The Acute Pain Service Nurse Practitioner: A Case Study in the Postoperative Care of the Child With Bladder Exstrophy

Lori J.Kozlowski, MS, RN, CPNP


J Pediatr Health Care. 2008;22(6):351-359. 

In This Article

Abstract and Introduction


Effective pain management for children requires leadership and effective interdisciplinary collaboration. At the Johns Hopkins Children's Center, a pediatric nurse practitioner-based, anesthesiologist supervised acute pain service model strives to improve the quality of pain management within the institution. A case study describing pain and sedation management of the child following bladder exstrophy repair demonstrates the integral role of the nurse practitioner in the promotion of quality outcomes for this complex patient population.


Since the adaptation of the revised Joint Commission on Accreditation of Healthcare Organizations (JCAHO) standards in 1999 (JCAHO, 1999), institutions have sought useful strategies to improve pain management. At the Johns Hopkins Children's Center, a pediatric nurse practitioner (PNP)-based, anesthesiologist-supervised acute pain service strives to improve quality of pain management within the institution. The acute pain service NP is in a unique position to provide leadership in the delivery of care to complex patient populations with challenging pain management needs.

This article will describe the role of the NP on a pediatric pain service caring for children born with bladder exstrophy. This patient population provides a unique case study for understanding the role of the NP. The postoperative care of this complex patient population following bladder closure requires appropriate pain and sedation management, which is crucial to surgical success and establishment of future voiding continence. The NP plays an integral role in achieving these goals, ultimately affecting outcomes and improving quality of care.


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