic review of faces scales for the self‐report of pain intensity in children Pediatrics 2010 Nov126(5)e1168‐98 PubMed PMID 20921070 Epub 20101006 eng
60 Von Baeyer CL Childrens self‐reports of pain intensity scale selection limitations and interpretation Pain Res Manag 2006 Autumn11(3)157‐62 PubMed PMID 16960632 Pubmed Central PMCID PMC2539005 Epub 20060909 eng
61 Ghai B Makkar J K amp Wig J (2008) Postoperative pain assesment in preverbal children and children with cognitive impairment Pediatric Anesthesia 18 462‐477
62 Malvia S Voepel‐Lewis T Tait A R Merkel S Lauer A Munro H Farley F (2001) Pain management in children with and without cognitive impairment following spine fusion surgery Pediatric Anasthesia 11 453‐458
63 Malvia S Voepel‐Lewis T Burke C Merkel S amp Tait A R (2006) The revised FLACC observational pain tool improved reliability and validity for pain assesment in children with cognitive impairment Pediatric Anestesia 16 258‐265
64 McJunkins A Green A amp Anand KJS (2010) Pain Assesment in cognitively Impared Functionally Impared Children Pilot Study Results Journal of Pediatric Nursing 25 307‐309
65 McKearnan K A Kieckhefer G Engel J M Jensen M amp Labyak S (2004) Pain in Children with cerebral Palsy A Review Journal of Neuroscience Nursing Vol 36 no 5 s252‐259
66 Voepel‐Lewis T Malviya S Tait A Merkel S Forter R amp Krane E (2008) A comparison of the clinical utility of pain assesment tools for children with cognitive impairment Pediatric Anesthesiology 106 (1) 72‐78
67 Baulch I Assessment and management of pain in the paediatric patient Nursing standard 2010 2510 35-40
68 Twycross A Why Managing Pain in Children Matters in Managing Pain in Children A Clinical Guide (eds A Twycross S J Dowden and E Bruce) Wiley-Blackwell 2009 Oxford UK doi 1010029781444322743ch1
69 Schug SA amp Pogatzki-Zhan EM Chronic Pain after Surgery or Injury Pain 2011 Clinical Updates XIX 11-5
70 Fredheim OMS Borchgrevink PC amp Kvarstein G Behandling av postoperativ smerte i sykehus Tidsskr Nor Legeforen 2011 131 1772-6
71 Steward DL Welge J amp Myer C Steroids for improving recovery following tonsillectomy in children Cochrane Database of Systematic Reviews 2003 Issue 1Art NoCD003997 DOI10100214651858CD003997
72 Hong JY Han SW Kim WO et al Effect of dexamethasone in combination with caudal analgesia on postoperative pain control in day-case paediatric orchioplexy British Journal of Anesthesia 2010 105(4)506-10
73 Den Norske Legeforening (2009) Retningslinjer for smertelindring [Online] URL httpwww legeforeningennoasset42585142585_1pdf
74 Association of Paediatric Anaesthetists (2008) Good Practice in Postoperative and Procedural Pain [Online] URL httpwwwbritishpainsocietyorgbook_apa_part1pdf
75 European Society of Regional Aneasthesia (2005) Postoperative Pain Management ndash Good Clinical Practice General recommendations and principles for successful pain management [Online] URL httpwwwesraeuropeorgPostoperativePainManagementpdf
76 Monsen ALB Skadberg BT amp Groslashnlie I Smertebehandling Norsk Barnelegeforeningen 2011 [Online] URL httpwwwlegeforeningennoid1104250
77 Smeland A amp Reinertsen H (2012) Smertevurdering og behandling av postoperative smerter hos barn Tidsskriftet Kirurgen 1 58-62 (5 s) [Online] Tilgjengelig paring httpwwwkirurgennopdf1201
78 Standing JF Savage I Pritchard D et al Diclofenac for acute pain in children Cochrane Database of Systematic Reviews 2009 Issue 4 Art No CD005538 DOI 10100214651858CD005538pub2
79 Standing JF Tibboel D Korpela R et al Diclofenac pharmacokinetic meta-analysis and dose recommendations for surgical pain in children aged 1ndash12 years Pediatric Anesthesia 2011 21 316ndash324 doi 101111j1460-9592201003509x
80 Riad W amp Moussa A Pre-operative analgesia with rectal diclofenac andor paracetamol in children undergoing hernia repair Anaesthesia 2007 Dec62(12)1241-5
81 Hiller A Meretoja OA Korpela R et al The Anagesic Efficacy of Acetaminophen Ketoprofen or Their Combination for Pediatric Surgical Patients Having Soft Tissue or Orthopedic Procedures Anesth Analg 20061021365-71
82 Norsk legemiddelharingndbok Antidoter ndash alfabetisk oversikt bruksomraringde og dosering httplegemiddelhandbokanoGenerelle153557i153779
83 Norsk legemiddelharingndbok Barn og legemidler httplegemiddelhandbokanoGenerelle153109
84 SickKids Aboutkidshealthca Myths About Pain httpwwwaboutkidshealthcaEnResourceCentresPainPainAssessmentPagesMyths-About-Painaspx
85 Psykososial preoperativ forberedelse av barn 0ndash18 aringr httpwwwhelsebiblioteketnomicrositefagprosedyrerfagprosedyrerpsykososial-preoperativ-forberedelse-av-barn-018-C3A5r
86 Twycross A Why Managing Pain in Children Matters in Managing Pain in Children A Clinical Guide (eds ATwycross S J Dowden and E Bruce) Wiley‐Blackwell 2009 Oxford UK doi 1010029781444322743ch1
Flowchart
Fase 1 Kartlegging
Forskningssposlashrsmaringl bull Hvilke kunnskaper og holdninger har sykepleiere til smerte hos barn og
ungdom
bull Hvordan praktiserer sykepleiere smerteharingndtering i postoperative avdelinger
bull Hva er barnas opplevelse av postoperativ smertebehandling
Datainnsamling bull Sposlashrreskjema PNKAS-N (alle avdelingene)
bull Observasjonsstudie (alle avdelingene)
bull Intervju av barn (to avdelinger)
Sposlashrreskjemaet bull Pediatric Nurses Knowledge and Attitudes Survey- Norsk
versjon (PNKAS-N)
ndash PNKAS-N bygger paring bull World Health Organization (WHO)
bull American Pain Society (APS)
bull The Agency for Health Care Policy and Research (AHCRP)
ndash PNKAS-N bestaringr av 40 sposlashrsmaringl bull 23 sposlashrsmaringlene er paringstander (santusant)
bull 13 er laquomultiple choiceraquo
bull fire casesposlashrsmaringl knyttet til pasienthistorier
bull Instrumentet ble oversatt til norsk og validert av Hovde i 2009
Observasjonsstudie
bull Ikke deltakende observasjon
bull Semistrukturert
bull Observasjons sjekkliste og feltnotater ndash Smertevurdering
ndash Ikke medikamentell smertelindring
ndash Medikamentell smertelindring
bull Pilottestet
bull Ca 6 tdag i 10 dager (ca 60 timer pr avd 360 timer totalt)
Intervju med barn
bull Semistrukturert
bull Intervjuguider (6-11 12-18) ndash Smerteopplevelsen
ndash Smertevurdering
ndash Ikke medikamentell smertelindring
ndash Medikamentell smertelindring
bull Pilottestet
bull Barn 6-18 aringr
bull 10 barnavd ndash to avdelinger (kontrollgruppeintervensjonsgruppe)
Fase 2 Utvikling av intervensjon
Baseres paring tidligere forskning resultatene fra fase 1 samt tilbakemeldinger fra fag og seksjonsledere
Intervensjonen bestod av
bullTemadag (seks timer)
ndash Undervisning og workshop
ndash Sykepleiere og leger
ndash Stefan Lundeberg og Hanne Reinertsen
bullVeiledning i praksis
ndash Klinisk veiledning i smertebehandling av barn
ndash Eva Carlsen
bullReminders
Fase 3 Evaluering av intervensjonen
Forskningssposlashrsmaringl
Vil intervensjonen oslashke sykepleieres kunnskaper og holdninger til smerte hos barn og ungdom
Vil intervensjonen bedre sykepleieres smerteharingndtering av barn og ungdom
Datainnsamling
bullT-2 1 mnd etter intervensjonen bull Sposlashrreskjema PKNAS-N (alle avd)
bull Observasjonsstudie (fire avd)
bull Intervju av barn (to avd)
bullT-3 6 mnd etter intervensjonen bull Sposlashrreskjema PKNAS-N (alle avd)
bull Observasjonsstudie (to avd)
Fremdriftsplan
Forarbeid November 2013 - juni 2014
Datainnsamling September - november 2014 T-1
Januar ndash februar 2015 Intervensjon
Mars ndash april 2015 T-2
September ndash oktober 2015 T-3
Analyse September 2015 - juli 2016
Artikkelskriving Januar ndash august 2015 artikkel 1
November 2015 ndash juni 2016 artikkel 2
August ndash desember 2016 artikkel 3
Tusen takk
Oppsummering Prosjektet er stoslashttet av
Nasjonalt kompetansenettverk for legemidler til barn
Kirurgisk avdeling for barn OUS
Norsk Sykepleierforbund
Sykehusbarn
Litteraturliste 1 Hauer J Jones BL amp Wolfe J Poplack D G Kim M S (2015) Evaluation and management of pain in children UpToDate httpwwwuptodatecomcontentsevaluation-
and-management-of-pain-in-childrensource=search_resultampsearch=PAIN+CHILDRENampselectedTitle=17E150
2 IASP (2011c) Acute Pain management in Newborn Infants Pain [Online] Tilgjengelig paring httpiaspfilescms-pluscomContentContentFoldersPublications2PainClinicalUpdatesArchivesPCU_19-6_final_12-8-11_1390260191290_1pdf [Lastet 14april 2014]
3 Bernadi M Catania G amp Tridello G (2007) Knowledge and attitudes about cancer pain management a national survey of Italian hospice nurses Cancer Nurs 30(2) E20-6
4 Coulling S (2005) Nurses and doctors knowledge of pain after surgery Nurs Stand 19(34) 41-49
5 Hovde K R Granheim T H Christophersen K-A amp Dihle A (2012) The Norwegian Version of the Pediatric Nursesrsquo Knowledge and attitudes Survey Regarding Pain Reliability and Validity Pedatric nursing 38 (5) 264-269
6 Hossain S (2010) Nursesrsquo Knowledge and Attitudes and Pain Management Practice of Post-Operative Children in Bangladesh Prince of Songkla University Nedlastet fra httpkbpsuacthpsukbbitstream201078261325999pdf
7 Huth M M Gregg T L Lin L (2010) Education changes Mexican nurses knowledge and attitudes regarding pediatric pain Pain Manag Nurs Dec11(4)201-8 doi 101016jpmn200911001
8 Lewthwaite B J Jabusch K M Wheeler B J Schnell-Hoehn K N Mills J Estrella-Holder E Fedorowicz A (2011) Nurses knowledge and attitudes regarding pain management in hospitalized adults J Contin Educ Nurs 42(6) 251-7 doi 10392800220124-20110103-03 Epub 2011 Jan 10
9 Manworren RC (2000) Pediatric nursesrsquo knowledge and attitudes survey regarding pain Pediatr Nurs 26 610-614
10 Rieman M T Gordon M amp Marvin J M (2007) Pediatric nursesrsquo knowledge and attitudes survey regarding pain a competency tool modification Pediatr Nurs 33 303-306
11 Simons JM amp MacDonald LM (2004) Pain assessment tools childrenrsquos nursesrsquo views Journal of Child Health Care 8 264 Doi 1011771367493504047317
12 Twycross A (2007) What is the impact of theoretical knowledge on childrenrsquos nursesrsquo post-operative pain management practices an exploratory study Nurse Educ Today 27 697-707
13 Smart S (2005) POST-OPERATIVE PAIN MANAGEMENT KNOWLEDGE AND ATTITUDES OF PAEDIATRIC NURSES- A NEW ZEALAND REGIONAL VIEW Victoria University of Wellington [Online] Tilgjengelig paring httpresearcharchivevuwacnzbitstreamhandle1006338thesispdfsequence=2 [Lastet 13april 2014]
14 Vincent C V H (2005) Nursesrsquo knowledge attitudes and practices regarding childrenrsquos pain MCN Am J Matern Child Nurs 30 177-183
15 Olsson G Jylli L (2001) Smaumlrta hos barn och ungdomar Lund Sverige Studentlitteratur
16 Peters J W Schouw R Anand K J van Dijk M Duivenvoorden H J Tibboel D (2005) Does neonatal surgery lead to increased pain sensitivity in later childhood Pain 114(3) 444-54
17 Anand K J S Gracia-Preats J A amp Kim M S (2015) Assessment of neonatal pain UpToDate httpwwwuptodatecomcontentsassessment-of-neonatal-pain
18 Anand K J S Gracia-Preats J A amp Kim M S (2015) Prevention and treatment of neonatal pain UpToDate httpwwwuptodatecomcontentsprevention-and-treatment-of-neonatal-painsource=related_link
19 IASP (2011a) Acute Pain and Surgery Global Year Against Acute Pain [Online] Tilgjengelig paring httpwwwiasp-painorgfilesContentContentFoldersGlobalYearAgainstPain2AcutePainFactSheets7-Surgerypdf [Lastet 14april 2014]
20 Howard R Carter B Curry J Jain A Liossi C Morton N Rivett K Rose M Tyrrell J Walker S Williams G (2012) Good Practice in Postoperative and Procedural pain management 2nd Edition Pediatric Anesthesia 22 1ndash79 doi 101111j1460-9592201203838x
21 IASP (2011b) Interventions Benefits and Barriers Global Year Against Acute Pain [Online] Tilgjengelig paring httpwwwiasp-painorgfilesContentContentFoldersGlobalYearAgainstPain2AcutePainFactSheets2-Interventionspdf [Lastet 14april 2014]
22 Benhamou D Berti M Brodner G De Andres J Draisci G Moreno-Azcoita M Neugebauer EA Schwenk W Torres LM Viel E (2007) Postoperative Analgesic THerapy Observational Survey (PATHOS) A practice pattern study in 7 CentralSouthern Eurpean countries Pain 136 134-141
23 Reinertsen H (2008) Smerte hos barn kap3I Rustoslashen T amp Wahl AK (red) Ulike tekster om smerte - fra nocisepsjon til livskvalitet Oslo Gyldendal Norsk Forlag AS
Litteraturliste 24 Smeland A amp Reinertsen H (2012) Smertevurdering og behandling av postoperative smerter hos barn Tidsskriftet Kirurgen 1 58-62 (5 s) [Online] Tilgjengelig paring
httpwwwkirurgennopdf1201 [Lastet 13april 2014]
25 Bringuier S Picot MC Dadure C et al (2009) A prospective comparison of post-surgical behavioral pain scales in preschoolers highlighting the risk of false evaluations Pain 145 60-68
26 Crelline D Sullivan T B Babl F E OSullivan R Hutchinson A (2007) Analysis of the validation of existing behavioral pain and distress scales for use in the procedural setting Pediatric Anesthesia 17 720-733
27 Ghai B Makkar JK amp Wig J (2008) Postoperative pain assessment in preverbal children and children with cognitive impairment Pediatric Anesthesia 18 462-477
28 Hicks CL von Baeyer CL Spafford P et al (2001) The Faces Pain Scale-Revised Toward a common metric in pain measurement Pain 93 173-183
29 Merkel SI Voepel-Lewis T amp Shayevitz et al (1997) The FLACC A Behavioral Scale for Scoring Postoperative Pain in Young Children Pediatric Nursing 23 293-7
30 Ellis J A McCleary L Blouin R Dube K Rowley B MacNeil M amp Cooke C (2007) Implementing best practice pain management in a pediatric hospital Journal for Specialists in Pediatric Nursing 12 264-277 doi101111j1744-6155200700121x
31 Johnston C C Gagnon A Rennick J Rosmus C Patenaude H Ellis J Shapiro C Filion F Ritchie J Byron J (2007) One-on-one coaching to improve pain assessment and management practices of pediatric nurses Journal of Pediatric Nursing 22 467-478 doi101016jpedn200707004
32 Le May S Johnston C C Choiniegravere M Fortin C Kudirka D Murray L Chalut D (2009) Pain Management Practices in a Pediatric Emergency Room (PAMPER) Study interventions with nurses Pediatr Emerg Care Aug25(8)498-503 doi 101097PEC0b013e3181b0a0af
33 Vincent C V H Wilkie D J amp Wang E (2011) Pediatric Nurses Beliefs and Pain Management Practices An Intervention Pilot West J Nurs Res 33 825 originally published online 20 December 2010
36 Twycross A Finley G A and Latimer M (2013) Pediatric nurses postoperative pain management practices An observational study Journal for Specialists in Pediatric Nursing 18 189ndash201 doi 101111jspn12026
42 Twycross A amp Finley G A (2013) Childrens and parents perceptions of postoperative pain management a mixed methods study Journal of Clinical Nursing 22(21-22) 3095-3108 doi 101111jocn12152 [Online] Tilgjengelig paring httponlinelibrarywileycomdoi101111jocn12152pdf (13042014)
43 Polkki T Pietila AM Vehvilainen-Julkunen K (2003) Hospitalized childrens descriptions of their experiences with postsurgical pain relieving methods Int J Nurs Stud Jan40(1)33-44 PubMed PMID 12550148 English
46 Abdalrahim MS Majali SA Stomberg MW Bergbom I (2011) The effect of postoperative pain management program on improving nurses knowledge and attitudes toward pain Nurse Educ Pract 2011 Jul11(4)250-5 doi 101016jnepr201011016 Epub 2010 Dec 24 httpwwwncbinlmnihgovpubmed21186139
47 IASP Pain definition IASP (International Association of the Study of Pain) Pain definition
48 Norsk Ledemiddelharingndbok Ulike smertetilstander [Online] Tilgjengelig paring httplegemiddelhandbokanoTerapi22816expand=1
49 Astrid Lindgrens Barnsjukhus ndash Riktlinjer foumlr smaumlrtbehandling
50 Groslashnseth R amp Markestad T (2011) Pediatri og pediatrisk sykepleie Bergen Fagbokforlaget Vigmostad amp Bjoslashrke AS httppediatriportfoliono
51 Hicks CL von Baeyer CL Spafford Pet al The Faces Pain Scale‐Revised Toward a common metric in pain measurement Pain 2001 93173‐183
52 Twycross A Why Managing Pain in Children Matters in Managing Pain in Children A Clinical Guide (eds A Twycross S J Dowden and E Bruce) Wiley‐Blackwell 2009 Oxford UK doi 1010029781444322743ch1
53 Von Bayer CL amp Spagrud LJ Systematic review of observational (behavioral) measures of pain for children and adolescents aged 3 to 18 years Pain 2007 127 140‐150
54 Voepel‐Lewis Terri RN MSN ZanottiJennifer RN MS CCRN CEN DammeyerJennifer A RN MSN and MerkelSandra RN MS (January 2010) Reliability and Validity of the Face Legs Activity Cry Consolability Behavioral Tool in Assessing Acute Pain in Critically Ill Patients American Journal of Critical Care 19 (1) 55ndash61
55 Merkel S Voepel‐Lewis T Shayevitz JR et al The FLACC A behavioural scale for scoring postoperative pain in young children Pediatric nursing 1997 23293‐797
56 McCaffery M amp Beebe F (1994) Pain‐Clinical Manual of for Nursing Practice Times Mirror International Publishers Ltd Norsk oversettelse Smerter Laeligrebok for helsepersonell Oslo Norge Gyldendal Norsk Forlag AS
57 Reinertsen H Christophersen K‐A Helseth S Vurdering av postoperativ smerte hos barn (0‐5 aringr) Validering og reliabilitetstesting av smertevurderingsverktoslashyet FLACC Sykepleien Forskning 2014 9 132‐140 httpwwwsykepleiennoforskningforskningsartikkel1466655validering‐og‐reliabilitetstesting‐av‐smertevurderingsverktoyet‐flacc
Litteraturliste 58 Stinson J (2009) Pain Assessment I Twycross A Dowden S J amp Bruce E Pain Assessment in Managing Pain in Children A Clinical Guide Oxford UK Wiley-Blackmell
59 Tomlinson D von Baeyer CL Stinson JN Sung L A systematic review of faces scales for the self‐report of pain intensity in children Pediatrics 2010 Nov126(5)e1168‐98 PubMed PMID 20921070 Epub 20101006 eng
60 Von Baeyer CL Childrens self‐reports of pain intensity scale selection limitations and interpretation Pain Res Manag 2006 Autumn11(3)157‐62 PubMed PMID 16960632 Pubmed Central PMCID PMC2539005 Epub 20060909 eng
61 Ghai B Makkar J K amp Wig J (2008) Postoperative pain assesment in preverbal children and children with cognitive impairment Pediatric Anesthesia 18 462‐477
62 Malvia S Voepel‐Lewis T Tait A R Merkel S Lauer A Munro H Farley F (2001) Pain management in children with and without cognitive impairment following spine fusion surgery Pediatric Anasthesia 11 453‐458
63 Malvia S Voepel‐Lewis T Burke C Merkel S amp Tait A R (2006) The revised FLACC observational pain tool improved reliability and validity for pain assesment in children with cognitive impairment Pediatric Anestesia 16 258‐265
64 McJunkins A Green A amp Anand KJS (2010) Pain Assesment in cognitively Impared Functionally Impared Children Pilot Study Results Journal of Pediatric Nursing 25 307‐309
65 McKearnan K A Kieckhefer G Engel J M Jensen M amp Labyak S (2004) Pain in Children with cerebral Palsy A Review Journal of Neuroscience Nursing Vol 36 no 5 s252‐259
66 Voepel‐Lewis T Malviya S Tait A Merkel S Forter R amp Krane E (2008) A comparison of the clinical utility of pain assesment tools for children with cognitive impairment Pediatric Anesthesiology 106 (1) 72‐78
67 Baulch I Assessment and management of pain in the paediatric patient Nursing standard 2010 2510 35-40
68 Twycross A Why Managing Pain in Children Matters in Managing Pain in Children A Clinical Guide (eds A Twycross S J Dowden and E Bruce) Wiley-Blackwell 2009 Oxford UK doi 1010029781444322743ch1
69 Schug SA amp Pogatzki-Zhan EM Chronic Pain after Surgery or Injury Pain 2011 Clinical Updates XIX 11-5
70 Fredheim OMS Borchgrevink PC amp Kvarstein G Behandling av postoperativ smerte i sykehus Tidsskr Nor Legeforen 2011 131 1772-6
71 Steward DL Welge J amp Myer C Steroids for improving recovery following tonsillectomy in children Cochrane Database of Systematic Reviews 2003 Issue 1Art NoCD003997 DOI10100214651858CD003997
72 Hong JY Han SW Kim WO et al Effect of dexamethasone in combination with caudal analgesia on postoperative pain control in day-case paediatric orchioplexy British Journal of Anesthesia 2010 105(4)506-10
73 Den Norske Legeforening (2009) Retningslinjer for smertelindring [Online] URL httpwww legeforeningennoasset42585142585_1pdf
74 Association of Paediatric Anaesthetists (2008) Good Practice in Postoperative and Procedural Pain [Online] URL httpwwwbritishpainsocietyorgbook_apa_part1pdf
75 European Society of Regional Aneasthesia (2005) Postoperative Pain Management ndash Good Clinical Practice General recommendations and principles for successful pain management [Online] URL httpwwwesraeuropeorgPostoperativePainManagementpdf
76 Monsen ALB Skadberg BT amp Groslashnlie I Smertebehandling Norsk Barnelegeforeningen 2011 [Online] URL httpwwwlegeforeningennoid1104250
77 Smeland A amp Reinertsen H (2012) Smertevurdering og behandling av postoperative smerter hos barn Tidsskriftet Kirurgen 1 58-62 (5 s) [Online] Tilgjengelig paring httpwwwkirurgennopdf1201
78 Standing JF Savage I Pritchard D et al Diclofenac for acute pain in children Cochrane Database of Systematic Reviews 2009 Issue 4 Art No CD005538 DOI 10100214651858CD005538pub2
79 Standing JF Tibboel D Korpela R et al Diclofenac pharmacokinetic meta-analysis and dose recommendations for surgical pain in children aged 1ndash12 years Pediatric Anesthesia 2011 21 316ndash324 doi 101111j1460-9592201003509x
80 Riad W amp Moussa A Pre-operative analgesia with rectal diclofenac andor paracetamol in children undergoing hernia repair Anaesthesia 2007 Dec62(12)1241-5
81 Hiller A Meretoja OA Korpela R et al The Anagesic Efficacy of Acetaminophen Ketoprofen or Their Combination for Pediatric Surgical Patients Having Soft Tissue or Orthopedic Procedures Anesth Analg 20061021365-71
82 Norsk legemiddelharingndbok Antidoter ndash alfabetisk oversikt bruksomraringde og dosering httplegemiddelhandbokanoGenerelle153557i153779
83 Norsk legemiddelharingndbok Barn og legemidler httplegemiddelhandbokanoGenerelle153109
84 SickKids Aboutkidshealthca Myths About Pain httpwwwaboutkidshealthcaEnResourceCentresPainPainAssessmentPagesMyths-About-Painaspx
85 Psykososial preoperativ forberedelse av barn 0ndash18 aringr httpwwwhelsebiblioteketnomicrositefagprosedyrerfagprosedyrerpsykososial-preoperativ-forberedelse-av-barn-018-C3A5r
86 Twycross A Why Managing Pain in Children Matters in Managing Pain in Children A Clinical Guide (eds ATwycross S J Dowden and E Bruce) Wiley‐Blackwell 2009 Oxford UK doi 1010029781444322743ch1
Fase 1 Kartlegging
Forskningssposlashrsmaringl bull Hvilke kunnskaper og holdninger har sykepleiere til smerte hos barn og
ungdom
bull Hvordan praktiserer sykepleiere smerteharingndtering i postoperative avdelinger
bull Hva er barnas opplevelse av postoperativ smertebehandling
Datainnsamling bull Sposlashrreskjema PNKAS-N (alle avdelingene)
bull Observasjonsstudie (alle avdelingene)
bull Intervju av barn (to avdelinger)
Sposlashrreskjemaet bull Pediatric Nurses Knowledge and Attitudes Survey- Norsk
versjon (PNKAS-N)
ndash PNKAS-N bygger paring bull World Health Organization (WHO)
bull American Pain Society (APS)
bull The Agency for Health Care Policy and Research (AHCRP)
ndash PNKAS-N bestaringr av 40 sposlashrsmaringl bull 23 sposlashrsmaringlene er paringstander (santusant)
bull 13 er laquomultiple choiceraquo
bull fire casesposlashrsmaringl knyttet til pasienthistorier
bull Instrumentet ble oversatt til norsk og validert av Hovde i 2009
Observasjonsstudie
bull Ikke deltakende observasjon
bull Semistrukturert
bull Observasjons sjekkliste og feltnotater ndash Smertevurdering
ndash Ikke medikamentell smertelindring
ndash Medikamentell smertelindring
bull Pilottestet
bull Ca 6 tdag i 10 dager (ca 60 timer pr avd 360 timer totalt)
Intervju med barn
bull Semistrukturert
bull Intervjuguider (6-11 12-18) ndash Smerteopplevelsen
ndash Smertevurdering
ndash Ikke medikamentell smertelindring
ndash Medikamentell smertelindring
bull Pilottestet
bull Barn 6-18 aringr
bull 10 barnavd ndash to avdelinger (kontrollgruppeintervensjonsgruppe)
Fase 2 Utvikling av intervensjon
Baseres paring tidligere forskning resultatene fra fase 1 samt tilbakemeldinger fra fag og seksjonsledere
Intervensjonen bestod av
bullTemadag (seks timer)
ndash Undervisning og workshop
ndash Sykepleiere og leger
ndash Stefan Lundeberg og Hanne Reinertsen
bullVeiledning i praksis
ndash Klinisk veiledning i smertebehandling av barn
ndash Eva Carlsen
bullReminders
Fase 3 Evaluering av intervensjonen
Forskningssposlashrsmaringl
Vil intervensjonen oslashke sykepleieres kunnskaper og holdninger til smerte hos barn og ungdom
Vil intervensjonen bedre sykepleieres smerteharingndtering av barn og ungdom
Datainnsamling
bullT-2 1 mnd etter intervensjonen bull Sposlashrreskjema PKNAS-N (alle avd)
bull Observasjonsstudie (fire avd)
bull Intervju av barn (to avd)
bullT-3 6 mnd etter intervensjonen bull Sposlashrreskjema PKNAS-N (alle avd)
bull Observasjonsstudie (to avd)
Fremdriftsplan
Forarbeid November 2013 - juni 2014
Datainnsamling September - november 2014 T-1
Januar ndash februar 2015 Intervensjon
Mars ndash april 2015 T-2
September ndash oktober 2015 T-3
Analyse September 2015 - juli 2016
Artikkelskriving Januar ndash august 2015 artikkel 1
November 2015 ndash juni 2016 artikkel 2
August ndash desember 2016 artikkel 3
Tusen takk
Oppsummering Prosjektet er stoslashttet av
Nasjonalt kompetansenettverk for legemidler til barn
Kirurgisk avdeling for barn OUS
Norsk Sykepleierforbund
Sykehusbarn
Litteraturliste 1 Hauer J Jones BL amp Wolfe J Poplack D G Kim M S (2015) Evaluation and management of pain in children UpToDate httpwwwuptodatecomcontentsevaluation-
and-management-of-pain-in-childrensource=search_resultampsearch=PAIN+CHILDRENampselectedTitle=17E150
2 IASP (2011c) Acute Pain management in Newborn Infants Pain [Online] Tilgjengelig paring httpiaspfilescms-pluscomContentContentFoldersPublications2PainClinicalUpdatesArchivesPCU_19-6_final_12-8-11_1390260191290_1pdf [Lastet 14april 2014]
3 Bernadi M Catania G amp Tridello G (2007) Knowledge and attitudes about cancer pain management a national survey of Italian hospice nurses Cancer Nurs 30(2) E20-6
4 Coulling S (2005) Nurses and doctors knowledge of pain after surgery Nurs Stand 19(34) 41-49
5 Hovde K R Granheim T H Christophersen K-A amp Dihle A (2012) The Norwegian Version of the Pediatric Nursesrsquo Knowledge and attitudes Survey Regarding Pain Reliability and Validity Pedatric nursing 38 (5) 264-269
6 Hossain S (2010) Nursesrsquo Knowledge and Attitudes and Pain Management Practice of Post-Operative Children in Bangladesh Prince of Songkla University Nedlastet fra httpkbpsuacthpsukbbitstream201078261325999pdf
7 Huth M M Gregg T L Lin L (2010) Education changes Mexican nurses knowledge and attitudes regarding pediatric pain Pain Manag Nurs Dec11(4)201-8 doi 101016jpmn200911001
8 Lewthwaite B J Jabusch K M Wheeler B J Schnell-Hoehn K N Mills J Estrella-Holder E Fedorowicz A (2011) Nurses knowledge and attitudes regarding pain management in hospitalized adults J Contin Educ Nurs 42(6) 251-7 doi 10392800220124-20110103-03 Epub 2011 Jan 10
9 Manworren RC (2000) Pediatric nursesrsquo knowledge and attitudes survey regarding pain Pediatr Nurs 26 610-614
10 Rieman M T Gordon M amp Marvin J M (2007) Pediatric nursesrsquo knowledge and attitudes survey regarding pain a competency tool modification Pediatr Nurs 33 303-306
11 Simons JM amp MacDonald LM (2004) Pain assessment tools childrenrsquos nursesrsquo views Journal of Child Health Care 8 264 Doi 1011771367493504047317
12 Twycross A (2007) What is the impact of theoretical knowledge on childrenrsquos nursesrsquo post-operative pain management practices an exploratory study Nurse Educ Today 27 697-707
13 Smart S (2005) POST-OPERATIVE PAIN MANAGEMENT KNOWLEDGE AND ATTITUDES OF PAEDIATRIC NURSES- A NEW ZEALAND REGIONAL VIEW Victoria University of Wellington [Online] Tilgjengelig paring httpresearcharchivevuwacnzbitstreamhandle1006338thesispdfsequence=2 [Lastet 13april 2014]
14 Vincent C V H (2005) Nursesrsquo knowledge attitudes and practices regarding childrenrsquos pain MCN Am J Matern Child Nurs 30 177-183
15 Olsson G Jylli L (2001) Smaumlrta hos barn och ungdomar Lund Sverige Studentlitteratur
16 Peters J W Schouw R Anand K J van Dijk M Duivenvoorden H J Tibboel D (2005) Does neonatal surgery lead to increased pain sensitivity in later childhood Pain 114(3) 444-54
17 Anand K J S Gracia-Preats J A amp Kim M S (2015) Assessment of neonatal pain UpToDate httpwwwuptodatecomcontentsassessment-of-neonatal-pain
18 Anand K J S Gracia-Preats J A amp Kim M S (2015) Prevention and treatment of neonatal pain UpToDate httpwwwuptodatecomcontentsprevention-and-treatment-of-neonatal-painsource=related_link
19 IASP (2011a) Acute Pain and Surgery Global Year Against Acute Pain [Online] Tilgjengelig paring httpwwwiasp-painorgfilesContentContentFoldersGlobalYearAgainstPain2AcutePainFactSheets7-Surgerypdf [Lastet 14april 2014]
20 Howard R Carter B Curry J Jain A Liossi C Morton N Rivett K Rose M Tyrrell J Walker S Williams G (2012) Good Practice in Postoperative and Procedural pain management 2nd Edition Pediatric Anesthesia 22 1ndash79 doi 101111j1460-9592201203838x
21 IASP (2011b) Interventions Benefits and Barriers Global Year Against Acute Pain [Online] Tilgjengelig paring httpwwwiasp-painorgfilesContentContentFoldersGlobalYearAgainstPain2AcutePainFactSheets2-Interventionspdf [Lastet 14april 2014]
22 Benhamou D Berti M Brodner G De Andres J Draisci G Moreno-Azcoita M Neugebauer EA Schwenk W Torres LM Viel E (2007) Postoperative Analgesic THerapy Observational Survey (PATHOS) A practice pattern study in 7 CentralSouthern Eurpean countries Pain 136 134-141
23 Reinertsen H (2008) Smerte hos barn kap3I Rustoslashen T amp Wahl AK (red) Ulike tekster om smerte - fra nocisepsjon til livskvalitet Oslo Gyldendal Norsk Forlag AS
Litteraturliste 24 Smeland A amp Reinertsen H (2012) Smertevurdering og behandling av postoperative smerter hos barn Tidsskriftet Kirurgen 1 58-62 (5 s) [Online] Tilgjengelig paring
httpwwwkirurgennopdf1201 [Lastet 13april 2014]
25 Bringuier S Picot MC Dadure C et al (2009) A prospective comparison of post-surgical behavioral pain scales in preschoolers highlighting the risk of false evaluations Pain 145 60-68
26 Crelline D Sullivan T B Babl F E OSullivan R Hutchinson A (2007) Analysis of the validation of existing behavioral pain and distress scales for use in the procedural setting Pediatric Anesthesia 17 720-733
27 Ghai B Makkar JK amp Wig J (2008) Postoperative pain assessment in preverbal children and children with cognitive impairment Pediatric Anesthesia 18 462-477
28 Hicks CL von Baeyer CL Spafford P et al (2001) The Faces Pain Scale-Revised Toward a common metric in pain measurement Pain 93 173-183
29 Merkel SI Voepel-Lewis T amp Shayevitz et al (1997) The FLACC A Behavioral Scale for Scoring Postoperative Pain in Young Children Pediatric Nursing 23 293-7
30 Ellis J A McCleary L Blouin R Dube K Rowley B MacNeil M amp Cooke C (2007) Implementing best practice pain management in a pediatric hospital Journal for Specialists in Pediatric Nursing 12 264-277 doi101111j1744-6155200700121x
31 Johnston C C Gagnon A Rennick J Rosmus C Patenaude H Ellis J Shapiro C Filion F Ritchie J Byron J (2007) One-on-one coaching to improve pain assessment and management practices of pediatric nurses Journal of Pediatric Nursing 22 467-478 doi101016jpedn200707004
32 Le May S Johnston C C Choiniegravere M Fortin C Kudirka D Murray L Chalut D (2009) Pain Management Practices in a Pediatric Emergency Room (PAMPER) Study interventions with nurses Pediatr Emerg Care Aug25(8)498-503 doi 101097PEC0b013e3181b0a0af
33 Vincent C V H Wilkie D J amp Wang E (2011) Pediatric Nurses Beliefs and Pain Management Practices An Intervention Pilot West J Nurs Res 33 825 originally published online 20 December 2010
36 Twycross A Finley G A and Latimer M (2013) Pediatric nurses postoperative pain management practices An observational study Journal for Specialists in Pediatric Nursing 18 189ndash201 doi 101111jspn12026
42 Twycross A amp Finley G A (2013) Childrens and parents perceptions of postoperative pain management a mixed methods study Journal of Clinical Nursing 22(21-22) 3095-3108 doi 101111jocn12152 [Online] Tilgjengelig paring httponlinelibrarywileycomdoi101111jocn12152pdf (13042014)
43 Polkki T Pietila AM Vehvilainen-Julkunen K (2003) Hospitalized childrens descriptions of their experiences with postsurgical pain relieving methods Int J Nurs Stud Jan40(1)33-44 PubMed PMID 12550148 English
46 Abdalrahim MS Majali SA Stomberg MW Bergbom I (2011) The effect of postoperative pain management program on improving nurses knowledge and attitudes toward pain Nurse Educ Pract 2011 Jul11(4)250-5 doi 101016jnepr201011016 Epub 2010 Dec 24 httpwwwncbinlmnihgovpubmed21186139
47 IASP Pain definition IASP (International Association of the Study of Pain) Pain definition
48 Norsk Ledemiddelharingndbok Ulike smertetilstander [Online] Tilgjengelig paring httplegemiddelhandbokanoTerapi22816expand=1
49 Astrid Lindgrens Barnsjukhus ndash Riktlinjer foumlr smaumlrtbehandling
50 Groslashnseth R amp Markestad T (2011) Pediatri og pediatrisk sykepleie Bergen Fagbokforlaget Vigmostad amp Bjoslashrke AS httppediatriportfoliono
51 Hicks CL von Baeyer CL Spafford Pet al The Faces Pain Scale‐Revised Toward a common metric in pain measurement Pain 2001 93173‐183
52 Twycross A Why Managing Pain in Children Matters in Managing Pain in Children A Clinical Guide (eds A Twycross S J Dowden and E Bruce) Wiley‐Blackwell 2009 Oxford UK doi 1010029781444322743ch1
53 Von Bayer CL amp Spagrud LJ Systematic review of observational (behavioral) measures of pain for children and adolescents aged 3 to 18 years Pain 2007 127 140‐150
54 Voepel‐Lewis Terri RN MSN ZanottiJennifer RN MS CCRN CEN DammeyerJennifer A RN MSN and MerkelSandra RN MS (January 2010) Reliability and Validity of the Face Legs Activity Cry Consolability Behavioral Tool in Assessing Acute Pain in Critically Ill Patients American Journal of Critical Care 19 (1) 55ndash61
55 Merkel S Voepel‐Lewis T Shayevitz JR et al The FLACC A behavioural scale for scoring postoperative pain in young children Pediatric nursing 1997 23293‐797
56 McCaffery M amp Beebe F (1994) Pain‐Clinical Manual of for Nursing Practice Times Mirror International Publishers Ltd Norsk oversettelse Smerter Laeligrebok for helsepersonell Oslo Norge Gyldendal Norsk Forlag AS
57 Reinertsen H Christophersen K‐A Helseth S Vurdering av postoperativ smerte hos barn (0‐5 aringr) Validering og reliabilitetstesting av smertevurderingsverktoslashyet FLACC Sykepleien Forskning 2014 9 132‐140 httpwwwsykepleiennoforskningforskningsartikkel1466655validering‐og‐reliabilitetstesting‐av‐smertevurderingsverktoyet‐flacc
Litteraturliste 58 Stinson J (2009) Pain Assessment I Twycross A Dowden S J amp Bruce E Pain Assessment in Managing Pain in Children A Clinical Guide Oxford UK Wiley-Blackmell
59 Tomlinson D von Baeyer CL Stinson JN Sung L A systematic review of faces scales for the self‐report of pain intensity in children Pediatrics 2010 Nov126(5)e1168‐98 PubMed PMID 20921070 Epub 20101006 eng
60 Von Baeyer CL Childrens self‐reports of pain intensity scale selection limitations and interpretation Pain Res Manag 2006 Autumn11(3)157‐62 PubMed PMID 16960632 Pubmed Central PMCID PMC2539005 Epub 20060909 eng
61 Ghai B Makkar J K amp Wig J (2008) Postoperative pain assesment in preverbal children and children with cognitive impairment Pediatric Anesthesia 18 462‐477
62 Malvia S Voepel‐Lewis T Tait A R Merkel S Lauer A Munro H Farley F (2001) Pain management in children with and without cognitive impairment following spine fusion surgery Pediatric Anasthesia 11 453‐458
63 Malvia S Voepel‐Lewis T Burke C Merkel S amp Tait A R (2006) The revised FLACC observational pain tool improved reliability and validity for pain assesment in children with cognitive impairment Pediatric Anestesia 16 258‐265
64 McJunkins A Green A amp Anand KJS (2010) Pain Assesment in cognitively Impared Functionally Impared Children Pilot Study Results Journal of Pediatric Nursing 25 307‐309
65 McKearnan K A Kieckhefer G Engel J M Jensen M amp Labyak S (2004) Pain in Children with cerebral Palsy A Review Journal of Neuroscience Nursing Vol 36 no 5 s252‐259
66 Voepel‐Lewis T Malviya S Tait A Merkel S Forter R amp Krane E (2008) A comparison of the clinical utility of pain assesment tools for children with cognitive impairment Pediatric Anesthesiology 106 (1) 72‐78
67 Baulch I Assessment and management of pain in the paediatric patient Nursing standard 2010 2510 35-40
68 Twycross A Why Managing Pain in Children Matters in Managing Pain in Children A Clinical Guide (eds A Twycross S J Dowden and E Bruce) Wiley-Blackwell 2009 Oxford UK doi 1010029781444322743ch1
69 Schug SA amp Pogatzki-Zhan EM Chronic Pain after Surgery or Injury Pain 2011 Clinical Updates XIX 11-5
70 Fredheim OMS Borchgrevink PC amp Kvarstein G Behandling av postoperativ smerte i sykehus Tidsskr Nor Legeforen 2011 131 1772-6
71 Steward DL Welge J amp Myer C Steroids for improving recovery following tonsillectomy in children Cochrane Database of Systematic Reviews 2003 Issue 1Art NoCD003997 DOI10100214651858CD003997
72 Hong JY Han SW Kim WO et al Effect of dexamethasone in combination with caudal analgesia on postoperative pain control in day-case paediatric orchioplexy British Journal of Anesthesia 2010 105(4)506-10
73 Den Norske Legeforening (2009) Retningslinjer for smertelindring [Online] URL httpwww legeforeningennoasset42585142585_1pdf
74 Association of Paediatric Anaesthetists (2008) Good Practice in Postoperative and Procedural Pain [Online] URL httpwwwbritishpainsocietyorgbook_apa_part1pdf
75 European Society of Regional Aneasthesia (2005) Postoperative Pain Management ndash Good Clinical Practice General recommendations and principles for successful pain management [Online] URL httpwwwesraeuropeorgPostoperativePainManagementpdf
76 Monsen ALB Skadberg BT amp Groslashnlie I Smertebehandling Norsk Barnelegeforeningen 2011 [Online] URL httpwwwlegeforeningennoid1104250
77 Smeland A amp Reinertsen H (2012) Smertevurdering og behandling av postoperative smerter hos barn Tidsskriftet Kirurgen 1 58-62 (5 s) [Online] Tilgjengelig paring httpwwwkirurgennopdf1201
78 Standing JF Savage I Pritchard D et al Diclofenac for acute pain in children Cochrane Database of Systematic Reviews 2009 Issue 4 Art No CD005538 DOI 10100214651858CD005538pub2
79 Standing JF Tibboel D Korpela R et al Diclofenac pharmacokinetic meta-analysis and dose recommendations for surgical pain in children aged 1ndash12 years Pediatric Anesthesia 2011 21 316ndash324 doi 101111j1460-9592201003509x
80 Riad W amp Moussa A Pre-operative analgesia with rectal diclofenac andor paracetamol in children undergoing hernia repair Anaesthesia 2007 Dec62(12)1241-5
81 Hiller A Meretoja OA Korpela R et al The Anagesic Efficacy of Acetaminophen Ketoprofen or Their Combination for Pediatric Surgical Patients Having Soft Tissue or Orthopedic Procedures Anesth Analg 20061021365-71
82 Norsk legemiddelharingndbok Antidoter ndash alfabetisk oversikt bruksomraringde og dosering httplegemiddelhandbokanoGenerelle153557i153779
83 Norsk legemiddelharingndbok Barn og legemidler httplegemiddelhandbokanoGenerelle153109
84 SickKids Aboutkidshealthca Myths About Pain httpwwwaboutkidshealthcaEnResourceCentresPainPainAssessmentPagesMyths-About-Painaspx
85 Psykososial preoperativ forberedelse av barn 0ndash18 aringr httpwwwhelsebiblioteketnomicrositefagprosedyrerfagprosedyrerpsykososial-preoperativ-forberedelse-av-barn-018-C3A5r
86 Twycross A Why Managing Pain in Children Matters in Managing Pain in Children A Clinical Guide (eds ATwycross S J Dowden and E Bruce) Wiley‐Blackwell 2009 Oxford UK doi 1010029781444322743ch1
Sposlashrreskjemaet bull Pediatric Nurses Knowledge and Attitudes Survey- Norsk
versjon (PNKAS-N)
ndash PNKAS-N bygger paring bull World Health Organization (WHO)
bull American Pain Society (APS)
bull The Agency for Health Care Policy and Research (AHCRP)
ndash PNKAS-N bestaringr av 40 sposlashrsmaringl bull 23 sposlashrsmaringlene er paringstander (santusant)
bull 13 er laquomultiple choiceraquo
bull fire casesposlashrsmaringl knyttet til pasienthistorier
bull Instrumentet ble oversatt til norsk og validert av Hovde i 2009
Observasjonsstudie
bull Ikke deltakende observasjon
bull Semistrukturert
bull Observasjons sjekkliste og feltnotater ndash Smertevurdering
ndash Ikke medikamentell smertelindring
ndash Medikamentell smertelindring
bull Pilottestet
bull Ca 6 tdag i 10 dager (ca 60 timer pr avd 360 timer totalt)
Intervju med barn
bull Semistrukturert
bull Intervjuguider (6-11 12-18) ndash Smerteopplevelsen
ndash Smertevurdering
ndash Ikke medikamentell smertelindring
ndash Medikamentell smertelindring
bull Pilottestet
bull Barn 6-18 aringr
bull 10 barnavd ndash to avdelinger (kontrollgruppeintervensjonsgruppe)
Fase 2 Utvikling av intervensjon
Baseres paring tidligere forskning resultatene fra fase 1 samt tilbakemeldinger fra fag og seksjonsledere
Intervensjonen bestod av
bullTemadag (seks timer)
ndash Undervisning og workshop
ndash Sykepleiere og leger
ndash Stefan Lundeberg og Hanne Reinertsen
bullVeiledning i praksis
ndash Klinisk veiledning i smertebehandling av barn
ndash Eva Carlsen
bullReminders
Fase 3 Evaluering av intervensjonen
Forskningssposlashrsmaringl
Vil intervensjonen oslashke sykepleieres kunnskaper og holdninger til smerte hos barn og ungdom
Vil intervensjonen bedre sykepleieres smerteharingndtering av barn og ungdom
Datainnsamling
bullT-2 1 mnd etter intervensjonen bull Sposlashrreskjema PKNAS-N (alle avd)
bull Observasjonsstudie (fire avd)
bull Intervju av barn (to avd)
bullT-3 6 mnd etter intervensjonen bull Sposlashrreskjema PKNAS-N (alle avd)
bull Observasjonsstudie (to avd)
Fremdriftsplan
Forarbeid November 2013 - juni 2014
Datainnsamling September - november 2014 T-1
Januar ndash februar 2015 Intervensjon
Mars ndash april 2015 T-2
September ndash oktober 2015 T-3
Analyse September 2015 - juli 2016
Artikkelskriving Januar ndash august 2015 artikkel 1
November 2015 ndash juni 2016 artikkel 2
August ndash desember 2016 artikkel 3
Tusen takk
Oppsummering Prosjektet er stoslashttet av
Nasjonalt kompetansenettverk for legemidler til barn
Kirurgisk avdeling for barn OUS
Norsk Sykepleierforbund
Sykehusbarn
Litteraturliste 1 Hauer J Jones BL amp Wolfe J Poplack D G Kim M S (2015) Evaluation and management of pain in children UpToDate httpwwwuptodatecomcontentsevaluation-
and-management-of-pain-in-childrensource=search_resultampsearch=PAIN+CHILDRENampselectedTitle=17E150
2 IASP (2011c) Acute Pain management in Newborn Infants Pain [Online] Tilgjengelig paring httpiaspfilescms-pluscomContentContentFoldersPublications2PainClinicalUpdatesArchivesPCU_19-6_final_12-8-11_1390260191290_1pdf [Lastet 14april 2014]
3 Bernadi M Catania G amp Tridello G (2007) Knowledge and attitudes about cancer pain management a national survey of Italian hospice nurses Cancer Nurs 30(2) E20-6
4 Coulling S (2005) Nurses and doctors knowledge of pain after surgery Nurs Stand 19(34) 41-49
5 Hovde K R Granheim T H Christophersen K-A amp Dihle A (2012) The Norwegian Version of the Pediatric Nursesrsquo Knowledge and attitudes Survey Regarding Pain Reliability and Validity Pedatric nursing 38 (5) 264-269
6 Hossain S (2010) Nursesrsquo Knowledge and Attitudes and Pain Management Practice of Post-Operative Children in Bangladesh Prince of Songkla University Nedlastet fra httpkbpsuacthpsukbbitstream201078261325999pdf
7 Huth M M Gregg T L Lin L (2010) Education changes Mexican nurses knowledge and attitudes regarding pediatric pain Pain Manag Nurs Dec11(4)201-8 doi 101016jpmn200911001
8 Lewthwaite B J Jabusch K M Wheeler B J Schnell-Hoehn K N Mills J Estrella-Holder E Fedorowicz A (2011) Nurses knowledge and attitudes regarding pain management in hospitalized adults J Contin Educ Nurs 42(6) 251-7 doi 10392800220124-20110103-03 Epub 2011 Jan 10
9 Manworren RC (2000) Pediatric nursesrsquo knowledge and attitudes survey regarding pain Pediatr Nurs 26 610-614
10 Rieman M T Gordon M amp Marvin J M (2007) Pediatric nursesrsquo knowledge and attitudes survey regarding pain a competency tool modification Pediatr Nurs 33 303-306
11 Simons JM amp MacDonald LM (2004) Pain assessment tools childrenrsquos nursesrsquo views Journal of Child Health Care 8 264 Doi 1011771367493504047317
12 Twycross A (2007) What is the impact of theoretical knowledge on childrenrsquos nursesrsquo post-operative pain management practices an exploratory study Nurse Educ Today 27 697-707
13 Smart S (2005) POST-OPERATIVE PAIN MANAGEMENT KNOWLEDGE AND ATTITUDES OF PAEDIATRIC NURSES- A NEW ZEALAND REGIONAL VIEW Victoria University of Wellington [Online] Tilgjengelig paring httpresearcharchivevuwacnzbitstreamhandle1006338thesispdfsequence=2 [Lastet 13april 2014]
14 Vincent C V H (2005) Nursesrsquo knowledge attitudes and practices regarding childrenrsquos pain MCN Am J Matern Child Nurs 30 177-183
15 Olsson G Jylli L (2001) Smaumlrta hos barn och ungdomar Lund Sverige Studentlitteratur
16 Peters J W Schouw R Anand K J van Dijk M Duivenvoorden H J Tibboel D (2005) Does neonatal surgery lead to increased pain sensitivity in later childhood Pain 114(3) 444-54
17 Anand K J S Gracia-Preats J A amp Kim M S (2015) Assessment of neonatal pain UpToDate httpwwwuptodatecomcontentsassessment-of-neonatal-pain
18 Anand K J S Gracia-Preats J A amp Kim M S (2015) Prevention and treatment of neonatal pain UpToDate httpwwwuptodatecomcontentsprevention-and-treatment-of-neonatal-painsource=related_link
19 IASP (2011a) Acute Pain and Surgery Global Year Against Acute Pain [Online] Tilgjengelig paring httpwwwiasp-painorgfilesContentContentFoldersGlobalYearAgainstPain2AcutePainFactSheets7-Surgerypdf [Lastet 14april 2014]
20 Howard R Carter B Curry J Jain A Liossi C Morton N Rivett K Rose M Tyrrell J Walker S Williams G (2012) Good Practice in Postoperative and Procedural pain management 2nd Edition Pediatric Anesthesia 22 1ndash79 doi 101111j1460-9592201203838x
21 IASP (2011b) Interventions Benefits and Barriers Global Year Against Acute Pain [Online] Tilgjengelig paring httpwwwiasp-painorgfilesContentContentFoldersGlobalYearAgainstPain2AcutePainFactSheets2-Interventionspdf [Lastet 14april 2014]
22 Benhamou D Berti M Brodner G De Andres J Draisci G Moreno-Azcoita M Neugebauer EA Schwenk W Torres LM Viel E (2007) Postoperative Analgesic THerapy Observational Survey (PATHOS) A practice pattern study in 7 CentralSouthern Eurpean countries Pain 136 134-141
23 Reinertsen H (2008) Smerte hos barn kap3I Rustoslashen T amp Wahl AK (red) Ulike tekster om smerte - fra nocisepsjon til livskvalitet Oslo Gyldendal Norsk Forlag AS
Litteraturliste 24 Smeland A amp Reinertsen H (2012) Smertevurdering og behandling av postoperative smerter hos barn Tidsskriftet Kirurgen 1 58-62 (5 s) [Online] Tilgjengelig paring
httpwwwkirurgennopdf1201 [Lastet 13april 2014]
25 Bringuier S Picot MC Dadure C et al (2009) A prospective comparison of post-surgical behavioral pain scales in preschoolers highlighting the risk of false evaluations Pain 145 60-68
26 Crelline D Sullivan T B Babl F E OSullivan R Hutchinson A (2007) Analysis of the validation of existing behavioral pain and distress scales for use in the procedural setting Pediatric Anesthesia 17 720-733
27 Ghai B Makkar JK amp Wig J (2008) Postoperative pain assessment in preverbal children and children with cognitive impairment Pediatric Anesthesia 18 462-477
28 Hicks CL von Baeyer CL Spafford P et al (2001) The Faces Pain Scale-Revised Toward a common metric in pain measurement Pain 93 173-183
29 Merkel SI Voepel-Lewis T amp Shayevitz et al (1997) The FLACC A Behavioral Scale for Scoring Postoperative Pain in Young Children Pediatric Nursing 23 293-7
30 Ellis J A McCleary L Blouin R Dube K Rowley B MacNeil M amp Cooke C (2007) Implementing best practice pain management in a pediatric hospital Journal for Specialists in Pediatric Nursing 12 264-277 doi101111j1744-6155200700121x
31 Johnston C C Gagnon A Rennick J Rosmus C Patenaude H Ellis J Shapiro C Filion F Ritchie J Byron J (2007) One-on-one coaching to improve pain assessment and management practices of pediatric nurses Journal of Pediatric Nursing 22 467-478 doi101016jpedn200707004
32 Le May S Johnston C C Choiniegravere M Fortin C Kudirka D Murray L Chalut D (2009) Pain Management Practices in a Pediatric Emergency Room (PAMPER) Study interventions with nurses Pediatr Emerg Care Aug25(8)498-503 doi 101097PEC0b013e3181b0a0af
33 Vincent C V H Wilkie D J amp Wang E (2011) Pediatric Nurses Beliefs and Pain Management Practices An Intervention Pilot West J Nurs Res 33 825 originally published online 20 December 2010
36 Twycross A Finley G A and Latimer M (2013) Pediatric nurses postoperative pain management practices An observational study Journal for Specialists in Pediatric Nursing 18 189ndash201 doi 101111jspn12026
42 Twycross A amp Finley G A (2013) Childrens and parents perceptions of postoperative pain management a mixed methods study Journal of Clinical Nursing 22(21-22) 3095-3108 doi 101111jocn12152 [Online] Tilgjengelig paring httponlinelibrarywileycomdoi101111jocn12152pdf (13042014)
43 Polkki T Pietila AM Vehvilainen-Julkunen K (2003) Hospitalized childrens descriptions of their experiences with postsurgical pain relieving methods Int J Nurs Stud Jan40(1)33-44 PubMed PMID 12550148 English
46 Abdalrahim MS Majali SA Stomberg MW Bergbom I (2011) The effect of postoperative pain management program on improving nurses knowledge and attitudes toward pain Nurse Educ Pract 2011 Jul11(4)250-5 doi 101016jnepr201011016 Epub 2010 Dec 24 httpwwwncbinlmnihgovpubmed21186139
47 IASP Pain definition IASP (International Association of the Study of Pain) Pain definition
48 Norsk Ledemiddelharingndbok Ulike smertetilstander [Online] Tilgjengelig paring httplegemiddelhandbokanoTerapi22816expand=1
49 Astrid Lindgrens Barnsjukhus ndash Riktlinjer foumlr smaumlrtbehandling
50 Groslashnseth R amp Markestad T (2011) Pediatri og pediatrisk sykepleie Bergen Fagbokforlaget Vigmostad amp Bjoslashrke AS httppediatriportfoliono
51 Hicks CL von Baeyer CL Spafford Pet al The Faces Pain Scale‐Revised Toward a common metric in pain measurement Pain 2001 93173‐183
52 Twycross A Why Managing Pain in Children Matters in Managing Pain in Children A Clinical Guide (eds A Twycross S J Dowden and E Bruce) Wiley‐Blackwell 2009 Oxford UK doi 1010029781444322743ch1
53 Von Bayer CL amp Spagrud LJ Systematic review of observational (behavioral) measures of pain for children and adolescents aged 3 to 18 years Pain 2007 127 140‐150
54 Voepel‐Lewis Terri RN MSN ZanottiJennifer RN MS CCRN CEN DammeyerJennifer A RN MSN and MerkelSandra RN MS (January 2010) Reliability and Validity of the Face Legs Activity Cry Consolability Behavioral Tool in Assessing Acute Pain in Critically Ill Patients American Journal of Critical Care 19 (1) 55ndash61
55 Merkel S Voepel‐Lewis T Shayevitz JR et al The FLACC A behavioural scale for scoring postoperative pain in young children Pediatric nursing 1997 23293‐797
56 McCaffery M amp Beebe F (1994) Pain‐Clinical Manual of for Nursing Practice Times Mirror International Publishers Ltd Norsk oversettelse Smerter Laeligrebok for helsepersonell Oslo Norge Gyldendal Norsk Forlag AS
57 Reinertsen H Christophersen K‐A Helseth S Vurdering av postoperativ smerte hos barn (0‐5 aringr) Validering og reliabilitetstesting av smertevurderingsverktoslashyet FLACC Sykepleien Forskning 2014 9 132‐140 httpwwwsykepleiennoforskningforskningsartikkel1466655validering‐og‐reliabilitetstesting‐av‐smertevurderingsverktoyet‐flacc
Litteraturliste 58 Stinson J (2009) Pain Assessment I Twycross A Dowden S J amp Bruce E Pain Assessment in Managing Pain in Children A Clinical Guide Oxford UK Wiley-Blackmell
59 Tomlinson D von Baeyer CL Stinson JN Sung L A systematic review of faces scales for the self‐report of pain intensity in children Pediatrics 2010 Nov126(5)e1168‐98 PubMed PMID 20921070 Epub 20101006 eng
60 Von Baeyer CL Childrens self‐reports of pain intensity scale selection limitations and interpretation Pain Res Manag 2006 Autumn11(3)157‐62 PubMed PMID 16960632 Pubmed Central PMCID PMC2539005 Epub 20060909 eng
61 Ghai B Makkar J K amp Wig J (2008) Postoperative pain assesment in preverbal children and children with cognitive impairment Pediatric Anesthesia 18 462‐477
62 Malvia S Voepel‐Lewis T Tait A R Merkel S Lauer A Munro H Farley F (2001) Pain management in children with and without cognitive impairment following spine fusion surgery Pediatric Anasthesia 11 453‐458
63 Malvia S Voepel‐Lewis T Burke C Merkel S amp Tait A R (2006) The revised FLACC observational pain tool improved reliability and validity for pain assesment in children with cognitive impairment Pediatric Anestesia 16 258‐265
64 McJunkins A Green A amp Anand KJS (2010) Pain Assesment in cognitively Impared Functionally Impared Children Pilot Study Results Journal of Pediatric Nursing 25 307‐309
65 McKearnan K A Kieckhefer G Engel J M Jensen M amp Labyak S (2004) Pain in Children with cerebral Palsy A Review Journal of Neuroscience Nursing Vol 36 no 5 s252‐259
66 Voepel‐Lewis T Malviya S Tait A Merkel S Forter R amp Krane E (2008) A comparison of the clinical utility of pain assesment tools for children with cognitive impairment Pediatric Anesthesiology 106 (1) 72‐78
67 Baulch I Assessment and management of pain in the paediatric patient Nursing standard 2010 2510 35-40
68 Twycross A Why Managing Pain in Children Matters in Managing Pain in Children A Clinical Guide (eds A Twycross S J Dowden and E Bruce) Wiley-Blackwell 2009 Oxford UK doi 1010029781444322743ch1
69 Schug SA amp Pogatzki-Zhan EM Chronic Pain after Surgery or Injury Pain 2011 Clinical Updates XIX 11-5
70 Fredheim OMS Borchgrevink PC amp Kvarstein G Behandling av postoperativ smerte i sykehus Tidsskr Nor Legeforen 2011 131 1772-6
71 Steward DL Welge J amp Myer C Steroids for improving recovery following tonsillectomy in children Cochrane Database of Systematic Reviews 2003 Issue 1Art NoCD003997 DOI10100214651858CD003997
72 Hong JY Han SW Kim WO et al Effect of dexamethasone in combination with caudal analgesia on postoperative pain control in day-case paediatric orchioplexy British Journal of Anesthesia 2010 105(4)506-10
73 Den Norske Legeforening (2009) Retningslinjer for smertelindring [Online] URL httpwww legeforeningennoasset42585142585_1pdf
74 Association of Paediatric Anaesthetists (2008) Good Practice in Postoperative and Procedural Pain [Online] URL httpwwwbritishpainsocietyorgbook_apa_part1pdf
75 European Society of Regional Aneasthesia (2005) Postoperative Pain Management ndash Good Clinical Practice General recommendations and principles for successful pain management [Online] URL httpwwwesraeuropeorgPostoperativePainManagementpdf
76 Monsen ALB Skadberg BT amp Groslashnlie I Smertebehandling Norsk Barnelegeforeningen 2011 [Online] URL httpwwwlegeforeningennoid1104250
77 Smeland A amp Reinertsen H (2012) Smertevurdering og behandling av postoperative smerter hos barn Tidsskriftet Kirurgen 1 58-62 (5 s) [Online] Tilgjengelig paring httpwwwkirurgennopdf1201
78 Standing JF Savage I Pritchard D et al Diclofenac for acute pain in children Cochrane Database of Systematic Reviews 2009 Issue 4 Art No CD005538 DOI 10100214651858CD005538pub2
79 Standing JF Tibboel D Korpela R et al Diclofenac pharmacokinetic meta-analysis and dose recommendations for surgical pain in children aged 1ndash12 years Pediatric Anesthesia 2011 21 316ndash324 doi 101111j1460-9592201003509x
80 Riad W amp Moussa A Pre-operative analgesia with rectal diclofenac andor paracetamol in children undergoing hernia repair Anaesthesia 2007 Dec62(12)1241-5
81 Hiller A Meretoja OA Korpela R et al The Anagesic Efficacy of Acetaminophen Ketoprofen or Their Combination for Pediatric Surgical Patients Having Soft Tissue or Orthopedic Procedures Anesth Analg 20061021365-71
82 Norsk legemiddelharingndbok Antidoter ndash alfabetisk oversikt bruksomraringde og dosering httplegemiddelhandbokanoGenerelle153557i153779
83 Norsk legemiddelharingndbok Barn og legemidler httplegemiddelhandbokanoGenerelle153109
84 SickKids Aboutkidshealthca Myths About Pain httpwwwaboutkidshealthcaEnResourceCentresPainPainAssessmentPagesMyths-About-Painaspx
85 Psykososial preoperativ forberedelse av barn 0ndash18 aringr httpwwwhelsebiblioteketnomicrositefagprosedyrerfagprosedyrerpsykososial-preoperativ-forberedelse-av-barn-018-C3A5r
86 Twycross A Why Managing Pain in Children Matters in Managing Pain in Children A Clinical Guide (eds ATwycross S J Dowden and E Bruce) Wiley‐Blackwell 2009 Oxford UK doi 1010029781444322743ch1
Observasjonsstudie
bull Ikke deltakende observasjon
bull Semistrukturert
bull Observasjons sjekkliste og feltnotater ndash Smertevurdering
ndash Ikke medikamentell smertelindring
ndash Medikamentell smertelindring
bull Pilottestet
bull Ca 6 tdag i 10 dager (ca 60 timer pr avd 360 timer totalt)
Intervju med barn
bull Semistrukturert
bull Intervjuguider (6-11 12-18) ndash Smerteopplevelsen
ndash Smertevurdering
ndash Ikke medikamentell smertelindring
ndash Medikamentell smertelindring
bull Pilottestet
bull Barn 6-18 aringr
bull 10 barnavd ndash to avdelinger (kontrollgruppeintervensjonsgruppe)
Fase 2 Utvikling av intervensjon
Baseres paring tidligere forskning resultatene fra fase 1 samt tilbakemeldinger fra fag og seksjonsledere
Intervensjonen bestod av
bullTemadag (seks timer)
ndash Undervisning og workshop
ndash Sykepleiere og leger
ndash Stefan Lundeberg og Hanne Reinertsen
bullVeiledning i praksis
ndash Klinisk veiledning i smertebehandling av barn
ndash Eva Carlsen
bullReminders
Fase 3 Evaluering av intervensjonen
Forskningssposlashrsmaringl
Vil intervensjonen oslashke sykepleieres kunnskaper og holdninger til smerte hos barn og ungdom
Vil intervensjonen bedre sykepleieres smerteharingndtering av barn og ungdom
Datainnsamling
bullT-2 1 mnd etter intervensjonen bull Sposlashrreskjema PKNAS-N (alle avd)
bull Observasjonsstudie (fire avd)
bull Intervju av barn (to avd)
bullT-3 6 mnd etter intervensjonen bull Sposlashrreskjema PKNAS-N (alle avd)
bull Observasjonsstudie (to avd)
Fremdriftsplan
Forarbeid November 2013 - juni 2014
Datainnsamling September - november 2014 T-1
Januar ndash februar 2015 Intervensjon
Mars ndash april 2015 T-2
September ndash oktober 2015 T-3
Analyse September 2015 - juli 2016
Artikkelskriving Januar ndash august 2015 artikkel 1
November 2015 ndash juni 2016 artikkel 2
August ndash desember 2016 artikkel 3
Tusen takk
Oppsummering Prosjektet er stoslashttet av
Nasjonalt kompetansenettverk for legemidler til barn
Kirurgisk avdeling for barn OUS
Norsk Sykepleierforbund
Sykehusbarn
Litteraturliste 1 Hauer J Jones BL amp Wolfe J Poplack D G Kim M S (2015) Evaluation and management of pain in children UpToDate httpwwwuptodatecomcontentsevaluation-
and-management-of-pain-in-childrensource=search_resultampsearch=PAIN+CHILDRENampselectedTitle=17E150
2 IASP (2011c) Acute Pain management in Newborn Infants Pain [Online] Tilgjengelig paring httpiaspfilescms-pluscomContentContentFoldersPublications2PainClinicalUpdatesArchivesPCU_19-6_final_12-8-11_1390260191290_1pdf [Lastet 14april 2014]
3 Bernadi M Catania G amp Tridello G (2007) Knowledge and attitudes about cancer pain management a national survey of Italian hospice nurses Cancer Nurs 30(2) E20-6
4 Coulling S (2005) Nurses and doctors knowledge of pain after surgery Nurs Stand 19(34) 41-49
5 Hovde K R Granheim T H Christophersen K-A amp Dihle A (2012) The Norwegian Version of the Pediatric Nursesrsquo Knowledge and attitudes Survey Regarding Pain Reliability and Validity Pedatric nursing 38 (5) 264-269
6 Hossain S (2010) Nursesrsquo Knowledge and Attitudes and Pain Management Practice of Post-Operative Children in Bangladesh Prince of Songkla University Nedlastet fra httpkbpsuacthpsukbbitstream201078261325999pdf
7 Huth M M Gregg T L Lin L (2010) Education changes Mexican nurses knowledge and attitudes regarding pediatric pain Pain Manag Nurs Dec11(4)201-8 doi 101016jpmn200911001
8 Lewthwaite B J Jabusch K M Wheeler B J Schnell-Hoehn K N Mills J Estrella-Holder E Fedorowicz A (2011) Nurses knowledge and attitudes regarding pain management in hospitalized adults J Contin Educ Nurs 42(6) 251-7 doi 10392800220124-20110103-03 Epub 2011 Jan 10
9 Manworren RC (2000) Pediatric nursesrsquo knowledge and attitudes survey regarding pain Pediatr Nurs 26 610-614
10 Rieman M T Gordon M amp Marvin J M (2007) Pediatric nursesrsquo knowledge and attitudes survey regarding pain a competency tool modification Pediatr Nurs 33 303-306
11 Simons JM amp MacDonald LM (2004) Pain assessment tools childrenrsquos nursesrsquo views Journal of Child Health Care 8 264 Doi 1011771367493504047317
12 Twycross A (2007) What is the impact of theoretical knowledge on childrenrsquos nursesrsquo post-operative pain management practices an exploratory study Nurse Educ Today 27 697-707
13 Smart S (2005) POST-OPERATIVE PAIN MANAGEMENT KNOWLEDGE AND ATTITUDES OF PAEDIATRIC NURSES- A NEW ZEALAND REGIONAL VIEW Victoria University of Wellington [Online] Tilgjengelig paring httpresearcharchivevuwacnzbitstreamhandle1006338thesispdfsequence=2 [Lastet 13april 2014]
14 Vincent C V H (2005) Nursesrsquo knowledge attitudes and practices regarding childrenrsquos pain MCN Am J Matern Child Nurs 30 177-183
15 Olsson G Jylli L (2001) Smaumlrta hos barn och ungdomar Lund Sverige Studentlitteratur
16 Peters J W Schouw R Anand K J van Dijk M Duivenvoorden H J Tibboel D (2005) Does neonatal surgery lead to increased pain sensitivity in later childhood Pain 114(3) 444-54
17 Anand K J S Gracia-Preats J A amp Kim M S (2015) Assessment of neonatal pain UpToDate httpwwwuptodatecomcontentsassessment-of-neonatal-pain
18 Anand K J S Gracia-Preats J A amp Kim M S (2015) Prevention and treatment of neonatal pain UpToDate httpwwwuptodatecomcontentsprevention-and-treatment-of-neonatal-painsource=related_link
19 IASP (2011a) Acute Pain and Surgery Global Year Against Acute Pain [Online] Tilgjengelig paring httpwwwiasp-painorgfilesContentContentFoldersGlobalYearAgainstPain2AcutePainFactSheets7-Surgerypdf [Lastet 14april 2014]
20 Howard R Carter B Curry J Jain A Liossi C Morton N Rivett K Rose M Tyrrell J Walker S Williams G (2012) Good Practice in Postoperative and Procedural pain management 2nd Edition Pediatric Anesthesia 22 1ndash79 doi 101111j1460-9592201203838x
21 IASP (2011b) Interventions Benefits and Barriers Global Year Against Acute Pain [Online] Tilgjengelig paring httpwwwiasp-painorgfilesContentContentFoldersGlobalYearAgainstPain2AcutePainFactSheets2-Interventionspdf [Lastet 14april 2014]
22 Benhamou D Berti M Brodner G De Andres J Draisci G Moreno-Azcoita M Neugebauer EA Schwenk W Torres LM Viel E (2007) Postoperative Analgesic THerapy Observational Survey (PATHOS) A practice pattern study in 7 CentralSouthern Eurpean countries Pain 136 134-141
23 Reinertsen H (2008) Smerte hos barn kap3I Rustoslashen T amp Wahl AK (red) Ulike tekster om smerte - fra nocisepsjon til livskvalitet Oslo Gyldendal Norsk Forlag AS
Litteraturliste 24 Smeland A amp Reinertsen H (2012) Smertevurdering og behandling av postoperative smerter hos barn Tidsskriftet Kirurgen 1 58-62 (5 s) [Online] Tilgjengelig paring
httpwwwkirurgennopdf1201 [Lastet 13april 2014]
25 Bringuier S Picot MC Dadure C et al (2009) A prospective comparison of post-surgical behavioral pain scales in preschoolers highlighting the risk of false evaluations Pain 145 60-68
26 Crelline D Sullivan T B Babl F E OSullivan R Hutchinson A (2007) Analysis of the validation of existing behavioral pain and distress scales for use in the procedural setting Pediatric Anesthesia 17 720-733
27 Ghai B Makkar JK amp Wig J (2008) Postoperative pain assessment in preverbal children and children with cognitive impairment Pediatric Anesthesia 18 462-477
28 Hicks CL von Baeyer CL Spafford P et al (2001) The Faces Pain Scale-Revised Toward a common metric in pain measurement Pain 93 173-183
29 Merkel SI Voepel-Lewis T amp Shayevitz et al (1997) The FLACC A Behavioral Scale for Scoring Postoperative Pain in Young Children Pediatric Nursing 23 293-7
30 Ellis J A McCleary L Blouin R Dube K Rowley B MacNeil M amp Cooke C (2007) Implementing best practice pain management in a pediatric hospital Journal for Specialists in Pediatric Nursing 12 264-277 doi101111j1744-6155200700121x
31 Johnston C C Gagnon A Rennick J Rosmus C Patenaude H Ellis J Shapiro C Filion F Ritchie J Byron J (2007) One-on-one coaching to improve pain assessment and management practices of pediatric nurses Journal of Pediatric Nursing 22 467-478 doi101016jpedn200707004
32 Le May S Johnston C C Choiniegravere M Fortin C Kudirka D Murray L Chalut D (2009) Pain Management Practices in a Pediatric Emergency Room (PAMPER) Study interventions with nurses Pediatr Emerg Care Aug25(8)498-503 doi 101097PEC0b013e3181b0a0af
33 Vincent C V H Wilkie D J amp Wang E (2011) Pediatric Nurses Beliefs and Pain Management Practices An Intervention Pilot West J Nurs Res 33 825 originally published online 20 December 2010
36 Twycross A Finley G A and Latimer M (2013) Pediatric nurses postoperative pain management practices An observational study Journal for Specialists in Pediatric Nursing 18 189ndash201 doi 101111jspn12026
42 Twycross A amp Finley G A (2013) Childrens and parents perceptions of postoperative pain management a mixed methods study Journal of Clinical Nursing 22(21-22) 3095-3108 doi 101111jocn12152 [Online] Tilgjengelig paring httponlinelibrarywileycomdoi101111jocn12152pdf (13042014)
43 Polkki T Pietila AM Vehvilainen-Julkunen K (2003) Hospitalized childrens descriptions of their experiences with postsurgical pain relieving methods Int J Nurs Stud Jan40(1)33-44 PubMed PMID 12550148 English
46 Abdalrahim MS Majali SA Stomberg MW Bergbom I (2011) The effect of postoperative pain management program on improving nurses knowledge and attitudes toward pain Nurse Educ Pract 2011 Jul11(4)250-5 doi 101016jnepr201011016 Epub 2010 Dec 24 httpwwwncbinlmnihgovpubmed21186139
47 IASP Pain definition IASP (International Association of the Study of Pain) Pain definition
48 Norsk Ledemiddelharingndbok Ulike smertetilstander [Online] Tilgjengelig paring httplegemiddelhandbokanoTerapi22816expand=1
49 Astrid Lindgrens Barnsjukhus ndash Riktlinjer foumlr smaumlrtbehandling
50 Groslashnseth R amp Markestad T (2011) Pediatri og pediatrisk sykepleie Bergen Fagbokforlaget Vigmostad amp Bjoslashrke AS httppediatriportfoliono
51 Hicks CL von Baeyer CL Spafford Pet al The Faces Pain Scale‐Revised Toward a common metric in pain measurement Pain 2001 93173‐183
52 Twycross A Why Managing Pain in Children Matters in Managing Pain in Children A Clinical Guide (eds A Twycross S J Dowden and E Bruce) Wiley‐Blackwell 2009 Oxford UK doi 1010029781444322743ch1
53 Von Bayer CL amp Spagrud LJ Systematic review of observational (behavioral) measures of pain for children and adolescents aged 3 to 18 years Pain 2007 127 140‐150
54 Voepel‐Lewis Terri RN MSN ZanottiJennifer RN MS CCRN CEN DammeyerJennifer A RN MSN and MerkelSandra RN MS (January 2010) Reliability and Validity of the Face Legs Activity Cry Consolability Behavioral Tool in Assessing Acute Pain in Critically Ill Patients American Journal of Critical Care 19 (1) 55ndash61
55 Merkel S Voepel‐Lewis T Shayevitz JR et al The FLACC A behavioural scale for scoring postoperative pain in young children Pediatric nursing 1997 23293‐797
56 McCaffery M amp Beebe F (1994) Pain‐Clinical Manual of for Nursing Practice Times Mirror International Publishers Ltd Norsk oversettelse Smerter Laeligrebok for helsepersonell Oslo Norge Gyldendal Norsk Forlag AS
57 Reinertsen H Christophersen K‐A Helseth S Vurdering av postoperativ smerte hos barn (0‐5 aringr) Validering og reliabilitetstesting av smertevurderingsverktoslashyet FLACC Sykepleien Forskning 2014 9 132‐140 httpwwwsykepleiennoforskningforskningsartikkel1466655validering‐og‐reliabilitetstesting‐av‐smertevurderingsverktoyet‐flacc
Litteraturliste 58 Stinson J (2009) Pain Assessment I Twycross A Dowden S J amp Bruce E Pain Assessment in Managing Pain in Children A Clinical Guide Oxford UK Wiley-Blackmell
59 Tomlinson D von Baeyer CL Stinson JN Sung L A systematic review of faces scales for the self‐report of pain intensity in children Pediatrics 2010 Nov126(5)e1168‐98 PubMed PMID 20921070 Epub 20101006 eng
60 Von Baeyer CL Childrens self‐reports of pain intensity scale selection limitations and interpretation Pain Res Manag 2006 Autumn11(3)157‐62 PubMed PMID 16960632 Pubmed Central PMCID PMC2539005 Epub 20060909 eng
61 Ghai B Makkar J K amp Wig J (2008) Postoperative pain assesment in preverbal children and children with cognitive impairment Pediatric Anesthesia 18 462‐477
62 Malvia S Voepel‐Lewis T Tait A R Merkel S Lauer A Munro H Farley F (2001) Pain management in children with and without cognitive impairment following spine fusion surgery Pediatric Anasthesia 11 453‐458
63 Malvia S Voepel‐Lewis T Burke C Merkel S amp Tait A R (2006) The revised FLACC observational pain tool improved reliability and validity for pain assesment in children with cognitive impairment Pediatric Anestesia 16 258‐265
64 McJunkins A Green A amp Anand KJS (2010) Pain Assesment in cognitively Impared Functionally Impared Children Pilot Study Results Journal of Pediatric Nursing 25 307‐309
65 McKearnan K A Kieckhefer G Engel J M Jensen M amp Labyak S (2004) Pain in Children with cerebral Palsy A Review Journal of Neuroscience Nursing Vol 36 no 5 s252‐259
66 Voepel‐Lewis T Malviya S Tait A Merkel S Forter R amp Krane E (2008) A comparison of the clinical utility of pain assesment tools for children with cognitive impairment Pediatric Anesthesiology 106 (1) 72‐78
67 Baulch I Assessment and management of pain in the paediatric patient Nursing standard 2010 2510 35-40
68 Twycross A Why Managing Pain in Children Matters in Managing Pain in Children A Clinical Guide (eds A Twycross S J Dowden and E Bruce) Wiley-Blackwell 2009 Oxford UK doi 1010029781444322743ch1
69 Schug SA amp Pogatzki-Zhan EM Chronic Pain after Surgery or Injury Pain 2011 Clinical Updates XIX 11-5
70 Fredheim OMS Borchgrevink PC amp Kvarstein G Behandling av postoperativ smerte i sykehus Tidsskr Nor Legeforen 2011 131 1772-6
71 Steward DL Welge J amp Myer C Steroids for improving recovery following tonsillectomy in children Cochrane Database of Systematic Reviews 2003 Issue 1Art NoCD003997 DOI10100214651858CD003997
72 Hong JY Han SW Kim WO et al Effect of dexamethasone in combination with caudal analgesia on postoperative pain control in day-case paediatric orchioplexy British Journal of Anesthesia 2010 105(4)506-10
73 Den Norske Legeforening (2009) Retningslinjer for smertelindring [Online] URL httpwww legeforeningennoasset42585142585_1pdf
74 Association of Paediatric Anaesthetists (2008) Good Practice in Postoperative and Procedural Pain [Online] URL httpwwwbritishpainsocietyorgbook_apa_part1pdf
75 European Society of Regional Aneasthesia (2005) Postoperative Pain Management ndash Good Clinical Practice General recommendations and principles for successful pain management [Online] URL httpwwwesraeuropeorgPostoperativePainManagementpdf
76 Monsen ALB Skadberg BT amp Groslashnlie I Smertebehandling Norsk Barnelegeforeningen 2011 [Online] URL httpwwwlegeforeningennoid1104250
77 Smeland A amp Reinertsen H (2012) Smertevurdering og behandling av postoperative smerter hos barn Tidsskriftet Kirurgen 1 58-62 (5 s) [Online] Tilgjengelig paring httpwwwkirurgennopdf1201
78 Standing JF Savage I Pritchard D et al Diclofenac for acute pain in children Cochrane Database of Systematic Reviews 2009 Issue 4 Art No CD005538 DOI 10100214651858CD005538pub2
79 Standing JF Tibboel D Korpela R et al Diclofenac pharmacokinetic meta-analysis and dose recommendations for surgical pain in children aged 1ndash12 years Pediatric Anesthesia 2011 21 316ndash324 doi 101111j1460-9592201003509x
80 Riad W amp Moussa A Pre-operative analgesia with rectal diclofenac andor paracetamol in children undergoing hernia repair Anaesthesia 2007 Dec62(12)1241-5
81 Hiller A Meretoja OA Korpela R et al The Anagesic Efficacy of Acetaminophen Ketoprofen or Their Combination for Pediatric Surgical Patients Having Soft Tissue or Orthopedic Procedures Anesth Analg 20061021365-71
82 Norsk legemiddelharingndbok Antidoter ndash alfabetisk oversikt bruksomraringde og dosering httplegemiddelhandbokanoGenerelle153557i153779
83 Norsk legemiddelharingndbok Barn og legemidler httplegemiddelhandbokanoGenerelle153109
84 SickKids Aboutkidshealthca Myths About Pain httpwwwaboutkidshealthcaEnResourceCentresPainPainAssessmentPagesMyths-About-Painaspx
85 Psykososial preoperativ forberedelse av barn 0ndash18 aringr httpwwwhelsebiblioteketnomicrositefagprosedyrerfagprosedyrerpsykososial-preoperativ-forberedelse-av-barn-018-C3A5r
86 Twycross A Why Managing Pain in Children Matters in Managing Pain in Children A Clinical Guide (eds ATwycross S J Dowden and E Bruce) Wiley‐Blackwell 2009 Oxford UK doi 1010029781444322743ch1
Intervju med barn
bull Semistrukturert
bull Intervjuguider (6-11 12-18) ndash Smerteopplevelsen
ndash Smertevurdering
ndash Ikke medikamentell smertelindring
ndash Medikamentell smertelindring
bull Pilottestet
bull Barn 6-18 aringr
bull 10 barnavd ndash to avdelinger (kontrollgruppeintervensjonsgruppe)
Fase 2 Utvikling av intervensjon
Baseres paring tidligere forskning resultatene fra fase 1 samt tilbakemeldinger fra fag og seksjonsledere
Intervensjonen bestod av
bullTemadag (seks timer)
ndash Undervisning og workshop
ndash Sykepleiere og leger
ndash Stefan Lundeberg og Hanne Reinertsen
bullVeiledning i praksis
ndash Klinisk veiledning i smertebehandling av barn
ndash Eva Carlsen
bullReminders
Fase 3 Evaluering av intervensjonen
Forskningssposlashrsmaringl
Vil intervensjonen oslashke sykepleieres kunnskaper og holdninger til smerte hos barn og ungdom
Vil intervensjonen bedre sykepleieres smerteharingndtering av barn og ungdom
Datainnsamling
bullT-2 1 mnd etter intervensjonen bull Sposlashrreskjema PKNAS-N (alle avd)
bull Observasjonsstudie (fire avd)
bull Intervju av barn (to avd)
bullT-3 6 mnd etter intervensjonen bull Sposlashrreskjema PKNAS-N (alle avd)
bull Observasjonsstudie (to avd)
Fremdriftsplan
Forarbeid November 2013 - juni 2014
Datainnsamling September - november 2014 T-1
Januar ndash februar 2015 Intervensjon
Mars ndash april 2015 T-2
September ndash oktober 2015 T-3
Analyse September 2015 - juli 2016
Artikkelskriving Januar ndash august 2015 artikkel 1
November 2015 ndash juni 2016 artikkel 2
August ndash desember 2016 artikkel 3
Tusen takk
Oppsummering Prosjektet er stoslashttet av
Nasjonalt kompetansenettverk for legemidler til barn
Kirurgisk avdeling for barn OUS
Norsk Sykepleierforbund
Sykehusbarn
Litteraturliste 1 Hauer J Jones BL amp Wolfe J Poplack D G Kim M S (2015) Evaluation and management of pain in children UpToDate httpwwwuptodatecomcontentsevaluation-
and-management-of-pain-in-childrensource=search_resultampsearch=PAIN+CHILDRENampselectedTitle=17E150
2 IASP (2011c) Acute Pain management in Newborn Infants Pain [Online] Tilgjengelig paring httpiaspfilescms-pluscomContentContentFoldersPublications2PainClinicalUpdatesArchivesPCU_19-6_final_12-8-11_1390260191290_1pdf [Lastet 14april 2014]
3 Bernadi M Catania G amp Tridello G (2007) Knowledge and attitudes about cancer pain management a national survey of Italian hospice nurses Cancer Nurs 30(2) E20-6
4 Coulling S (2005) Nurses and doctors knowledge of pain after surgery Nurs Stand 19(34) 41-49
5 Hovde K R Granheim T H Christophersen K-A amp Dihle A (2012) The Norwegian Version of the Pediatric Nursesrsquo Knowledge and attitudes Survey Regarding Pain Reliability and Validity Pedatric nursing 38 (5) 264-269
6 Hossain S (2010) Nursesrsquo Knowledge and Attitudes and Pain Management Practice of Post-Operative Children in Bangladesh Prince of Songkla University Nedlastet fra httpkbpsuacthpsukbbitstream201078261325999pdf
7 Huth M M Gregg T L Lin L (2010) Education changes Mexican nurses knowledge and attitudes regarding pediatric pain Pain Manag Nurs Dec11(4)201-8 doi 101016jpmn200911001
8 Lewthwaite B J Jabusch K M Wheeler B J Schnell-Hoehn K N Mills J Estrella-Holder E Fedorowicz A (2011) Nurses knowledge and attitudes regarding pain management in hospitalized adults J Contin Educ Nurs 42(6) 251-7 doi 10392800220124-20110103-03 Epub 2011 Jan 10
9 Manworren RC (2000) Pediatric nursesrsquo knowledge and attitudes survey regarding pain Pediatr Nurs 26 610-614
10 Rieman M T Gordon M amp Marvin J M (2007) Pediatric nursesrsquo knowledge and attitudes survey regarding pain a competency tool modification Pediatr Nurs 33 303-306
11 Simons JM amp MacDonald LM (2004) Pain assessment tools childrenrsquos nursesrsquo views Journal of Child Health Care 8 264 Doi 1011771367493504047317
12 Twycross A (2007) What is the impact of theoretical knowledge on childrenrsquos nursesrsquo post-operative pain management practices an exploratory study Nurse Educ Today 27 697-707
13 Smart S (2005) POST-OPERATIVE PAIN MANAGEMENT KNOWLEDGE AND ATTITUDES OF PAEDIATRIC NURSES- A NEW ZEALAND REGIONAL VIEW Victoria University of Wellington [Online] Tilgjengelig paring httpresearcharchivevuwacnzbitstreamhandle1006338thesispdfsequence=2 [Lastet 13april 2014]
14 Vincent C V H (2005) Nursesrsquo knowledge attitudes and practices regarding childrenrsquos pain MCN Am J Matern Child Nurs 30 177-183
15 Olsson G Jylli L (2001) Smaumlrta hos barn och ungdomar Lund Sverige Studentlitteratur
16 Peters J W Schouw R Anand K J van Dijk M Duivenvoorden H J Tibboel D (2005) Does neonatal surgery lead to increased pain sensitivity in later childhood Pain 114(3) 444-54
17 Anand K J S Gracia-Preats J A amp Kim M S (2015) Assessment of neonatal pain UpToDate httpwwwuptodatecomcontentsassessment-of-neonatal-pain
18 Anand K J S Gracia-Preats J A amp Kim M S (2015) Prevention and treatment of neonatal pain UpToDate httpwwwuptodatecomcontentsprevention-and-treatment-of-neonatal-painsource=related_link
19 IASP (2011a) Acute Pain and Surgery Global Year Against Acute Pain [Online] Tilgjengelig paring httpwwwiasp-painorgfilesContentContentFoldersGlobalYearAgainstPain2AcutePainFactSheets7-Surgerypdf [Lastet 14april 2014]
20 Howard R Carter B Curry J Jain A Liossi C Morton N Rivett K Rose M Tyrrell J Walker S Williams G (2012) Good Practice in Postoperative and Procedural pain management 2nd Edition Pediatric Anesthesia 22 1ndash79 doi 101111j1460-9592201203838x
21 IASP (2011b) Interventions Benefits and Barriers Global Year Against Acute Pain [Online] Tilgjengelig paring httpwwwiasp-painorgfilesContentContentFoldersGlobalYearAgainstPain2AcutePainFactSheets2-Interventionspdf [Lastet 14april 2014]
22 Benhamou D Berti M Brodner G De Andres J Draisci G Moreno-Azcoita M Neugebauer EA Schwenk W Torres LM Viel E (2007) Postoperative Analgesic THerapy Observational Survey (PATHOS) A practice pattern study in 7 CentralSouthern Eurpean countries Pain 136 134-141
23 Reinertsen H (2008) Smerte hos barn kap3I Rustoslashen T amp Wahl AK (red) Ulike tekster om smerte - fra nocisepsjon til livskvalitet Oslo Gyldendal Norsk Forlag AS
Litteraturliste 24 Smeland A amp Reinertsen H (2012) Smertevurdering og behandling av postoperative smerter hos barn Tidsskriftet Kirurgen 1 58-62 (5 s) [Online] Tilgjengelig paring
httpwwwkirurgennopdf1201 [Lastet 13april 2014]
25 Bringuier S Picot MC Dadure C et al (2009) A prospective comparison of post-surgical behavioral pain scales in preschoolers highlighting the risk of false evaluations Pain 145 60-68
26 Crelline D Sullivan T B Babl F E OSullivan R Hutchinson A (2007) Analysis of the validation of existing behavioral pain and distress scales for use in the procedural setting Pediatric Anesthesia 17 720-733
27 Ghai B Makkar JK amp Wig J (2008) Postoperative pain assessment in preverbal children and children with cognitive impairment Pediatric Anesthesia 18 462-477
28 Hicks CL von Baeyer CL Spafford P et al (2001) The Faces Pain Scale-Revised Toward a common metric in pain measurement Pain 93 173-183
29 Merkel SI Voepel-Lewis T amp Shayevitz et al (1997) The FLACC A Behavioral Scale for Scoring Postoperative Pain in Young Children Pediatric Nursing 23 293-7
30 Ellis J A McCleary L Blouin R Dube K Rowley B MacNeil M amp Cooke C (2007) Implementing best practice pain management in a pediatric hospital Journal for Specialists in Pediatric Nursing 12 264-277 doi101111j1744-6155200700121x
31 Johnston C C Gagnon A Rennick J Rosmus C Patenaude H Ellis J Shapiro C Filion F Ritchie J Byron J (2007) One-on-one coaching to improve pain assessment and management practices of pediatric nurses Journal of Pediatric Nursing 22 467-478 doi101016jpedn200707004
32 Le May S Johnston C C Choiniegravere M Fortin C Kudirka D Murray L Chalut D (2009) Pain Management Practices in a Pediatric Emergency Room (PAMPER) Study interventions with nurses Pediatr Emerg Care Aug25(8)498-503 doi 101097PEC0b013e3181b0a0af
33 Vincent C V H Wilkie D J amp Wang E (2011) Pediatric Nurses Beliefs and Pain Management Practices An Intervention Pilot West J Nurs Res 33 825 originally published online 20 December 2010
36 Twycross A Finley G A and Latimer M (2013) Pediatric nurses postoperative pain management practices An observational study Journal for Specialists in Pediatric Nursing 18 189ndash201 doi 101111jspn12026
42 Twycross A amp Finley G A (2013) Childrens and parents perceptions of postoperative pain management a mixed methods study Journal of Clinical Nursing 22(21-22) 3095-3108 doi 101111jocn12152 [Online] Tilgjengelig paring httponlinelibrarywileycomdoi101111jocn12152pdf (13042014)
43 Polkki T Pietila AM Vehvilainen-Julkunen K (2003) Hospitalized childrens descriptions of their experiences with postsurgical pain relieving methods Int J Nurs Stud Jan40(1)33-44 PubMed PMID 12550148 English
46 Abdalrahim MS Majali SA Stomberg MW Bergbom I (2011) The effect of postoperative pain management program on improving nurses knowledge and attitudes toward pain Nurse Educ Pract 2011 Jul11(4)250-5 doi 101016jnepr201011016 Epub 2010 Dec 24 httpwwwncbinlmnihgovpubmed21186139
47 IASP Pain definition IASP (International Association of the Study of Pain) Pain definition
48 Norsk Ledemiddelharingndbok Ulike smertetilstander [Online] Tilgjengelig paring httplegemiddelhandbokanoTerapi22816expand=1
49 Astrid Lindgrens Barnsjukhus ndash Riktlinjer foumlr smaumlrtbehandling
50 Groslashnseth R amp Markestad T (2011) Pediatri og pediatrisk sykepleie Bergen Fagbokforlaget Vigmostad amp Bjoslashrke AS httppediatriportfoliono
51 Hicks CL von Baeyer CL Spafford Pet al The Faces Pain Scale‐Revised Toward a common metric in pain measurement Pain 2001 93173‐183
52 Twycross A Why Managing Pain in Children Matters in Managing Pain in Children A Clinical Guide (eds A Twycross S J Dowden and E Bruce) Wiley‐Blackwell 2009 Oxford UK doi 1010029781444322743ch1
53 Von Bayer CL amp Spagrud LJ Systematic review of observational (behavioral) measures of pain for children and adolescents aged 3 to 18 years Pain 2007 127 140‐150
54 Voepel‐Lewis Terri RN MSN ZanottiJennifer RN MS CCRN CEN DammeyerJennifer A RN MSN and MerkelSandra RN MS (January 2010) Reliability and Validity of the Face Legs Activity Cry Consolability Behavioral Tool in Assessing Acute Pain in Critically Ill Patients American Journal of Critical Care 19 (1) 55ndash61
55 Merkel S Voepel‐Lewis T Shayevitz JR et al The FLACC A behavioural scale for scoring postoperative pain in young children Pediatric nursing 1997 23293‐797
56 McCaffery M amp Beebe F (1994) Pain‐Clinical Manual of for Nursing Practice Times Mirror International Publishers Ltd Norsk oversettelse Smerter Laeligrebok for helsepersonell Oslo Norge Gyldendal Norsk Forlag AS
57 Reinertsen H Christophersen K‐A Helseth S Vurdering av postoperativ smerte hos barn (0‐5 aringr) Validering og reliabilitetstesting av smertevurderingsverktoslashyet FLACC Sykepleien Forskning 2014 9 132‐140 httpwwwsykepleiennoforskningforskningsartikkel1466655validering‐og‐reliabilitetstesting‐av‐smertevurderingsverktoyet‐flacc
Litteraturliste 58 Stinson J (2009) Pain Assessment I Twycross A Dowden S J amp Bruce E Pain Assessment in Managing Pain in Children A Clinical Guide Oxford UK Wiley-Blackmell
59 Tomlinson D von Baeyer CL Stinson JN Sung L A systematic review of faces scales for the self‐report of pain intensity in children Pediatrics 2010 Nov126(5)e1168‐98 PubMed PMID 20921070 Epub 20101006 eng
60 Von Baeyer CL Childrens self‐reports of pain intensity scale selection limitations and interpretation Pain Res Manag 2006 Autumn11(3)157‐62 PubMed PMID 16960632 Pubmed Central PMCID PMC2539005 Epub 20060909 eng
61 Ghai B Makkar J K amp Wig J (2008) Postoperative pain assesment in preverbal children and children with cognitive impairment Pediatric Anesthesia 18 462‐477
62 Malvia S Voepel‐Lewis T Tait A R Merkel S Lauer A Munro H Farley F (2001) Pain management in children with and without cognitive impairment following spine fusion surgery Pediatric Anasthesia 11 453‐458
63 Malvia S Voepel‐Lewis T Burke C Merkel S amp Tait A R (2006) The revised FLACC observational pain tool improved reliability and validity for pain assesment in children with cognitive impairment Pediatric Anestesia 16 258‐265
64 McJunkins A Green A amp Anand KJS (2010) Pain Assesment in cognitively Impared Functionally Impared Children Pilot Study Results Journal of Pediatric Nursing 25 307‐309
65 McKearnan K A Kieckhefer G Engel J M Jensen M amp Labyak S (2004) Pain in Children with cerebral Palsy A Review Journal of Neuroscience Nursing Vol 36 no 5 s252‐259
66 Voepel‐Lewis T Malviya S Tait A Merkel S Forter R amp Krane E (2008) A comparison of the clinical utility of pain assesment tools for children with cognitive impairment Pediatric Anesthesiology 106 (1) 72‐78
67 Baulch I Assessment and management of pain in the paediatric patient Nursing standard 2010 2510 35-40
68 Twycross A Why Managing Pain in Children Matters in Managing Pain in Children A Clinical Guide (eds A Twycross S J Dowden and E Bruce) Wiley-Blackwell 2009 Oxford UK doi 1010029781444322743ch1
69 Schug SA amp Pogatzki-Zhan EM Chronic Pain after Surgery or Injury Pain 2011 Clinical Updates XIX 11-5
70 Fredheim OMS Borchgrevink PC amp Kvarstein G Behandling av postoperativ smerte i sykehus Tidsskr Nor Legeforen 2011 131 1772-6
71 Steward DL Welge J amp Myer C Steroids for improving recovery following tonsillectomy in children Cochrane Database of Systematic Reviews 2003 Issue 1Art NoCD003997 DOI10100214651858CD003997
72 Hong JY Han SW Kim WO et al Effect of dexamethasone in combination with caudal analgesia on postoperative pain control in day-case paediatric orchioplexy British Journal of Anesthesia 2010 105(4)506-10
73 Den Norske Legeforening (2009) Retningslinjer for smertelindring [Online] URL httpwww legeforeningennoasset42585142585_1pdf
74 Association of Paediatric Anaesthetists (2008) Good Practice in Postoperative and Procedural Pain [Online] URL httpwwwbritishpainsocietyorgbook_apa_part1pdf
75 European Society of Regional Aneasthesia (2005) Postoperative Pain Management ndash Good Clinical Practice General recommendations and principles for successful pain management [Online] URL httpwwwesraeuropeorgPostoperativePainManagementpdf
76 Monsen ALB Skadberg BT amp Groslashnlie I Smertebehandling Norsk Barnelegeforeningen 2011 [Online] URL httpwwwlegeforeningennoid1104250
77 Smeland A amp Reinertsen H (2012) Smertevurdering og behandling av postoperative smerter hos barn Tidsskriftet Kirurgen 1 58-62 (5 s) [Online] Tilgjengelig paring httpwwwkirurgennopdf1201
78 Standing JF Savage I Pritchard D et al Diclofenac for acute pain in children Cochrane Database of Systematic Reviews 2009 Issue 4 Art No CD005538 DOI 10100214651858CD005538pub2
79 Standing JF Tibboel D Korpela R et al Diclofenac pharmacokinetic meta-analysis and dose recommendations for surgical pain in children aged 1ndash12 years Pediatric Anesthesia 2011 21 316ndash324 doi 101111j1460-9592201003509x
80 Riad W amp Moussa A Pre-operative analgesia with rectal diclofenac andor paracetamol in children undergoing hernia repair Anaesthesia 2007 Dec62(12)1241-5
81 Hiller A Meretoja OA Korpela R et al The Anagesic Efficacy of Acetaminophen Ketoprofen or Their Combination for Pediatric Surgical Patients Having Soft Tissue or Orthopedic Procedures Anesth Analg 20061021365-71
82 Norsk legemiddelharingndbok Antidoter ndash alfabetisk oversikt bruksomraringde og dosering httplegemiddelhandbokanoGenerelle153557i153779
83 Norsk legemiddelharingndbok Barn og legemidler httplegemiddelhandbokanoGenerelle153109
84 SickKids Aboutkidshealthca Myths About Pain httpwwwaboutkidshealthcaEnResourceCentresPainPainAssessmentPagesMyths-About-Painaspx
85 Psykososial preoperativ forberedelse av barn 0ndash18 aringr httpwwwhelsebiblioteketnomicrositefagprosedyrerfagprosedyrerpsykososial-preoperativ-forberedelse-av-barn-018-C3A5r
86 Twycross A Why Managing Pain in Children Matters in Managing Pain in Children A Clinical Guide (eds ATwycross S J Dowden and E Bruce) Wiley‐Blackwell 2009 Oxford UK doi 1010029781444322743ch1
Fase 2 Utvikling av intervensjon
Baseres paring tidligere forskning resultatene fra fase 1 samt tilbakemeldinger fra fag og seksjonsledere
Intervensjonen bestod av
bullTemadag (seks timer)
ndash Undervisning og workshop
ndash Sykepleiere og leger
ndash Stefan Lundeberg og Hanne Reinertsen
bullVeiledning i praksis
ndash Klinisk veiledning i smertebehandling av barn
ndash Eva Carlsen
bullReminders
Fase 3 Evaluering av intervensjonen
Forskningssposlashrsmaringl
Vil intervensjonen oslashke sykepleieres kunnskaper og holdninger til smerte hos barn og ungdom
Vil intervensjonen bedre sykepleieres smerteharingndtering av barn og ungdom
Datainnsamling
bullT-2 1 mnd etter intervensjonen bull Sposlashrreskjema PKNAS-N (alle avd)
bull Observasjonsstudie (fire avd)
bull Intervju av barn (to avd)
bullT-3 6 mnd etter intervensjonen bull Sposlashrreskjema PKNAS-N (alle avd)
bull Observasjonsstudie (to avd)
Fremdriftsplan
Forarbeid November 2013 - juni 2014
Datainnsamling September - november 2014 T-1
Januar ndash februar 2015 Intervensjon
Mars ndash april 2015 T-2
September ndash oktober 2015 T-3
Analyse September 2015 - juli 2016
Artikkelskriving Januar ndash august 2015 artikkel 1
November 2015 ndash juni 2016 artikkel 2
August ndash desember 2016 artikkel 3
Tusen takk
Oppsummering Prosjektet er stoslashttet av
Nasjonalt kompetansenettverk for legemidler til barn
Kirurgisk avdeling for barn OUS
Norsk Sykepleierforbund
Sykehusbarn
Litteraturliste 1 Hauer J Jones BL amp Wolfe J Poplack D G Kim M S (2015) Evaluation and management of pain in children UpToDate httpwwwuptodatecomcontentsevaluation-
and-management-of-pain-in-childrensource=search_resultampsearch=PAIN+CHILDRENampselectedTitle=17E150
2 IASP (2011c) Acute Pain management in Newborn Infants Pain [Online] Tilgjengelig paring httpiaspfilescms-pluscomContentContentFoldersPublications2PainClinicalUpdatesArchivesPCU_19-6_final_12-8-11_1390260191290_1pdf [Lastet 14april 2014]
3 Bernadi M Catania G amp Tridello G (2007) Knowledge and attitudes about cancer pain management a national survey of Italian hospice nurses Cancer Nurs 30(2) E20-6
4 Coulling S (2005) Nurses and doctors knowledge of pain after surgery Nurs Stand 19(34) 41-49
5 Hovde K R Granheim T H Christophersen K-A amp Dihle A (2012) The Norwegian Version of the Pediatric Nursesrsquo Knowledge and attitudes Survey Regarding Pain Reliability and Validity Pedatric nursing 38 (5) 264-269
6 Hossain S (2010) Nursesrsquo Knowledge and Attitudes and Pain Management Practice of Post-Operative Children in Bangladesh Prince of Songkla University Nedlastet fra httpkbpsuacthpsukbbitstream201078261325999pdf
7 Huth M M Gregg T L Lin L (2010) Education changes Mexican nurses knowledge and attitudes regarding pediatric pain Pain Manag Nurs Dec11(4)201-8 doi 101016jpmn200911001
8 Lewthwaite B J Jabusch K M Wheeler B J Schnell-Hoehn K N Mills J Estrella-Holder E Fedorowicz A (2011) Nurses knowledge and attitudes regarding pain management in hospitalized adults J Contin Educ Nurs 42(6) 251-7 doi 10392800220124-20110103-03 Epub 2011 Jan 10
9 Manworren RC (2000) Pediatric nursesrsquo knowledge and attitudes survey regarding pain Pediatr Nurs 26 610-614
10 Rieman M T Gordon M amp Marvin J M (2007) Pediatric nursesrsquo knowledge and attitudes survey regarding pain a competency tool modification Pediatr Nurs 33 303-306
11 Simons JM amp MacDonald LM (2004) Pain assessment tools childrenrsquos nursesrsquo views Journal of Child Health Care 8 264 Doi 1011771367493504047317
12 Twycross A (2007) What is the impact of theoretical knowledge on childrenrsquos nursesrsquo post-operative pain management practices an exploratory study Nurse Educ Today 27 697-707
13 Smart S (2005) POST-OPERATIVE PAIN MANAGEMENT KNOWLEDGE AND ATTITUDES OF PAEDIATRIC NURSES- A NEW ZEALAND REGIONAL VIEW Victoria University of Wellington [Online] Tilgjengelig paring httpresearcharchivevuwacnzbitstreamhandle1006338thesispdfsequence=2 [Lastet 13april 2014]
14 Vincent C V H (2005) Nursesrsquo knowledge attitudes and practices regarding childrenrsquos pain MCN Am J Matern Child Nurs 30 177-183
15 Olsson G Jylli L (2001) Smaumlrta hos barn och ungdomar Lund Sverige Studentlitteratur
16 Peters J W Schouw R Anand K J van Dijk M Duivenvoorden H J Tibboel D (2005) Does neonatal surgery lead to increased pain sensitivity in later childhood Pain 114(3) 444-54
17 Anand K J S Gracia-Preats J A amp Kim M S (2015) Assessment of neonatal pain UpToDate httpwwwuptodatecomcontentsassessment-of-neonatal-pain
18 Anand K J S Gracia-Preats J A amp Kim M S (2015) Prevention and treatment of neonatal pain UpToDate httpwwwuptodatecomcontentsprevention-and-treatment-of-neonatal-painsource=related_link
19 IASP (2011a) Acute Pain and Surgery Global Year Against Acute Pain [Online] Tilgjengelig paring httpwwwiasp-painorgfilesContentContentFoldersGlobalYearAgainstPain2AcutePainFactSheets7-Surgerypdf [Lastet 14april 2014]
20 Howard R Carter B Curry J Jain A Liossi C Morton N Rivett K Rose M Tyrrell J Walker S Williams G (2012) Good Practice in Postoperative and Procedural pain management 2nd Edition Pediatric Anesthesia 22 1ndash79 doi 101111j1460-9592201203838x
21 IASP (2011b) Interventions Benefits and Barriers Global Year Against Acute Pain [Online] Tilgjengelig paring httpwwwiasp-painorgfilesContentContentFoldersGlobalYearAgainstPain2AcutePainFactSheets2-Interventionspdf [Lastet 14april 2014]
22 Benhamou D Berti M Brodner G De Andres J Draisci G Moreno-Azcoita M Neugebauer EA Schwenk W Torres LM Viel E (2007) Postoperative Analgesic THerapy Observational Survey (PATHOS) A practice pattern study in 7 CentralSouthern Eurpean countries Pain 136 134-141
23 Reinertsen H (2008) Smerte hos barn kap3I Rustoslashen T amp Wahl AK (red) Ulike tekster om smerte - fra nocisepsjon til livskvalitet Oslo Gyldendal Norsk Forlag AS
Litteraturliste 24 Smeland A amp Reinertsen H (2012) Smertevurdering og behandling av postoperative smerter hos barn Tidsskriftet Kirurgen 1 58-62 (5 s) [Online] Tilgjengelig paring
httpwwwkirurgennopdf1201 [Lastet 13april 2014]
25 Bringuier S Picot MC Dadure C et al (2009) A prospective comparison of post-surgical behavioral pain scales in preschoolers highlighting the risk of false evaluations Pain 145 60-68
26 Crelline D Sullivan T B Babl F E OSullivan R Hutchinson A (2007) Analysis of the validation of existing behavioral pain and distress scales for use in the procedural setting Pediatric Anesthesia 17 720-733
27 Ghai B Makkar JK amp Wig J (2008) Postoperative pain assessment in preverbal children and children with cognitive impairment Pediatric Anesthesia 18 462-477
28 Hicks CL von Baeyer CL Spafford P et al (2001) The Faces Pain Scale-Revised Toward a common metric in pain measurement Pain 93 173-183
29 Merkel SI Voepel-Lewis T amp Shayevitz et al (1997) The FLACC A Behavioral Scale for Scoring Postoperative Pain in Young Children Pediatric Nursing 23 293-7
30 Ellis J A McCleary L Blouin R Dube K Rowley B MacNeil M amp Cooke C (2007) Implementing best practice pain management in a pediatric hospital Journal for Specialists in Pediatric Nursing 12 264-277 doi101111j1744-6155200700121x
31 Johnston C C Gagnon A Rennick J Rosmus C Patenaude H Ellis J Shapiro C Filion F Ritchie J Byron J (2007) One-on-one coaching to improve pain assessment and management practices of pediatric nurses Journal of Pediatric Nursing 22 467-478 doi101016jpedn200707004
32 Le May S Johnston C C Choiniegravere M Fortin C Kudirka D Murray L Chalut D (2009) Pain Management Practices in a Pediatric Emergency Room (PAMPER) Study interventions with nurses Pediatr Emerg Care Aug25(8)498-503 doi 101097PEC0b013e3181b0a0af
33 Vincent C V H Wilkie D J amp Wang E (2011) Pediatric Nurses Beliefs and Pain Management Practices An Intervention Pilot West J Nurs Res 33 825 originally published online 20 December 2010
36 Twycross A Finley G A and Latimer M (2013) Pediatric nurses postoperative pain management practices An observational study Journal for Specialists in Pediatric Nursing 18 189ndash201 doi 101111jspn12026
42 Twycross A amp Finley G A (2013) Childrens and parents perceptions of postoperative pain management a mixed methods study Journal of Clinical Nursing 22(21-22) 3095-3108 doi 101111jocn12152 [Online] Tilgjengelig paring httponlinelibrarywileycomdoi101111jocn12152pdf (13042014)
43 Polkki T Pietila AM Vehvilainen-Julkunen K (2003) Hospitalized childrens descriptions of their experiences with postsurgical pain relieving methods Int J Nurs Stud Jan40(1)33-44 PubMed PMID 12550148 English
46 Abdalrahim MS Majali SA Stomberg MW Bergbom I (2011) The effect of postoperative pain management program on improving nurses knowledge and attitudes toward pain Nurse Educ Pract 2011 Jul11(4)250-5 doi 101016jnepr201011016 Epub 2010 Dec 24 httpwwwncbinlmnihgovpubmed21186139
47 IASP Pain definition IASP (International Association of the Study of Pain) Pain definition
48 Norsk Ledemiddelharingndbok Ulike smertetilstander [Online] Tilgjengelig paring httplegemiddelhandbokanoTerapi22816expand=1
49 Astrid Lindgrens Barnsjukhus ndash Riktlinjer foumlr smaumlrtbehandling
50 Groslashnseth R amp Markestad T (2011) Pediatri og pediatrisk sykepleie Bergen Fagbokforlaget Vigmostad amp Bjoslashrke AS httppediatriportfoliono
51 Hicks CL von Baeyer CL Spafford Pet al The Faces Pain Scale‐Revised Toward a common metric in pain measurement Pain 2001 93173‐183
52 Twycross A Why Managing Pain in Children Matters in Managing Pain in Children A Clinical Guide (eds A Twycross S J Dowden and E Bruce) Wiley‐Blackwell 2009 Oxford UK doi 1010029781444322743ch1
53 Von Bayer CL amp Spagrud LJ Systematic review of observational (behavioral) measures of pain for children and adolescents aged 3 to 18 years Pain 2007 127 140‐150
54 Voepel‐Lewis Terri RN MSN ZanottiJennifer RN MS CCRN CEN DammeyerJennifer A RN MSN and MerkelSandra RN MS (January 2010) Reliability and Validity of the Face Legs Activity Cry Consolability Behavioral Tool in Assessing Acute Pain in Critically Ill Patients American Journal of Critical Care 19 (1) 55ndash61
55 Merkel S Voepel‐Lewis T Shayevitz JR et al The FLACC A behavioural scale for scoring postoperative pain in young children Pediatric nursing 1997 23293‐797
56 McCaffery M amp Beebe F (1994) Pain‐Clinical Manual of for Nursing Practice Times Mirror International Publishers Ltd Norsk oversettelse Smerter Laeligrebok for helsepersonell Oslo Norge Gyldendal Norsk Forlag AS
57 Reinertsen H Christophersen K‐A Helseth S Vurdering av postoperativ smerte hos barn (0‐5 aringr) Validering og reliabilitetstesting av smertevurderingsverktoslashyet FLACC Sykepleien Forskning 2014 9 132‐140 httpwwwsykepleiennoforskningforskningsartikkel1466655validering‐og‐reliabilitetstesting‐av‐smertevurderingsverktoyet‐flacc
Litteraturliste 58 Stinson J (2009) Pain Assessment I Twycross A Dowden S J amp Bruce E Pain Assessment in Managing Pain in Children A Clinical Guide Oxford UK Wiley-Blackmell
59 Tomlinson D von Baeyer CL Stinson JN Sung L A systematic review of faces scales for the self‐report of pain intensity in children Pediatrics 2010 Nov126(5)e1168‐98 PubMed PMID 20921070 Epub 20101006 eng
60 Von Baeyer CL Childrens self‐reports of pain intensity scale selection limitations and interpretation Pain Res Manag 2006 Autumn11(3)157‐62 PubMed PMID 16960632 Pubmed Central PMCID PMC2539005 Epub 20060909 eng
61 Ghai B Makkar J K amp Wig J (2008) Postoperative pain assesment in preverbal children and children with cognitive impairment Pediatric Anesthesia 18 462‐477
62 Malvia S Voepel‐Lewis T Tait A R Merkel S Lauer A Munro H Farley F (2001) Pain management in children with and without cognitive impairment following spine fusion surgery Pediatric Anasthesia 11 453‐458
63 Malvia S Voepel‐Lewis T Burke C Merkel S amp Tait A R (2006) The revised FLACC observational pain tool improved reliability and validity for pain assesment in children with cognitive impairment Pediatric Anestesia 16 258‐265
64 McJunkins A Green A amp Anand KJS (2010) Pain Assesment in cognitively Impared Functionally Impared Children Pilot Study Results Journal of Pediatric Nursing 25 307‐309
65 McKearnan K A Kieckhefer G Engel J M Jensen M amp Labyak S (2004) Pain in Children with cerebral Palsy A Review Journal of Neuroscience Nursing Vol 36 no 5 s252‐259
66 Voepel‐Lewis T Malviya S Tait A Merkel S Forter R amp Krane E (2008) A comparison of the clinical utility of pain assesment tools for children with cognitive impairment Pediatric Anesthesiology 106 (1) 72‐78
67 Baulch I Assessment and management of pain in the paediatric patient Nursing standard 2010 2510 35-40
68 Twycross A Why Managing Pain in Children Matters in Managing Pain in Children A Clinical Guide (eds A Twycross S J Dowden and E Bruce) Wiley-Blackwell 2009 Oxford UK doi 1010029781444322743ch1
69 Schug SA amp Pogatzki-Zhan EM Chronic Pain after Surgery or Injury Pain 2011 Clinical Updates XIX 11-5
70 Fredheim OMS Borchgrevink PC amp Kvarstein G Behandling av postoperativ smerte i sykehus Tidsskr Nor Legeforen 2011 131 1772-6
71 Steward DL Welge J amp Myer C Steroids for improving recovery following tonsillectomy in children Cochrane Database of Systematic Reviews 2003 Issue 1Art NoCD003997 DOI10100214651858CD003997
72 Hong JY Han SW Kim WO et al Effect of dexamethasone in combination with caudal analgesia on postoperative pain control in day-case paediatric orchioplexy British Journal of Anesthesia 2010 105(4)506-10
73 Den Norske Legeforening (2009) Retningslinjer for smertelindring [Online] URL httpwww legeforeningennoasset42585142585_1pdf
74 Association of Paediatric Anaesthetists (2008) Good Practice in Postoperative and Procedural Pain [Online] URL httpwwwbritishpainsocietyorgbook_apa_part1pdf
75 European Society of Regional Aneasthesia (2005) Postoperative Pain Management ndash Good Clinical Practice General recommendations and principles for successful pain management [Online] URL httpwwwesraeuropeorgPostoperativePainManagementpdf
76 Monsen ALB Skadberg BT amp Groslashnlie I Smertebehandling Norsk Barnelegeforeningen 2011 [Online] URL httpwwwlegeforeningennoid1104250
77 Smeland A amp Reinertsen H (2012) Smertevurdering og behandling av postoperative smerter hos barn Tidsskriftet Kirurgen 1 58-62 (5 s) [Online] Tilgjengelig paring httpwwwkirurgennopdf1201
78 Standing JF Savage I Pritchard D et al Diclofenac for acute pain in children Cochrane Database of Systematic Reviews 2009 Issue 4 Art No CD005538 DOI 10100214651858CD005538pub2
79 Standing JF Tibboel D Korpela R et al Diclofenac pharmacokinetic meta-analysis and dose recommendations for surgical pain in children aged 1ndash12 years Pediatric Anesthesia 2011 21 316ndash324 doi 101111j1460-9592201003509x
80 Riad W amp Moussa A Pre-operative analgesia with rectal diclofenac andor paracetamol in children undergoing hernia repair Anaesthesia 2007 Dec62(12)1241-5
81 Hiller A Meretoja OA Korpela R et al The Anagesic Efficacy of Acetaminophen Ketoprofen or Their Combination for Pediatric Surgical Patients Having Soft Tissue or Orthopedic Procedures Anesth Analg 20061021365-71
82 Norsk legemiddelharingndbok Antidoter ndash alfabetisk oversikt bruksomraringde og dosering httplegemiddelhandbokanoGenerelle153557i153779
83 Norsk legemiddelharingndbok Barn og legemidler httplegemiddelhandbokanoGenerelle153109
84 SickKids Aboutkidshealthca Myths About Pain httpwwwaboutkidshealthcaEnResourceCentresPainPainAssessmentPagesMyths-About-Painaspx
85 Psykososial preoperativ forberedelse av barn 0ndash18 aringr httpwwwhelsebiblioteketnomicrositefagprosedyrerfagprosedyrerpsykososial-preoperativ-forberedelse-av-barn-018-C3A5r
86 Twycross A Why Managing Pain in Children Matters in Managing Pain in Children A Clinical Guide (eds ATwycross S J Dowden and E Bruce) Wiley‐Blackwell 2009 Oxford UK doi 1010029781444322743ch1
Fase 3 Evaluering av intervensjonen
Forskningssposlashrsmaringl
Vil intervensjonen oslashke sykepleieres kunnskaper og holdninger til smerte hos barn og ungdom
Vil intervensjonen bedre sykepleieres smerteharingndtering av barn og ungdom
Datainnsamling
bullT-2 1 mnd etter intervensjonen bull Sposlashrreskjema PKNAS-N (alle avd)
bull Observasjonsstudie (fire avd)
bull Intervju av barn (to avd)
bullT-3 6 mnd etter intervensjonen bull Sposlashrreskjema PKNAS-N (alle avd)
bull Observasjonsstudie (to avd)
Fremdriftsplan
Forarbeid November 2013 - juni 2014
Datainnsamling September - november 2014 T-1
Januar ndash februar 2015 Intervensjon
Mars ndash april 2015 T-2
September ndash oktober 2015 T-3
Analyse September 2015 - juli 2016
Artikkelskriving Januar ndash august 2015 artikkel 1
November 2015 ndash juni 2016 artikkel 2
August ndash desember 2016 artikkel 3
Tusen takk
Oppsummering Prosjektet er stoslashttet av
Nasjonalt kompetansenettverk for legemidler til barn
Kirurgisk avdeling for barn OUS
Norsk Sykepleierforbund
Sykehusbarn
Litteraturliste 1 Hauer J Jones BL amp Wolfe J Poplack D G Kim M S (2015) Evaluation and management of pain in children UpToDate httpwwwuptodatecomcontentsevaluation-
and-management-of-pain-in-childrensource=search_resultampsearch=PAIN+CHILDRENampselectedTitle=17E150
2 IASP (2011c) Acute Pain management in Newborn Infants Pain [Online] Tilgjengelig paring httpiaspfilescms-pluscomContentContentFoldersPublications2PainClinicalUpdatesArchivesPCU_19-6_final_12-8-11_1390260191290_1pdf [Lastet 14april 2014]
3 Bernadi M Catania G amp Tridello G (2007) Knowledge and attitudes about cancer pain management a national survey of Italian hospice nurses Cancer Nurs 30(2) E20-6
4 Coulling S (2005) Nurses and doctors knowledge of pain after surgery Nurs Stand 19(34) 41-49
5 Hovde K R Granheim T H Christophersen K-A amp Dihle A (2012) The Norwegian Version of the Pediatric Nursesrsquo Knowledge and attitudes Survey Regarding Pain Reliability and Validity Pedatric nursing 38 (5) 264-269
6 Hossain S (2010) Nursesrsquo Knowledge and Attitudes and Pain Management Practice of Post-Operative Children in Bangladesh Prince of Songkla University Nedlastet fra httpkbpsuacthpsukbbitstream201078261325999pdf
7 Huth M M Gregg T L Lin L (2010) Education changes Mexican nurses knowledge and attitudes regarding pediatric pain Pain Manag Nurs Dec11(4)201-8 doi 101016jpmn200911001
8 Lewthwaite B J Jabusch K M Wheeler B J Schnell-Hoehn K N Mills J Estrella-Holder E Fedorowicz A (2011) Nurses knowledge and attitudes regarding pain management in hospitalized adults J Contin Educ Nurs 42(6) 251-7 doi 10392800220124-20110103-03 Epub 2011 Jan 10
9 Manworren RC (2000) Pediatric nursesrsquo knowledge and attitudes survey regarding pain Pediatr Nurs 26 610-614
10 Rieman M T Gordon M amp Marvin J M (2007) Pediatric nursesrsquo knowledge and attitudes survey regarding pain a competency tool modification Pediatr Nurs 33 303-306
11 Simons JM amp MacDonald LM (2004) Pain assessment tools childrenrsquos nursesrsquo views Journal of Child Health Care 8 264 Doi 1011771367493504047317
12 Twycross A (2007) What is the impact of theoretical knowledge on childrenrsquos nursesrsquo post-operative pain management practices an exploratory study Nurse Educ Today 27 697-707
13 Smart S (2005) POST-OPERATIVE PAIN MANAGEMENT KNOWLEDGE AND ATTITUDES OF PAEDIATRIC NURSES- A NEW ZEALAND REGIONAL VIEW Victoria University of Wellington [Online] Tilgjengelig paring httpresearcharchivevuwacnzbitstreamhandle1006338thesispdfsequence=2 [Lastet 13april 2014]
14 Vincent C V H (2005) Nursesrsquo knowledge attitudes and practices regarding childrenrsquos pain MCN Am J Matern Child Nurs 30 177-183
15 Olsson G Jylli L (2001) Smaumlrta hos barn och ungdomar Lund Sverige Studentlitteratur
16 Peters J W Schouw R Anand K J van Dijk M Duivenvoorden H J Tibboel D (2005) Does neonatal surgery lead to increased pain sensitivity in later childhood Pain 114(3) 444-54
17 Anand K J S Gracia-Preats J A amp Kim M S (2015) Assessment of neonatal pain UpToDate httpwwwuptodatecomcontentsassessment-of-neonatal-pain
18 Anand K J S Gracia-Preats J A amp Kim M S (2015) Prevention and treatment of neonatal pain UpToDate httpwwwuptodatecomcontentsprevention-and-treatment-of-neonatal-painsource=related_link
19 IASP (2011a) Acute Pain and Surgery Global Year Against Acute Pain [Online] Tilgjengelig paring httpwwwiasp-painorgfilesContentContentFoldersGlobalYearAgainstPain2AcutePainFactSheets7-Surgerypdf [Lastet 14april 2014]
20 Howard R Carter B Curry J Jain A Liossi C Morton N Rivett K Rose M Tyrrell J Walker S Williams G (2012) Good Practice in Postoperative and Procedural pain management 2nd Edition Pediatric Anesthesia 22 1ndash79 doi 101111j1460-9592201203838x
21 IASP (2011b) Interventions Benefits and Barriers Global Year Against Acute Pain [Online] Tilgjengelig paring httpwwwiasp-painorgfilesContentContentFoldersGlobalYearAgainstPain2AcutePainFactSheets2-Interventionspdf [Lastet 14april 2014]
22 Benhamou D Berti M Brodner G De Andres J Draisci G Moreno-Azcoita M Neugebauer EA Schwenk W Torres LM Viel E (2007) Postoperative Analgesic THerapy Observational Survey (PATHOS) A practice pattern study in 7 CentralSouthern Eurpean countries Pain 136 134-141
23 Reinertsen H (2008) Smerte hos barn kap3I Rustoslashen T amp Wahl AK (red) Ulike tekster om smerte - fra nocisepsjon til livskvalitet Oslo Gyldendal Norsk Forlag AS
Litteraturliste 24 Smeland A amp Reinertsen H (2012) Smertevurdering og behandling av postoperative smerter hos barn Tidsskriftet Kirurgen 1 58-62 (5 s) [Online] Tilgjengelig paring
httpwwwkirurgennopdf1201 [Lastet 13april 2014]
25 Bringuier S Picot MC Dadure C et al (2009) A prospective comparison of post-surgical behavioral pain scales in preschoolers highlighting the risk of false evaluations Pain 145 60-68
26 Crelline D Sullivan T B Babl F E OSullivan R Hutchinson A (2007) Analysis of the validation of existing behavioral pain and distress scales for use in the procedural setting Pediatric Anesthesia 17 720-733
27 Ghai B Makkar JK amp Wig J (2008) Postoperative pain assessment in preverbal children and children with cognitive impairment Pediatric Anesthesia 18 462-477
28 Hicks CL von Baeyer CL Spafford P et al (2001) The Faces Pain Scale-Revised Toward a common metric in pain measurement Pain 93 173-183
29 Merkel SI Voepel-Lewis T amp Shayevitz et al (1997) The FLACC A Behavioral Scale for Scoring Postoperative Pain in Young Children Pediatric Nursing 23 293-7
30 Ellis J A McCleary L Blouin R Dube K Rowley B MacNeil M amp Cooke C (2007) Implementing best practice pain management in a pediatric hospital Journal for Specialists in Pediatric Nursing 12 264-277 doi101111j1744-6155200700121x
31 Johnston C C Gagnon A Rennick J Rosmus C Patenaude H Ellis J Shapiro C Filion F Ritchie J Byron J (2007) One-on-one coaching to improve pain assessment and management practices of pediatric nurses Journal of Pediatric Nursing 22 467-478 doi101016jpedn200707004
32 Le May S Johnston C C Choiniegravere M Fortin C Kudirka D Murray L Chalut D (2009) Pain Management Practices in a Pediatric Emergency Room (PAMPER) Study interventions with nurses Pediatr Emerg Care Aug25(8)498-503 doi 101097PEC0b013e3181b0a0af
33 Vincent C V H Wilkie D J amp Wang E (2011) Pediatric Nurses Beliefs and Pain Management Practices An Intervention Pilot West J Nurs Res 33 825 originally published online 20 December 2010
36 Twycross A Finley G A and Latimer M (2013) Pediatric nurses postoperative pain management practices An observational study Journal for Specialists in Pediatric Nursing 18 189ndash201 doi 101111jspn12026
42 Twycross A amp Finley G A (2013) Childrens and parents perceptions of postoperative pain management a mixed methods study Journal of Clinical Nursing 22(21-22) 3095-3108 doi 101111jocn12152 [Online] Tilgjengelig paring httponlinelibrarywileycomdoi101111jocn12152pdf (13042014)
43 Polkki T Pietila AM Vehvilainen-Julkunen K (2003) Hospitalized childrens descriptions of their experiences with postsurgical pain relieving methods Int J Nurs Stud Jan40(1)33-44 PubMed PMID 12550148 English
46 Abdalrahim MS Majali SA Stomberg MW Bergbom I (2011) The effect of postoperative pain management program on improving nurses knowledge and attitudes toward pain Nurse Educ Pract 2011 Jul11(4)250-5 doi 101016jnepr201011016 Epub 2010 Dec 24 httpwwwncbinlmnihgovpubmed21186139
47 IASP Pain definition IASP (International Association of the Study of Pain) Pain definition
48 Norsk Ledemiddelharingndbok Ulike smertetilstander [Online] Tilgjengelig paring httplegemiddelhandbokanoTerapi22816expand=1
49 Astrid Lindgrens Barnsjukhus ndash Riktlinjer foumlr smaumlrtbehandling
50 Groslashnseth R amp Markestad T (2011) Pediatri og pediatrisk sykepleie Bergen Fagbokforlaget Vigmostad amp Bjoslashrke AS httppediatriportfoliono
51 Hicks CL von Baeyer CL Spafford Pet al The Faces Pain Scale‐Revised Toward a common metric in pain measurement Pain 2001 93173‐183
52 Twycross A Why Managing Pain in Children Matters in Managing Pain in Children A Clinical Guide (eds A Twycross S J Dowden and E Bruce) Wiley‐Blackwell 2009 Oxford UK doi 1010029781444322743ch1
53 Von Bayer CL amp Spagrud LJ Systematic review of observational (behavioral) measures of pain for children and adolescents aged 3 to 18 years Pain 2007 127 140‐150
54 Voepel‐Lewis Terri RN MSN ZanottiJennifer RN MS CCRN CEN DammeyerJennifer A RN MSN and MerkelSandra RN MS (January 2010) Reliability and Validity of the Face Legs Activity Cry Consolability Behavioral Tool in Assessing Acute Pain in Critically Ill Patients American Journal of Critical Care 19 (1) 55ndash61
55 Merkel S Voepel‐Lewis T Shayevitz JR et al The FLACC A behavioural scale for scoring postoperative pain in young children Pediatric nursing 1997 23293‐797
56 McCaffery M amp Beebe F (1994) Pain‐Clinical Manual of for Nursing Practice Times Mirror International Publishers Ltd Norsk oversettelse Smerter Laeligrebok for helsepersonell Oslo Norge Gyldendal Norsk Forlag AS
57 Reinertsen H Christophersen K‐A Helseth S Vurdering av postoperativ smerte hos barn (0‐5 aringr) Validering og reliabilitetstesting av smertevurderingsverktoslashyet FLACC Sykepleien Forskning 2014 9 132‐140 httpwwwsykepleiennoforskningforskningsartikkel1466655validering‐og‐reliabilitetstesting‐av‐smertevurderingsverktoyet‐flacc
Litteraturliste 58 Stinson J (2009) Pain Assessment I Twycross A Dowden S J amp Bruce E Pain Assessment in Managing Pain in Children A Clinical Guide Oxford UK Wiley-Blackmell
59 Tomlinson D von Baeyer CL Stinson JN Sung L A systematic review of faces scales for the self‐report of pain intensity in children Pediatrics 2010 Nov126(5)e1168‐98 PubMed PMID 20921070 Epub 20101006 eng
60 Von Baeyer CL Childrens self‐reports of pain intensity scale selection limitations and interpretation Pain Res Manag 2006 Autumn11(3)157‐62 PubMed PMID 16960632 Pubmed Central PMCID PMC2539005 Epub 20060909 eng
61 Ghai B Makkar J K amp Wig J (2008) Postoperative pain assesment in preverbal children and children with cognitive impairment Pediatric Anesthesia 18 462‐477
62 Malvia S Voepel‐Lewis T Tait A R Merkel S Lauer A Munro H Farley F (2001) Pain management in children with and without cognitive impairment following spine fusion surgery Pediatric Anasthesia 11 453‐458
63 Malvia S Voepel‐Lewis T Burke C Merkel S amp Tait A R (2006) The revised FLACC observational pain tool improved reliability and validity for pain assesment in children with cognitive impairment Pediatric Anestesia 16 258‐265
64 McJunkins A Green A amp Anand KJS (2010) Pain Assesment in cognitively Impared Functionally Impared Children Pilot Study Results Journal of Pediatric Nursing 25 307‐309
65 McKearnan K A Kieckhefer G Engel J M Jensen M amp Labyak S (2004) Pain in Children with cerebral Palsy A Review Journal of Neuroscience Nursing Vol 36 no 5 s252‐259
66 Voepel‐Lewis T Malviya S Tait A Merkel S Forter R amp Krane E (2008) A comparison of the clinical utility of pain assesment tools for children with cognitive impairment Pediatric Anesthesiology 106 (1) 72‐78
67 Baulch I Assessment and management of pain in the paediatric patient Nursing standard 2010 2510 35-40
68 Twycross A Why Managing Pain in Children Matters in Managing Pain in Children A Clinical Guide (eds A Twycross S J Dowden and E Bruce) Wiley-Blackwell 2009 Oxford UK doi 1010029781444322743ch1
69 Schug SA amp Pogatzki-Zhan EM Chronic Pain after Surgery or Injury Pain 2011 Clinical Updates XIX 11-5
70 Fredheim OMS Borchgrevink PC amp Kvarstein G Behandling av postoperativ smerte i sykehus Tidsskr Nor Legeforen 2011 131 1772-6
71 Steward DL Welge J amp Myer C Steroids for improving recovery following tonsillectomy in children Cochrane Database of Systematic Reviews 2003 Issue 1Art NoCD003997 DOI10100214651858CD003997
72 Hong JY Han SW Kim WO et al Effect of dexamethasone in combination with caudal analgesia on postoperative pain control in day-case paediatric orchioplexy British Journal of Anesthesia 2010 105(4)506-10
73 Den Norske Legeforening (2009) Retningslinjer for smertelindring [Online] URL httpwww legeforeningennoasset42585142585_1pdf
74 Association of Paediatric Anaesthetists (2008) Good Practice in Postoperative and Procedural Pain [Online] URL httpwwwbritishpainsocietyorgbook_apa_part1pdf
75 European Society of Regional Aneasthesia (2005) Postoperative Pain Management ndash Good Clinical Practice General recommendations and principles for successful pain management [Online] URL httpwwwesraeuropeorgPostoperativePainManagementpdf
76 Monsen ALB Skadberg BT amp Groslashnlie I Smertebehandling Norsk Barnelegeforeningen 2011 [Online] URL httpwwwlegeforeningennoid1104250
77 Smeland A amp Reinertsen H (2012) Smertevurdering og behandling av postoperative smerter hos barn Tidsskriftet Kirurgen 1 58-62 (5 s) [Online] Tilgjengelig paring httpwwwkirurgennopdf1201
78 Standing JF Savage I Pritchard D et al Diclofenac for acute pain in children Cochrane Database of Systematic Reviews 2009 Issue 4 Art No CD005538 DOI 10100214651858CD005538pub2
79 Standing JF Tibboel D Korpela R et al Diclofenac pharmacokinetic meta-analysis and dose recommendations for surgical pain in children aged 1ndash12 years Pediatric Anesthesia 2011 21 316ndash324 doi 101111j1460-9592201003509x
80 Riad W amp Moussa A Pre-operative analgesia with rectal diclofenac andor paracetamol in children undergoing hernia repair Anaesthesia 2007 Dec62(12)1241-5
81 Hiller A Meretoja OA Korpela R et al The Anagesic Efficacy of Acetaminophen Ketoprofen or Their Combination for Pediatric Surgical Patients Having Soft Tissue or Orthopedic Procedures Anesth Analg 20061021365-71
82 Norsk legemiddelharingndbok Antidoter ndash alfabetisk oversikt bruksomraringde og dosering httplegemiddelhandbokanoGenerelle153557i153779
83 Norsk legemiddelharingndbok Barn og legemidler httplegemiddelhandbokanoGenerelle153109
84 SickKids Aboutkidshealthca Myths About Pain httpwwwaboutkidshealthcaEnResourceCentresPainPainAssessmentPagesMyths-About-Painaspx
85 Psykososial preoperativ forberedelse av barn 0ndash18 aringr httpwwwhelsebiblioteketnomicrositefagprosedyrerfagprosedyrerpsykososial-preoperativ-forberedelse-av-barn-018-C3A5r
86 Twycross A Why Managing Pain in Children Matters in Managing Pain in Children A Clinical Guide (eds ATwycross S J Dowden and E Bruce) Wiley‐Blackwell 2009 Oxford UK doi 1010029781444322743ch1
Fremdriftsplan
Forarbeid November 2013 - juni 2014
Datainnsamling September - november 2014 T-1
Januar ndash februar 2015 Intervensjon
Mars ndash april 2015 T-2
September ndash oktober 2015 T-3
Analyse September 2015 - juli 2016
Artikkelskriving Januar ndash august 2015 artikkel 1
November 2015 ndash juni 2016 artikkel 2
August ndash desember 2016 artikkel 3
Tusen takk
Oppsummering Prosjektet er stoslashttet av
Nasjonalt kompetansenettverk for legemidler til barn
Kirurgisk avdeling for barn OUS
Norsk Sykepleierforbund
Sykehusbarn
Litteraturliste 1 Hauer J Jones BL amp Wolfe J Poplack D G Kim M S (2015) Evaluation and management of pain in children UpToDate httpwwwuptodatecomcontentsevaluation-
and-management-of-pain-in-childrensource=search_resultampsearch=PAIN+CHILDRENampselectedTitle=17E150
2 IASP (2011c) Acute Pain management in Newborn Infants Pain [Online] Tilgjengelig paring httpiaspfilescms-pluscomContentContentFoldersPublications2PainClinicalUpdatesArchivesPCU_19-6_final_12-8-11_1390260191290_1pdf [Lastet 14april 2014]
3 Bernadi M Catania G amp Tridello G (2007) Knowledge and attitudes about cancer pain management a national survey of Italian hospice nurses Cancer Nurs 30(2) E20-6
4 Coulling S (2005) Nurses and doctors knowledge of pain after surgery Nurs Stand 19(34) 41-49
5 Hovde K R Granheim T H Christophersen K-A amp Dihle A (2012) The Norwegian Version of the Pediatric Nursesrsquo Knowledge and attitudes Survey Regarding Pain Reliability and Validity Pedatric nursing 38 (5) 264-269
6 Hossain S (2010) Nursesrsquo Knowledge and Attitudes and Pain Management Practice of Post-Operative Children in Bangladesh Prince of Songkla University Nedlastet fra httpkbpsuacthpsukbbitstream201078261325999pdf
7 Huth M M Gregg T L Lin L (2010) Education changes Mexican nurses knowledge and attitudes regarding pediatric pain Pain Manag Nurs Dec11(4)201-8 doi 101016jpmn200911001
8 Lewthwaite B J Jabusch K M Wheeler B J Schnell-Hoehn K N Mills J Estrella-Holder E Fedorowicz A (2011) Nurses knowledge and attitudes regarding pain management in hospitalized adults J Contin Educ Nurs 42(6) 251-7 doi 10392800220124-20110103-03 Epub 2011 Jan 10
9 Manworren RC (2000) Pediatric nursesrsquo knowledge and attitudes survey regarding pain Pediatr Nurs 26 610-614
10 Rieman M T Gordon M amp Marvin J M (2007) Pediatric nursesrsquo knowledge and attitudes survey regarding pain a competency tool modification Pediatr Nurs 33 303-306
11 Simons JM amp MacDonald LM (2004) Pain assessment tools childrenrsquos nursesrsquo views Journal of Child Health Care 8 264 Doi 1011771367493504047317
12 Twycross A (2007) What is the impact of theoretical knowledge on childrenrsquos nursesrsquo post-operative pain management practices an exploratory study Nurse Educ Today 27 697-707
13 Smart S (2005) POST-OPERATIVE PAIN MANAGEMENT KNOWLEDGE AND ATTITUDES OF PAEDIATRIC NURSES- A NEW ZEALAND REGIONAL VIEW Victoria University of Wellington [Online] Tilgjengelig paring httpresearcharchivevuwacnzbitstreamhandle1006338thesispdfsequence=2 [Lastet 13april 2014]
14 Vincent C V H (2005) Nursesrsquo knowledge attitudes and practices regarding childrenrsquos pain MCN Am J Matern Child Nurs 30 177-183
15 Olsson G Jylli L (2001) Smaumlrta hos barn och ungdomar Lund Sverige Studentlitteratur
16 Peters J W Schouw R Anand K J van Dijk M Duivenvoorden H J Tibboel D (2005) Does neonatal surgery lead to increased pain sensitivity in later childhood Pain 114(3) 444-54
17 Anand K J S Gracia-Preats J A amp Kim M S (2015) Assessment of neonatal pain UpToDate httpwwwuptodatecomcontentsassessment-of-neonatal-pain
18 Anand K J S Gracia-Preats J A amp Kim M S (2015) Prevention and treatment of neonatal pain UpToDate httpwwwuptodatecomcontentsprevention-and-treatment-of-neonatal-painsource=related_link
19 IASP (2011a) Acute Pain and Surgery Global Year Against Acute Pain [Online] Tilgjengelig paring httpwwwiasp-painorgfilesContentContentFoldersGlobalYearAgainstPain2AcutePainFactSheets7-Surgerypdf [Lastet 14april 2014]
20 Howard R Carter B Curry J Jain A Liossi C Morton N Rivett K Rose M Tyrrell J Walker S Williams G (2012) Good Practice in Postoperative and Procedural pain management 2nd Edition Pediatric Anesthesia 22 1ndash79 doi 101111j1460-9592201203838x
21 IASP (2011b) Interventions Benefits and Barriers Global Year Against Acute Pain [Online] Tilgjengelig paring httpwwwiasp-painorgfilesContentContentFoldersGlobalYearAgainstPain2AcutePainFactSheets2-Interventionspdf [Lastet 14april 2014]
22 Benhamou D Berti M Brodner G De Andres J Draisci G Moreno-Azcoita M Neugebauer EA Schwenk W Torres LM Viel E (2007) Postoperative Analgesic THerapy Observational Survey (PATHOS) A practice pattern study in 7 CentralSouthern Eurpean countries Pain 136 134-141
23 Reinertsen H (2008) Smerte hos barn kap3I Rustoslashen T amp Wahl AK (red) Ulike tekster om smerte - fra nocisepsjon til livskvalitet Oslo Gyldendal Norsk Forlag AS
Litteraturliste 24 Smeland A amp Reinertsen H (2012) Smertevurdering og behandling av postoperative smerter hos barn Tidsskriftet Kirurgen 1 58-62 (5 s) [Online] Tilgjengelig paring
httpwwwkirurgennopdf1201 [Lastet 13april 2014]
25 Bringuier S Picot MC Dadure C et al (2009) A prospective comparison of post-surgical behavioral pain scales in preschoolers highlighting the risk of false evaluations Pain 145 60-68
26 Crelline D Sullivan T B Babl F E OSullivan R Hutchinson A (2007) Analysis of the validation of existing behavioral pain and distress scales for use in the procedural setting Pediatric Anesthesia 17 720-733
27 Ghai B Makkar JK amp Wig J (2008) Postoperative pain assessment in preverbal children and children with cognitive impairment Pediatric Anesthesia 18 462-477
28 Hicks CL von Baeyer CL Spafford P et al (2001) The Faces Pain Scale-Revised Toward a common metric in pain measurement Pain 93 173-183
29 Merkel SI Voepel-Lewis T amp Shayevitz et al (1997) The FLACC A Behavioral Scale for Scoring Postoperative Pain in Young Children Pediatric Nursing 23 293-7
30 Ellis J A McCleary L Blouin R Dube K Rowley B MacNeil M amp Cooke C (2007) Implementing best practice pain management in a pediatric hospital Journal for Specialists in Pediatric Nursing 12 264-277 doi101111j1744-6155200700121x
31 Johnston C C Gagnon A Rennick J Rosmus C Patenaude H Ellis J Shapiro C Filion F Ritchie J Byron J (2007) One-on-one coaching to improve pain assessment and management practices of pediatric nurses Journal of Pediatric Nursing 22 467-478 doi101016jpedn200707004
32 Le May S Johnston C C Choiniegravere M Fortin C Kudirka D Murray L Chalut D (2009) Pain Management Practices in a Pediatric Emergency Room (PAMPER) Study interventions with nurses Pediatr Emerg Care Aug25(8)498-503 doi 101097PEC0b013e3181b0a0af
33 Vincent C V H Wilkie D J amp Wang E (2011) Pediatric Nurses Beliefs and Pain Management Practices An Intervention Pilot West J Nurs Res 33 825 originally published online 20 December 2010
36 Twycross A Finley G A and Latimer M (2013) Pediatric nurses postoperative pain management practices An observational study Journal for Specialists in Pediatric Nursing 18 189ndash201 doi 101111jspn12026
42 Twycross A amp Finley G A (2013) Childrens and parents perceptions of postoperative pain management a mixed methods study Journal of Clinical Nursing 22(21-22) 3095-3108 doi 101111jocn12152 [Online] Tilgjengelig paring httponlinelibrarywileycomdoi101111jocn12152pdf (13042014)
43 Polkki T Pietila AM Vehvilainen-Julkunen K (2003) Hospitalized childrens descriptions of their experiences with postsurgical pain relieving methods Int J Nurs Stud Jan40(1)33-44 PubMed PMID 12550148 English
46 Abdalrahim MS Majali SA Stomberg MW Bergbom I (2011) The effect of postoperative pain management program on improving nurses knowledge and attitudes toward pain Nurse Educ Pract 2011 Jul11(4)250-5 doi 101016jnepr201011016 Epub 2010 Dec 24 httpwwwncbinlmnihgovpubmed21186139
47 IASP Pain definition IASP (International Association of the Study of Pain) Pain definition
48 Norsk Ledemiddelharingndbok Ulike smertetilstander [Online] Tilgjengelig paring httplegemiddelhandbokanoTerapi22816expand=1
49 Astrid Lindgrens Barnsjukhus ndash Riktlinjer foumlr smaumlrtbehandling
50 Groslashnseth R amp Markestad T (2011) Pediatri og pediatrisk sykepleie Bergen Fagbokforlaget Vigmostad amp Bjoslashrke AS httppediatriportfoliono
51 Hicks CL von Baeyer CL Spafford Pet al The Faces Pain Scale‐Revised Toward a common metric in pain measurement Pain 2001 93173‐183
52 Twycross A Why Managing Pain in Children Matters in Managing Pain in Children A Clinical Guide (eds A Twycross S J Dowden and E Bruce) Wiley‐Blackwell 2009 Oxford UK doi 1010029781444322743ch1
53 Von Bayer CL amp Spagrud LJ Systematic review of observational (behavioral) measures of pain for children and adolescents aged 3 to 18 years Pain 2007 127 140‐150
54 Voepel‐Lewis Terri RN MSN ZanottiJennifer RN MS CCRN CEN DammeyerJennifer A RN MSN and MerkelSandra RN MS (January 2010) Reliability and Validity of the Face Legs Activity Cry Consolability Behavioral Tool in Assessing Acute Pain in Critically Ill Patients American Journal of Critical Care 19 (1) 55ndash61
55 Merkel S Voepel‐Lewis T Shayevitz JR et al The FLACC A behavioural scale for scoring postoperative pain in young children Pediatric nursing 1997 23293‐797
56 McCaffery M amp Beebe F (1994) Pain‐Clinical Manual of for Nursing Practice Times Mirror International Publishers Ltd Norsk oversettelse Smerter Laeligrebok for helsepersonell Oslo Norge Gyldendal Norsk Forlag AS
57 Reinertsen H Christophersen K‐A Helseth S Vurdering av postoperativ smerte hos barn (0‐5 aringr) Validering og reliabilitetstesting av smertevurderingsverktoslashyet FLACC Sykepleien Forskning 2014 9 132‐140 httpwwwsykepleiennoforskningforskningsartikkel1466655validering‐og‐reliabilitetstesting‐av‐smertevurderingsverktoyet‐flacc
Litteraturliste 58 Stinson J (2009) Pain Assessment I Twycross A Dowden S J amp Bruce E Pain Assessment in Managing Pain in Children A Clinical Guide Oxford UK Wiley-Blackmell
59 Tomlinson D von Baeyer CL Stinson JN Sung L A systematic review of faces scales for the self‐report of pain intensity in children Pediatrics 2010 Nov126(5)e1168‐98 PubMed PMID 20921070 Epub 20101006 eng
60 Von Baeyer CL Childrens self‐reports of pain intensity scale selection limitations and interpretation Pain Res Manag 2006 Autumn11(3)157‐62 PubMed PMID 16960632 Pubmed Central PMCID PMC2539005 Epub 20060909 eng
61 Ghai B Makkar J K amp Wig J (2008) Postoperative pain assesment in preverbal children and children with cognitive impairment Pediatric Anesthesia 18 462‐477
62 Malvia S Voepel‐Lewis T Tait A R Merkel S Lauer A Munro H Farley F (2001) Pain management in children with and without cognitive impairment following spine fusion surgery Pediatric Anasthesia 11 453‐458
63 Malvia S Voepel‐Lewis T Burke C Merkel S amp Tait A R (2006) The revised FLACC observational pain tool improved reliability and validity for pain assesment in children with cognitive impairment Pediatric Anestesia 16 258‐265
64 McJunkins A Green A amp Anand KJS (2010) Pain Assesment in cognitively Impared Functionally Impared Children Pilot Study Results Journal of Pediatric Nursing 25 307‐309
65 McKearnan K A Kieckhefer G Engel J M Jensen M amp Labyak S (2004) Pain in Children with cerebral Palsy A Review Journal of Neuroscience Nursing Vol 36 no 5 s252‐259
66 Voepel‐Lewis T Malviya S Tait A Merkel S Forter R amp Krane E (2008) A comparison of the clinical utility of pain assesment tools for children with cognitive impairment Pediatric Anesthesiology 106 (1) 72‐78
67 Baulch I Assessment and management of pain in the paediatric patient Nursing standard 2010 2510 35-40
68 Twycross A Why Managing Pain in Children Matters in Managing Pain in Children A Clinical Guide (eds A Twycross S J Dowden and E Bruce) Wiley-Blackwell 2009 Oxford UK doi 1010029781444322743ch1
69 Schug SA amp Pogatzki-Zhan EM Chronic Pain after Surgery or Injury Pain 2011 Clinical Updates XIX 11-5
70 Fredheim OMS Borchgrevink PC amp Kvarstein G Behandling av postoperativ smerte i sykehus Tidsskr Nor Legeforen 2011 131 1772-6
71 Steward DL Welge J amp Myer C Steroids for improving recovery following tonsillectomy in children Cochrane Database of Systematic Reviews 2003 Issue 1Art NoCD003997 DOI10100214651858CD003997
72 Hong JY Han SW Kim WO et al Effect of dexamethasone in combination with caudal analgesia on postoperative pain control in day-case paediatric orchioplexy British Journal of Anesthesia 2010 105(4)506-10
73 Den Norske Legeforening (2009) Retningslinjer for smertelindring [Online] URL httpwww legeforeningennoasset42585142585_1pdf
74 Association of Paediatric Anaesthetists (2008) Good Practice in Postoperative and Procedural Pain [Online] URL httpwwwbritishpainsocietyorgbook_apa_part1pdf
75 European Society of Regional Aneasthesia (2005) Postoperative Pain Management ndash Good Clinical Practice General recommendations and principles for successful pain management [Online] URL httpwwwesraeuropeorgPostoperativePainManagementpdf
76 Monsen ALB Skadberg BT amp Groslashnlie I Smertebehandling Norsk Barnelegeforeningen 2011 [Online] URL httpwwwlegeforeningennoid1104250
77 Smeland A amp Reinertsen H (2012) Smertevurdering og behandling av postoperative smerter hos barn Tidsskriftet Kirurgen 1 58-62 (5 s) [Online] Tilgjengelig paring httpwwwkirurgennopdf1201
78 Standing JF Savage I Pritchard D et al Diclofenac for acute pain in children Cochrane Database of Systematic Reviews 2009 Issue 4 Art No CD005538 DOI 10100214651858CD005538pub2
79 Standing JF Tibboel D Korpela R et al Diclofenac pharmacokinetic meta-analysis and dose recommendations for surgical pain in children aged 1ndash12 years Pediatric Anesthesia 2011 21 316ndash324 doi 101111j1460-9592201003509x
80 Riad W amp Moussa A Pre-operative analgesia with rectal diclofenac andor paracetamol in children undergoing hernia repair Anaesthesia 2007 Dec62(12)1241-5
81 Hiller A Meretoja OA Korpela R et al The Anagesic Efficacy of Acetaminophen Ketoprofen or Their Combination for Pediatric Surgical Patients Having Soft Tissue or Orthopedic Procedures Anesth Analg 20061021365-71
82 Norsk legemiddelharingndbok Antidoter ndash alfabetisk oversikt bruksomraringde og dosering httplegemiddelhandbokanoGenerelle153557i153779
83 Norsk legemiddelharingndbok Barn og legemidler httplegemiddelhandbokanoGenerelle153109
84 SickKids Aboutkidshealthca Myths About Pain httpwwwaboutkidshealthcaEnResourceCentresPainPainAssessmentPagesMyths-About-Painaspx
85 Psykososial preoperativ forberedelse av barn 0ndash18 aringr httpwwwhelsebiblioteketnomicrositefagprosedyrerfagprosedyrerpsykososial-preoperativ-forberedelse-av-barn-018-C3A5r
86 Twycross A Why Managing Pain in Children Matters in Managing Pain in Children A Clinical Guide (eds ATwycross S J Dowden and E Bruce) Wiley‐Blackwell 2009 Oxford UK doi 1010029781444322743ch1
Tusen takk
Oppsummering Prosjektet er stoslashttet av
Nasjonalt kompetansenettverk for legemidler til barn
Kirurgisk avdeling for barn OUS
Norsk Sykepleierforbund
Sykehusbarn
Litteraturliste 1 Hauer J Jones BL amp Wolfe J Poplack D G Kim M S (2015) Evaluation and management of pain in children UpToDate httpwwwuptodatecomcontentsevaluation-
and-management-of-pain-in-childrensource=search_resultampsearch=PAIN+CHILDRENampselectedTitle=17E150
2 IASP (2011c) Acute Pain management in Newborn Infants Pain [Online] Tilgjengelig paring httpiaspfilescms-pluscomContentContentFoldersPublications2PainClinicalUpdatesArchivesPCU_19-6_final_12-8-11_1390260191290_1pdf [Lastet 14april 2014]
3 Bernadi M Catania G amp Tridello G (2007) Knowledge and attitudes about cancer pain management a national survey of Italian hospice nurses Cancer Nurs 30(2) E20-6
4 Coulling S (2005) Nurses and doctors knowledge of pain after surgery Nurs Stand 19(34) 41-49
5 Hovde K R Granheim T H Christophersen K-A amp Dihle A (2012) The Norwegian Version of the Pediatric Nursesrsquo Knowledge and attitudes Survey Regarding Pain Reliability and Validity Pedatric nursing 38 (5) 264-269
6 Hossain S (2010) Nursesrsquo Knowledge and Attitudes and Pain Management Practice of Post-Operative Children in Bangladesh Prince of Songkla University Nedlastet fra httpkbpsuacthpsukbbitstream201078261325999pdf
7 Huth M M Gregg T L Lin L (2010) Education changes Mexican nurses knowledge and attitudes regarding pediatric pain Pain Manag Nurs Dec11(4)201-8 doi 101016jpmn200911001
8 Lewthwaite B J Jabusch K M Wheeler B J Schnell-Hoehn K N Mills J Estrella-Holder E Fedorowicz A (2011) Nurses knowledge and attitudes regarding pain management in hospitalized adults J Contin Educ Nurs 42(6) 251-7 doi 10392800220124-20110103-03 Epub 2011 Jan 10
9 Manworren RC (2000) Pediatric nursesrsquo knowledge and attitudes survey regarding pain Pediatr Nurs 26 610-614
10 Rieman M T Gordon M amp Marvin J M (2007) Pediatric nursesrsquo knowledge and attitudes survey regarding pain a competency tool modification Pediatr Nurs 33 303-306
11 Simons JM amp MacDonald LM (2004) Pain assessment tools childrenrsquos nursesrsquo views Journal of Child Health Care 8 264 Doi 1011771367493504047317
12 Twycross A (2007) What is the impact of theoretical knowledge on childrenrsquos nursesrsquo post-operative pain management practices an exploratory study Nurse Educ Today 27 697-707
13 Smart S (2005) POST-OPERATIVE PAIN MANAGEMENT KNOWLEDGE AND ATTITUDES OF PAEDIATRIC NURSES- A NEW ZEALAND REGIONAL VIEW Victoria University of Wellington [Online] Tilgjengelig paring httpresearcharchivevuwacnzbitstreamhandle1006338thesispdfsequence=2 [Lastet 13april 2014]
14 Vincent C V H (2005) Nursesrsquo knowledge attitudes and practices regarding childrenrsquos pain MCN Am J Matern Child Nurs 30 177-183
15 Olsson G Jylli L (2001) Smaumlrta hos barn och ungdomar Lund Sverige Studentlitteratur
16 Peters J W Schouw R Anand K J van Dijk M Duivenvoorden H J Tibboel D (2005) Does neonatal surgery lead to increased pain sensitivity in later childhood Pain 114(3) 444-54
17 Anand K J S Gracia-Preats J A amp Kim M S (2015) Assessment of neonatal pain UpToDate httpwwwuptodatecomcontentsassessment-of-neonatal-pain
18 Anand K J S Gracia-Preats J A amp Kim M S (2015) Prevention and treatment of neonatal pain UpToDate httpwwwuptodatecomcontentsprevention-and-treatment-of-neonatal-painsource=related_link
19 IASP (2011a) Acute Pain and Surgery Global Year Against Acute Pain [Online] Tilgjengelig paring httpwwwiasp-painorgfilesContentContentFoldersGlobalYearAgainstPain2AcutePainFactSheets7-Surgerypdf [Lastet 14april 2014]
20 Howard R Carter B Curry J Jain A Liossi C Morton N Rivett K Rose M Tyrrell J Walker S Williams G (2012) Good Practice in Postoperative and Procedural pain management 2nd Edition Pediatric Anesthesia 22 1ndash79 doi 101111j1460-9592201203838x
21 IASP (2011b) Interventions Benefits and Barriers Global Year Against Acute Pain [Online] Tilgjengelig paring httpwwwiasp-painorgfilesContentContentFoldersGlobalYearAgainstPain2AcutePainFactSheets2-Interventionspdf [Lastet 14april 2014]
22 Benhamou D Berti M Brodner G De Andres J Draisci G Moreno-Azcoita M Neugebauer EA Schwenk W Torres LM Viel E (2007) Postoperative Analgesic THerapy Observational Survey (PATHOS) A practice pattern study in 7 CentralSouthern Eurpean countries Pain 136 134-141
23 Reinertsen H (2008) Smerte hos barn kap3I Rustoslashen T amp Wahl AK (red) Ulike tekster om smerte - fra nocisepsjon til livskvalitet Oslo Gyldendal Norsk Forlag AS
Litteraturliste 24 Smeland A amp Reinertsen H (2012) Smertevurdering og behandling av postoperative smerter hos barn Tidsskriftet Kirurgen 1 58-62 (5 s) [Online] Tilgjengelig paring
httpwwwkirurgennopdf1201 [Lastet 13april 2014]
25 Bringuier S Picot MC Dadure C et al (2009) A prospective comparison of post-surgical behavioral pain scales in preschoolers highlighting the risk of false evaluations Pain 145 60-68
26 Crelline D Sullivan T B Babl F E OSullivan R Hutchinson A (2007) Analysis of the validation of existing behavioral pain and distress scales for use in the procedural setting Pediatric Anesthesia 17 720-733
27 Ghai B Makkar JK amp Wig J (2008) Postoperative pain assessment in preverbal children and children with cognitive impairment Pediatric Anesthesia 18 462-477
28 Hicks CL von Baeyer CL Spafford P et al (2001) The Faces Pain Scale-Revised Toward a common metric in pain measurement Pain 93 173-183
29 Merkel SI Voepel-Lewis T amp Shayevitz et al (1997) The FLACC A Behavioral Scale for Scoring Postoperative Pain in Young Children Pediatric Nursing 23 293-7
30 Ellis J A McCleary L Blouin R Dube K Rowley B MacNeil M amp Cooke C (2007) Implementing best practice pain management in a pediatric hospital Journal for Specialists in Pediatric Nursing 12 264-277 doi101111j1744-6155200700121x
31 Johnston C C Gagnon A Rennick J Rosmus C Patenaude H Ellis J Shapiro C Filion F Ritchie J Byron J (2007) One-on-one coaching to improve pain assessment and management practices of pediatric nurses Journal of Pediatric Nursing 22 467-478 doi101016jpedn200707004
32 Le May S Johnston C C Choiniegravere M Fortin C Kudirka D Murray L Chalut D (2009) Pain Management Practices in a Pediatric Emergency Room (PAMPER) Study interventions with nurses Pediatr Emerg Care Aug25(8)498-503 doi 101097PEC0b013e3181b0a0af
33 Vincent C V H Wilkie D J amp Wang E (2011) Pediatric Nurses Beliefs and Pain Management Practices An Intervention Pilot West J Nurs Res 33 825 originally published online 20 December 2010
36 Twycross A Finley G A and Latimer M (2013) Pediatric nurses postoperative pain management practices An observational study Journal for Specialists in Pediatric Nursing 18 189ndash201 doi 101111jspn12026
42 Twycross A amp Finley G A (2013) Childrens and parents perceptions of postoperative pain management a mixed methods study Journal of Clinical Nursing 22(21-22) 3095-3108 doi 101111jocn12152 [Online] Tilgjengelig paring httponlinelibrarywileycomdoi101111jocn12152pdf (13042014)
43 Polkki T Pietila AM Vehvilainen-Julkunen K (2003) Hospitalized childrens descriptions of their experiences with postsurgical pain relieving methods Int J Nurs Stud Jan40(1)33-44 PubMed PMID 12550148 English
46 Abdalrahim MS Majali SA Stomberg MW Bergbom I (2011) The effect of postoperative pain management program on improving nurses knowledge and attitudes toward pain Nurse Educ Pract 2011 Jul11(4)250-5 doi 101016jnepr201011016 Epub 2010 Dec 24 httpwwwncbinlmnihgovpubmed21186139
47 IASP Pain definition IASP (International Association of the Study of Pain) Pain definition
48 Norsk Ledemiddelharingndbok Ulike smertetilstander [Online] Tilgjengelig paring httplegemiddelhandbokanoTerapi22816expand=1
49 Astrid Lindgrens Barnsjukhus ndash Riktlinjer foumlr smaumlrtbehandling
50 Groslashnseth R amp Markestad T (2011) Pediatri og pediatrisk sykepleie Bergen Fagbokforlaget Vigmostad amp Bjoslashrke AS httppediatriportfoliono
51 Hicks CL von Baeyer CL Spafford Pet al The Faces Pain Scale‐Revised Toward a common metric in pain measurement Pain 2001 93173‐183
52 Twycross A Why Managing Pain in Children Matters in Managing Pain in Children A Clinical Guide (eds A Twycross S J Dowden and E Bruce) Wiley‐Blackwell 2009 Oxford UK doi 1010029781444322743ch1
53 Von Bayer CL amp Spagrud LJ Systematic review of observational (behavioral) measures of pain for children and adolescents aged 3 to 18 years Pain 2007 127 140‐150
54 Voepel‐Lewis Terri RN MSN ZanottiJennifer RN MS CCRN CEN DammeyerJennifer A RN MSN and MerkelSandra RN MS (January 2010) Reliability and Validity of the Face Legs Activity Cry Consolability Behavioral Tool in Assessing Acute Pain in Critically Ill Patients American Journal of Critical Care 19 (1) 55ndash61
55 Merkel S Voepel‐Lewis T Shayevitz JR et al The FLACC A behavioural scale for scoring postoperative pain in young children Pediatric nursing 1997 23293‐797
56 McCaffery M amp Beebe F (1994) Pain‐Clinical Manual of for Nursing Practice Times Mirror International Publishers Ltd Norsk oversettelse Smerter Laeligrebok for helsepersonell Oslo Norge Gyldendal Norsk Forlag AS
57 Reinertsen H Christophersen K‐A Helseth S Vurdering av postoperativ smerte hos barn (0‐5 aringr) Validering og reliabilitetstesting av smertevurderingsverktoslashyet FLACC Sykepleien Forskning 2014 9 132‐140 httpwwwsykepleiennoforskningforskningsartikkel1466655validering‐og‐reliabilitetstesting‐av‐smertevurderingsverktoyet‐flacc
Litteraturliste 58 Stinson J (2009) Pain Assessment I Twycross A Dowden S J amp Bruce E Pain Assessment in Managing Pain in Children A Clinical Guide Oxford UK Wiley-Blackmell
59 Tomlinson D von Baeyer CL Stinson JN Sung L A systematic review of faces scales for the self‐report of pain intensity in children Pediatrics 2010 Nov126(5)e1168‐98 PubMed PMID 20921070 Epub 20101006 eng
60 Von Baeyer CL Childrens self‐reports of pain intensity scale selection limitations and interpretation Pain Res Manag 2006 Autumn11(3)157‐62 PubMed PMID 16960632 Pubmed Central PMCID PMC2539005 Epub 20060909 eng
61 Ghai B Makkar J K amp Wig J (2008) Postoperative pain assesment in preverbal children and children with cognitive impairment Pediatric Anesthesia 18 462‐477
62 Malvia S Voepel‐Lewis T Tait A R Merkel S Lauer A Munro H Farley F (2001) Pain management in children with and without cognitive impairment following spine fusion surgery Pediatric Anasthesia 11 453‐458
63 Malvia S Voepel‐Lewis T Burke C Merkel S amp Tait A R (2006) The revised FLACC observational pain tool improved reliability and validity for pain assesment in children with cognitive impairment Pediatric Anestesia 16 258‐265
64 McJunkins A Green A amp Anand KJS (2010) Pain Assesment in cognitively Impared Functionally Impared Children Pilot Study Results Journal of Pediatric Nursing 25 307‐309
65 McKearnan K A Kieckhefer G Engel J M Jensen M amp Labyak S (2004) Pain in Children with cerebral Palsy A Review Journal of Neuroscience Nursing Vol 36 no 5 s252‐259
66 Voepel‐Lewis T Malviya S Tait A Merkel S Forter R amp Krane E (2008) A comparison of the clinical utility of pain assesment tools for children with cognitive impairment Pediatric Anesthesiology 106 (1) 72‐78
67 Baulch I Assessment and management of pain in the paediatric patient Nursing standard 2010 2510 35-40
68 Twycross A Why Managing Pain in Children Matters in Managing Pain in Children A Clinical Guide (eds A Twycross S J Dowden and E Bruce) Wiley-Blackwell 2009 Oxford UK doi 1010029781444322743ch1
69 Schug SA amp Pogatzki-Zhan EM Chronic Pain after Surgery or Injury Pain 2011 Clinical Updates XIX 11-5
70 Fredheim OMS Borchgrevink PC amp Kvarstein G Behandling av postoperativ smerte i sykehus Tidsskr Nor Legeforen 2011 131 1772-6
71 Steward DL Welge J amp Myer C Steroids for improving recovery following tonsillectomy in children Cochrane Database of Systematic Reviews 2003 Issue 1Art NoCD003997 DOI10100214651858CD003997
72 Hong JY Han SW Kim WO et al Effect of dexamethasone in combination with caudal analgesia on postoperative pain control in day-case paediatric orchioplexy British Journal of Anesthesia 2010 105(4)506-10
73 Den Norske Legeforening (2009) Retningslinjer for smertelindring [Online] URL httpwww legeforeningennoasset42585142585_1pdf
74 Association of Paediatric Anaesthetists (2008) Good Practice in Postoperative and Procedural Pain [Online] URL httpwwwbritishpainsocietyorgbook_apa_part1pdf
75 European Society of Regional Aneasthesia (2005) Postoperative Pain Management ndash Good Clinical Practice General recommendations and principles for successful pain management [Online] URL httpwwwesraeuropeorgPostoperativePainManagementpdf
76 Monsen ALB Skadberg BT amp Groslashnlie I Smertebehandling Norsk Barnelegeforeningen 2011 [Online] URL httpwwwlegeforeningennoid1104250
77 Smeland A amp Reinertsen H (2012) Smertevurdering og behandling av postoperative smerter hos barn Tidsskriftet Kirurgen 1 58-62 (5 s) [Online] Tilgjengelig paring httpwwwkirurgennopdf1201
78 Standing JF Savage I Pritchard D et al Diclofenac for acute pain in children Cochrane Database of Systematic Reviews 2009 Issue 4 Art No CD005538 DOI 10100214651858CD005538pub2
79 Standing JF Tibboel D Korpela R et al Diclofenac pharmacokinetic meta-analysis and dose recommendations for surgical pain in children aged 1ndash12 years Pediatric Anesthesia 2011 21 316ndash324 doi 101111j1460-9592201003509x
80 Riad W amp Moussa A Pre-operative analgesia with rectal diclofenac andor paracetamol in children undergoing hernia repair Anaesthesia 2007 Dec62(12)1241-5
81 Hiller A Meretoja OA Korpela R et al The Anagesic Efficacy of Acetaminophen Ketoprofen or Their Combination for Pediatric Surgical Patients Having Soft Tissue or Orthopedic Procedures Anesth Analg 20061021365-71
82 Norsk legemiddelharingndbok Antidoter ndash alfabetisk oversikt bruksomraringde og dosering httplegemiddelhandbokanoGenerelle153557i153779
83 Norsk legemiddelharingndbok Barn og legemidler httplegemiddelhandbokanoGenerelle153109
84 SickKids Aboutkidshealthca Myths About Pain httpwwwaboutkidshealthcaEnResourceCentresPainPainAssessmentPagesMyths-About-Painaspx
85 Psykososial preoperativ forberedelse av barn 0ndash18 aringr httpwwwhelsebiblioteketnomicrositefagprosedyrerfagprosedyrerpsykososial-preoperativ-forberedelse-av-barn-018-C3A5r
86 Twycross A Why Managing Pain in Children Matters in Managing Pain in Children A Clinical Guide (eds ATwycross S J Dowden and E Bruce) Wiley‐Blackwell 2009 Oxford UK doi 1010029781444322743ch1
Oppsummering Prosjektet er stoslashttet av
Nasjonalt kompetansenettverk for legemidler til barn
Kirurgisk avdeling for barn OUS
Norsk Sykepleierforbund
Sykehusbarn
Litteraturliste 1 Hauer J Jones BL amp Wolfe J Poplack D G Kim M S (2015) Evaluation and management of pain in children UpToDate httpwwwuptodatecomcontentsevaluation-
and-management-of-pain-in-childrensource=search_resultampsearch=PAIN+CHILDRENampselectedTitle=17E150
2 IASP (2011c) Acute Pain management in Newborn Infants Pain [Online] Tilgjengelig paring httpiaspfilescms-pluscomContentContentFoldersPublications2PainClinicalUpdatesArchivesPCU_19-6_final_12-8-11_1390260191290_1pdf [Lastet 14april 2014]
3 Bernadi M Catania G amp Tridello G (2007) Knowledge and attitudes about cancer pain management a national survey of Italian hospice nurses Cancer Nurs 30(2) E20-6
4 Coulling S (2005) Nurses and doctors knowledge of pain after surgery Nurs Stand 19(34) 41-49
5 Hovde K R Granheim T H Christophersen K-A amp Dihle A (2012) The Norwegian Version of the Pediatric Nursesrsquo Knowledge and attitudes Survey Regarding Pain Reliability and Validity Pedatric nursing 38 (5) 264-269
6 Hossain S (2010) Nursesrsquo Knowledge and Attitudes and Pain Management Practice of Post-Operative Children in Bangladesh Prince of Songkla University Nedlastet fra httpkbpsuacthpsukbbitstream201078261325999pdf
7 Huth M M Gregg T L Lin L (2010) Education changes Mexican nurses knowledge and attitudes regarding pediatric pain Pain Manag Nurs Dec11(4)201-8 doi 101016jpmn200911001
8 Lewthwaite B J Jabusch K M Wheeler B J Schnell-Hoehn K N Mills J Estrella-Holder E Fedorowicz A (2011) Nurses knowledge and attitudes regarding pain management in hospitalized adults J Contin Educ Nurs 42(6) 251-7 doi 10392800220124-20110103-03 Epub 2011 Jan 10
9 Manworren RC (2000) Pediatric nursesrsquo knowledge and attitudes survey regarding pain Pediatr Nurs 26 610-614
10 Rieman M T Gordon M amp Marvin J M (2007) Pediatric nursesrsquo knowledge and attitudes survey regarding pain a competency tool modification Pediatr Nurs 33 303-306
11 Simons JM amp MacDonald LM (2004) Pain assessment tools childrenrsquos nursesrsquo views Journal of Child Health Care 8 264 Doi 1011771367493504047317
12 Twycross A (2007) What is the impact of theoretical knowledge on childrenrsquos nursesrsquo post-operative pain management practices an exploratory study Nurse Educ Today 27 697-707
13 Smart S (2005) POST-OPERATIVE PAIN MANAGEMENT KNOWLEDGE AND ATTITUDES OF PAEDIATRIC NURSES- A NEW ZEALAND REGIONAL VIEW Victoria University of Wellington [Online] Tilgjengelig paring httpresearcharchivevuwacnzbitstreamhandle1006338thesispdfsequence=2 [Lastet 13april 2014]
14 Vincent C V H (2005) Nursesrsquo knowledge attitudes and practices regarding childrenrsquos pain MCN Am J Matern Child Nurs 30 177-183
15 Olsson G Jylli L (2001) Smaumlrta hos barn och ungdomar Lund Sverige Studentlitteratur
16 Peters J W Schouw R Anand K J van Dijk M Duivenvoorden H J Tibboel D (2005) Does neonatal surgery lead to increased pain sensitivity in later childhood Pain 114(3) 444-54
17 Anand K J S Gracia-Preats J A amp Kim M S (2015) Assessment of neonatal pain UpToDate httpwwwuptodatecomcontentsassessment-of-neonatal-pain
18 Anand K J S Gracia-Preats J A amp Kim M S (2015) Prevention and treatment of neonatal pain UpToDate httpwwwuptodatecomcontentsprevention-and-treatment-of-neonatal-painsource=related_link
19 IASP (2011a) Acute Pain and Surgery Global Year Against Acute Pain [Online] Tilgjengelig paring httpwwwiasp-painorgfilesContentContentFoldersGlobalYearAgainstPain2AcutePainFactSheets7-Surgerypdf [Lastet 14april 2014]
20 Howard R Carter B Curry J Jain A Liossi C Morton N Rivett K Rose M Tyrrell J Walker S Williams G (2012) Good Practice in Postoperative and Procedural pain management 2nd Edition Pediatric Anesthesia 22 1ndash79 doi 101111j1460-9592201203838x
21 IASP (2011b) Interventions Benefits and Barriers Global Year Against Acute Pain [Online] Tilgjengelig paring httpwwwiasp-painorgfilesContentContentFoldersGlobalYearAgainstPain2AcutePainFactSheets2-Interventionspdf [Lastet 14april 2014]
22 Benhamou D Berti M Brodner G De Andres J Draisci G Moreno-Azcoita M Neugebauer EA Schwenk W Torres LM Viel E (2007) Postoperative Analgesic THerapy Observational Survey (PATHOS) A practice pattern study in 7 CentralSouthern Eurpean countries Pain 136 134-141
23 Reinertsen H (2008) Smerte hos barn kap3I Rustoslashen T amp Wahl AK (red) Ulike tekster om smerte - fra nocisepsjon til livskvalitet Oslo Gyldendal Norsk Forlag AS
Litteraturliste 24 Smeland A amp Reinertsen H (2012) Smertevurdering og behandling av postoperative smerter hos barn Tidsskriftet Kirurgen 1 58-62 (5 s) [Online] Tilgjengelig paring
httpwwwkirurgennopdf1201 [Lastet 13april 2014]
25 Bringuier S Picot MC Dadure C et al (2009) A prospective comparison of post-surgical behavioral pain scales in preschoolers highlighting the risk of false evaluations Pain 145 60-68
26 Crelline D Sullivan T B Babl F E OSullivan R Hutchinson A (2007) Analysis of the validation of existing behavioral pain and distress scales for use in the procedural setting Pediatric Anesthesia 17 720-733
27 Ghai B Makkar JK amp Wig J (2008) Postoperative pain assessment in preverbal children and children with cognitive impairment Pediatric Anesthesia 18 462-477
28 Hicks CL von Baeyer CL Spafford P et al (2001) The Faces Pain Scale-Revised Toward a common metric in pain measurement Pain 93 173-183
29 Merkel SI Voepel-Lewis T amp Shayevitz et al (1997) The FLACC A Behavioral Scale for Scoring Postoperative Pain in Young Children Pediatric Nursing 23 293-7
30 Ellis J A McCleary L Blouin R Dube K Rowley B MacNeil M amp Cooke C (2007) Implementing best practice pain management in a pediatric hospital Journal for Specialists in Pediatric Nursing 12 264-277 doi101111j1744-6155200700121x
31 Johnston C C Gagnon A Rennick J Rosmus C Patenaude H Ellis J Shapiro C Filion F Ritchie J Byron J (2007) One-on-one coaching to improve pain assessment and management practices of pediatric nurses Journal of Pediatric Nursing 22 467-478 doi101016jpedn200707004
32 Le May S Johnston C C Choiniegravere M Fortin C Kudirka D Murray L Chalut D (2009) Pain Management Practices in a Pediatric Emergency Room (PAMPER) Study interventions with nurses Pediatr Emerg Care Aug25(8)498-503 doi 101097PEC0b013e3181b0a0af
33 Vincent C V H Wilkie D J amp Wang E (2011) Pediatric Nurses Beliefs and Pain Management Practices An Intervention Pilot West J Nurs Res 33 825 originally published online 20 December 2010
36 Twycross A Finley G A and Latimer M (2013) Pediatric nurses postoperative pain management practices An observational study Journal for Specialists in Pediatric Nursing 18 189ndash201 doi 101111jspn12026
42 Twycross A amp Finley G A (2013) Childrens and parents perceptions of postoperative pain management a mixed methods study Journal of Clinical Nursing 22(21-22) 3095-3108 doi 101111jocn12152 [Online] Tilgjengelig paring httponlinelibrarywileycomdoi101111jocn12152pdf (13042014)
43 Polkki T Pietila AM Vehvilainen-Julkunen K (2003) Hospitalized childrens descriptions of their experiences with postsurgical pain relieving methods Int J Nurs Stud Jan40(1)33-44 PubMed PMID 12550148 English
46 Abdalrahim MS Majali SA Stomberg MW Bergbom I (2011) The effect of postoperative pain management program on improving nurses knowledge and attitudes toward pain Nurse Educ Pract 2011 Jul11(4)250-5 doi 101016jnepr201011016 Epub 2010 Dec 24 httpwwwncbinlmnihgovpubmed21186139
47 IASP Pain definition IASP (International Association of the Study of Pain) Pain definition
48 Norsk Ledemiddelharingndbok Ulike smertetilstander [Online] Tilgjengelig paring httplegemiddelhandbokanoTerapi22816expand=1
49 Astrid Lindgrens Barnsjukhus ndash Riktlinjer foumlr smaumlrtbehandling
50 Groslashnseth R amp Markestad T (2011) Pediatri og pediatrisk sykepleie Bergen Fagbokforlaget Vigmostad amp Bjoslashrke AS httppediatriportfoliono
51 Hicks CL von Baeyer CL Spafford Pet al The Faces Pain Scale‐Revised Toward a common metric in pain measurement Pain 2001 93173‐183
52 Twycross A Why Managing Pain in Children Matters in Managing Pain in Children A Clinical Guide (eds A Twycross S J Dowden and E Bruce) Wiley‐Blackwell 2009 Oxford UK doi 1010029781444322743ch1
53 Von Bayer CL amp Spagrud LJ Systematic review of observational (behavioral) measures of pain for children and adolescents aged 3 to 18 years Pain 2007 127 140‐150
54 Voepel‐Lewis Terri RN MSN ZanottiJennifer RN MS CCRN CEN DammeyerJennifer A RN MSN and MerkelSandra RN MS (January 2010) Reliability and Validity of the Face Legs Activity Cry Consolability Behavioral Tool in Assessing Acute Pain in Critically Ill Patients American Journal of Critical Care 19 (1) 55ndash61
55 Merkel S Voepel‐Lewis T Shayevitz JR et al The FLACC A behavioural scale for scoring postoperative pain in young children Pediatric nursing 1997 23293‐797
56 McCaffery M amp Beebe F (1994) Pain‐Clinical Manual of for Nursing Practice Times Mirror International Publishers Ltd Norsk oversettelse Smerter Laeligrebok for helsepersonell Oslo Norge Gyldendal Norsk Forlag AS
57 Reinertsen H Christophersen K‐A Helseth S Vurdering av postoperativ smerte hos barn (0‐5 aringr) Validering og reliabilitetstesting av smertevurderingsverktoslashyet FLACC Sykepleien Forskning 2014 9 132‐140 httpwwwsykepleiennoforskningforskningsartikkel1466655validering‐og‐reliabilitetstesting‐av‐smertevurderingsverktoyet‐flacc
Litteraturliste 58 Stinson J (2009) Pain Assessment I Twycross A Dowden S J amp Bruce E Pain Assessment in Managing Pain in Children A Clinical Guide Oxford UK Wiley-Blackmell
59 Tomlinson D von Baeyer CL Stinson JN Sung L A systematic review of faces scales for the self‐report of pain intensity in children Pediatrics 2010 Nov126(5)e1168‐98 PubMed PMID 20921070 Epub 20101006 eng
60 Von Baeyer CL Childrens self‐reports of pain intensity scale selection limitations and interpretation Pain Res Manag 2006 Autumn11(3)157‐62 PubMed PMID 16960632 Pubmed Central PMCID PMC2539005 Epub 20060909 eng
61 Ghai B Makkar J K amp Wig J (2008) Postoperative pain assesment in preverbal children and children with cognitive impairment Pediatric Anesthesia 18 462‐477
62 Malvia S Voepel‐Lewis T Tait A R Merkel S Lauer A Munro H Farley F (2001) Pain management in children with and without cognitive impairment following spine fusion surgery Pediatric Anasthesia 11 453‐458
63 Malvia S Voepel‐Lewis T Burke C Merkel S amp Tait A R (2006) The revised FLACC observational pain tool improved reliability and validity for pain assesment in children with cognitive impairment Pediatric Anestesia 16 258‐265
64 McJunkins A Green A amp Anand KJS (2010) Pain Assesment in cognitively Impared Functionally Impared Children Pilot Study Results Journal of Pediatric Nursing 25 307‐309
65 McKearnan K A Kieckhefer G Engel J M Jensen M amp Labyak S (2004) Pain in Children with cerebral Palsy A Review Journal of Neuroscience Nursing Vol 36 no 5 s252‐259
66 Voepel‐Lewis T Malviya S Tait A Merkel S Forter R amp Krane E (2008) A comparison of the clinical utility of pain assesment tools for children with cognitive impairment Pediatric Anesthesiology 106 (1) 72‐78
67 Baulch I Assessment and management of pain in the paediatric patient Nursing standard 2010 2510 35-40
68 Twycross A Why Managing Pain in Children Matters in Managing Pain in Children A Clinical Guide (eds A Twycross S J Dowden and E Bruce) Wiley-Blackwell 2009 Oxford UK doi 1010029781444322743ch1
69 Schug SA amp Pogatzki-Zhan EM Chronic Pain after Surgery or Injury Pain 2011 Clinical Updates XIX 11-5
70 Fredheim OMS Borchgrevink PC amp Kvarstein G Behandling av postoperativ smerte i sykehus Tidsskr Nor Legeforen 2011 131 1772-6
71 Steward DL Welge J amp Myer C Steroids for improving recovery following tonsillectomy in children Cochrane Database of Systematic Reviews 2003 Issue 1Art NoCD003997 DOI10100214651858CD003997
72 Hong JY Han SW Kim WO et al Effect of dexamethasone in combination with caudal analgesia on postoperative pain control in day-case paediatric orchioplexy British Journal of Anesthesia 2010 105(4)506-10
73 Den Norske Legeforening (2009) Retningslinjer for smertelindring [Online] URL httpwww legeforeningennoasset42585142585_1pdf
74 Association of Paediatric Anaesthetists (2008) Good Practice in Postoperative and Procedural Pain [Online] URL httpwwwbritishpainsocietyorgbook_apa_part1pdf
75 European Society of Regional Aneasthesia (2005) Postoperative Pain Management ndash Good Clinical Practice General recommendations and principles for successful pain management [Online] URL httpwwwesraeuropeorgPostoperativePainManagementpdf
76 Monsen ALB Skadberg BT amp Groslashnlie I Smertebehandling Norsk Barnelegeforeningen 2011 [Online] URL httpwwwlegeforeningennoid1104250
77 Smeland A amp Reinertsen H (2012) Smertevurdering og behandling av postoperative smerter hos barn Tidsskriftet Kirurgen 1 58-62 (5 s) [Online] Tilgjengelig paring httpwwwkirurgennopdf1201
78 Standing JF Savage I Pritchard D et al Diclofenac for acute pain in children Cochrane Database of Systematic Reviews 2009 Issue 4 Art No CD005538 DOI 10100214651858CD005538pub2
79 Standing JF Tibboel D Korpela R et al Diclofenac pharmacokinetic meta-analysis and dose recommendations for surgical pain in children aged 1ndash12 years Pediatric Anesthesia 2011 21 316ndash324 doi 101111j1460-9592201003509x
80 Riad W amp Moussa A Pre-operative analgesia with rectal diclofenac andor paracetamol in children undergoing hernia repair Anaesthesia 2007 Dec62(12)1241-5
81 Hiller A Meretoja OA Korpela R et al The Anagesic Efficacy of Acetaminophen Ketoprofen or Their Combination for Pediatric Surgical Patients Having Soft Tissue or Orthopedic Procedures Anesth Analg 20061021365-71
82 Norsk legemiddelharingndbok Antidoter ndash alfabetisk oversikt bruksomraringde og dosering httplegemiddelhandbokanoGenerelle153557i153779
83 Norsk legemiddelharingndbok Barn og legemidler httplegemiddelhandbokanoGenerelle153109
84 SickKids Aboutkidshealthca Myths About Pain httpwwwaboutkidshealthcaEnResourceCentresPainPainAssessmentPagesMyths-About-Painaspx
85 Psykososial preoperativ forberedelse av barn 0ndash18 aringr httpwwwhelsebiblioteketnomicrositefagprosedyrerfagprosedyrerpsykososial-preoperativ-forberedelse-av-barn-018-C3A5r
86 Twycross A Why Managing Pain in Children Matters in Managing Pain in Children A Clinical Guide (eds ATwycross S J Dowden and E Bruce) Wiley‐Blackwell 2009 Oxford UK doi 1010029781444322743ch1
Litteraturliste 1 Hauer J Jones BL amp Wolfe J Poplack D G Kim M S (2015) Evaluation and management of pain in children UpToDate httpwwwuptodatecomcontentsevaluation-
and-management-of-pain-in-childrensource=search_resultampsearch=PAIN+CHILDRENampselectedTitle=17E150
2 IASP (2011c) Acute Pain management in Newborn Infants Pain [Online] Tilgjengelig paring httpiaspfilescms-pluscomContentContentFoldersPublications2PainClinicalUpdatesArchivesPCU_19-6_final_12-8-11_1390260191290_1pdf [Lastet 14april 2014]
3 Bernadi M Catania G amp Tridello G (2007) Knowledge and attitudes about cancer pain management a national survey of Italian hospice nurses Cancer Nurs 30(2) E20-6
4 Coulling S (2005) Nurses and doctors knowledge of pain after surgery Nurs Stand 19(34) 41-49
5 Hovde K R Granheim T H Christophersen K-A amp Dihle A (2012) The Norwegian Version of the Pediatric Nursesrsquo Knowledge and attitudes Survey Regarding Pain Reliability and Validity Pedatric nursing 38 (5) 264-269
6 Hossain S (2010) Nursesrsquo Knowledge and Attitudes and Pain Management Practice of Post-Operative Children in Bangladesh Prince of Songkla University Nedlastet fra httpkbpsuacthpsukbbitstream201078261325999pdf
7 Huth M M Gregg T L Lin L (2010) Education changes Mexican nurses knowledge and attitudes regarding pediatric pain Pain Manag Nurs Dec11(4)201-8 doi 101016jpmn200911001
8 Lewthwaite B J Jabusch K M Wheeler B J Schnell-Hoehn K N Mills J Estrella-Holder E Fedorowicz A (2011) Nurses knowledge and attitudes regarding pain management in hospitalized adults J Contin Educ Nurs 42(6) 251-7 doi 10392800220124-20110103-03 Epub 2011 Jan 10
9 Manworren RC (2000) Pediatric nursesrsquo knowledge and attitudes survey regarding pain Pediatr Nurs 26 610-614
10 Rieman M T Gordon M amp Marvin J M (2007) Pediatric nursesrsquo knowledge and attitudes survey regarding pain a competency tool modification Pediatr Nurs 33 303-306
11 Simons JM amp MacDonald LM (2004) Pain assessment tools childrenrsquos nursesrsquo views Journal of Child Health Care 8 264 Doi 1011771367493504047317
12 Twycross A (2007) What is the impact of theoretical knowledge on childrenrsquos nursesrsquo post-operative pain management practices an exploratory study Nurse Educ Today 27 697-707
13 Smart S (2005) POST-OPERATIVE PAIN MANAGEMENT KNOWLEDGE AND ATTITUDES OF PAEDIATRIC NURSES- A NEW ZEALAND REGIONAL VIEW Victoria University of Wellington [Online] Tilgjengelig paring httpresearcharchivevuwacnzbitstreamhandle1006338thesispdfsequence=2 [Lastet 13april 2014]
14 Vincent C V H (2005) Nursesrsquo knowledge attitudes and practices regarding childrenrsquos pain MCN Am J Matern Child Nurs 30 177-183
15 Olsson G Jylli L (2001) Smaumlrta hos barn och ungdomar Lund Sverige Studentlitteratur
16 Peters J W Schouw R Anand K J van Dijk M Duivenvoorden H J Tibboel D (2005) Does neonatal surgery lead to increased pain sensitivity in later childhood Pain 114(3) 444-54
17 Anand K J S Gracia-Preats J A amp Kim M S (2015) Assessment of neonatal pain UpToDate httpwwwuptodatecomcontentsassessment-of-neonatal-pain
18 Anand K J S Gracia-Preats J A amp Kim M S (2015) Prevention and treatment of neonatal pain UpToDate httpwwwuptodatecomcontentsprevention-and-treatment-of-neonatal-painsource=related_link
19 IASP (2011a) Acute Pain and Surgery Global Year Against Acute Pain [Online] Tilgjengelig paring httpwwwiasp-painorgfilesContentContentFoldersGlobalYearAgainstPain2AcutePainFactSheets7-Surgerypdf [Lastet 14april 2014]
20 Howard R Carter B Curry J Jain A Liossi C Morton N Rivett K Rose M Tyrrell J Walker S Williams G (2012) Good Practice in Postoperative and Procedural pain management 2nd Edition Pediatric Anesthesia 22 1ndash79 doi 101111j1460-9592201203838x
21 IASP (2011b) Interventions Benefits and Barriers Global Year Against Acute Pain [Online] Tilgjengelig paring httpwwwiasp-painorgfilesContentContentFoldersGlobalYearAgainstPain2AcutePainFactSheets2-Interventionspdf [Lastet 14april 2014]
22 Benhamou D Berti M Brodner G De Andres J Draisci G Moreno-Azcoita M Neugebauer EA Schwenk W Torres LM Viel E (2007) Postoperative Analgesic THerapy Observational Survey (PATHOS) A practice pattern study in 7 CentralSouthern Eurpean countries Pain 136 134-141
23 Reinertsen H (2008) Smerte hos barn kap3I Rustoslashen T amp Wahl AK (red) Ulike tekster om smerte - fra nocisepsjon til livskvalitet Oslo Gyldendal Norsk Forlag AS
Litteraturliste 24 Smeland A amp Reinertsen H (2012) Smertevurdering og behandling av postoperative smerter hos barn Tidsskriftet Kirurgen 1 58-62 (5 s) [Online] Tilgjengelig paring
httpwwwkirurgennopdf1201 [Lastet 13april 2014]
25 Bringuier S Picot MC Dadure C et al (2009) A prospective comparison of post-surgical behavioral pain scales in preschoolers highlighting the risk of false evaluations Pain 145 60-68
26 Crelline D Sullivan T B Babl F E OSullivan R Hutchinson A (2007) Analysis of the validation of existing behavioral pain and distress scales for use in the procedural setting Pediatric Anesthesia 17 720-733
27 Ghai B Makkar JK amp Wig J (2008) Postoperative pain assessment in preverbal children and children with cognitive impairment Pediatric Anesthesia 18 462-477
28 Hicks CL von Baeyer CL Spafford P et al (2001) The Faces Pain Scale-Revised Toward a common metric in pain measurement Pain 93 173-183
29 Merkel SI Voepel-Lewis T amp Shayevitz et al (1997) The FLACC A Behavioral Scale for Scoring Postoperative Pain in Young Children Pediatric Nursing 23 293-7
30 Ellis J A McCleary L Blouin R Dube K Rowley B MacNeil M amp Cooke C (2007) Implementing best practice pain management in a pediatric hospital Journal for Specialists in Pediatric Nursing 12 264-277 doi101111j1744-6155200700121x
31 Johnston C C Gagnon A Rennick J Rosmus C Patenaude H Ellis J Shapiro C Filion F Ritchie J Byron J (2007) One-on-one coaching to improve pain assessment and management practices of pediatric nurses Journal of Pediatric Nursing 22 467-478 doi101016jpedn200707004
32 Le May S Johnston C C Choiniegravere M Fortin C Kudirka D Murray L Chalut D (2009) Pain Management Practices in a Pediatric Emergency Room (PAMPER) Study interventions with nurses Pediatr Emerg Care Aug25(8)498-503 doi 101097PEC0b013e3181b0a0af
33 Vincent C V H Wilkie D J amp Wang E (2011) Pediatric Nurses Beliefs and Pain Management Practices An Intervention Pilot West J Nurs Res 33 825 originally published online 20 December 2010
36 Twycross A Finley G A and Latimer M (2013) Pediatric nurses postoperative pain management practices An observational study Journal for Specialists in Pediatric Nursing 18 189ndash201 doi 101111jspn12026
42 Twycross A amp Finley G A (2013) Childrens and parents perceptions of postoperative pain management a mixed methods study Journal of Clinical Nursing 22(21-22) 3095-3108 doi 101111jocn12152 [Online] Tilgjengelig paring httponlinelibrarywileycomdoi101111jocn12152pdf (13042014)
43 Polkki T Pietila AM Vehvilainen-Julkunen K (2003) Hospitalized childrens descriptions of their experiences with postsurgical pain relieving methods Int J Nurs Stud Jan40(1)33-44 PubMed PMID 12550148 English
46 Abdalrahim MS Majali SA Stomberg MW Bergbom I (2011) The effect of postoperative pain management program on improving nurses knowledge and attitudes toward pain Nurse Educ Pract 2011 Jul11(4)250-5 doi 101016jnepr201011016 Epub 2010 Dec 24 httpwwwncbinlmnihgovpubmed21186139
47 IASP Pain definition IASP (International Association of the Study of Pain) Pain definition
48 Norsk Ledemiddelharingndbok Ulike smertetilstander [Online] Tilgjengelig paring httplegemiddelhandbokanoTerapi22816expand=1
49 Astrid Lindgrens Barnsjukhus ndash Riktlinjer foumlr smaumlrtbehandling
50 Groslashnseth R amp Markestad T (2011) Pediatri og pediatrisk sykepleie Bergen Fagbokforlaget Vigmostad amp Bjoslashrke AS httppediatriportfoliono
51 Hicks CL von Baeyer CL Spafford Pet al The Faces Pain Scale‐Revised Toward a common metric in pain measurement Pain 2001 93173‐183
52 Twycross A Why Managing Pain in Children Matters in Managing Pain in Children A Clinical Guide (eds A Twycross S J Dowden and E Bruce) Wiley‐Blackwell 2009 Oxford UK doi 1010029781444322743ch1
53 Von Bayer CL amp Spagrud LJ Systematic review of observational (behavioral) measures of pain for children and adolescents aged 3 to 18 years Pain 2007 127 140‐150
54 Voepel‐Lewis Terri RN MSN ZanottiJennifer RN MS CCRN CEN DammeyerJennifer A RN MSN and MerkelSandra RN MS (January 2010) Reliability and Validity of the Face Legs Activity Cry Consolability Behavioral Tool in Assessing Acute Pain in Critically Ill Patients American Journal of Critical Care 19 (1) 55ndash61
55 Merkel S Voepel‐Lewis T Shayevitz JR et al The FLACC A behavioural scale for scoring postoperative pain in young children Pediatric nursing 1997 23293‐797
56 McCaffery M amp Beebe F (1994) Pain‐Clinical Manual of for Nursing Practice Times Mirror International Publishers Ltd Norsk oversettelse Smerter Laeligrebok for helsepersonell Oslo Norge Gyldendal Norsk Forlag AS
57 Reinertsen H Christophersen K‐A Helseth S Vurdering av postoperativ smerte hos barn (0‐5 aringr) Validering og reliabilitetstesting av smertevurderingsverktoslashyet FLACC Sykepleien Forskning 2014 9 132‐140 httpwwwsykepleiennoforskningforskningsartikkel1466655validering‐og‐reliabilitetstesting‐av‐smertevurderingsverktoyet‐flacc
Litteraturliste 58 Stinson J (2009) Pain Assessment I Twycross A Dowden S J amp Bruce E Pain Assessment in Managing Pain in Children A Clinical Guide Oxford UK Wiley-Blackmell
59 Tomlinson D von Baeyer CL Stinson JN Sung L A systematic review of faces scales for the self‐report of pain intensity in children Pediatrics 2010 Nov126(5)e1168‐98 PubMed PMID 20921070 Epub 20101006 eng
60 Von Baeyer CL Childrens self‐reports of pain intensity scale selection limitations and interpretation Pain Res Manag 2006 Autumn11(3)157‐62 PubMed PMID 16960632 Pubmed Central PMCID PMC2539005 Epub 20060909 eng
61 Ghai B Makkar J K amp Wig J (2008) Postoperative pain assesment in preverbal children and children with cognitive impairment Pediatric Anesthesia 18 462‐477
62 Malvia S Voepel‐Lewis T Tait A R Merkel S Lauer A Munro H Farley F (2001) Pain management in children with and without cognitive impairment following spine fusion surgery Pediatric Anasthesia 11 453‐458
63 Malvia S Voepel‐Lewis T Burke C Merkel S amp Tait A R (2006) The revised FLACC observational pain tool improved reliability and validity for pain assesment in children with cognitive impairment Pediatric Anestesia 16 258‐265
64 McJunkins A Green A amp Anand KJS (2010) Pain Assesment in cognitively Impared Functionally Impared Children Pilot Study Results Journal of Pediatric Nursing 25 307‐309
65 McKearnan K A Kieckhefer G Engel J M Jensen M amp Labyak S (2004) Pain in Children with cerebral Palsy A Review Journal of Neuroscience Nursing Vol 36 no 5 s252‐259
66 Voepel‐Lewis T Malviya S Tait A Merkel S Forter R amp Krane E (2008) A comparison of the clinical utility of pain assesment tools for children with cognitive impairment Pediatric Anesthesiology 106 (1) 72‐78
67 Baulch I Assessment and management of pain in the paediatric patient Nursing standard 2010 2510 35-40
68 Twycross A Why Managing Pain in Children Matters in Managing Pain in Children A Clinical Guide (eds A Twycross S J Dowden and E Bruce) Wiley-Blackwell 2009 Oxford UK doi 1010029781444322743ch1
69 Schug SA amp Pogatzki-Zhan EM Chronic Pain after Surgery or Injury Pain 2011 Clinical Updates XIX 11-5
70 Fredheim OMS Borchgrevink PC amp Kvarstein G Behandling av postoperativ smerte i sykehus Tidsskr Nor Legeforen 2011 131 1772-6
71 Steward DL Welge J amp Myer C Steroids for improving recovery following tonsillectomy in children Cochrane Database of Systematic Reviews 2003 Issue 1Art NoCD003997 DOI10100214651858CD003997
72 Hong JY Han SW Kim WO et al Effect of dexamethasone in combination with caudal analgesia on postoperative pain control in day-case paediatric orchioplexy British Journal of Anesthesia 2010 105(4)506-10
73 Den Norske Legeforening (2009) Retningslinjer for smertelindring [Online] URL httpwww legeforeningennoasset42585142585_1pdf
74 Association of Paediatric Anaesthetists (2008) Good Practice in Postoperative and Procedural Pain [Online] URL httpwwwbritishpainsocietyorgbook_apa_part1pdf
75 European Society of Regional Aneasthesia (2005) Postoperative Pain Management ndash Good Clinical Practice General recommendations and principles for successful pain management [Online] URL httpwwwesraeuropeorgPostoperativePainManagementpdf
76 Monsen ALB Skadberg BT amp Groslashnlie I Smertebehandling Norsk Barnelegeforeningen 2011 [Online] URL httpwwwlegeforeningennoid1104250
77 Smeland A amp Reinertsen H (2012) Smertevurdering og behandling av postoperative smerter hos barn Tidsskriftet Kirurgen 1 58-62 (5 s) [Online] Tilgjengelig paring httpwwwkirurgennopdf1201
78 Standing JF Savage I Pritchard D et al Diclofenac for acute pain in children Cochrane Database of Systematic Reviews 2009 Issue 4 Art No CD005538 DOI 10100214651858CD005538pub2
79 Standing JF Tibboel D Korpela R et al Diclofenac pharmacokinetic meta-analysis and dose recommendations for surgical pain in children aged 1ndash12 years Pediatric Anesthesia 2011 21 316ndash324 doi 101111j1460-9592201003509x
80 Riad W amp Moussa A Pre-operative analgesia with rectal diclofenac andor paracetamol in children undergoing hernia repair Anaesthesia 2007 Dec62(12)1241-5
81 Hiller A Meretoja OA Korpela R et al The Anagesic Efficacy of Acetaminophen Ketoprofen or Their Combination for Pediatric Surgical Patients Having Soft Tissue or Orthopedic Procedures Anesth Analg 20061021365-71
82 Norsk legemiddelharingndbok Antidoter ndash alfabetisk oversikt bruksomraringde og dosering httplegemiddelhandbokanoGenerelle153557i153779
83 Norsk legemiddelharingndbok Barn og legemidler httplegemiddelhandbokanoGenerelle153109
84 SickKids Aboutkidshealthca Myths About Pain httpwwwaboutkidshealthcaEnResourceCentresPainPainAssessmentPagesMyths-About-Painaspx
85 Psykososial preoperativ forberedelse av barn 0ndash18 aringr httpwwwhelsebiblioteketnomicrositefagprosedyrerfagprosedyrerpsykososial-preoperativ-forberedelse-av-barn-018-C3A5r
86 Twycross A Why Managing Pain in Children Matters in Managing Pain in Children A Clinical Guide (eds ATwycross S J Dowden and E Bruce) Wiley‐Blackwell 2009 Oxford UK doi 1010029781444322743ch1
Litteraturliste 24 Smeland A amp Reinertsen H (2012) Smertevurdering og behandling av postoperative smerter hos barn Tidsskriftet Kirurgen 1 58-62 (5 s) [Online] Tilgjengelig paring
httpwwwkirurgennopdf1201 [Lastet 13april 2014]
25 Bringuier S Picot MC Dadure C et al (2009) A prospective comparison of post-surgical behavioral pain scales in preschoolers highlighting the risk of false evaluations Pain 145 60-68
26 Crelline D Sullivan T B Babl F E OSullivan R Hutchinson A (2007) Analysis of the validation of existing behavioral pain and distress scales for use in the procedural setting Pediatric Anesthesia 17 720-733
27 Ghai B Makkar JK amp Wig J (2008) Postoperative pain assessment in preverbal children and children with cognitive impairment Pediatric Anesthesia 18 462-477
28 Hicks CL von Baeyer CL Spafford P et al (2001) The Faces Pain Scale-Revised Toward a common metric in pain measurement Pain 93 173-183
29 Merkel SI Voepel-Lewis T amp Shayevitz et al (1997) The FLACC A Behavioral Scale for Scoring Postoperative Pain in Young Children Pediatric Nursing 23 293-7
30 Ellis J A McCleary L Blouin R Dube K Rowley B MacNeil M amp Cooke C (2007) Implementing best practice pain management in a pediatric hospital Journal for Specialists in Pediatric Nursing 12 264-277 doi101111j1744-6155200700121x
31 Johnston C C Gagnon A Rennick J Rosmus C Patenaude H Ellis J Shapiro C Filion F Ritchie J Byron J (2007) One-on-one coaching to improve pain assessment and management practices of pediatric nurses Journal of Pediatric Nursing 22 467-478 doi101016jpedn200707004
32 Le May S Johnston C C Choiniegravere M Fortin C Kudirka D Murray L Chalut D (2009) Pain Management Practices in a Pediatric Emergency Room (PAMPER) Study interventions with nurses Pediatr Emerg Care Aug25(8)498-503 doi 101097PEC0b013e3181b0a0af
33 Vincent C V H Wilkie D J amp Wang E (2011) Pediatric Nurses Beliefs and Pain Management Practices An Intervention Pilot West J Nurs Res 33 825 originally published online 20 December 2010
36 Twycross A Finley G A and Latimer M (2013) Pediatric nurses postoperative pain management practices An observational study Journal for Specialists in Pediatric Nursing 18 189ndash201 doi 101111jspn12026
42 Twycross A amp Finley G A (2013) Childrens and parents perceptions of postoperative pain management a mixed methods study Journal of Clinical Nursing 22(21-22) 3095-3108 doi 101111jocn12152 [Online] Tilgjengelig paring httponlinelibrarywileycomdoi101111jocn12152pdf (13042014)
43 Polkki T Pietila AM Vehvilainen-Julkunen K (2003) Hospitalized childrens descriptions of their experiences with postsurgical pain relieving methods Int J Nurs Stud Jan40(1)33-44 PubMed PMID 12550148 English
46 Abdalrahim MS Majali SA Stomberg MW Bergbom I (2011) The effect of postoperative pain management program on improving nurses knowledge and attitudes toward pain Nurse Educ Pract 2011 Jul11(4)250-5 doi 101016jnepr201011016 Epub 2010 Dec 24 httpwwwncbinlmnihgovpubmed21186139
47 IASP Pain definition IASP (International Association of the Study of Pain) Pain definition
48 Norsk Ledemiddelharingndbok Ulike smertetilstander [Online] Tilgjengelig paring httplegemiddelhandbokanoTerapi22816expand=1
49 Astrid Lindgrens Barnsjukhus ndash Riktlinjer foumlr smaumlrtbehandling
50 Groslashnseth R amp Markestad T (2011) Pediatri og pediatrisk sykepleie Bergen Fagbokforlaget Vigmostad amp Bjoslashrke AS httppediatriportfoliono
51 Hicks CL von Baeyer CL Spafford Pet al The Faces Pain Scale‐Revised Toward a common metric in pain measurement Pain 2001 93173‐183
52 Twycross A Why Managing Pain in Children Matters in Managing Pain in Children A Clinical Guide (eds A Twycross S J Dowden and E Bruce) Wiley‐Blackwell 2009 Oxford UK doi 1010029781444322743ch1
53 Von Bayer CL amp Spagrud LJ Systematic review of observational (behavioral) measures of pain for children and adolescents aged 3 to 18 years Pain 2007 127 140‐150
54 Voepel‐Lewis Terri RN MSN ZanottiJennifer RN MS CCRN CEN DammeyerJennifer A RN MSN and MerkelSandra RN MS (January 2010) Reliability and Validity of the Face Legs Activity Cry Consolability Behavioral Tool in Assessing Acute Pain in Critically Ill Patients American Journal of Critical Care 19 (1) 55ndash61
55 Merkel S Voepel‐Lewis T Shayevitz JR et al The FLACC A behavioural scale for scoring postoperative pain in young children Pediatric nursing 1997 23293‐797
56 McCaffery M amp Beebe F (1994) Pain‐Clinical Manual of for Nursing Practice Times Mirror International Publishers Ltd Norsk oversettelse Smerter Laeligrebok for helsepersonell Oslo Norge Gyldendal Norsk Forlag AS
57 Reinertsen H Christophersen K‐A Helseth S Vurdering av postoperativ smerte hos barn (0‐5 aringr) Validering og reliabilitetstesting av smertevurderingsverktoslashyet FLACC Sykepleien Forskning 2014 9 132‐140 httpwwwsykepleiennoforskningforskningsartikkel1466655validering‐og‐reliabilitetstesting‐av‐smertevurderingsverktoyet‐flacc
Litteraturliste 58 Stinson J (2009) Pain Assessment I Twycross A Dowden S J amp Bruce E Pain Assessment in Managing Pain in Children A Clinical Guide Oxford UK Wiley-Blackmell
59 Tomlinson D von Baeyer CL Stinson JN Sung L A systematic review of faces scales for the self‐report of pain intensity in children Pediatrics 2010 Nov126(5)e1168‐98 PubMed PMID 20921070 Epub 20101006 eng
60 Von Baeyer CL Childrens self‐reports of pain intensity scale selection limitations and interpretation Pain Res Manag 2006 Autumn11(3)157‐62 PubMed PMID 16960632 Pubmed Central PMCID PMC2539005 Epub 20060909 eng
61 Ghai B Makkar J K amp Wig J (2008) Postoperative pain assesment in preverbal children and children with cognitive impairment Pediatric Anesthesia 18 462‐477
62 Malvia S Voepel‐Lewis T Tait A R Merkel S Lauer A Munro H Farley F (2001) Pain management in children with and without cognitive impairment following spine fusion surgery Pediatric Anasthesia 11 453‐458
63 Malvia S Voepel‐Lewis T Burke C Merkel S amp Tait A R (2006) The revised FLACC observational pain tool improved reliability and validity for pain assesment in children with cognitive impairment Pediatric Anestesia 16 258‐265
64 McJunkins A Green A amp Anand KJS (2010) Pain Assesment in cognitively Impared Functionally Impared Children Pilot Study Results Journal of Pediatric Nursing 25 307‐309
65 McKearnan K A Kieckhefer G Engel J M Jensen M amp Labyak S (2004) Pain in Children with cerebral Palsy A Review Journal of Neuroscience Nursing Vol 36 no 5 s252‐259
66 Voepel‐Lewis T Malviya S Tait A Merkel S Forter R amp Krane E (2008) A comparison of the clinical utility of pain assesment tools for children with cognitive impairment Pediatric Anesthesiology 106 (1) 72‐78
67 Baulch I Assessment and management of pain in the paediatric patient Nursing standard 2010 2510 35-40
68 Twycross A Why Managing Pain in Children Matters in Managing Pain in Children A Clinical Guide (eds A Twycross S J Dowden and E Bruce) Wiley-Blackwell 2009 Oxford UK doi 1010029781444322743ch1
69 Schug SA amp Pogatzki-Zhan EM Chronic Pain after Surgery or Injury Pain 2011 Clinical Updates XIX 11-5
70 Fredheim OMS Borchgrevink PC amp Kvarstein G Behandling av postoperativ smerte i sykehus Tidsskr Nor Legeforen 2011 131 1772-6
71 Steward DL Welge J amp Myer C Steroids for improving recovery following tonsillectomy in children Cochrane Database of Systematic Reviews 2003 Issue 1Art NoCD003997 DOI10100214651858CD003997
72 Hong JY Han SW Kim WO et al Effect of dexamethasone in combination with caudal analgesia on postoperative pain control in day-case paediatric orchioplexy British Journal of Anesthesia 2010 105(4)506-10
73 Den Norske Legeforening (2009) Retningslinjer for smertelindring [Online] URL httpwww legeforeningennoasset42585142585_1pdf
74 Association of Paediatric Anaesthetists (2008) Good Practice in Postoperative and Procedural Pain [Online] URL httpwwwbritishpainsocietyorgbook_apa_part1pdf
75 European Society of Regional Aneasthesia (2005) Postoperative Pain Management ndash Good Clinical Practice General recommendations and principles for successful pain management [Online] URL httpwwwesraeuropeorgPostoperativePainManagementpdf
76 Monsen ALB Skadberg BT amp Groslashnlie I Smertebehandling Norsk Barnelegeforeningen 2011 [Online] URL httpwwwlegeforeningennoid1104250
77 Smeland A amp Reinertsen H (2012) Smertevurdering og behandling av postoperative smerter hos barn Tidsskriftet Kirurgen 1 58-62 (5 s) [Online] Tilgjengelig paring httpwwwkirurgennopdf1201
78 Standing JF Savage I Pritchard D et al Diclofenac for acute pain in children Cochrane Database of Systematic Reviews 2009 Issue 4 Art No CD005538 DOI 10100214651858CD005538pub2
79 Standing JF Tibboel D Korpela R et al Diclofenac pharmacokinetic meta-analysis and dose recommendations for surgical pain in children aged 1ndash12 years Pediatric Anesthesia 2011 21 316ndash324 doi 101111j1460-9592201003509x
80 Riad W amp Moussa A Pre-operative analgesia with rectal diclofenac andor paracetamol in children undergoing hernia repair Anaesthesia 2007 Dec62(12)1241-5
81 Hiller A Meretoja OA Korpela R et al The Anagesic Efficacy of Acetaminophen Ketoprofen or Their Combination for Pediatric Surgical Patients Having Soft Tissue or Orthopedic Procedures Anesth Analg 20061021365-71
82 Norsk legemiddelharingndbok Antidoter ndash alfabetisk oversikt bruksomraringde og dosering httplegemiddelhandbokanoGenerelle153557i153779
83 Norsk legemiddelharingndbok Barn og legemidler httplegemiddelhandbokanoGenerelle153109
84 SickKids Aboutkidshealthca Myths About Pain httpwwwaboutkidshealthcaEnResourceCentresPainPainAssessmentPagesMyths-About-Painaspx
85 Psykososial preoperativ forberedelse av barn 0ndash18 aringr httpwwwhelsebiblioteketnomicrositefagprosedyrerfagprosedyrerpsykososial-preoperativ-forberedelse-av-barn-018-C3A5r
86 Twycross A Why Managing Pain in Children Matters in Managing Pain in Children A Clinical Guide (eds ATwycross S J Dowden and E Bruce) Wiley‐Blackwell 2009 Oxford UK doi 1010029781444322743ch1
Litteraturliste 58 Stinson J (2009) Pain Assessment I Twycross A Dowden S J amp Bruce E Pain Assessment in Managing Pain in Children A Clinical Guide Oxford UK Wiley-Blackmell
59 Tomlinson D von Baeyer CL Stinson JN Sung L A systematic review of faces scales for the self‐report of pain intensity in children Pediatrics 2010 Nov126(5)e1168‐98 PubMed PMID 20921070 Epub 20101006 eng
60 Von Baeyer CL Childrens self‐reports of pain intensity scale selection limitations and interpretation Pain Res Manag 2006 Autumn11(3)157‐62 PubMed PMID 16960632 Pubmed Central PMCID PMC2539005 Epub 20060909 eng
61 Ghai B Makkar J K amp Wig J (2008) Postoperative pain assesment in preverbal children and children with cognitive impairment Pediatric Anesthesia 18 462‐477
62 Malvia S Voepel‐Lewis T Tait A R Merkel S Lauer A Munro H Farley F (2001) Pain management in children with and without cognitive impairment following spine fusion surgery Pediatric Anasthesia 11 453‐458
63 Malvia S Voepel‐Lewis T Burke C Merkel S amp Tait A R (2006) The revised FLACC observational pain tool improved reliability and validity for pain assesment in children with cognitive impairment Pediatric Anestesia 16 258‐265
64 McJunkins A Green A amp Anand KJS (2010) Pain Assesment in cognitively Impared Functionally Impared Children Pilot Study Results Journal of Pediatric Nursing 25 307‐309
65 McKearnan K A Kieckhefer G Engel J M Jensen M amp Labyak S (2004) Pain in Children with cerebral Palsy A Review Journal of Neuroscience Nursing Vol 36 no 5 s252‐259
66 Voepel‐Lewis T Malviya S Tait A Merkel S Forter R amp Krane E (2008) A comparison of the clinical utility of pain assesment tools for children with cognitive impairment Pediatric Anesthesiology 106 (1) 72‐78
67 Baulch I Assessment and management of pain in the paediatric patient Nursing standard 2010 2510 35-40
68 Twycross A Why Managing Pain in Children Matters in Managing Pain in Children A Clinical Guide (eds A Twycross S J Dowden and E Bruce) Wiley-Blackwell 2009 Oxford UK doi 1010029781444322743ch1
69 Schug SA amp Pogatzki-Zhan EM Chronic Pain after Surgery or Injury Pain 2011 Clinical Updates XIX 11-5
70 Fredheim OMS Borchgrevink PC amp Kvarstein G Behandling av postoperativ smerte i sykehus Tidsskr Nor Legeforen 2011 131 1772-6
71 Steward DL Welge J amp Myer C Steroids for improving recovery following tonsillectomy in children Cochrane Database of Systematic Reviews 2003 Issue 1Art NoCD003997 DOI10100214651858CD003997
72 Hong JY Han SW Kim WO et al Effect of dexamethasone in combination with caudal analgesia on postoperative pain control in day-case paediatric orchioplexy British Journal of Anesthesia 2010 105(4)506-10
73 Den Norske Legeforening (2009) Retningslinjer for smertelindring [Online] URL httpwww legeforeningennoasset42585142585_1pdf
74 Association of Paediatric Anaesthetists (2008) Good Practice in Postoperative and Procedural Pain [Online] URL httpwwwbritishpainsocietyorgbook_apa_part1pdf
75 European Society of Regional Aneasthesia (2005) Postoperative Pain Management ndash Good Clinical Practice General recommendations and principles for successful pain management [Online] URL httpwwwesraeuropeorgPostoperativePainManagementpdf
76 Monsen ALB Skadberg BT amp Groslashnlie I Smertebehandling Norsk Barnelegeforeningen 2011 [Online] URL httpwwwlegeforeningennoid1104250
77 Smeland A amp Reinertsen H (2012) Smertevurdering og behandling av postoperative smerter hos barn Tidsskriftet Kirurgen 1 58-62 (5 s) [Online] Tilgjengelig paring httpwwwkirurgennopdf1201
78 Standing JF Savage I Pritchard D et al Diclofenac for acute pain in children Cochrane Database of Systematic Reviews 2009 Issue 4 Art No CD005538 DOI 10100214651858CD005538pub2
79 Standing JF Tibboel D Korpela R et al Diclofenac pharmacokinetic meta-analysis and dose recommendations for surgical pain in children aged 1ndash12 years Pediatric Anesthesia 2011 21 316ndash324 doi 101111j1460-9592201003509x
80 Riad W amp Moussa A Pre-operative analgesia with rectal diclofenac andor paracetamol in children undergoing hernia repair Anaesthesia 2007 Dec62(12)1241-5
81 Hiller A Meretoja OA Korpela R et al The Anagesic Efficacy of Acetaminophen Ketoprofen or Their Combination for Pediatric Surgical Patients Having Soft Tissue or Orthopedic Procedures Anesth Analg 20061021365-71
82 Norsk legemiddelharingndbok Antidoter ndash alfabetisk oversikt bruksomraringde og dosering httplegemiddelhandbokanoGenerelle153557i153779
83 Norsk legemiddelharingndbok Barn og legemidler httplegemiddelhandbokanoGenerelle153109
84 SickKids Aboutkidshealthca Myths About Pain httpwwwaboutkidshealthcaEnResourceCentresPainPainAssessmentPagesMyths-About-Painaspx
85 Psykososial preoperativ forberedelse av barn 0ndash18 aringr httpwwwhelsebiblioteketnomicrositefagprosedyrerfagprosedyrerpsykososial-preoperativ-forberedelse-av-barn-018-C3A5r
86 Twycross A Why Managing Pain in Children Matters in Managing Pain in Children A Clinical Guide (eds ATwycross S J Dowden and E Bruce) Wiley‐Blackwell 2009 Oxford UK doi 1010029781444322743ch1
