Membership
APS Member Spotlight
Featured in the March 2011 Issue of ENews
Renee C. B. Manworren, PhD RN-BC CNS
Renee C. B. Manworren, PhD RN-BC CNS
Director, Clinical Practice Development
Texas Scottish Rite Hospital for Children
What is your area of specialty?
Pediatric acute pain management
What initially sparked your interest in working in your field? Briefly describe your career path
Tears rolled down my daughter's face after surgery to repair her congenital heart defect and as her mother, I was helpless to comfort her: but, because I had completed 3 years of nursing school, I checked the IV pumps to see if an adjustment could be made. I was shocked to find that my daughter was on a paralytic but was receiving nothing for pain. I was warned by the nurses, intensivists, cardiologists, and administrators that pain medicines were too dangerous in her condition. Some even tried to tell me she didn't have pain and that the tears were merely a side effect from being intubated and on a ventilator. I insisted she be medicated for pain and the administrators insisted I leave. Someone finally called the surgeon. The doctor arrived around 10 pm, and simply stated something like "if the mother wants her to have something for pain, then give her something for pain."
My husband challenged me to finish school and fix this situation for other families—he believed only an "insider" could empower lasting change. With his support, I completed my BSN from Loyola University of Chicago and my MS in pediatric nursing from Rush University. I treated pain as a bedside pediatric nurse, then as a pediatric surgery clinical nurse specialist. Several years later, we requested my daughter's chart for record of an eye exam. In the notes, I was often referred to as "the young demanding mother." I'm not as young as I was, but I still demand optimal pain management.
In 1998, I was offered the opportunity to start the pain management service at Children's Medical Center Dallas. Ironically, one of my first projects was developing a new cardiac surgery analgesic protocol with another of my daughter's cardiologists! We have made dramatic progress in pediatric acute pain management. Yet, I remain concerned that clinicians at the bedside may still have to wait for someone more knowledgeable or powerful (like Dr. Idriss) or demanding to arrive to rescue a suffering child from a system of undertreatment of pain. I recently completed my PhD in nursing research at the University of Texas at Arlington. My program of research now explores system issues that positively influence or deter bedside clinicians from achieving optimal pain management for their pediatric patients.
What has been a highlight of your work? Perhaps you and your staff are proud of a certain project or accomplishment.
When we started the pain management service in 1998, we wanted to identify gaps in clinician's knowledge of pain management and opportunities for improvement. With permission, I modified Ferrell and McCaffrey's Nurses' Knowledge and Attitude Survey (PNKAS) Regarding Pain to create the Pediatric Nurses' Knowledge and Attitude Survey Regarding Pain. This tool has been used by more than 100 organizations in the United States, as well as international institutions. The tool has also been translated by researchers in China, Taiwan, Israel, Norway, Peru, Portugal, and Italy for use by pediatric nurses. The tool was further modified to eliminate reference to cancer pain for facilities that do not provide pediatric hematology/oncology care. The PNKAS (Shriners revision 2002) has been used in many organizations in the United States, and a cross-cultural validated version is available in German.
Is there a particular challenge that you've either overcome or hope to address soon?
Despite the amazing advances we have made in acute pediatric pain management, we do not know how long children require treatment at home with analgesics after common surgical procedures. We are challenged to ensure enough analgesics are prescribed to provide optimal pain management, but prevent a surplus that may be misused. We have a responsibility to safeguard controlled analgesics for use by patients with pain, and decrease the opportunity for diversion from our patients by their friends, neighbors, and relatives.
How has membership in APS been of value to you and your professional development?
APS members are a consistent source of inspiration and ideas. Networking with APS members has helped me treat individual patients, develop systems to improve pain management in my healthcare organizations, and advocate for evidence-based practice and public policy changes. Given the interdisciplinary nature of APS, I can count on members to enlighten me with their diverse expertise, help rethink a problem, and develop effective solutions.
