1. Summary / Background

 The growth of the nursing field in the past several decades has seen many students following their educational dream of working with physicians, patients and medical staff. However, their realization of how the field is difficult is not so advertised as the satisfaction and rewards facets from medical care and especially the patients (Fisher, 2016). However, by understanding the emotional and physical stress which comes with the practice of nursing, is imperative to those that are in the field so as to combat the build-up factors which may cause the nurse burnout phenomenon that incites what is mostly termed as the impairment in nursing abilities especially when dealing with the management of pain in children (Berkowitz, 2016).  There are many incidences of nurse burnout which is in fact, an impairment both to the nurse and those working with the impaired nurse as it will have an overall negative impact on the entirety of the nurse practices in the pain management of children or any other surrounding environment which they are required to work under. 

Nurse burnout is the long term response to any type of physical, interpersonal, chronic and emotional stress on the job. Mostly there are three specific dimensions that are looked at in pain management of children which includes depersonalization, reduced personal accomplishment and emotional exhaustion (Anon, 2015).   The first one is a suggestion of the cynical attitude, or the negative feelings towards child patients or other recipients of care. The reduction of individual accomplishment which looks at negatively evaluating individual’s work and the emotional exhaustion that comes with it which can also be termed as  the feeling one gets of being emotionally drained because of the continued contact with the child patient and other care providers or caregivers.

1.2. Significance of the Problem

Nurse burnout is often considered as an occupational hazard, the problem has continued to increase in nurses because of the rising cost of healthcare, the increased use of technology in provision of care and due to the increased amount of regulation for the patient care. In this manner, some changes and the increases form a part of the causation for the stress within the field of the nursing especially those that deal with children who are not able to express themselves as adults.  The field thus attracts a lot of interest in studying where most experts now suggest that one of five nurse working with children will suffer burnout within the first year of their work, the challenge is even higher for those nurses that work in a paediatric ward setting.

Looking at the suggestion from those who have worked in the field of nursing discussing at where the child environment is among the main factors and causes for burnout on the nurse as well. In order to continue determining the preventative and intervention methods that can be used to end nurse burnout during pain management of children (Pantrini, 2016). Experts have in this line considered the type of environment that cause the most stress for the nurses. This is because nurses need to cover different shifts, they are also more prone to the issue of burnout due to the lack of enough staffing for nurses working in the paediatric wards that has also led to a longer need for the coverage shift to take care of the shortages.     

1.3 Current Practices related to Nurses Burnout and management of Pain

For nurses to be able to combat burnout during management of pain among paediatrics, there are many educational avenues like universities and colleges which the nurse will undertake a course to prepare them on methods that the can use in recognition, prevention and treatment of burnout symptoms well before the issue has become very serious or one that will affect the way they treat and care for children in a paediatric setting. For one to do so, there are several diverse methods of education which is continually introduced  like have educators work with the healthcare facility to  continue on the said educational endeavour for those nurses that are already working  in the pain management department (Rushton, Batcheller, Schroeder, & Donohue, 2015). Various healthcare facilities will also provide and expect to ensure that there is a continued education for the mental health and wellbeing of the nurse in charge of children even as they continue to advance in their careers and continue to work well beyond after graduation and their college years.

The preventative and intervention measures that are used for burnout among nurses working with children has at times failed because of lack of support from leaders in the nursing industry. The intervention and prevention of programs to deal with the nurse burnout, however has continued to show some positive results for the nursing industry which in the end leads reduced time in pain management and a decrease in chronic stress and mental health issues related with caring for paediatrics. There are several different strategies use for intervention which are inclusive to education classes on the reduction of stress that also provides for self-care techniques which are application to the children care environment in which the nurse is working under (Rushton, Batcheller, Schroeder, & Donohue, 2015). Various training sessions are also of great advantage since it will allow those nurses that have a build-up of the stressors to continue being on the watch for burnout. In most cases, the buddy and mentor programs may also provide for social support through the nursing staff members. The ability for the nurse to have engagement with the nurses between team members may also assist in enjoining the problem solving which will also help in mitigation of stress. Other mentoring programs are also good in offering support, providing value in nursing education and providing for an internal locus of control in relation to nursing administrations.  According to one evaluation done by Berkowitz, (2016) in a mentoring program where nursing students learned a particular pattern of behavior which was used in identifying some of the stressors and methods  of coping with the respective stressors through suggestion from their mentors.

From the study, it was discovered that since stress is a major factor when it comes to management of pain in children in may also lead to some common psychological stress in nurses, physical issues and behavioural problems, thus coping methods are better taught through examples. Such examples were also found to be accepted by new nursing staff in the practice when they have been instructed by the experienced nurse who has worked in the same field of pain management of patients or those that have undergone the burnout symptoms associated with pain management of children patients (Berkowitz, 2016). The nursing mentors that are offering provisional ways of solving the burnout problems when dealing with different forms of stress before it builds up to the burnout level in relation to the lessened propensity for the new nurse to show required symptoms of burnout even when they are later in their nursing work years.

1.4 How Burnout Affects the Organization and Patient’s Cultural Background

With the issue of burnout, the nurse working in the healthcare facility is supposed to ensure the provision of the best quality care as possible for all their patients no regardless of their cultural values, beliefs, preferences and health behaviors; especially when dealing with children since the intervention of parents and other caregivers will be paramount.  However, in the event that the nurse is suffering from burnout, the respective cultural of quality and safety of care for these patients will be lost. Such a case is going to also have an effect on the various diverse factors that will include the failure of care and management of pain for the child patient, harmful or dangerous care outcomes for the patient. In addition, the healthcare facility will also suffer with the poor disregard, CMS or JCO violation or even lead to closure of the facility (Edgoose, Regner, & Zakletskaia, 2015).  Some of the problems that come with the nurse burnout has also had an effect on the complexities related to healthcare systems, which is very vital to the recognition of those factors which will in essence affect the patient and nursing environment.

2.0 Literature Review

The literature for this project was conducted using the following database: Cumulative Index to Nursing and Allied Health Literature (CINHAL), Medline, ProQuest, Cochrane Library, HubMed, JSTOR, and Google Scholar which utilized the literature that was published within the past five years. The main areas of interest for this search included finding articles that are related to nursing burnout and the key words included: burnout, paediatric wards, pain management, quality care, hospitalized patients, curriculum, education, barriers and nursing practice environment.  After this the scholarly literature was reviewed and articles that discussed the long term care, Pediatric care, and burnout were selected. Some organisations which were also reviewed included International Association for the study of Pain and American Academy of Pain Management (Edgoose, Regner, & Zakletskaia, 2015). Other articles were also found and analysed and read to pick out the necessary content with were related to the assignment. The total number of articles viewed were about 20 with most of them being necessary on the literature review, cohort studies and single qualitative and descriptive studies.

As a way to narrow on the field of study, on the required articles were inclusive in randomizing the controlled trial which were selected with rest of eliminated. In this regard, there were about 17 articles found (Berkowitz, 2016). The final and deciding factor for the selection of articles was based in regard to positive results and outcomes that eliminated others. In this regard, the top five were also selected for this task.  In this regard, two research evidence based articles were considered and they included Abarghouei, Sorbi, Abarghouei, Bidaki, & Yazdanpoor, (2016) and Asefzadeh, Kalhor, & Tir, (2017). The former provided information that related to how longer shifts in the Pediatric wards were responsible to burnout in nurses. In this regard the authors also provide for a strong evidence from the study of three common healthcare facility identifiers which were used as a sample population of over 22,000 participants. However because of the fact that the study was cross sectional in nature, with a high number of limitations due to time that the study was dated, leading to more prevalent publications. Also the latter  provided for an exemplary study of on the effect of environment which provides for more propensity of the nursing care burnout with a cross section of survey that was conducted among nurses, patients and Pediatric healthcare facilities (Abarghouei, Sorbi, Abarghouei, Bidaki, & Yazdanpoor, 2016).  However the date was maintained at a five year limited as requirement of the current assignment.

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In addition, there were two no research articles that were considered, the articles were evidently sourced in which considered Berkowitz (2016) and Edgoose, Regner, & Zakletskaia, (2015). In respect to Berkowitz (2016) the researcher discussed more about the satisfaction of patients and their experience in the way nurses management their situation in the event of burnout.  The article was important as a resource which was mainly based on the opinion of the authors, with no important data used in establishment of any substantial evidence. In this manner, as it was part of disregard to this assignment, the latter article by Berkowitz, (2016)  was also put in consideration as the authors were able to present important suggestions on the reasons nurses working on pain management among Pediatrics suffered burnout from environment and personal factors. In addition, these findings were also only related to the single hospital in the local area of the people that were involved in pain management related burnout.

2.1 Pico Table

PICO Question

Given the condition of dealing with Pediatric patients on pain management, would ensuring a shift in nurse to patient ratios along with the evidence based staffing and the regular healthcare checks in addition to all the nursing staff due to a decrease incidence in nursing burnout?

3. Recommended Practice

In respect to the above evidence based study, it is shows that there is a lot of deficit in knowledge regarding pain management and nursing burnout. The study also shows that nurse can gain a lot from training and support regarding burnout and pain management as a foundation for nursing practice (Asefzadeh, Kalhor, & Tir, 2017). Even though this quality improvement project can help to raise knowledge, and successful implementation of what they known in to practice which depends on the nurse own choice in using the knowledge and other organisational factors that will neither inhibit or promote the use of this knowledge (Abarghouei, Sorbi, Abarghouei, Bidaki, & Yazdanpoor, 2016). In addition, there are other organisational factors that will influence  the use of acquired knowledge  which will also include deficit policy, systems of documentation  that incorporate or not incorporate the evidence based knowledge and order from the nurses bosses whether they are given or not. By providing the nurses with the avenue for reducing pain management will also deficit and translate the acquired knowledge into practice, this will have a positive impact in the way nurses work with Pediatrics in management of pain (Anon, 2015). By managing the patient’s pain will also improve the outcome in different ways one that also decreases the time they spend in hospital before they are taken out for home care. Training and support should also be part of the ongoing practice for nurse working with Pediatrics with acute pain. It needs to be part of orientation so that the knowledge is also increased before the nurse is actively involved with the children.

The other recommendation is to increase the ration between nurses and patients which will significantly decrease the burnout experienced by nurses in Pediatric wards for children with acute pain for a number of reasons.  One of the major reasons for the burnout involve the tasks entailed in caring for children which is more than that of adults. In most cases, the nurse will have to provide maximum care and observation for these children as they may not be able to do some minor tasks for themselves, which means they may be forced to overstay their shift. In addition, the nurse may develop a strong attachment with the child who may refused to be attended to by another nurse (Asefzadeh, Kalhor, & Tir, 2017). Even if the number of nurses is increased, managing pain among Pediatric patients is often more complex than that of the adults. It is important that the management of the hospital find ways of rotating nurses so as to reduce the amount of workload one nurse may undergo (Fisher, 2016). If this is not done, it is possible that the nurse will not be able to concentrate on their work leading to poor delivery.

4. Process for Implementing Change

To ensure implementation of this project, there will be a great need to involve three stakeholders who will be vital in the implementation of the said recommendation as professional associations, administration and the nurses in particular. The administrators are important in ensuring that they have improved the staffing in their respected department in hospitals so as to improve the amount of time spent by a nurse in caring for a patient with acute pain. Also the professional association should provide nurses with the advice, including physicians and administrators on the relevance implementing these changes in the Pediatric wards (Rushton, Batcheller, Schroeder, & Donohue, 2015).  Also it is important that nurses make themselves available for the regular assessment to ensure that they are in the best mind to are for Pediatrics with acute pain and whether they are unfit to carry out the duties involved.  One of the main obstacles which may be faced in the implementation of these activities is the lack of training support in hospital environment.

For a Pediatric hospital to ensure that there are an enough nurses to care and help in managing acute pain on children, it is important that these hospitals have enough financial capital to pay the nurses. There may also be the barrier of poor cooperation among the old school nurses who may resist change of administration in the nursing sector. Among the best strategies to overcome this barrier is to ensure that the federal government, Nursing boards and the state is involved in the improvement of nursing care. For example, the government can provide grants that train nurses on patient care and self-management, they can also ensure that public hospitals especially are facilitated with more nurses. In respect to changing the attitude of administrators, there needs to be a campaign which should be carried out in respect to educating them on the advantages of hiring more nurses and making sure that  the nursing staff works in a healthy environment (Nagykaldi et al., 2017). Among the best indicators in measuring outcome of the recommendation is through carrying out a survey on the quality care given to Pediatrics suffering from acute pain and how this is related to burnout.

Evidence Matrix

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