1
|
Kwa ZY, Li J, Loh DL, Lee YY, Liu G, Zhu L, Pikkarainen M, He H, Mali VP. An Intelligent Customer-Driven Digital Solution to Improve Perioperative Health Outcomes Among Children Undergoing Circumcision and Their Parents: Development and Evaluation. JMIR Form Res 2024; 8:e52337. [PMID: 38363589 PMCID: PMC10907943 DOI: 10.2196/52337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 01/17/2024] [Accepted: 01/20/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Circumcision as a common elective pediatric surgery worldwide is a stressful and anxiety-inducing experience for parents and children. Although current perioperative interventions proved effective, such as reducing preoperative anxiety, there are limited holistic solutions using mobile apps. OBJECTIVE This paper aims to describe the development and primary evaluation of an intelligent customer-driven smartphone-based app program (ICory-Circumcision) to enhance health outcomes among children undergoing circumcision and their family caregivers. METHODS Based on the review of the literature and previous studies, Bandura's self-efficacy theory was adopted as the conceptual framework. A multidisciplinary team was built to identify the content and develop the apps. Semistructured interviews were conducted to evaluate the ICory-Circumcision. RESULTS The ICory-Circumcision study was carried out from March 2019 to January 2020 and comprised 2 mobile apps, BuddyCare app and Triumf Health mobile game app. The former provides a day-by-day perioperative guide for parents whose children are undergoing circumcision, while the latter provides emotional support and distraction to children. In total, 6 participants were recruited to use the apps and interviewed to evaluate the program. In total, 4 main categories and 10 subcategories were generated from content analysis. CONCLUSIONS ICory-Circumcision seemed to lean toward being useful. Revisions to ICory-Circumcision are necessary to enhance its contents and features before advancing to the randomized controlled trial. TRIAL REGISTRATION ClinicalTrials.gov NCT04174404; https://clinicaltrials.gov/ct2/show/NCT04174404.
Collapse
Affiliation(s)
- Zhi Yin Kwa
- Department of Nursing, National University Hospital, Singapore, Singapore
- National University Health System, Singapore, Singapore
| | - Jinqiu Li
- Nursing Department, Zhuhai Campus, Zunyi Medical University, Zhuhai, China
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Dale Lincoln Loh
- National University Health System, Singapore, Singapore
- Department of Paediatric Surgery, National University Hospital, Singapore, Singapore
| | - Yang Yang Lee
- National University Health System, Singapore, Singapore
- Department of Paediatric Surgery, National University Hospital, Singapore, Singapore
| | - Guangyu Liu
- Integrated Health Promotion, Ministry of Health Office for Healthcare Transformation, Singapore, Singapore
| | - Lixia Zhu
- Hôpital Chinois de Montréal, Centre Intégré Universitaire de Santé et de Services Sociaux du Centre-Sud-de-l'Île-de-Montréal, Montreal, QC, Canada
| | - Minna Pikkarainen
- Department of Health Technology and Rehabilitation and Department of Product Design, Oslo Metropolitan University, Oslo, Norway
- Martti Ahtisaari Institute, Oulu Business School, University of Oulu, Oulu, Finland
| | - Honggu He
- National University Health System, Singapore, Singapore
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Vidyadhar Padmakar Mali
- National University Health System, Singapore, Singapore
- Department of Paediatric Surgery, National University Hospital, Singapore, Singapore
| |
Collapse
|
2
|
Ruskin D, Szczech K, Tyrrell J, Isaac L. Innovative Program to Prevent Pediatric Chronic Postsurgical Pain: Patient Partner Feedback on Intervention Development. Healthcare (Basel) 2024; 12:360. [PMID: 38338245 PMCID: PMC10855720 DOI: 10.3390/healthcare12030360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/17/2024] [Accepted: 01/26/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND The risk of developing chronic postsurgical pain (CPSP) in youth is related to psychological factors, including preoperative anxiety, depression, patient/caregiver pain catastrophizing, and poor self-efficacy in managing pain. While interventions exist to address these factors, they are generally brief and educational in nature. The current paper details patient partner feedback on the development of a psychologist-delivered perioperative psychological program (PPP) designed to identify and target psychological risk factors for CPSP and improve self-efficacy in managing pain. METHODS Qualitative interviews were conducted with two patients and their caregivers to discuss their surgical and pain management experience and to advise on components of the PPP. RESULTS Reflexive thematic analysis of interviews generated the following themes, which were incorporated into the content and implementation of the PPP: caregiver involvement, psychological and physical strategies for pain management, biopsychosocial pain education, intervention structure, and supporting materials. CONCLUSIONS The development of a novel psychologist-led PPP is a promising approach to mitigate mental health risks associated with pediatric CPSP and potentially boost postoperative outcomes and family wellbeing. Integrating patient partner feedback ensures that the PPP is relevant, acceptable, and aligned with the needs and preferences of the patients it is designed to serve.
Collapse
Affiliation(s)
- Danielle Ruskin
- Department of Psychology, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada;
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (J.T.); (L.I.)
- Department of Psychology, York University, Toronto, ON M3J 1P3, Canada
| | - Klaudia Szczech
- Department of Psychology, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada;
| | - Jennifer Tyrrell
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (J.T.); (L.I.)
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON M5T 1P8, Canada
| | - Lisa Isaac
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (J.T.); (L.I.)
- Department of Anesthesiology and Pain Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada
| |
Collapse
|
3
|
Kim JS. Children's experiences of intravenous injection using the draw, write, and tell method: A mixed-methods study. J Pediatr Nurs 2023; 71:14-22. [PMID: 36958135 DOI: 10.1016/j.pedn.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/09/2023] [Accepted: 03/09/2023] [Indexed: 03/25/2023]
Abstract
PURPOSES This study aimed to explore children's perceptions and experiences of receiving intravenous (IV) injections and the self-reported pain scores and management strategies that can support children while receiving IV injections. DESIGN AND METHODS This mixed-methods study included 17 children aged 4-11 years who presented to the outpatient clinic of a pediatric hospital and received IV injections. Data were collected using the draw, write, and tell method (DWT) and Facial Pain Rating Scale. Descriptive statistics and content analyses were performed. RESULTS The children's self-reported mean pain score was 4.82, indicating moderate pain. Many expressions indicated that IV injections were painful or caused tingling or stinging sensations. A vague fear of needles in addition to pain was identified after listening to the children and analyzing their own interpretation of drawings. Three main themes were identified: (1) physical and emotional experiences, (2) parents as my secure base, and (3) comfort and relief strategies. CONCLUSIONS Children expressed their experiences during IV injections, the alleviation of their pain and fear, and their suggestions for comfort and relief strategies visually, auditorily, and verbally. Parents played an important role in supporting their children and reducing pain, anxiety, and distress related to the IV procedure. PRACTICE IMPLICATIONS The DWT, as an arts-based and child-centered approach, is a useful and valid method to understand children's experience related to the IV injection. Children experience comfort and relief within a family-centered care context during IV injection. Nurses should promote children's and parents' participation in the development of strategies to reduce the negative effects of IV injections in children.
Collapse
Affiliation(s)
- Jin Sun Kim
- Department of Nursing, Chosun University, South Korea.
| |
Collapse
|
4
|
Ndengeyingoma A, Lebel V, Alvarez SB. Children and pain: Assessment and management according to parents' perspective. Res Nurs Health 2023; 46:93-100. [PMID: 36286326 DOI: 10.1002/nur.22271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 09/27/2022] [Accepted: 10/08/2022] [Indexed: 01/09/2023]
Abstract
Pain in children is frequent. Parents evaluate their children's pain to decide how to manage it or to share information with caregivers. This qualitative descriptive study aims to identify elements influencing the evaluation and management of pain in children from a parent's perspective. Participants were recruited through a pediatric center and university family medicine clinic. Participants had to have used medication for their child that was prescribed "as needed" to manage their child's pain in the month preceding the interview, whether it was a prescription-strength medication or an over-the-counter strength prescription. Semi-directed interviews 30-45 min in duration were conducted with 16 parents in the Outaouais region of Quebec (Canada), either at the participant's home or by phone (after the declaration of the COVID-19 pandemic). A thematic analysis was completed to identify themes in the data from these individual interviews. The evaluation of children's pain by their parents is influenced by the parents' experience with pain and the expression of the pain by the children, whereas the actions to relieve the pain are based on the beliefs surrounding pain management in children. Evaluation of pain is complex since many parents' beliefs influence this evaluation and the subsequent pain management. The study results raise healthcare professionals' awareness regarding several elements which influence the evaluation of children's pain and its management by their parents.
Collapse
Affiliation(s)
| | - Valérie Lebel
- Department of Nursing, Université du Québec en Outaouais, Gatineau, Québec, Canada
| | | |
Collapse
|
5
|
Yang JX, Yao WY, Zhang F, Jiang WT, Gu Y, Xu HZ. The effectiveness of a parent participation in postoperative pain management programs for children in a urology ward: A randomized controlled trial. J Nurs Scholarsh 2021; 54:554-561. [PMID: 34958176 DOI: 10.1111/jnu.12762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 12/12/2021] [Accepted: 12/15/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Postoperative pain has adverse effects on children after urology treatment, including sleep disturbance, incision dehiscence, bleeding, and delayed recovery. Parents, as the most direct caregivers of children, can make accurate assessments of children´s personal behaviors and responses, which is very important for the management of postoperative pain in children. PURPOSE The purpose of the current study was to develop a Parent Participation in Postoperative Pain Management Program for children in a urology ward and to evaluate its effects on children's postoperative pain scores and other outcome indicators. DESIGN This research comprised two phases. The first phase was the development of a Parent Participation in Postoperative Pain Management Program. The second phase was a randomized controlled trial between two groups, and was carried out in a 45-bed inpatient urology ward of a tertiary children's hospital in China. In the trial, 211 children and their parents were randomly selected as a control group between July 1 and August 15, 2019, and 202 children and their parents were randomly selected as an intervention group between August 16 and September 15, 2019. METHODS Following the framework and methods of the Evidence-based Continuous Quality Improvement Model developed at Fudan University Evidence-Based Nursing Center, we systematically gathered evidence regarding parental involvement in postoperative pain management in children to construct the program. To evaluate the program's effectiveness, the control group performed routine postoperative pain management, while the intervention group underwent the Parent Participation in Postoperative Pain Management Program. The management period was during hospitalization, and generally ranged 3-7 days. The Statistical Table of Pain Assessment for Children after Urology was employed by researchers. FINDINGS The results revealed no significant differences in demographic characteristics between the two groups of children and their parents. Children's pain scores during dressing removal (Z = -3.108, p = 0.002), at discharge (Z = -2.185, p = 0.029) and during catheter removal (Z = -6.553, p = 0.000) were significantly lower in the intervention group compared with the control group. CONCLUSIONS AND CLINICAL RELEVANCE The Parent Participation in Postoperative Pain Management Program was found to be effective for alleviating postoperative pain scores among children, and provided useful information regarding postoperative pain management in children involving four aspects of parental involvement: cognition, guidance, documentation and support.
Collapse
Affiliation(s)
- Jin-Xia Yang
- Deparment of Nursing, Children's Hospital of Soochow University, Suzhou, China
| | - Wen-Ying Yao
- Deparment of Nursing, Children's Hospital of Soochow University, Suzhou, China
| | - Fang Zhang
- Deparment of Nursing, Children's Hospital of Soochow University, Suzhou, China
| | - Wen-Ting Jiang
- Deparment of Urology, Children's Hospital of Soochow University, Suzhou, China
| | - Ying Gu
- Deparment of Nursing, Children's Hospital of Fudan University, Fudan University Evidence-based Nursing Cooperation Center of Joanna Briggs Institute, Shanghai, China
| | - Hong-Zhen Xu
- Deparment of Nursing, Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China
| |
Collapse
|
6
|
Nurse and Provider Pain Management Education Priorities and Barriers. Pain Manag Nurs 2021; 22:579-585. [PMID: 34393038 DOI: 10.1016/j.pmn.2021.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 05/25/2021] [Accepted: 06/19/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND The purpose of this research was to describe health care nurse and providers' pain management education priorities and barriers for pediatric cardio-thoracic surgical (CTS) patients and their caregivers. DESIGN This was a qualitative-descriptive study design using survey methodology. METHODS A convenience sample of 206 (CTS) health care professionals including 172 nurses, 11 advanced practice providers, and 23 physicians were invited to participate in this study. The survey was distributed through a work e-mail within a 145-bed tertiary pediatric hospital and focused on collaborative pain management educational priorities and barriers. RESULTS Of the 206 cardio-thoracic service health care nurses/providers surveyed, 45.6 % (N = 94) responded to the survey. The top pain management education priority for these nurses/providers included immediate postoperative pain management knowledge for the caregiver and pediatric CTS patient. The lowest priority 13.8% (N = 13) included education related to pain management needs after discharge. Of the 94 nurses/providers who responded, 31.9% (n = 30) identified the presence of timing and communication barriers in providing pain management education with caregivers and pediatric CTS patients. AIMS The aim of this research was to describe health care providers pain management education priorities and barriers for cardio-thoracic surgical (CTS) pediatric patients and their caregivers. SETTING 145-bed tertiary pediatric hospital. PARTICIPANTS/SUBJECTS Nurses, advanced practice providers [APP's], and physicians. CONCLUSIONS Nurses and providers prioritize immediate postoperative pain management education; however, there remains a need to focus more on the outcomes of pain management education for caregivers and pediatric CTS patients after discharge.
Collapse
|
7
|
Yu KE, Kim JS. Pediatric Postoperative Pain Management in Korea: Parental Attitudes Toward Pain and Analgesics, Self-Efficacy, and Pain Management. J Pediatr Nurs 2021; 58:e28-e36. [PMID: 33358485 DOI: 10.1016/j.pedn.2020.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 12/03/2020] [Accepted: 12/03/2020] [Indexed: 11/29/2022]
Abstract
PURPOSES This study aimed to explore parental attitudes toward children's pain and analgesic drugs and parental self-efficacy and use of pain relief strategies in children's postoperative pain management in Korea, and to identify the relationships among these variables. DESIGN AND METHODS A cross sectional descriptive study was conducted. Participants were 124 parents of hospitalized children (aged 4-9 years) undergoing tonsillectomy in Korea. RESULTS A considerable proportion of parents held misconceptions about how children express pain. For example, 87.9% of parents perceived that children always tell their parents when they are in pain. Moreover, parents reported significant attitudinal barriers to analgesic use with 60.5% of parents believed that side effects are something to worry about when giving children pain medication. Parental attitudes to use analgesics were significantly different by children's gender, family income, and length of hospital stay. Emotional support methods such as touch, parental presence, and comfort/reassurance were the frequently used, whereas cognitive-behavioral approaches such as distraction were less frequently used nonpharmacological pain relief strategies. A parent's self-efficacy in managing children's pain significantly correlated with the appropriate use of analgesics and parental use of pain relief strategies. CONCLUSIONS Promoting parental self-efficacy in postoperative pain management is important. Educational interventions focused on behavioral changes of parents, including practical guidance for pharmacological and nonpharmacological pain relief strategies, are needed. PRACTICE IMPLICATIONS Providing parents with proper, effective education about children's postoperative pain management should not only provide accurate information but should also enhance parents' self-efficacy in assessing and managing children's pain.
Collapse
Affiliation(s)
- Kyoung Eun Yu
- Department of Nursing, Donggang University, South Korea
| | - Jin Sun Kim
- Department of Nursing, Chosun University, South Korea.
| |
Collapse
|
8
|
KURT A, SEVAL M. The Effect of Finger Puppets on Postoperative Pain in Children: A Randomized Controlled Trial. CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2021. [DOI: 10.33808/clinexphealthsci.713672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
9
|
Hall PED, Card EB. Uses of Complementary and Alternative Medicine for Perioperative and Other Patients. Nurs Clin North Am 2020; 55:537-542. [PMID: 33131630 DOI: 10.1016/j.cnur.2020.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The efficacy of using complementary and alternative medicine (CAM) is supported by the literature to decrease preoperative anxiety, postoperative pain and opioid requirements, as well as nausea and vomiting and to improve severity of headaches and increase wound healing. Nursing care includes interventions using CAs for treatment of a range of patient needs. Being supportive while educating parents and patients demonstrates altruism, which also is beneficial for improving health outcomes with CAM.
Collapse
Affiliation(s)
| | - Elizabeth Borg Card
- Nursing Research Office, Vanderbilt University Medical Center, 2611 West End Avenue Suite 328, Nashville, TN 37203, USA
| |
Collapse
|
10
|
Chang CM, Li Y, Or LL, Pikkarainen M, Pölkki T, Wang W, Lau ST, He HG. A Qualitative Study Exploring Singaporean Parents' Perceptions on PreParing their Child for Surgery. J Pediatr Nurs 2020; 54:e69-e77. [PMID: 32473825 DOI: 10.1016/j.pedn.2020.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/08/2020] [Accepted: 05/08/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To explore the perceptions of parents regarding the preparation of their children for surgery. DESIGN AND METHODS A qualitative descriptive study was conducted. Sixteen parents of children who were undergoing various types of elective surgery in a public tertiary hospital in Singapore were recruited. Data were collected through face-to-face interviews and analyzed using thematic analysis. RESULTS Five themes were derived: (1) assumed roles of the parents; (2) communication, decision-making, and emotional challenges; (3) factors facilitating the preparation of children for surgery; (4) surgery-related and financial concerns; and (5) the desire for more information and better management. While preparing their children for surgery, parents undertook several roles to ensure readiness and to provide support. Parents faced challenges while communicating with their children regarding their surgeries, experiencing negative emotions and dilemmas in making decisions for surgery. Factors such as previous experiences, children's positive mentality, and access to information helped to facilitate their preparation. Parents expressed surgery-related concerns such as anesthesia and a successful outcome of the surgery, the timing of the surgery, and postoperative care. Parents expressed a desire for easier to understand information through the use of visual materials, and improvements in current practices and management. CONCLUSION This study provides a greater understanding of parents' perceptions of their roles, challenges, influencing factors, concerns, and needs when preparing their children for surgery. PRACTICE IMPLICATIONS The study findings provide insightful aspects for improving current healthcare practices and informing future research studies in exploring better surgery preparation programs for both parents and children.
Collapse
Affiliation(s)
- Cherie Mun Chang
- Division of Nursing, KK Women's and Children's Hospital, Singapore.
| | - Yan Li
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, UK.
| | - Leng Leng Or
- Major Operating Theatre, KK Women's and Children's Hospital, Singapore.
| | - Minna Pikkarainen
- Martti Ahtisaari Institute, Oulu Business School, University of Oulu, VTT Technical Research Centre of Finland, Faculty of Medicine, University of Oulu, Finland.
| | - Tarja Pölkki
- University of Oulu, Finland; Department of Children and Women, Oulu University Hospital, Finland.
| | - Wenru Wang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; National University Health System, Singapore.
| | - Siew Tiang Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; National University Health System, Singapore.
| | - Hong-Gu He
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; National University Health System, Singapore.
| |
Collapse
|