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Major Brief – Pain Managment in Infants

Topic: Major Brief – Pain Managment in Infants
Order Description
Major Policy Brief:
Procedural Pain Management in Infants
Word count: 1500words (+/- 10%)
Submitted via Dropbox as a Portfolio Presentation (plus a Word version)
Contributes 40% of total Unit mark
Assessment: Policy Brief
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Background
According to the International Association for the Study of Pain (IASP) (2012), the definition of pain is “an unpleasant sensory and emotional experience associated with actual or potential tissue
damage…” (2012, para. 5).
IASP explains that the lack of ability to communicate using language does not mean that a
child is not experiencing pain.
From the moment they are born, babies are exposed to a host of potentially painful medical procedures. Heel-prick tests (sometimes called a Newborn Screening Test), where the newborn’s heel is
lanced or punctured, are routine and conducted within the baby’s first 48-72 hours of life. The procedure involves collecting a small sample of blood from the baby’s heel to test for a range of
genetic disorders, including an enzyme deficiency, called phenylketonuria (PKU) and cystic fibrosis, which affects the lungs and digestive system. It is important to identify these disorders early,
since they can often be managed with intervention. Other early experiences with pain include routine immunizations, a range of procedures for premature babies, and for many boys, circumcision,
which involves surgical removal of the foreskin covering the penis.
For years, it was believed that due to their immature nervous systems, newborns and young children did not experience pain on a par with older children or adults (see the link below):
https://www.sciencedaily.com/releases/2015/04/150421084812.htm
However, we now know that not only do newborns experience pain, but they are actually more sensitive to pain than older children and adults. Early pain experiences can actually result in rewiring
of the nervous system to be more sensitive to pain later in life. For example, one study of male infants circumcised within 2 days of birth indicated that they had higher pain scores when receiving
two-month immunizations than male babies who had not been circumcised (Stevens, 2007).
Despite many calls to recognize the importance of minimizing children’s experiences of pain, studies show that health care providers may not be consistently assessing pain, may not always believe
children when they report pain, and may not treat pain adequately (Kortesluoma et al., 2008; Twycross & Collis, 2012). In addition, parents are often unaware of the impact of early painful
procedures on development, or on successful strategies for minimizing pain in infants and children. There are a number of ways that infants and children’s experience of pain can be minimized. One
example that we provide links to demonstrate is administering sucrose (a sweetened solution) while the baby is undergoing a medical procedure. A number of other methods are available in the
literature (one of your jobs will be to find an additional 3 such strategies that have scientific evidence).
Your Task
Given the number of early pain experiences in infancy, and the potential impact of early exposure to pain, many professionals and researchers interested in child development are concerned about the
range of painful procedures children are exposed to, often without adequate pain relief.
The topic of this assignment is procedural pain management and includes:
1) the relevance of protecting children from early pain experiences for future wellbeing;
2) strategies for relieving pain in infants, and
3) making recommendations about disseminating this information to parents/health care provides etc.
There is a great deal of information about pain management strategies. In order to orient you to the area, we have provided some links below. These links should prompt your thinking about the
problem, and some of them even provide guidelines about infant pain management. For example, the following sites from the Royal Children’s Hospital detail pain assessment guidelines and
instructions about administering sucrose (sugar solution) to infants undergoing procedural pain.
https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Sucrose_oral_for_procedural_pain_management_in_infants/

Here is another helpful website about children’s pain from the Royal Children’s Hospital:
https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/procedural_pain_management/
Your task is to create a policy brief about minimizing infant pain during medical procedures. Relying on the links provided is not sufficient. You are expected to find your own sources of quality
evidence to inform your policy brief. Please also remember that your brief is about more than simply listing a single pain management strategy (or even a combination of strategies). You must also
consider and search the literature on the relevance of protecting children from early pain experiences for future wellbeing, and recommendations for disseminating this information.
Another important note is that pain management involves developmental considerations, and part of your brief will be to demonstrate understanding about children’s brain and cognitive development
and appropriate strategies for the child’s level of development. For example, humour works very well in distracting older children from pain. For rather obvious reasons, it doesn’t work as well
with infants!
Policy Brief: In this assignment, you will summarise the effects of pain on infants and how to alleviate or minimize procedural pain in infants. You will then make recommendations about what can be
done to alert healthcare providers, parents etc about the importance of this topic. This assignment will take the form of a Policy Brief. A Policy Brief draws on current research and international
best practice and aims to:
1. Stimulate informed debate about a particular issue/problem,
2. Convince readers of the urgency of the issue/problem, and
3. Convince readers of the need to take action based on recommendations outlined.
Your policy brief will be assessed on how well it satisfies these three criteria.
An example of a Policy Brief (entitled “TV and early Childhood Development Policy Brief”) is available in the Assessment Folder on CloudDeakin. You can use the example Policy Brief as a guide when
writing your own. The structure of a Policy Brief is essentially to:
a) Outline a problem,
b) Provide empirical evidence about a problem, and
c) Set out a number of recommendations that can help address the problem.
Although we suggest that you use the example Policy Brief as a guide to writing your own, please note that your Policy Brief will be written in the form of an online Presentation using the
Presentation software in your ePortfolio (as for your Skeleton Policy Brief). We suggest that you first prepare the policy brief in a Word document and copy over to the Presentation Software – this
helps you keep track of word count, punctuation and spelling. The Word document will be submitted in conjunction with your Presentation.
The assignment will be written in APA format. There are several links to sites providing examples and information about APA format in the Assessment folder on CloudDeakin.
Submission details
1. Submission is via Dropbox on CloudDeakin. Please note that late penalties will be applied for late submission
2. You are required to submit your Word Document with your Portfolio Presentation when submitting to Dropbox.
3. Please label your final file: Major Policy Brief. Note: Dropbox will refuse file names with punctuation marks in the title and you will not be able to upload your assignment.
The following sections should be included in your Policy Brief in the order presented below:
POLICY BRIEF
Title of your brief
Executive Summary (10%): The executive summary is the opening paragraph that highlights the purpose and importance of your brief. You should provide an overview of the issues to be covered in your
brief, and the implications of these issues (you will be shown how and where to find this information in your library database tutorial). There is no ‘heading’ for the Executive Summary. This
section is a little like an Abstract in an essay or lab report.
Statement of issue: At the end of your executive summary, provide a statement of the issue/problem being addressed in your policy brief. The statement comes immediately after the executive summary,
is brief (i.e., one or two sentences only) and is not labelled with a title.
The body of the brief is then set out in four sections, each of which is headed with the titles provided (see bolded and underlined headings below).
Why is this issue important? (15%) – The aim of this section is to alert the reader to the seriousness of the problem and the potential implications of the problem. It is intended to orient the
reader rather than provide detailed information (the information you provide here will be unpacked in detail in the following section, with appropriate references). This section is a little like a
brief Introduction section of an essay in which you outline the main points to be covered in the body of the essay (in this case, ‘the body’ is the section titled ‘What does the research tell us?).
In this section, you:
1. Provide an overview of the developmental outcomes associated with exposure to pain in childhood (this will be unpacked in the next section).
2. Provide an overall explanation of how exposure to pain might negatively impact children’s development (this will be unpacked in the next section).
What does the research tell us? (50%)
This is the section of your policy brief that will receive the most scrutiny and attract the most marks. In this section you will unpack the general statements made in the previous section,
(ensuring you reference your sources of information. Please do not use secondary sources – you are expected to find the original sources of information in this assignment). If you want to show
changing trends over time, you would need to find older sources of information and compare the data with more recent sources (so in this case older sources of information would be necessary).
Otherwise you should try to restrict your sources to those that were published in the last 10 years. This brief differs from the skeleton brief in that you have the chance to explain the evidence
(rather than simply list factors), so this section is like a combination of all three sections of the Skeleton Policy Brief (impact, risk factors and conceptualisation/linking/explanation). Higher
marks are generally achieved through better explanations of the research. Try to answer the following questions in this section:
1. What is the urgency of the problem? Provide evidence and explanation about the importance and prevalence of this issue, and the developmental impact it has on children/adolescents/young adults.
In order to create a sense of urgency in your reader, it is ideal that you provide some evidence about the prevalence and impact of exposure to pain (i.e., This is a big problem because it (i)
affects LOTS of people, and (ii) it has BAD consequences…)
i. Try to provide some evidence about prevalence. If you cannot find information about prevalence (this can be difficult), provide evidence that there is growing concern or that the issue is
becoming more prominent. You can do this by looking at evidence used by other researchers (i.e., how do others demonstrate that pain is a problem?) or by demonstrating public concern (the existence
of media reports and blogs are evidence of public concern. Note that the ‘evidence’ in these sources is not good quality and should not be used, but the fact that the reports and blogs exist is
evidence that there is public concern over the issue).
ii. Identify the range of undesirable outcomes associated with the issue.
2. How is the issue (i.e., procedural pain in infants) related to the undesirable outcomes (hint: what are some of the biological mechanisms involved)? How can we modify the risk of exposure to
pain in infancy (in addition to sucrose you need to identify 3 more evidence-based pain management strategies). Provide evidence and explanation of how pain in infancy is linked to the undesirable
outcomes and how we might alleviate it.
3. Who is at risk? Provide evidence and explanation about factors that might influence who is exposed to pain (for example, are certain infants more or less likely to receive procedures, or receive
pain relief for those procedures?) Some risk factors are modifiable and so could be addressed in interventions to reduce the impact of painful procedures. Another aspect of your recommendations
should be on how to present this information to your targeted audience.
Note, the purpose of this section is to link the problem to causes; the causes can then be considered in relation to possible solutions. So the purpose of this section of your Policy Brief is to
justify your recommendations. Please note that this section requires you to provide:
i. EVIDENCE (i.e., empirical evidence which includes providing details of your sources of evidence – no evidence/references = no marks), and
ii. EXPLANATION. It is not enough to provide a list of evidence; you must use the evidence to link outcomes to pain exposure, and pain exposure with modifiable risk factors.
What are the implications of the research? (10%)
In this section you will summarise the research findings and the implications of pain exposure in infancy with a clear focus on the risk factors. This helps orient the reader to focus on the
modifiable factors that could be targeted for intervention, and anticipate the nature of the recommendations that you will make to address the problem in the next section. This section will be
brief but powerful.
Considerations for policy (15%)
In this section you will provide recommendations for policy and research that could help us address problems associated with pain exposure in infancy. Aim to provide a minimum of two
recommendations. These can relate to changes in parenting education, support etc., and future research in this area, but the recommendations must be justified, explained, and able to be
implemented. It is not enough to recommend that ‘parents should be educated’. In order to be useful, your recommendation needs to include ways of achieving this goal. If you want to suggest
parenting classes, you will need to (a) have shown previously that parents currently lack this skill/knowledge, and (b) explain what parents should be taught, who should be targeted, and how they
can participate.
Please note that we have allocated 15% of the marks to this section. This means that we consider this section to be very important. Your recommendations need to be thoughtful, practical, and
justified, given the evidence you have provided in your brief.
An approximate guide to word length for each section/subsection:
• An executive summary (at the very beginning – under your policy brief title) – 10% of overall length
• Statement of the issue/problem being addressed (immediately after executive statement – not labelled with a title) – one or two sentences only
• Subsections with headings:
• Why is this issue important? – 15% of overall length
• What does the research tell us? – 50% of overall length
• What are the implications of the research? – 10% of overall length
• Considerations for policy – 15% of overall length

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