‘It’s Not Easy’: School Nurse Pain Assessment Practices for Students with Special Needs

Brenna L. Quinn PhD, RN, NCSN

Assistant Professor, Susan & Alan Solomont School of Nursing, Email: Brenna_Quinn@uml.edu

Abstract

Assessing pain in children with special needs presents unique challenges for school nurses, as no evidence-based or clinical standards to guide practices have been established for use in the school setting. Additionally, school nurse staffing has not kept pace with the growth in the population of children with special needs, which has increased by 60% since 2002. The aim of this study was to explore school nurses’ pain assessment practices for students with special needs. A cross-sectional study was conducted via the web. Participants/Subjects: Of 3,071 special needs school nurses invited, 27% participated (n = 825). STATA13 was used to analyze descriptive statistics, while content analysis was performed in NVIVO 10. The majority of participants assessed pain in students with special needs using objective assessments (97.34%) and consultations with teachers (91.09%) and parents (88.64%). School nurses utilize pain assessment methods used previously in other practice areas, and rated pain assessment practices at the low benchmark of adequate. Overall, school nurses assess pain by selecting approaches that are best matched to the abilities of the student with special needs. When assessing students with special needs, nurses should utilize objective clinical assessments, teacher consultations, and parent input scales. In addition to continuing education, policies facilitating lower nurse-to-student ratios are needed to improve pain assessment practices in the school setting. Research to understand the perspectives of nurses, teachers, parents, and students is needed to support the creation of evidence-based policies and procedures.

PMID: 27105572; DOI:10.1016/j.pmn.2016.01.005

Pain and pain assessment in people with ID

Pain and pain assessment in people with intellectual disability: Issues and challenges in practice

Source: Pain and pain assessment in people with intellectual disability: Issues and challenges in practice – Doody – 2017 – British Journal of Learning Disabilities – Wiley Online Library

Accessible summary

  • Pain is difficult to identify when people cannot communicate.
  • If pain is not identified, it cannot be managed and causes stress.
  • Pain assessment is essential in order to identify pain.
  • Pain assessment requires a combination of knowledge, health assessments and observations.

Abstract

Background

Individuals with intellectual disability experience the same chronic diseases and conditions as the general population, but are more likely to have physical and psychological co-morbidities, resulting in a higher risk of experiencing pain and having more frequent or severe pain.

Method

This position paper aims to highlight the importance of pain assessment for people with intellectual disability.

Results

As people with intellectual disability live within the community and/or remain in the family home, they are accessing a wide range of healthcare services. This necessitates that nurses across all care settings are knowledgeable regarding appropriate/alternative pain assessment methods for people with intellectual disability. While many pain assessment tools are available for use with the intellectual disability population, they are often not well established or infrequently used to establish their validity.

Conclusion

Although self-report is the gold standard in pain assessment, pain assessment for people with intellectual disability is often challenging as they may be unable to self-report their pain due to their levels of communication or cognitive ability. Assessment requires a combination of approaches amalgamating: pain assessment, health assessment and observation of behaviours.