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
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):
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).
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.
Here is another helpful website about children’s pain from the Royal Children’s Hospital:
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.
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:
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
1. Avoid using any direct quotations (that is, express your points in your own words). Quoting the words of others is not appropriate at this level of study. When your marker reads a quote they think “This student does not understand this point so has had to copy and paste it” and this is usually the case. Inappropriate use of quotes (i) interrupts the flow of ideas and writing, (ii) is often unintelligible because the importance of the quoted words are usually not explained and the point is not linked to the argument, and so (iii) significantly decreases the strength of the argument and the credibility of the writer. Most quotes are used because the student is unable to paraphrase and synthesise and your markers are aware of this. Our very strong recommendation to you is not to use any quotes.
2. Remember that an argument is a conclusion that is supported by evidence. Your Policy Brief will have an overall argument, supported by smaller arguments, or points, that build to your recommendations. Each minor argument, or point, will be supported by evidence (references) and sound logical reasoning.
3. Make sure that you acknowledge your sources of evidence. Acknowledging your sources is very important because it increases your credibility as a writer as you demonstrate that you are familiar with the related theories and/or empirical evidence and understand the issue. Acknowledging your sources is also important because it provides an opportunity for your reader to verify the evidence you have provided, and this demonstrates your confidence in your interpretation of the evidence. Providing the sources allows the reader to evaluate the quality of the evidence you have selected, and therefore, the strength of your claim. But most importantly, acknowledging your sources acknowledges the ideas and contributions of researchers and writers who have provided the evidence you cite. If you fail to cite your sources, your evidence will be discounted (and therefore the section will attract no marks), and you risk being charged with stealing the ideas of others – this is plagiarism and taken very seriously by the university.
4. Do not use your own opinion, personal anecdotes or emotive language. Do not use newspapers or magazines as knowledgeable sources of evidence of research because they (i) are secondary sources (i.e., they provide evidence gained by others and frequently do not provide the sources of their evidence for scrutiny), and (ii) have an agenda (so are often biased). Cite peer-reviewed references (in academic journals) or references from reputable government websites. When providing evidence about public concern, newspapers etc., can be used.
5. Have a friend read your Policy Brief once you have written it to ensure that your sections/subsections and arguments/writing within are clear, logical, and well supported.
When submitting the Policy Brief you will need to include:
The Policy Brief submitted as a Portfolio Presentation (via Dropbox) – with section/subsections as outlined above.
References – at the end, and on a separate page, list all references you cite in the Policy Brief, using APA format. We are aware that it is difficult to format your references with a hanging indent in ePortfolio so we will accept your References left justified. However we expect your Reference page in the Word document to adhere to APA format. The Reference List is not included in the word count.
A copy of your Policy Brief as a Word Document
Frequently asked Questions:
What is the word count and what does this include?
For HPS202 the word count is 1500 words.
The word count includes all words from the beginning of the Policy Brief (excluding the title) to the end of the considerations for policy section. Included in the word count are all in-text citations. The Reference List is NOT included in the word count.
i. How do I conduct a database search?
The second seminar includes a visit to the library to learn how to conduct a database search. A recording of the visit will be made when Cloud students visit the library via the eLive room. If you miss your seminar, you can listen to this recording
ii. Do I format the Policy Brief in columns like the example Policy Brief on CloudDeakin?
You can do this if you would like to but it will not attract extra marks. We will be assessing the content of the information provided in the Policy Brief – not whether it is presented in two columns.
iii. Will you or my tutor read a draft?
Unfortunately, this is not possible. Given the limited time available to us for teaching, is not possible for academic teaching staff to read drafts and provide feedback in time for you to submit a final draft by the due date. However, we do have the support of Language and Learning Advisers who will be happy to read sections of your draft and offer helpful answers to targeted questions about your draft. Information on academic skills and support is available at www.deakin.edu.au/study-skills
iv. How many recommendations should I present in the “considerations for policy” section?
No less than two recommendations should be presented and the upper limit is up to your discretion based on the research you have reviewed and the word limit of the overall Policy Brief and the subsection on “considerations for policy”. It is better to come up with fewer recommendations that are innovative and well explained than to provide an extensive list of recommendations that are not explained well.
v. How old should my references be?
It is best to search for articles/references over the last decade from say, the year 2000 onwards. You need to be citing the most contemporary research so your Policy Brief is informed by the latest research.
vi. How do I submit my Policy Brief?
Assignments will be submitted, and marked, online for both on- and off-campus students. A Drop Box will appear on CloudDeakin and instructions for submitting your assignment using the Drop Box will be uploaded to CloudDeakin before the due date.
vii. Do you really impose penalties for late submission? Yes we do, and the penalties are stiff – 10% deduction for the first day and another 5% each day after that. After 5 days we will not accept your assignment. Please note that extensions are rarely granted when applied for within 3 days of the due date because we expect that assignments will be almost completed by that time. Extension applications must include a draft of the assignment to show that you have been working on the assignment prior to the event that caused your significant disruption.
viii. Can I cite secondary sources?
Please do not cite secondary sources. We would prefer that you did not cite textbooks or references from articles you have read because these are secondary sources and not ideal at the tertiary level. Please source and cite the original article. You will be completing a library skills training session as a part of your seminar sequence which will assist you in your literature search for the assessment.
ix. How many references should I cite?
A minimum of 5 references and up to 20 references would seem reasonable. Essentially you need as many sources as is necessary to support the claims that you make. A better-informed document will be more persuasive and so will probably receive more marks.
Policy Brief Name: Institutional Affiliation: Executive Summary Pediatricians today are on a changing course from practices that were deemed inhumane during the late 1970s and early 1980s. They were under the assumptions that sue to the lack of proper development of nociceptive nerve ending under the skin of infants that they were less likely to experience pain. However, a group of researchers through extensive research and studies found out the contrary. As a matter of fact, infants have a higher density of nerve endings under their skins compared to adults, meaning they perceive pain at a higher level. This led to the further study of the long-term effects of this pain at a young age and the results were even more shocking. The results showed that the perception of intense pain at such a tender age can result to memory deficits, poor concentration and anxiety disorders all signs of post trauma. The policy brief is intended to inform all readers on the trauma that these infants undergo when going through invasive procedures such as circumcision. It is important also that pediatric be aware of the damage they cause when carrying out their duties. For this pain to be managed in situations where anesthetic may not be needed, simple actions such as breastfeeding is encouraged and use of pacifiers. The main intention is to distract the child as the procedures are being conducted. This policy of managing pain should be adopted by all health institutions that offer pediatri...