Journal of Korean Critical Care Nursing (중환자간호학회지)

Korean Society of Critical Care Nursing (한국중환자간호학회)
권호 표지

Pediatric Nurses' Knowledge and Attitude on Iatrogenic Narcotic Analgesic Withdrawal Symptoms Management

소아환자 마약성 진통제 금단증상관리에 대한 간호사의 지식과 태도

  • Received : 2018.08.27
  • Accepted : 2018.10.08
  • Published : 2018.10.31
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose : This study investigates pediatric nurses' knowledge and attitudes regarding iatrogenic narcotic analgesic withdrawal symptoms management (INAWSM). Methods : In this cross-sectional study, 253 pediatric nurses working at a tertiary hospital in Seoul participated. Instruments were the inventory consisting questionnaires on 35 items knowledge and 12 items attitude for INAWSM. Further, descriptive statistics, t-test, and analysis of variance were used to evaluate the nurses' knowledge and attitudes. Results : The correct answers rate of knowledge toward INAWSM was 44.9%. With respect to the pediatric nurses' attitudes, the participants scored an average value of $2.83{\pm}0.25$ out of 4 points. The factor related to the knowledge and attitude level was age, pediatric nursing experience, educational experience, and educational needs. Conclusions : Results revealed that pediatric nurses had inadequate knowledge and attitude on INAWSM despite a compulsory education. Therefore, it is necessary to develop an efficient INAWSM educational program.

Keywords

References

  1. Abdouni, R., Reyburn-Orne, T., Youssef, T. H., Haddad, I. Y., & Gerkin, R.D. (2016). Impact of a standardized treatment guideline for pediatric iatrogenic opioids dependence: A quality improvement initiative. The Journal of Pediatric Pharmacology and Therapeutics, 21 (1), 54-65. https://doi.org/10.5863/1551-6776-21.1.54
  2. Anand, K. J., Willson, D. F., Berger, J., Harrison, R., Meert, K. L., Zimmerman, J., & Nicholson, C. (2010). Tolerance and withdrawal from prolonged opioid use in critically ill children. Pediatrics, 125 (5), e1208-1225. https://doi.org/10.1542/peds.2009-0489
  3. Best, K. M., Boullata, J. I., & Curley, M. A. (2015). Risk factors associated with iatrogenic opioid and benzodiazepine withdrawal in critically ill pediatric patients: A systematic review and conceptual model. Pediatric Critical Care Medicine, 16 (2), 175-183. https://doi.org/10.1097/PCC.0000000000000306
  4. Best, K. M., Wypij, D., Asaro, L. A., & Curley, M. A. (2017). Patient, process, and system predictors of iatrogenic withdrawal syndrome in critically ill children. Critical Care Medicine, 45 (1), e7-e15. https://doi.org/10.1097/CCM.0000000000001953
  5. Birchley, G. (2009). Opioid and benzodiazepine withdrawal syndromes in the paediatric intensive care unit: A review of recent literature. Nursing in Critical Care, 14 (1), 26-37. https://doi.org/10.1111/j.1478-5153.2008.00311.x
  6. Dreyfus, L., Javouhey, E., Denis, A., Touzet, S., & Bordet, F. (2017). Implementation and evaluation of a paediatric nurse-driven sedation protocol in a paediatric intensive care unit. Annals of Intensive Care, 7 (1), 36. https://doi.org/10.1186/s13613-017-0256-7
  7. Franck, L. S., Harris, S. K., Soetenga, D. J., Amling, J. K., & Curley, M. A. (2008). The withdrawal assessment tool-1 (WAT-1): An assessment instrument for monitoring opioid and benzodiazepine withdrawal symptoms in pediatric patients. Pediatric Critical Care Medicine, 9 (6), 573-580. https://doi.org/10.1097/PCC.0b013e31818c8328
  8. Franck, L. S., Naughton, I., & Winter, I. (2004). Opioid and benzodiazepine withdrawal symptoms in paediatric intensive care patients. Intensive and Critical Care Nursing, 20 (6), 344-351. https://doi.org/10.1016/j.iccn.2004.07.008
  9. Franck, L. S., Vilardi, J., Durand, D., & Powers, R. (1998). Opioid withdrawal in neonates after continuous infusions of morphine or fentanyl during extracorporeal membrane oxygenation. American Journal of Critical Care, 7 (5), 364-369.
  10. Galinkin, J., & Koh, J. L. (2014). Recognition and management of iatrogenically induced opioid dependence and withdrawal in children. Pediatrics, 133 (1), 152-155. https://doi.org/10.1542/peds.2013-3398
  11. Harris, J., Ramelet, A. S., van Dijk, M., Pokorna, P., Wielenga, J., Tume, L., . . . Ista, E. (2016). Clinical recommendations for pain, sedation, withdrawal and delirium assessment in critically ill infants and children: An ESPNIC position statement for healthcare professionals. Intensive Care Medicine, 42 (6), 972-986. https://doi.org/10.1007/s00134-016-4344-1
  12. Hudak, M. L., & Tan, R. C. (2012). Neonatal drug withdrawal. Pediatrics, 129 (2), e540-560. https://doi.org/10.1542/peds.2011-3212
  13. Hwang, K. H., Ryoo, E. N., & Park, K. S. (2007). A Study of the nurses' knowledge and attitude about pain management. The Journal of Korean Academic Society of Nursing Education, 13 (1), 41-51.
  14. Ista, E., van Dijk, M., Gamel, C., Tibboel, D., & de Hoog, M. (2007). Withdrawal symptoms in children after long-term administration of sedatives and/or analgesics: A literature review. "Assessment remains troublesome". Intensive Care Medicine, 33 (8), 1396-1406. https://doi.org/10.1007/s00134-007-0696-x
  15. Ista, E., van Dijk, M., Gamel, C., Tibboel, D., & de Hoog, M. (2008). Withdrawal symptoms in critically ill children after long-term administration of sedatives and/or analgesics: A first evaluation. Critical Care Medicine, 36 (8), 2427-2432. https://doi.org/10.1097/CCM.0b013e318181600d
  16. Jenkins, I. A., Playfor, S. D., Bevan, C., Davies, G., & Wolf, A. R. (2007). Current United Kingdom sedation practice in pediatric intensive care. Paediatric Anaesthesia, 17(7), 675-683. https://doi.org/10.1111/j.1460-9592.2006.02180.x
  17. Lee, K. A., Kim, S. H., Jo, J. H., Ahn, J. H., Son, E. S., Kim, S. E., . . . Seok, K. J. (2012). Tapering of opioid analgesics injected to the patients hospitalized in Surgical Intensive Care Unit. Journal of Korean Society of Health-System Pharmacists, 29 (4), 384-393. https://doi.org/10.32429/jkshp.2012.29.4.002
  18. Maguire, D., Cline, G. J., Parnell, L., & Tai, C. Y. (2013). Validation of the Finnegan neonatal abstinence syndrome tool-short form. Advances in Neo- natal Care, 13 (6), 430-437. https://doi.org/10.1097/ANC.0000000000000033
  19. Marx, C. M., Rosenberg, D. I., Ambuel, B., Hamlett, K. W., & Blumer, J. L. (1993). Pediatric intensive care sedation: Survey of fellowship training programs. Pediatrics, 91 (2), 369-378.
  20. Motta, E., Luglio, M., Delgado, A. F., & Carvalho, W. B. (2016). Importance of the use of protocols for the management of analgesia and sedation in pediatric intensive care unit. Journal of the Brazilian Medical Association, 62 (6), 602-609.
  21. Neunhoeffer, F., Kumpf, M., Renk, H., Hanelt, M., Berneck, N., Bosk, A., . . . Hofbeck, M. (2015). Nurse-driven pediatric analgesia and sedation protocol reduces withdrawal symptoms in critically ill medical pediatric patients. Pediatric Anesthesia, 25 (8), 786-794. https://doi.org/10.1111/pan.12649
  22. Park, J. S., & Lee, H. S. (2007). Actual condition, knowledge and attitude of patient controlled analgesics (PCA) in postoperative patients. Journal of Korean Academy of Fundamentals of Nursing, 14 (1), 18-28.
  23. Shin, E. S., & Lee, E. S. (2002). Stress of the open heart surgery patient’s family in the ICU. Chonnam Journal of Nursing Science, 7, 129-140.
  24. Tobias, J. D. (2000). Tolerance, withdrawal, and physical dependency after long-term sedation and analgesia of children in the pediatric intensive care unit. Critical Care Medicine, 28 (6), 2122-2132. https://doi.org/10.1097/00003246-200006000-00079
  25. Tobias, J. D. (2005). Sedation and analgesia in the pediatric intensive care unit. Pediatric Annals, 34 (8), 636-645. https://doi.org/10.3928/0090-4481-20050801-12
  26. Trope, R., Vaz, S., Zinger, M., & Sagy, M. (2015). An updated therapeutic intervention scoring system for critically ill children enables nursing workload assessment with insight into potential untoward events. Journal of Intensive Care Medicine, 30 (6), 344-350. https://doi.org/10.1177/0885066613519938
  27. Veldman, A., Trautschold, T., Weiss, K., Fischer, D., & Bauer, K. (2006). Characteristics and outcome of unplanned extubation in ventilated preterm and term newborns on a neonatal intensive care unit. Paediatric Anaesthesia, 16 (9), 968-973. https://doi.org/10.1111/j.1460-9592.2006.01902.x