OBJECTIVES: To describe how nurses assess and manage pain in critically ill children. DESIGN: Descriptive, comparative research design, with use of the Indicators of Pain in Critically Ill Children assessment tool. SETTING: Twelve-bed pediatric intensive care unit in a metropolitan general hospital with a level II pediatric trauma center. PARTICIPANTS: Twenty-four pediatric intensive care unit nurses who conducted 112 assessments of 25 critically ill children. RESULTS: Pain indicators selected most frequently by nurses included cardiovascular and respiratory changes (increased heart rate, respiratory rate, and blood pressure), followed by behavioral indicators (irritable/fussy, verbalizing pain, crying), and neuromuscular responses (tenseness/rigidity, squirming, drawing up legs). The average number of pain indicators selected during each medication event was 5.3. More indicators were selected for trauma, surgery, and younger patients; fewer indicators were selected for patients receiving ventilation treatment. CONCLUSION: Pain assessment of critically ill children includes unique indicators, as compared to less sick children, and must take into account the child's decreased ability to communicate pain.
